Primary Health Care System Research Articles

The Strategies to Improve Primary Health Care Services: A Scoping Review

Context: Evaluation of health policies and identification of their challenges are vital for improving and implementing reforms in the healthcare system. The present study was conducted to identify interventions aimed at improving primary healthcare (PHC) services in Iran. Evidence Acquisition: This research utilizes a scoping review to examine reform interventions in PHC services across 10 selected countries: Qatar, Oman, Turkey, Georgia, Armenia, United Arab Emirates, Saudi Arabia, Bahrain, Kazakhstan, and Kuwait. The study covers areas such as the PHC delivery system, human resource management, financial mechanisms, and the framework of community participation and intersectoral collaboration from 2010 to 2022. Results: The main reform strategies for PHC systems in the reviewed countries included the establishment of family medical centers with nurse support as a comprehensive strategy for service provision in public health centers; providing comprehensive and quality healthcare service packages including maternal and child health, infectious disease immunization, chronic disease monitoring, and dental care services; health education; access to essential medications; improvement of electronic health services; implementation of health promotion and continuous prevention programs; capacity enhancement; and a greater focus on health screening programs and grading of healthcare centers. Conclusions: The major findings from the reviewed countries indicate that healthcare policymakers focus on providing preventive care services, reducing maternal and child mortality, and increasing life expectancy. Programs such as referral systems, service grading, and the adoption of electronic health services are part of their reform agenda.

Using an experience-based co-design approach to develop strategies for implementing an intravenous iron intervention to treat moderate and severe anemia in pregnancy in Malawi.

In low- and middle-income countries, women experiencing anemia during pregnancy are recommended to take 30mg to 60mg of oral iron daily throughout pregnancy. However, oral iron tablets are often poorly tolerated and slow in correcting anemia, resulting in low adherence, prolonged anemia, and increased risk of adverse maternal and fetal outcomes. An alternative to oral iron is intravenous (IV) iron, commonly used in high-income countries to restore the body's iron stores rapidly. A randomized controlled trial was conducted to investigate the effectiveness and safety of IV iron compared to standard-of-care oral iron supplementation for pregnant women with moderate and severe anemia in the third trimester in Malawi (REVAMP-TT). Using an experience-based co-design approach, our study aimed to identify barriers and facilitators to IV iron use to treat anemia in pregnancy in the primary healthcare system of Malawi, and develop mitigating strategies for the successful implementation of REVAMP-TT. The co-design process involved two phases: i) We conducted an information-gathering exercise to identify barriers and facilitators to IV iron use to treat anemia in pregnancy in the primary healthcare system of Malawi. We interviewed key informants (n = 53) including the policymakers, government partners, healthcare managers, and healthcare providers. We also gathered previous research findings from a formative qualitative study on the perceptions and experiences of IV iron treatment for pregnant women experiencing anemia in Malawi (n = 29). ii) We conducted two co-design workshops with end-users (n = 20) and healthcare providers (n = 20) to confirm and identify the key barriers and facilitators and developed mitigating strategies to inform the successful implementation of the REVAMP-TT trial. We mapped the emerging barriers to the Consolidated Framework for Implementation Research 2.0 (CFIR 2.0) and matched the mitigating strategies to the corresponding Expert Recommendations for Implementing Change (ERIC) compilation. The following were identified as key barriers to IV iron use to treat anemia in pregnancy in the primary healthcare system of Malawi: the cost of IV iron, the lack of available resources and knowledge, local attitudes including myths and misconceptions about IV iron and keeping pregnancy a secret, local conditions, the lack of political will and buy-in from high-level leaders, the lack of capability of healthcare providers to deliver IV iron, and the lack of male involvement to support pregnant women's access to antenatal care. The proposed strategies to mitigate the barriers for the successful implementation of the REVAMP TT trial included providing financial strategy, developing stakeholder relationships, training and educating stakeholders, supporting clinicians, and engaging end-users. The use of the experience-based co-design approach in our study provided a valuable method to expose the potential barriers and facilitators to IV iron use and develop mitigating strategies to successfully implement the REVAMP-TT trial. Engaging both the key informants and end users promoted ownership and consensus among stakeholders and ensured a collaborative environment for sharing deeply rooted real-world experiences and insights. Not only do these findings address the needs of this study, but they also, lay a groundwork for the possible integration of IV iron into routine care in Malawi and provide knowledge for policymakers to make informed decisions on the management of anemia in the primary healthcare systems of Malawi.

