Role Of Primary Health Care Research Articles

Practices of disease diagnosis and patient monitoring by traditional herbalists in Mpigi district, Uganda: Implications for integration into the conventional health care system

BackgroundThe use of herbs by traditional healers plays a vital role in primary health care in rural Uganda, where most patients still prefer and use herbal medicines. However, specific literature on the traditional healing practices of herbalists is lacking. This study documented the methods traditional herbalists in Mpigi District, Uganda, employ to diagnose disease, monitor patients and handle cases of treatment failure. Materials and methodsAn exploratory study was carried out from June to November 2019 in the rural district of Mpigi in Uganda. In-depth interviews were conducted with 20 herbalists. The interviews were audiotaped, transcribed verbatim, and themes were generated using qualitative content analysis. ResultsThe methods used to diagnose disease included; prior conventional diagnosis, the patient’s description of their experience with the disease condition (including signs, symptoms, and history of disease), physical examination for signs of disease, referral for conventional diagnosis, or to another herbalist, and use of conventional tools. Herbalists use phone calls, patients’ visits, and set review dates to monitor response to therapy. Patient monitoring during therapy emphasizes the improvement or resolution of signs and symptoms of disease and does not consider adverse drug reactions to therapy. Disease conditions that do not respond to therapy are referred to conventional health centres and other traditional health practitioners. ConclusionsDiagnosis of disease and monitoring of patients depends on presenting symptomatology as observed by the herbalist or described by the patient. There is considerable dependence on the conventional health system through referral for diagnosis and management of non-responsive conditions.

The Evolution and Challenges of Academic Family Medicine: Insights from the Banja Luka Declaration

Abstract Academic medicine encompasses education, research and clinical practice, and plays a crucial role in advancing medical science and training physicians. However, the field faces a crisis, with fewer graduates pursuing academic careers. Family medicine emerged as an academic discipline in the second half of the 20th century, contributing significantly to science and primary healthcare. Despite its recognised status, the World Health Organization has yet to formally define it as an academic discipline. Nevertheless, the discipline must continually update its academic dimension in order to address future challenges. The international conference in Banja Luka, attended by deans or representatives of Medical Faculties in Southeast Europe, emphasized family medicine's role in primary healthcare and academic medicine, adopting the Banja Luka Declaration to promote family medicine as an independent academic discipline. The conference aims to inspire global support for family medicine as an academic discipline.

Advancing Indigenous primary health care research and education capacity: a qualitative study in Alberta, Canada

Background/Purpose The study explores the perspectives of family physicians in Alberta regarding Indigenous health research education within the framework of primary health care (PHC). Recognizing the key role of PHC in healthcare system, the research identified the preferences and needs of family physicians for relevant and accessible research skills education. To design effective research education, it is critical to understand the skills, content, and delivery methods desired by family physicians engaged in Indigenous health research. The Indigenous Primary Health Care and Policy Research (IPHCPR) Network is examined as a potential transformative platform aligned with Truth and Reconciliation Commission principles and Calls to Action. Methods Through purposive sampling, 12 family physicians practicing in Alberta were recruited to participate in semi-structured qualitative interviews . The study utilized a thematic content approach for data analysis. Results Four key themes emerged from the analysis: 1) Indigenous role modeling; 2) cohort-based learning; 3) relational learning; and 4) the epistemic importance of Indigenous perspectives on learning. Participants emphasized the need for mentorship, collaborative learning settings, and meaningful connections within a research network. Discussion The IPHCPR Network stands out as a pivotal platform for transformative change in healthcare research education, offering opportunities for family physicians, researchers, trainees, and communities to collaboratively improve Indigenous health outcomes. Through its inclusive practices, the network aligns with TRC principles to advance Indigenous health equity and addressing critical gaps in Indigenous primary health research and practice.

Ten Year Evaluation of JKN: Strengthening Primary Health Care for National Resilience

This study evaluates the achievements of the National Health Insurance (JKN) over the past ten years, focusing on strengthening primary healthcare for national health system resilience. Launched on January 1, 2014, JKN aims for equitable healthcare access for all Indonesians, with participants reaching over 220 million by 2023. JKN has increased basic health service coverage, including immunization, maternal and child care, and treatment of diseases. Primary healthcare's role is vital in disease prevention, early diagnosis, treatment, and chronic disease management. Case studies highlight successful outreach programs. Challenges include funding deficits, uneven service quality, and lack of medical personnel in remote areas. Recommendations include increased budget allocations, incentive policies, continuous training, integration of services, effective health information systems, and community participation

