Primary Health Care Service Delivery Research Articles

Perceived Public Participation and Health Delivery in Local Government Districts in Uganda

Abstract: Citizen participation is a crucial aspect of the national health system, empowering individuals to contribute to improving local health services through Health Committees (HCs). HCs promote the participation of citizens in the delivery of primary healthcare services. The study explores the perceptions of citizen participation in the context of the Ruhama County Ntungamo local government area, Uganda. This study aims to understand the impact of HCs on healthcare service delivery. Using a qualitative approach of inquiry grounded in thematic analysis and rooted in principal–agent theory in a single case study, this study examined citizens’ participation in the delivery of a local healthcare service. The study is based on interviews with 66 participants comprising health workers, patients, residents, health administrators, local councillors, and HC members. The findings reveal a notable absence of a health committee in healthcare delivery in Ruhama County. The absence is attributed to a need for a formalised citizen participation structure in managing health facilities and service delivery. It raises concerns about the limited influence of citizens in shaping healthcare policies and decision-making processes. The study recommends the incorporation of health committees into the local health systems to enhance participation and grant communities greater influence over the management of health facilities and service delivery. Incorporating health committees into local health systems strengthens citizen participation and leads to more effective and sustainable healthcare services aligned with people’s needs and preferences. Integrating health committees within Itojo Hospital and similar facilities can grant citizens a meaningful role in shaping the future of their healthcare.

Impact of Covid-19 Pandemic on Primary Healthcare Services Delivery as Perceived by Rural Residents

This study assessed the impact of the CoViD-19 pandemic on primary healthcare services in Barangay Mabua, Surigao City. Employing a quantitative research design, the study profiled participants and investigated the pandemic’s effects on healthcare delivery. Purposive sampling was used, and data was collected through a validated questionnaire. The research objectives included examining variance based on participant profiles and deriving recommendations. The findings revealed a significant impact of the pandemic on primary healthcare services, with preventive and rehabilitative services showing variance across demographics. The study concluded that despite challenges, primary healthcare services continued to cater to the community. The implications of the research were far-reaching, offering insights for policymakers, healthcare providers, and the community. The recommendations encompassed health literacy campaigns, collaborative efforts, and financial assistance programs to address the identified challenges. The study not only contributes valuable insights to the field but also lays the groundwork for future research endeavors in healthcare service delivery during crises.

A mixed methods study examining the impact of primary health care financing transitions on facility functioning and service delivery in Kenya: a study protocol

Background Kenya has experienced several health financing changes that have implications for financing primary healthcare (PHC). These include transitions from funding by two key donors (the World Bank and the Danish International Development Agency (DANIDA)) and the abolishment of conditional grants that were earmarked for financing primary healthcare facilities. This protocol lays out study plans to evaluate the impact and implementation experience of these financing changes on PHC facility functioning and service delivery in Kenya. Methods/design A sequential mixed methods design will be applied to address our research objectives. Firstly, we will perform a document review to understand the evolution of policy changes understudy. Second, we will conduct an interrupted time series analysis across all 47 counties in Kenya to assess these financing changes' impact on health service utilization in all public primary healthcare facilities (level 2 and 3 facilities). Data for this analysis will be obtained from the Kenya Health Information System (KHIS). Third, we will carry out in-depth interviews with health financing stakeholders at the national, county, and health facility levels to examine their perceptions of the experiences with these changes in health financing. Discussion This mixed methods study will contribute to evidence on the sustainability of financing primary healthcare in low and middle-income countries facing financing changes and donor transitions.

Challenges of Local Government in the Provision of Primary Health Care Services in Ebonyi State. Nigeria

Rural areas in Nigeria including Ebonyi State, suffer from development challenges. One of these challenges is inadequate provision of primary healthcare services to the people. This ugly condition has worsened the case of infant and maternal mortalities in Nigeria and Ebonyi State in particular and this demands urgent attention of the local governments as well as other key development partners in order to address the challenge and improve the standard of living of people at the grassroots. It is based on this that this study investigated the challenges of local government in the provision of primary healthcare services in Ebonyi State. Data were sourced from text books, journals, and internet and library materials. As a qualitative study, content and narrative techniques were adopted to analyze the study. The study revealed that minimum standards set for provision of primary healthcare service delivery have not been met in Ebonyi State; hence, local governments in the study area have not optimally contributed to reduction of infant and maternal mortalities due to certain factors which include: poor healthcare financing, dilapidated primary healthcare infrastructure, shortage of qualified healthcare personnel, corruption in the healthcare sector, and lack of broad-based data bank for beneficiaries of primary healthcare services in the area. The paper therefore recommended proper funding of primary healthcare centres in Ebonyi State in line with the international and national benchmarks. This can be achieved through increased budgetary allocations by granting financial autonomy to local governments; more hospitals and clinics should be provided to increase access to health care facilities; there is also urgent need for massive recruitment of qualified healthcare personnel in the study area to among other things improve the quality of healthcare services available to the people in the localities.