FEATURES OF TRAINING A YOUNG DOCTOR IN MODERN CONDITIONS

Reforming the system of primary health care in healthcare in the Russian Federation over the past decade has been a priority task of the state. On instructions from the President, the Government continues to create conditions to increase the availability of medical care. A decision was made to expand the capabilities of the primary health care development program in rural areas, urban settlements and small towns of the country. This resolution was signed by Prime Minister Mikhail Mishustin (Resolution No. 2226 dated December 21, 2023). In the course of the conducted survey of 128 district therapists of the Stavropol Territory who started medical practice immediately after graduation, the main problems they faced when starting their work were identified: lack of practical training for independent professional activity, the assignment of a mentor to not every young specialist; insufficient equipment of the workplace with the necessary tools; incomplete computerization jobs (especially in rural areas); not all district doctors are assigned nurses; the number of attached population in 1 therapeutic area exceeds the norm. The difficulties of the professional activity of young specialists were associated with an insufficient number of hours of practical training in 5-6 years of study at the university and the cancellation of the internship. In order to revive the traditions of mentoring and increase the level of competence of young district therapists who received a diploma after 2017, the Ministry of Health of the Stavropol Territory, together with the Department of Polyclinic Therapy of Stavropol State Medical University, organized the work of the "School of a young therapist", which showed great effectiveness in the practical activities of young doctors in the region.

PROBLEMS OF THE ORGANIZATION OF THE STATE POLICY OF THE PROVISION OF MEDICAL SERVICES BY THE PRIMARY LINK OF MEDICAL AID IN UKRAINE

The article highlights key issues related to management at the level of primary health care in Ukraine. The focus is on aspects such as the growing role of primary care. Primary care is the foundation of the health care system, providing a patient's first contact with health services, prevention, diagnosis and treatment. It is especially important in the conditions of limited financial resources to continue the reforms of the medical industry in Ukraine. The article raises the issue of the availability of medical care: the relevance of management problems is due to uneven access to medical services in rural areas and remote regions. Improving the management of the medical field is necessary to overcome these difficulties. The article examines current problems in the field of primary medical care and ways to overcome them through the reform of state policy in the field of health care. The authors explore key challenges facing primary care, including insufficient funding, lack of qualified staff, uneven distribution of resources, and lack of effective governance mechanisms at various levels. Attention is paid to the issues of ensuring the availability of medical services, the quality of medical care and the implementation of new models of the organization of medical institutions. The article analyzes the reformative steps aimed at improving the functioning of the primary health care system, in particular, the introduction of family medicine and increasing the role of general practitioners. The role of state funding and the involvement of local communities in the management of medical institutions is considered separately. The conclusions emphasize the importance of improving the state's primary health care policy by strengthening financial support, infrastructure development, and improving the qualifications of medical workers to ensure a sustainable and effective health care system in Ukraine. The topic of economic challenges and management efficiency is interesting for analysis. Optimizing the use of financial resources requires their effective use, finding ways to increase the economic sustainability of healthcare institutions.

Factors associated with perceived health of school-aged children in rural Rwanda: an opportunity to leverage community health workers to enhance school health promotion and primary healthcare systems linkages

