Walk the Talk: A Program Model of Community-Oriented Primary Health Care

Abstract

While there is a dearth of value-based primary care services in low- and middle-income countries, primary care has been demonstrated to be associated with enhanced access to health services and better health outcomes. The demonstrated barriers to high-quality primary care are under-resourcing, inadequate payment models, lack of community linkages, limited scope and comprehensiveness, limited integration with other components of the health system, and unexciting/unattractive conditions for physicians. Based on global data, we propose a transformative community-oriented primary care program model with a network of ambulatory, virtual, and comprehensive community services. Community-oriented primary care is medical practice that undertakes responsibility for the health of a defined population. Key components of this medical service program are 1. Community health workers (CHWs) responsible for specific populations, with expanded portfolios to provide communicable and noncommunicable disease home health care, health education, and disease registry maintenance; 2. A 24/7 virtual care service to back up and supplement CHW activities; 3. A primary care ambulatory service facility with major paraprofessional-specialist conduct of routine processes and record-keeping utilizing algorithmic guidelines; 4. Multiple point-of-care diagnostic capacities and immediate tele-consults for both ambulatory facility and CHW services; 5. A customized interoperable electronic medical record system, focused on patient care functionalities such as charting and decision-support; 6. Wireless broadband connections for all program workers; and 7. Sustainable economics with revenue from locally determined subscription systems, sliding scale fees for services from ambulatory care facilities, limited CHW service fees, core per capita government support, research projects, and philanthropy.