Impact de la COVID-19 sur les services de prévention du VIH et de prise en charge des personnes vivant avec le VIH dans la ville de Bukavu : une étude mixte séquentielle explicative

Introduction : Depuis son apparition fin 2019 en Chine, les mesures de riposte contre l’infection à COVID-19 ont perturbé la prestation des services de santé primaires dont ceux liés au virus de l’immunodéficience humaine (VIH). En République démocratique du Congo, l’effet des mesures anti-COVID-19 (confinement) sur l’utilisation des services de prévention du VIH et de prise en charge des personnes vivant avec le VIH (PVVIH) reste peu décrit à ce jour. Objectif : Comparer et comprendre l’effet des mesures anti-COVID-19 sur l’utilisation des services préventifs du VIH et de prise en charge des PVVIH dans les Centres de traitement ambulatoire (CTA) de Bukavu avant (octobre 2019 à février 2020) et pendant (mars à juillet 2020) la période des mesures anti-COVID-19. Méthodes : Étude mixte multisite avec un devis séquentiel explicatif réalisée à Bukavu entre juillet et septembre 2021. La phase quantitative est observationnelle, descriptive, rétrospective et basée sur des données programmatiques issues des CTA. La phase qualitative, guidée par les résultats quantitatifs, est basée sur 31 entretiens semi-structurés avec les soignants et les PVVIH. Résultats : Par comparaison avec la période pré-COVID-19, les mesures anti-COVID-19 ont entrainé une baisse de 11 à 20% des services de prévention du VIH et de prise en charge des PVVIH. Elles ont également induit les ruptures de stock d’antirétroviraux et de tests VIH, la réorganisation des services VIH, la contamination de certains soignants à la COVID-19 et le décès d’autres, ainsi qu’une baisse de l’utilisation des services VIH. Discussion et conclusion : À Bukavu, les mesures anti-COVID-19 ont eu un impact négatif sur le parcours de soins des personnes à risque et infectées par le VIH. Elles ont entravé les progrès vers les objectifs : 95% des personnes dépistées au VIH, 95% des PVVIH sous traitement et 95% des PVVIH avec une charge virale supprimée.

Achieving COVID-19 and Routine Immunization Data Systems Integration on the Electronic Management of Immunization Data System in Nigeria.

In 2021, Nigeria developed a novel Electronic Management of Immunization Data (EMID) system to address COVID-19 data management challenges and ensure the successful implementation of its COVID-19 vaccine deployment plan. The EMID system was envisioned to be interoperable with the DHIS2 national data management system and serve as a gateway into the integration of other primary health care (PHC) service data management. However, the EMID system faced challenges, including inability to filter reports, missing or loss of data, and difficulties with data synchronization, which curtailed its potential to meet the country's needs for COVID-19 data management and negatively impacted system scalability to enable integration with other PHC data systems. Multilayered stakeholder interviews were conducted to determine the optimal functionality requirements for the EMID system. Based on these findings, an optimization plan was designed and implemented to address identified gaps and create a more stable and scalable system to enable further system integrations. Following optimization, a routine immunization module was developed and integrated with the EMID system as a first step to achieving an integrated data management system for PHC services in Nigeria. The integrated system currently provides an opportunity to address data fragmentation and strengthen PHC service delivery in Nigeria. By allowing 1 health care worker to deliver both vaccinations, there is also potential for reduction in cost and redundancies, informing redistribution of the health workforce and overall system strengthening. The journey from the initial challenges faced by the EMID system to the development of an integrated system for PHC services in Nigeria has been a transformative one. Through a thorough optimization process, training and capacity-building, stakeholder-driven improvements, and an elicitation exercise, the EMID system has evolved into a powerful tool for addressing data fragmentation and enhancing public health service delivery in the country.

An assessment of primary health care costs and resource requirements in Kaduna and Kano, Nigeria.