BackgroundIn many low-income countries, enhancing the health of school-aged children is often impeded by insufficient or limited knowledge regarding their health status. Further, hands-on health promotion interventions are nearly non-existent due to the lack of designated health workers. The disconnection between schools and primary care facilities further exacerbates this issue. To address these challenges, the World Health Organization has introduced the Health Promoting School (HPS) framework, a comprehensive model designed to integrate health into all aspects of school life and promote physical, mental, and social well-being. We sought to assess the perceived health status of school-aged children, identify associated factors, and explore the role of community health workers (CHWs) in public schools in rural Rwanda.MethodsWe carried out a convergent mixed methods study among teachers and community members in rural areas of Musanze, Rwanda. Data collection instruments were adapted from the World Health Organization’s HPS framework and the literature. We conducted six in-depth interviews and three focus group discussions. We performed a logistic regression analysis to examine the factors associated with perceived health. Thematic analysis was used to analyze the qualitative data.ResultsA total of 479 individuals participated in this survey. Of these, 425 (89%) were community members, while 54 (11%) were employed as teachers at Nyabirehe or Rwinzovu public schools. Almost half of respondents 221 (46%) described the children’s health as poor. Many factors were associated with perceived children’s health, including having an established leadership team for school-based health promotion (OR = 1.97, 95%CI: 1.01,3,84), and being familiar with school-based health promotion (OR = 4.77, 95%CI: 2.27,10.0). Qualitative results described the CHW as a bridge between communities, schools, and primary healthcare centers.ConclusionThis study revealed that the health of schoolchildren needs particular attention. In resource-limited settings, HPS presents a promising opportunity to address the health and well-being of children at rural public schools. However, adapted policies, the establishment of health promotion teams, and hands-on orientation for teachers and community members are necessary to ensure an effective implementation of HPS. In Rwanda and other low-income countries where public schools lack nursing staff, CHWs could play a vital role in enhancing HPS and the linkage between schools and primary healthcare facilities.

Flexible ngo-donor coordination in aid interventions to strengthen resilience: the case of Lebanon’s primary healthcare system

IntroductionWith shifts in international aid, international donors have increasingly regarded non-governmental organisations (NGOs) as capable of providing alternative public service arrangements. As funding flows to NGOs, particularly in contexts where...

Pharmacists in global primary healthcare systems: A comprehensive model for community health empowerment

Pharmacists play an increasingly important role in global primary healthcare systems, evolving from traditional dispensers to active participants in patient-centered care. This paper advocates for the stronger integration of pharmacists into healthcare teams to improve patient outcomes, medication adherence, and overall healthcare delivery. Through a comprehensive review, we examine the evolving role of pharmacists, the key challenges to their full integration, and the substantial opportunities they present, particularly in managing chronic diseases, providing preventative care, and enhancing patient education. We propose a model for empowering pharmacists to contribute more effectively to community health, especially in underserved areas. The paper also highlights the potential global impact of pharmacists in reducing healthcare costs, improving disease management, and promoting public health initiatives. Lastly, recommendations for future policy reforms, education enhancements, and research directions are offered to support the continued expansion of pharmacists' roles in primary healthcare systems worldwide.

Enablers and barriers of community health programs for improved equity and universal coverage of primary health care services: A scoping review

BackgroundCommunity health programs (CHPs) are integral components of primary health care (PHC) systems and support the delivery of primary care and allied health and nursing care services. CHPs are necessary platforms for delivering health services toward universal health coverage (UHC). There are limited prior studies on comprehensive evidence synthesis on how CHPs strengthen community health systems for the demand and supply of PHC services. Therefore, this scoping review synthesized existing evidence on the interlinkage between CHPs and the community health system and beyond for delivering and utilising PHC services toward UHC.MethodsWe conducted a scoping review of research articles on CHPs. We identified research articles in six databases (PubMed/Medline, CINAHL, Scopus, Cochrane, Web of Science, and Embase) and Google Scholar using search terms under three concepts: CHPs, PHC, and UHC. Of the 3836 records identified, 1407 duplicates were removed, and 2346 were removed based on titles and abstracts. A total of 83 articles were eligible for the full-text review; of them, 18 articles were removed with reasons, and the other 16 were included through hand search. Themes were identified and explained using Sacks and colleagues’ “Beyond the Building Block” framework.ResultsA total of 81 studies were included in the final review. Studies described CHPs as foundations for community health system readiness for PHC services, including decentralization in the health sector, community-controlled governance, resource mobilization, ensuring health commodities (e.g., through community pharmacies), and information evidence. These foundational inputs mediate the actions of CHPs by partnership with community organizations and health workforces (e.g., community health workers). CHPs contributed to improved access to health services by providing health services in public health emergencies, affordable and comprehensive care, and modifying social determinants of health.ConclusionsCHPs are platforms for implementing and delivering PHC services close to communities. They help to modify social determinants of health, promote health and wellbeing, reduce care costs, prevent disease progression, and reduce hospitalisation rates. CHPs are integral parts of community health systems and require investment to improve access to PHC services. Gaps and challenges of CHPs include inadequate funding, limited engagement of the private sector, poor quality of health services, and limited focus on non-communicable diseases (NCDs). Further implementation research is needed to mitigate the burden of NCDs. Health systems efforts focus on increasing resources (e.g., financial and human) required in CHPs to ensure the quality of PHC services provided through CHPs toward better service access, and reaching the unreached and achieve equity and universality of PHC services.