Protocol to develop strategies to improve the effectiveness and efficiency of Village Health Workers in service delivery in a selected district of Zimbabwe

Village Health Workers (VHWs) in Zimbabwe complement the healthcare staff in primary health care delivery. In 2015 the Ministry of Health streamlined services offered by the VHWs with the VHW Strengthening Plan to improve the effectiveness of the program. However, these continue to offer services not addressing the current and emerging health problems. This three-phased study seeks to develop strategies to improve the effectiveness and efficiency of VHWs in service delivery. Systematic literature review shall be used to develop a conceptual framework to guide the development of VHWs service delivery strategies. Exploratory sequential mixed methods design shall explore VHWs roles in primary health care. A survey in the first stage shall collect qualitative data from 45 purposely selected healthcare workers and VHWs using interviews and then thematically analyzed with MAXQDA. The variables generated will have a cross-sectional survey used to collect quantitative data from 134 VHWs and analyzed on SPSS. The SWOT and basic logic models shall be used to develop strategies validated by the Delphi Technique and Key Stakeholders. Informed consent will be maintained in the study with findings published in journals and presentation symposiums. This protocol was approved by the University of Venda Research Ethics Committee (Registration FHS/23/pH/11/0709).

Allocation of Financial Resources to Primary Healthcare: A Scoping Review Protocol.

Countries possessing robust primary healthcare (PHC) systems typically yield superior health outcomes, reduced inequality, and diminished healthcare expenses for their citizens. Moreover, PHC demonstrates a direct correlation with the efficient utilization of resources. However, the allocation of financial resources dedicated to PHC varies significantly among countries and lacks explicit clarity. Therefore, this paper aims to conduct a review of published literature to ascertain the extent of resource allocation to PHC across diverse nations. In addition, it aims to explore associated factors, challenges, and mechanisms influencing this allocation. This scoping review protocol will adopt the Joanna Briggs Institute's scoping review methodology, which was updated in 2020. It will leverage library studies and refer to reputable databases. The inclusion criteria will include studies conducted between January 2000 and December 2023, focusing on criteria, amounts, mechanisms, and challenges associated with financial resource allocation to PHC globally. In addition, studies must be published in either English and Persian. Studies lacking full-text availability will be excluded from the review. Mendeley software will be utilized to organize and manage the collected studies. The study selection process will be visually depicted using the PRISMA-SCR diagram. Conventional content analysis will be employed to analyze the studies. Considering the position and role of primary health care in promoting the health of society, by implementing this protocol, the data obtained from the proposed scoping review will enable the managers and officials of the health system to follow the experiences of different countries in the field of scientific and fair allocation of financial resources to PHC, reinforcing Universal Health Coverage (UHC).

A qualitative examination of the experiences and perspectives of interprofessional primary health care teams in the distribution of the COVID-19 vaccination in Ontario, Canada.

Primary health care (PHC) teams contributed to all phases of the COVID-19 vaccination distribution. However, there has been criticism for not fully utilizing the expertise and infrastructure of PHC teams for vaccination distribution. Our study sought to understand the role PHC teams had in the distribution of the COVID-19 vaccine in Ontario, Canada. The key objective informing this study was to explore the experiences and perspectives of interprofessional PHC teams in the distribution of COVID-19 vaccination across Ontario. A qualitative approach was used for this study, which involved 39 participants from the six health regions of the province. Eight focus groups were conducted with a range of interprofessional healthcare providers, administrators, and staff working in PHC teams across Ontario. The sample reflected a diverse range of clinical, administrative, and leadership roles in PHC. Focus groups were audio-recorded and transcribed, while transcriptions were then analyzed using thematic analysis. We identified the following four themes in the data: i) PHC teams know their patients; ii) mobilizing team capacity for vaccination, iii) intersectoral collaborations, and iv) operational challenges. PHC teams were an instrumental component in supporting COVID-19 vaccinations in Ontario. The involvement of PHC in future vaccination efforts is key but requires additional resourcing and inclusion of PHC in decision-making. This will ensure provider well-being and maintain collaborations established during COVID-19 vaccination.