The availability of quality primary health care (PHC) services in Nigeria is limited. The PHC system faces significant challenges and the improvement and expansion of PHC services is constrained by low government spending on health, especially on PHC. Out-of-pocket (OOP) expenditures dominate health spending in Nigeria and the reliance on OOP payments leads to financial burdens on the poorest and most vulnerable populations. To address these challenges, the Nigerian government has implemented several legislative and policy reforms, including the National Health Insurance Authority (NHIA) Act enacted in 2022 to make health insurance mandatory for all Nigerian citizens and residents. Our study aimed to determine the costs of providing PHC services at public health facilities in Kaduna and Kano, Nigeria. We compared the actual PHC service delivery costs to the normative costs of delivering the Minimum Service Package (MSP) in the two states. We collected primary data from 50 health facilities (25 per state), including PHC facilities-health posts, health clinics, health centers-and general hospitals. Data on facility-level recurrent costs were collected retrospectively for 2019 to estimate economic costs from the provider's perspective. Statewide actual costs were estimated by extrapolating the PHC cost estimates at sampled health facilities, while normative costs were derived using standard treatment protocols (STPs) and the populations requiring PHC services in each state. We found that average actual PHC costs per capita at PHC facilities-where most PHC services should be provided according to government guidelines-ranged from US$ 18.9 to US$ 28 in Kaduna and US$ 15.9 to US$ 20.4 in Kano, depending on the estimation methods used. When also considering the costs of PHC services provided at general hospitals-where approximately a third of PHC services are delivered in both states-the actual per capita costs of PHC services ranged from US$ 20 to US$ 30.6 in Kaduna and US$ 17.8 to US$ 22 in Kano. All estimates of actual PHC costs per capita were markedly lower than the normative per capita costs of delivering quality PHC services to all those who need them, projected at US$ 44.9 in Kaduna and US$ 49.5 in Kano. Bridging this resource gap would require significant increases in expenditures on PHC in both states. These results can provide useful information for ongoing discussions on the implementation of the NHIA Act including the refinement of provider payment strategies to ensure that PHC providers are remunerated fairly and that they are incentivized to provide quality PHC services.

Coordinating external assistance forUHC: Pakistan's early experience ofthe SDG3 GAP.

Pakistan is a lower middle-income setting. External assistance for health and development partners play an important role in health sector development. The federal system and health care delivery as a devolved provincial subject warrant regular and effective coordination among federating units and partners. Pakistan was selected as a priority country in 2019 for the implementation of the Global Action Plan for Healthy Lives and Well-being for All (SDG3 GAP). Given the ongoing universal health coverage (UHC) reforms, the country prioritized two SDG3 GAP accelerators, related to primary health care (PHC) and sustainable financing for health (SFH). Eight partner agencies representing PHC and SFH accelerators jointly planned and conducted a 'PHC for UHC mission' to Pakistan in 2021. This mission paved the way for setting up an SDG3 GAP Coordination Committee and a 'PHC Service Delivery and Financing working group', which have been regularly coming together through in-person and virtual meetings; the latter was relatively uncommon previously and this new way of working provided a chance to build rapport, share workplans, identify duplications in technical assistance and jointly gauge governments' priorities. This has shifted the focus of reforms deliberations from 'what' to 'how', enabling joint strategic planning and implementation. The joint work by SDG3 GAP partners with the Ministry of National Health Services Regulation & Coordination linked discussions on health financing and service delivery reforms for the first time, and has contributed to advocacy, analysis, strategic policy dialogue, institutional strengthening and implementation of UHC reforms, with a focus on PHC. Even though joint work by SDG3 GAP partners undoubtedly shows the potential for better alignment and collaboration, translation of the commitment to better collaboration into concrete impact has been the result of committed and engaged staff members, rather than institutionalized change, which will require strong incentives for collaboration.

The Primary Health Care Services in a Philippine Province

The study aimed to assess the effectiveness of primary health care (PHC) in selected municipalities in Batangas, focusing on various health programs. It involved 384 respondents from different municipalities. The questionnaire was the primary data collection instrument, validated by experts and based on national health programs provided by the Department of Health. The findings revealed that the majority of respondents were females aged 40 to 50, with a high school education, and primarily from Barangay Buli, Taal, Batangas. The effectiveness of PHC services varied across different health programs. Programs like maternal and child health, Expanded Program on Immunization, tuberculosis control, and dental health were considered effective. However, diarrheal disease and STD/AIDS prevention programs were rated less effective. Significant differences were observed when assessing the effectiveness of PHC services based on respondent profiles. Respondents aged 51 and above had a more positive view of PHC effectiveness, except for the Diarrheal Disease program. Females generally perceived PHC services as more effective than males, except for specific programs. Educational attainment also influenced the perceptions of effectiveness. Recommendations included requesting increased budget allocation, building facilities, and using social media for awareness campaigns to improve PHC services.The proposed action plan was suggested for future implementation and evaluation. Future research should explore the delivery of PHC services using different variables, specifically focusing on service delivery in PHC.Keywords: Primary health care; Health programs; Effectiveness; Survey method

The costs and financing needs of delivering Kenya's primary health care service package.