Challenges And Strategies For Implementing Performance-Based Capitation In Indonesian Community Health Center : A Scoping Review

This study examines the implementation and challenges of performance-based capitation (KBK) at Community Health Centers (Puskesmas) in Indonesia, as a part of the National Health Insurance Program, aiming to improve the efficiency and quality of primary health services. Despite its potential, the implementation of KBK faces various challenges including inadequate human resources, limited infrastructure, and insufficient monitoring systems. The study uses a scoping review framework based on the Public Health Care Monitoring Conceptual Framework by WHO, analyzing 11 selected studies from 2021 to 2024. Findings indicate that internal factors such as management capacity, health worker competence, and organizational culture significantly impact the effectiveness of KBK. External factors like local government support, funding policies, and infrastructure availability also play crucial roles. Technological barriers, particularly in remote areas, hinder optimal policy implementation. The study emphasizes the need for clear regulations, consistent policy dissemination, and effective monitoring to ensure successful KBK implementation. Recommendations include strengthening leadership, training health workers, improving infrastructure, and enhancing digital health technology utilization. These strategies aim to optimize resource allocation, enhance service access, and improve patient satisfaction in Indonesia’s primary health care system.

Exploring methodologies and frameworks for best practice transfer at the primary care level

Abstract Background In Feb 2023, the EU’s Joint Action on the transfer of best praCtices In pRimary CarE (CIRCE-JA) was launched with the objective of effectively transferring and implementing six best practices (BPs) among Member States (MS). Transferability from one primary care (PC) setting to another can be challenging given organizational, legal, cultural, social, economic, and environmental factors, requiring robust a methodological framework to guide the transfer process. A scoping review was conducted to identify conceptual models and methodological frameworks for context-relevant and evidence-informed BP transfer in PC settings. Methods The study aimed to identify models or frameworks to guide BP transfer in PC settings, whilst maximizing transferability. The JBI methodology was used, and an extensive search was conducted in PubMed (time limit: Jan ‘13-May ‘23). All publications of original research, systematic reviews, and text and opinion papers in English were eligible for inclusion. Key exclusion criteria were set, i.e., intervention type, level of care and reporting quality. The search was supplemented by gray literature review. Results From a total of 369 publications, 9 met eligibility criteria, reporting on 10 conceptual and methodological models/framework largely varying. These included transfer models applicable to all BPs as well as elements specific to some BPs, i.e., addressing integration, patient-centered care, care coordination, and health promotion. Strengths and weaknesses were identified for all. Conclusions Transferability of health interventions is complex, requiring systematic consideration of setting and intervention characteristics to inform and support local adaptation, implementation, and decision-making. Key elements identified can support the CIRCE-JA BP transfer and are largely relevant for further BP transfer across PC settings in EU MS, incl. for local adaptation, stakeholder engagement and effective implementation monitoring. Key messages • Innovative BPs are successfully deployed in many EU MS. To best support transformation for strong EU primary care and resilient health systems, it is important to ensure evidence-informed BP transfer. • This review reports on the selection of appropriate frameworks and models, and key elements thereof, to allow successful transfer of CIRCE-JA BPs and other BP transfer across PC settings in Europe.