For many Kenyans, high-quality primary health care (PHC) services remain unavailable, inaccessible, or unaffordable. To address these challenges, the Government of Kenya has committed to strengthening the country's PHC system by introducing a comprehensive package of PHC services and promoting the efficient use of existing resources through its primary care network approach. Our study estimated the costs of delivering PHC services in public sector facilities in seven sub-counties, comparing actual costs to normative costs of delivering Kenya's PHC package and determining the corresponding financial resource gap to achieving universal coverage. We collected primary data from a sample of 71 facilities, including dispensaries, health centers, and sub-county hospitals. Data on facility-level recurrent costs were collected retrospectively for 1 year (2018-2019) to estimate economic costs from the public sector perspective. Total actual costs from the sampled facilities were extrapolated using service utilization data from the Kenya Health Information System for the universe of facilities to obtain sub-county and national PHC cost estimates. Normative costs were estimated based on standard treatment protocols and the populations in need of PHC in each sub-county. The average actual PHC cost per capita ranged from US$ 9.3 in Ganze sub-county to US$ 47.2 in Mukurweini while the normative cost per capita ranged from US$ 31.8 in Ganze to US$ 42.4 in Kibwezi West. With the exception of Mukurweini (where there was no financial resource gap), closing the resource gap would require significant increases in PHC expenditures and/or improvements to increase the efficiency of PHC service delivery such as improved staff distribution, increased demand for services and patient loads per clinical staff, and reduced bypass to higher level facilities. This study offers valuable evidence on sub-national cost variations and resource requirements to guide the implementation of the government's PHC reforms and resource mobilization efforts.

Primary healthcare service delivery for older people with progressive multimorbidity in low- and middle-income countries: a systematic review.

Ensuring primary healthcare (PHC) accessibility to older people with multimorbidity is vital in preventing unnecessary health deterioration. However, older people ≥50y of age in low- and middle-income countries (LMICs) face challenges in effectively accessing and utilizing PHC. A systematic review was conducted adopting the Andersen-Newman theoretical framework for health services utilization to assess evidence on factors that affect access to PHC by older people. This framework predicts that a series of factors (predisposing, enabling and need factors) influence the utilization of health services by people in general. Seven publications were identified and a narrative analytical method revealed limited research in this area. Facilitating factors included family support, closeness to the PHC facility, friendly service providers and improved functional status of the older people. Barriers included long distance and disjointed PHC services, fewer health professionals and a lack of person-centred care. The following needs were identified: increasing the number of health professionals, provision of PHC services under one roof and regular screening services. There is a need for more investment in infrastructure development, coordination of service delivery and capacity building of service providers in LMICs to improve access and utilization of PHC services for older people.

Assessment of Kaduna State Primary Health Care Board Financial Management Capacity on Primary Health Care Service Delivery in Kaduna State, Nigeria

The establishment of the Kaduna State Primary Healthcare Board was passed into law in 2015 to tackle fragmentation in primary healthcare and ensure preventive healthcare services are accessible and affordable to all. The institutional capacity of the SPHCB is aimed at tackling several issues, including poor release of funding, poor infrastructural services, inadequate health personnel capacity, poor supply of essential drugs and other commodities, poor referral system, poor monitoring, and supervision affecting the PHCs across the state. The paper specifically assesses the financial management capacity of the SPHCB in ensuring the funding of PHC services across the health centres. Both primary and secondary data were used and analysed using descriptive and inferential statistical tools. Linear regression analysis was used in testing the hypothesis postulated. It was revealed that the financial capacity has improved the funding for routine immunisation and family planning programmes at the PHCs in the LGAs. A timelier release of funds is necessary to ensure efficiency and transparency in PHC service delivery. Keywords: Financial management, PHC, service delivery, funding.