Implementing a pilot primary care program: Armenia’s steps toward universal health coverage

Abstract Problem Armenia has struggled to transform its ineffective primary healthcare (PHC) system into one that can address the non-communicable disease burden, which causes 93% of mortality. To address this issue, Armenia aims to establish universal health coverage and invest in high-quality primary care. Description In 2023, the Armenian Ministry of Health signed a multisectoral policy to implement a pilot primary care program to trial a multitude of reforms related to diabetes (DM) and hypertension (HTN). Pilot interventions include pathways for screening/diagnosis, provider training, free medications and diagnostics, and new provider financial incentives. The key question to be answered is if these pilot interventions cause DM and HTN health outcomes to improve. Beginning in 2024, the program is being piloted in a primary care clinic in Dsegh. Results As a result of the 2023 Ministerial policy, multisectoral stakeholders designed and implemented this pilot program. Baseline focus groups found that the pilot addresses the financial barriers that community members noted lead to delays in seeking care and that providers perceive the pilot to be beneficial to their patients. Although final results are not yet available, the pilot has already positively changed features in the national EMR and brought together stakeholders in a way never done before. Lessons The pilot’s innovation comes from it being the first time that hypertension and cholesterol medications are provided by the government for free, provider bonuses are based on outcome indicators, indicator targets are set this high, a point-of-care A1c machine is utilized, and a robust monitoring and evaluation (M&E) plan is implemented, all of which are currently shaping discussions on national policy. For countries similarly working on strengthening primary care, it is recommended to pilot specific reforms and establish mechanisms through M&E systems that allow pilots to inform evidence-based decision making. Key messages • To move towards universal health coverage, pilot programs designed with multi-sectoral stakeholders are needed to trial suggested healthcare reforms. • It is essential to invest in monitoring and evaluations systems to generate the data necessary to develop evidence-based policies.

Introduction of wastewater surveillance of SARS-CoV-2 in Ukraine

Abstract Since the Russian invasion, Ukraine has faced humanitarian crises and challenges in diseases surveillance. The primary healthcare (PHC) system struggled with growing numbers of internally displaced and wounded people. In October 2022, the PATH-led, USAID-funded Support TB Control Efforts in Ukraine (STBCEU) project, supported implementation of wastewater surveillance (WWS) for SARS-CoV-2 in four oblasts on request of the Ministry of Health (MoH), expanding to 18 oblasts by October 2023. Samples were collected from 64 sites twice per week and tested for SARS-CoV-2 and influenza A/B using BioExtract® Premium Mag test kits in regional laboratories. From October 2022 to April 2024, 4,784 samples were collected at municipal aqueducts, with SARS-CoV-2 delta and omicron variants detected across all regions. WWS sample results were compared with routine surveillance to assess trends in concentrations and reported cases among population. Gradual decrease in SARS-CoV-2 concentration to zero by May 29, 2023, coincided with a decrease in morbidity. In the last week of August 2023, the concentration of the SARS-CoV-2 in wastewater began its gradual increase with the beginning of new cases registration among the population within 2 weeks, by mid-September. From October 2023, SARS-CoV-2 dominated in 96.6% of positive WWS testing results; in other specimens, influenza and respiratory viruses have been identified. The implementation of WWS in Ukraine highlighted its effectiveness as a public health tool in settings where traditional surveillance methods are disrupted, providing timely data on the viral pathogens for outbreaks prediction and responses, underscoring its role in preventive health measures. The MOH of Ukraine recommended extending the method nationwide for routine surveillance of SARS-CoV-2 and other pathogens, enhancing Ukraine’s capacity to manage public health threats and strengthen the resilience of its health system against future crises. Key messages • WWS in Ukraine underscores its effectiveness as a public health tool, providing timely data on viral pathogens for outbreak prediction and response in disrupted settings. • Notable decline in SARS-CoV-2 concentration in wastewater correlates with reduced morbidity, highlighting WWS’s predictive value.