Funding primary health care service delivery in the West Nile sub-region, Uganda

The provision of primary health care services is a global concern and quality health service delivery is based on a number of factors, including motivated health workers, good-quality infrastructure, consistent supply of medicines and technologies, adequate funding, sound health plans, and evidence-based policies. This study investigated the funding of primary health care service delivery in three local government districts in Uganda’s West Nile sub-region, and identified deficiencies in the allocation, disbursement and timeliness of health funding which have a negative impact on service delivery. Inadequate funding affects the quality of services, limits essential supplies and causes excessive reliance on private financing, which is not sustainable in poor rural economies. In view of these findings, the study recommended deliberate action by both central government and district councils to increase the percentage of funding allocated in their annual budgets to the health sector, in line with the 2001 Abuja Declaration. The government of Uganda should consider prioritising an increase in total national budget allocations to local governments; primary health care disbursements from central government should be paid on time directly to health facilities by use of the ‘straight-through processing system’ for all types of funding; the government should introduce, support and encourage additional community financing initiatives such as Community Health Insurance Schemes; and district and local community leaders should be sensitised on the benefits of this approach.

Artificial intelligence and digital health in improving primary health care service delivery in LMICs: A systematic review.

Technology including artificial intelligence (AI) may play a key role to strengthen primary health care services in resource-poor settings. This systematic review aims to explore the evidence on the use of AI and digital health in improving primary health care service delivery. Three electronic databases were searched using a comprehensive search strategy without providing any restriction in June 2023. Retrieved articles were screened independently using the "Rayyan" software. Data extraction and quality assessment were conducted independently by two review authors. A narrative synthesis of the included interventions was conducted. A total of 4596 articles were screened, and finally, 48 articles were included from 21 different countries published between 2013 and 2021. The main focus of the included studies was noncommunicable diseases (n=15), maternal and child health care (n=11), primary care (n=8), infectious diseases including tuberculosis, leprosy, and HIV (n=7), and mental health (n=6). Included studies considered interventions using AI, and digital health of which mobile-phone-based interventions were prominent. m-health interventions were well adopted and easy to use and improved the record-keeping, service deliver, and patient satisfaction. AI and the application of digital technologies improve primary health care service delivery in resource-poor settings in various ways. However, in most of the cases, the application of AI and digital health is implemented through m-health. There is a great scope to conduct further research exploring the interventions on a large scale.

Integrating Pelvic Floor Muscle Training During Pregnancy in Primary Health Care: A Policy Brief

Women with urinary incontinence (UI) during pregnancy may have a greater of experiencing postpartum UI symptoms than women who do not. Pelvic floor muscle exercises can reduce the symptoms of urinary stress incontinence. This policy brief concisely summarizes research findings and policy recommendations to improve antenatal and postnatal pelvic floor muscle training. However, this policy does not work automatically and must be incorporated in primary health care service design and delivery. This policy brief discusses a clear recommendation based on the best evidence to improve prenatal care services. It argues that the key is high-quality prenatal care that is available, affordable, accessible, and compatible with the needs of pregnant women and health care providers.

Of primary health care reforms and pandemic responses: understanding perspectives of health system actors in Kerala before and during COVID-19

BackgroundIn 2016, the Government of the southern Indian state of Kerala launched the Aardram mission, a set of reforms in the state’s health sector with the support of Local Self Governments (LSG). Primary Health Centres (PHCs) were slated for transformation into Family Health Centres (FHCs), with extended hours of operation as well as improved quality and range of services. With the COVID-19 pandemic emerging soon after their introduction, we studied the outcomes of the transformation from PHC to FHC and how they related to primary healthcare service delivery during COVID-19.MethodsA qualitative study was conducted using In-depth interviews with 80 health system actors (male n = 32, female n = 48) aged between 30–63 years in eight primary care facilities of four districts in Kerala from July to October 2021. Participants included LSG members, medical and public health staff, as well as community leaders. Questions about the need for primary healthcare reforms, their implementation, challenges, achievements, and the impact of COVID-19 on service delivery were asked. Written informed consent was obtained and interview transcripts – transliterated into English—were thematically analysed by a team of four researchers using ATLAS.ti 9 software.ResultsLSG members and health staff felt that the PHC was an institution that guarantees preventive, promotive, and curative care to the poorest section of society and can help in reducing the high cost of care. Post-transformation to FHCs, improved timings, additional human resources, new services, fully functioning laboratories, and well stocked pharmacies were observed and linked to improved service utilization and reduced cost of care. Challenges of geographical access remained, along with concerns about the lack of attention to public health functions, and sustainability in low-revenue LSGs. COVID-19 pandemic restrictions disrupted promotive services, awareness sessions and outreach activities; newly introduced services were stopped, and outpatient numbers were reduced drastically. Essential health delivery and COVID-19 management increased the workload of health workers and LSG members, as the emphasis was placed on managing the COVID-19 pandemic and delivering essential health services.ConclusionMost of the health system actors expressed their belief in and commitment to primary health care reforms and noted positive impacts on the clinical side with remaining challenges of access, outreach, and sustainability. COVID-19 reduced service coverage and utilisation, but motivated greater efforts on the part of both health workers and community representatives. Primary health care is a shared priority now, with a need for greater focus on systems strengthening, collaboration, and primary prevention.