Starting Right, an evidence-based assessment of children in municipalities healthcare centers

Abstract During the last century, children’s health has evolved significantly, with mental health issues becoming a prominent public health concern. Childhood health problems profoundly impact quality of life (QoL), development, school functioning, and social interactions, affecting society broadly. In Norway, child and school health services offer free comprehensive care within the municipal primary health care system, prioritizing health promotion and prevention to address social health inequalities. The Norwegian Starting RightTM project recruits’ children aged 6 months to16 years and their parents, emphasizing early intervention and support to reduce health inequalities and promote well-being. In the Starting RightTM project, online proxy- and child-reported questionnaires are used to support public health nurses (PHNs) in assessing children’s health and development in routine follow- up. Parents and children receive an SMS text message asking them to answer an online questionnaire before attending their regular appointments in child or school health services. Validated instruments measure the development (ASQ, ASQ-SE), mental health (SDQ) and health-related quality of life (HRQoL), (KIDSCREEN -27). By mapping children and adolescents’ health and through discussions with PHNs, parents and children may be more involved in children’s health and development and may increase their Health Literacy. The primary objective of the proposed project is to develop child and school health services and improve children’s health and HRQoL. The ongoing project is the first to systematically assess development, health and HRQoL in children and adolescents in Norway through ordinary services, and to do so longitudinally. At present, >2000 children have been included. The large sample size combined with a broad multi- and interdisciplinary approach is unique from a national perspective. The upcoming workshop will showcase findings from this innovative study.

The state of primary health care systems in ten high-income countries

Abstract Primary care systems in high-income countries perform comparatively better than the U.S. system in large part due to decades of investment, an adequate workforce supply, and universal healthcare. This research identifies successes and areas of improvement of 10 high-performing primary care systems in four areas of care: 1) access, 2) continuity, 3) comprehensiveness, 4) and coordination. Cross-national comparisons using primary data from the 2022 CMWF International Health Policy Survey of Primary Care Physicians (N ranged from 321-2,092) and the 2023 CMWF International Health Policy Survey on the General Population (N ranged from 750-4,820). Countries included: Australia, Canada, France, Germany, Netherlands, New Zealand, Sweden, Switzerland, the U.K., and the U.S. • More than 90% of adults in all surveyed countries reported having a regular primary care doctor except Sweden, the U.S., and Canada. • Less than 5% of physicians reported high telehealth use in their patient encounters, except for in the U.K. and New Zealand where over 10% reported high use. • Over a quarter of physicians in the U.S., Germany, and France report screening patients for social needs, compared to just 8% in the Netherlands. • Care coordination with social services was a major challenge in all surveyed countries, with over 75% of physicians in the U.K., Australia, and France reporting major challenges. Primary care systems in 10 other high-income countries outperform the U.S. system, particularly when it comes to access to care and care continuity. Policy options to consider for U.S. policymakers include narrowing the wage gap between generalist and specialist physicians and rewarding and holding providers accountable for continuity of care. On the other hand, countries like Sweden and the Netherlands can learn from the U.S. on how to adequately coordinate care between primary care physicians, specialists, and hospitals. Key messages • Investment in primary care yields better health outcomes, greater equity and lower costs. • Many high-income countries in Europe have high performing primary care systems, something the U.S. system can learn from.

Driving innovation in primary healthcare though co-creation with stakeholders in Switzerland

Abstract Issue/problem Primary healthcare systems worldwide face challenges such as socio-demographic shifts, increasing chronic diseases, rising costs, and workforce shortages, demanding innovative solutions for the future of primary care. Description of the problem Addressing the complex challenges of creating a resilient primary healthcare model involves considering interdependent factors such as health policies, funding, workforce training, technology, and evolving diseases, alongside diverse stakeholder interests. To tackle this, the ‘Health2040: Co-creation of a Future Outpatient Primary Healthcare Model in Switzerland’ project was launched in 2023 to develop a forward-looking model by integrating insights from various stakeholders. Results The project involved 40 stakeholders, including patients, researchers, healthcare professionals, policy-makers, and insurers, in two full-day workshops aimed at co-creating a vision and actionable framework for Switzerland’s future primary care. The first workshop focused on developing and visualizing potential models, while the second targeted the transition to these new models and the creation of an implementation plan. These sessions were underpinned by a comprehensive literature review on emerging primary care models, providing a scientific foundation for the discussions. Lessons Successful co-creation requires significant preparatory efforts and innovative creativity techniques, such as Future Newspapers, brainstorming, games, and user personas. Engaging stakeholders throughout various stages of the project helped to enhance relevance. Feedback from a steering group on the workshop’s concept, methodologies, and evidence synthesis was instrumental. Healthcare practitioners also contributed their insights on patient personas, ensuring the models developed were pertinent to actual healthcare practices. Stakeholder engagement process was essential for fostering innovative ideas and ensuring stakeholder buy-in for the developed solutions. Key messages • Co-creation with stakeholders is a promising way to develop innovative solutions for health systems. • Integrating stakeholder input is crucial at all the project stages, from preparation to evaluation.

General Practitioner Availability and Accessibility in Serbia Before and During the Pandemic

Abstract Background During the COVID-19 pandemic in Serbia, state-owned primary health centres’ general practitioners (GPs) served as the first point of care for adults (the population aged 19 years and older) and gatekeepers of the health system. The study highlights changes in the overall availability, accessibility, and workload of GPs during the pandemic. Methods We used routine health facility data at the national level to describe the changes in GPs over the past three years, before the pandemic (2017-2019) and during the pandemic (2020-2022). Specifically, we looked at the total number of GPs, the percentage of specialists, the average number of citizens per GP, the services used per capita, the average number of visits per GP, and the leading causes of morbidity. Results The study found a decrease in the total number of GPs in both periods (before: -10%, during: -9%) and in the number of specialists (before: -2%, during: -3%). During the pandemic, the average number of citizens per GP varied. In 2022, the average number of visits per GP decreased noticeably to 3557 GPs, of which 37% were specialists. In the same year, each GP received 6661 annual visits and served 1509 citizens on average. However, these figures exhibit considerable regional and geographical differences. Circulatory and respiratory diseases were the most common reasons for visiting a GP (about 14% and 13% of all visits, respectively). Up to 10% of all visits resulted in either a diagnosis of external factors that influence health status or in ill-defined symptoms, clinical and laboratory findings. Conclusions This study’s findings underscore the critical reductions in availability, accessibility, and workload of general practitioners in the Serbian public sector and emphasize the importance of strengthening the primary healthcare system to better respond to future challenges. Key messages • Public health officials should prioritize the development of effective strategies and policies that focus on improving the quality and accessibility of primary health care services in Serbia. • A greater investment in general practice is necessary to ensure it can effectively meet the population’s needs during health emergencies.

A qualitative study on rehabilitation services at primary health care: insights from primary health care stakeholders in low-resource contexts

BackgroundThe chasm between rehabilitation needs and available rehabilitation services is widening. In most low-resource contexts, there are inadequate rehabilitation professionals at primary health care (PHC), leaving nonrehabilitation primary care providers’ (PCPs) and district rehabilitation professionals and managers to address patients’ rehabilitation needs. This study explored rehabilitation and non-rehabilitation PCPs’ and managers’ perspectives on the situation of rehabilitation service provision in PHC settings and the challenges experienced in providing rehabilitation care.MethodsIn this descriptive, exploratory qualitative study, individual semi-structured interviews and focus group discussions were conducted with purposefully sampled PCPs in Manicaland, Zimbabwe and Eastern Cape, South Africa. The transcripts were analysed thematically using Atlas.ti. version 22.2®.ResultsThirty-six PCPs (29 nonrehabilitation and 7 rehabilitation) and one district manager participated in the study. The current PHC rehabilitation services in the two low-resource contexts were described as inadequate, if not nonexistent. District rehabilitation professionals attempted to fill the gap through outreach and home visits, but resource limitations, particularly in Zimbabwe, often hampered this strategy. The nonrehabilitation PCPs took on task-shifting roles in the identification, referral, and education of patients with rehabilitation needs in the absence of rehabilitation professionals at PHC. Challenges encountered in providing rehabilitation care at PHC included unsupportive leadership, human resource shortages, lack of comprehensive PHC rehabilitation guidelines, no or delayed rehabilitation referral, lack of clear communication strategies, and users’ low demand for PHC rehabilitation.ConclusionTailored approaches, including context-specific rehabilitation guidance for existing task-shifting models, increased investment in rehabilitation and increased rehabilitation awareness, are needed to establish basic rehabilitation services in the described contexts because they are mostly absent. Importantly, the PHC systems in which rehabilitation is to be nested need to be strengthened.