Rural health: strengthening primary health care in Kisumu County, Kenya.

Primary health care (PHC) presents an opportunity to reduce disparities in access and utilization of healthcare services between rural and urban areas in Kenya and beyond. The Government of Kenya has prioritised PHC with an aim of reducing inequity and making essential health services person-centric. This study sought to assess the status of PHC systems prior to the set-up of primary care networks (PCNs) in a rural underserved setting in Kisumu County, Kenya. Primary data were collected using mixed method approaches alongside secondary data extraction from routine health information systems. Emphasis was placed on seeking community voices and feedback through community scorecards and focus groups discussions with community participants. 100% of PHC facilities reported commodity stock outs. 82% reported shortages in health workforce while half (50%) had inadequate infrastructure to deliver PHC. While the setting had 100% of households covered by a trained community health worker within their village, community concerns included lack of drugs, poor roads, and lack of access to safe water. Disparities were evident: some communities had no 24-hour health facility within a 5km radius. This assessment has provided comprehensive data that have informed planning for the delivery of quality and responsive PHC services, with community and stakeholders' involvement. Identified gaps are being addressed multi-sectorally to reduce health disparities as Kisumu County makes strides to wards the achievement of universal health coverage targets.

Capacity and quality of maternal and child health services delivery at the subnational primary healthcare level in relation to intermediate health outputs: a cross-sectional study of 12 low-income and middle-income countries

ObjectivesTo examine the capacity and quality of maternal and child health (MCH) services at the subnational primary healthcare (PHC) level in 12 low-income and middle-income countries (LMICs) and its association...

Perceptions towards integrated care through the narrative of practicing social workers and psychologists in PHC: a cross-case analysis

PurposeIn a collective effort to build a patient-centered and coordinated health care system, social workers and psychologists are being progressively introduced to primary health care (PHC) settings worldwide. The present study aims to explore the current status of integration through the narrative of social workers and psychologists in PHC settings in Kazakhstan.Design/methodology/approachIn this paper purposive snowball sampling was utilized to recruit social workers and psychologists who work, or used to work, in PHC settings since the onset of integration in Nur-Sultan for participation in an in-depth interview. A semistructured interview guide was based on normalization process theory (NPT). Interviews were conducted via video conference, in Russian language, lasted no more than 50 min, and transcribed verbatim. Cross-case analysis of eight cases was performed using NPT constructs.FindingsCross-case analysis included findings from the interviews from five social workers and three psychologists. Four major constructs of implementation process from NPT were reflected in the findings: coherence (believes integration improves patient care, functions within integrated care), cognitive participation (individual changes to role performance, mechanisms of work), collective action (status of support from stakeholders, cooperation within a multidisciplinary team) and reflective monitoring (existing mechanisms for monitoring the integration).Research limitations/implicationsDespite organizational integration, there is a lack of successful clinical integration of social workers and psychologists in PHC settings of Kazakhstan, which is manifested by a lack of understanding of responsibilities and functions of these mental health care specialists. Consensus was reached by all participants that both social workers and psychologists are valuable assets in a multidisciplinary team.Originality/valueThe present study contributes to the current knowledge of integrated PHC service delivery by addressing the status of integrated care in Kazakhstan from interviews with key stakeholders in social work and mental health. Moving forward, improvements are needed to (1) establish the monitoring mechanism to evaluate the status of integration, (2) enhance effective collaboration within multidisciplinary teams in PHC settings and (3) increase awareness among medical workers and community members on mental health issues and the available support offered by social workers and psychologists to promote quality of life in a holistic, integrated manner.

Can higher spending on primary healthcare mitigate the impact of ageing and non-communicable diseases on health expenditure?

IntroductionFinancing healthcare for ageing populations has become an increasingly urgent policy concern. Primary healthcare (PHC) has been viewed as the cornerstone of health systems. While most research has examined the...