Organizational innovations related to Primary Care Access Points (GAP) for unattached patients in Quebec: a multi-case qualitative study

BackgroundBeing attached to a primary care (PC) provider is at the core of a strong primary health care system. Centralized waiting lists (CWL) for unattached patients have been implemented in eight provinces of Canada to support the attachment process. In Quebec, the Ministry of Health mandated the implementation of Primary Care Access Points (GAP) across the province to help unattached patients navigate the health system while awaiting attachment through the CWL. Several local health territories developed complementary innovations to the GAP to respond to local population needs. This paper aims to describe five organizational innovations implemented locally.MethodsThis multi-case qualitative study was conducted in four local health territories in the province of Quebec. Fifty-two semi-structured interviews with healthcare managers, nurses, physicians, other health professionals and administrative staff were conducted between April 2023 and April 2024. An interview guide was developed based on existing frameworks on the implementation of innovations and the evaluation of the GAP. Thematic analysis was conducted using NVivo software. Inductive and deductive approaches were used to develop relevant codes and themes. Logic models were built to describe the organizational innovations.ResultsFive organizational innovations are described. First, a multidisciplinary clinic aimed at responding to patients with mental health issues was implemented. Second, a nurse clinic was implemented to provide temporary care for patients with unstable chronic illnesses. The third innovation is a mobile proximity clinic where unattached GAP patients are first evaluated by a paramedic before receiving care from a nurse. Fourth, a pharmacist trajectory was implemented to increase engagement of community pharmacists to respond to GAP patients. The last innovation is a decentralized GAP offering in-person nursing care to unattached GAP patients.ConclusionsDescriptions of these five innovations are key to inform other territories and provinces on ways to improve access for unattached patients while they are waiting to be attached. The introduction of the GAP and the organizational innovations, suggests a transition where access to PC services does not rely solely on attachment status.

Review on the Global Healthcare System and the Posture of the Nigerian Primary Healthcare System

Review on the Global Healthcare System and the Posture of the Nigerian Primary Healthcare System

Primary health care as the main guarantor of a healthy population in the country and a global challenge in the world: a systematic review

Background Primary health care (PHC) is a fundamental aspect of healthcare systems globally, playing a crucial role in maintaining the health of the population. Despite its importance, there are still gaps in the delivery of PHC services. This study aims to analyze the healthcare system and the existing gaps to develop strategies for improving PHC services. Methods This study is a mixed method a combination of documentary analysis and narrative synthesis as an alternative to meta-analysis. For our systematic review, we primarily focused on articles published within the last 10 years. However, we also included some older articles (published between 2003 and 2009) that provided valuable insights into the historical context and evolution of primary healthcare systems. Data of each article reviewed during the review - Study, Article, Study setting, Study design, Study assessment, Study suggestions are presented in Table 1. A total of 38 articles were reviewed. The data sources include peer-reviewed articles and other relevant literature on PHC services. With appropriate keywords. Results The study identifies gaps in PHC services, including issues with access to care, affordability, and quality of care. It provides insights into the challenges faced by PHC systems worldwide, highlighting the need for strategies to address these issues. Conclusions The study contributes to a better understanding of the challenges faced by PHC systems worldwide and provides insights for policymakers and healthcare providers to improve healthcare services. The systematic review, which focuses on PHC, was conducted following the PRISMA guidelines. The PRISMA diagram of study selection was used to illustrate the process of article inclusion and exclusion. Table 1 provides a summary of the key information from the selected articles.