Addressing the growing burden of obesity, diabetes and asthma in children and adolescents: The role of primary health care and the WHO Pocket book in Europe for a healthy future

The burden of obesity, diabetes mellitus and asthma remains a significant public health issue worldwide. These conditions are associated with premature deaths and a reduced quality of life. Primary health care plays a key role in the prevention, detection, and management of noncommunicable diseases in childhood, including diabetes and asthma. Health promotion is crucial for a healthy life from early childhood, preventing from obesity, a sedentary lifestyle, exposure to tobacco smoke, and other risk factors associated to noncommunicable diseases. Asthma and type 1 diabetes mainly begin in childhood; thus, recognition and early detection at the primary health care level are essential. In the long term, management of children with chronic diseases requires regular follow-up and cooperation with a specialized team. Care coordination by the primary health care provider is key for optimal control of the disease and development of the child or adolescent in the physical, emotional, and social spheres. Over-referral for diagnosis and follow-up is associated with unnecessary specialist overload, patient anxiety, and financial burden for the families and the health system. Clear criteria and referral pathways with efficient communication between the professional team members are essential to empower primary health care providers, avoid unnecessary referrals, and optimize the care and quality of life of children and adolescents with chronic diseases.The WHO Pocket book of primary health care for children and adolescents was recently developed to address knowledge gaps and improve the diagnosis and management of children and adolescents at the outpatient level. It dedicates an entire chapter to health promotion and disease prevention with counselling messages addressed to children, adolescents and their families; provides guidance for the diagnosis and management of asthma, diabetes and other chronic diseases; and includes additional considerations for adolescents living with chronic conditions.

Knowledge regarding human papillomavirus and cervical cancer prevention among medical students from Chulalongkorn University in Thailand

BackgroundCervical cancer is one of the leading causes of death among women in Thailand. General practitioners, within their primary healthcare role, play a vital role in the cervical cancer screening program, as they are the healthcare professionals most easily accessible to the general population. This study aims to determine the level of knowledge of cervical cancer and human papillomavirus (HPV) infection, HPV vaccination, and cervical cancer screening among last-year medical students.MethodsA cross-sectional study was conducted among sixth-year medical students using an electronic self-administered questionnaire. The two-part questionnaire comprised demographic data and 12 true/false questions that assessed knowledge regarding HPV infection, HPV vaccination, and cervical cancer screening recommendations. Pilot testing revealed a high Cronbach’s alpha and test–retest reliability coefficient.ResultsA 67% response rate was achieved. Among the 198 respondents, only one (0.5%) student correctly answered over 80% of the questions while most respondents (172, 71.7%) correctly answered less than 60% of the questions. Less than half of the respondents correctly identified crucial aspects such as the primary cause of cervical cancer, recommended vaccination age, cytology sensitivity compared to HPV testing, and the recommended screening frequency for average-risk women.ConclusionsThis study highlights a significant lack of comprehension among Thai medical students concerning HPV infection, vaccination, and cervical cancer screening guidelines. Encouraging educational enhancement, effective communication, and heightened awareness of these crucial topics within the medical school curriculum are imperative.

Exploring the feasibility of a gambling harm screening model in general practice and community service settings in Fairfield: a pilot study.

Gambling is a growing public health issue in Australia. However, limited research has examined the role of primary health care and social services in routine screening for gambling harm in Australia. This research aimed to explore the enablers and barriers to implementing a co-designed gambling screening model in Fairfield, New South Wales - an area with high gambling expenditure. A co-designed gambling screening and referral model for GP and community-based organisations was implemented in Fairfield in 2020. Follow-up interviews were conducted with nine health care professionals who implemented the screening in 130 patients. Thematic analysis generated key barriers and enablers for implementation of this model. Key enablers for the screening model implementation included structural factors (alignment of the screening model with current work), process factors and staffing factors (staff empowerment). However, we also noted process factors as a barrier to implementation, particularly the referral pathway following screening. Other barriers included social and structural factors, such as the complexity of gambling harm and project funding. Embedding routine screening in primary and community care settings can play a role in treating, reducing and preventing gambling-related harm, and reducing stigma in Fairfield and beyond. Additionally, screening models such as this provide health systems with clear evidence on the level of gambling harm in their community (particularly important in culturally and linguistically diverse communities who are underrepresented in research). This evidence is important for addressing system-level drivers of harm and advocating for political reform to reduce the impact of gambling on communities.

Challenges in Diagnosing and Initial Treatment of Advanced Eyelid Basal Cell Carcinoma in Rural Area: A Case Report

Introduction : Basal cell carcinoma (BCC) is the most common non-melanoma eyelid cancer with a high risk of recurrence. This case report discusses the management of extensive BCC in a rural setting with limited resources.
 Case Illustration : A 62-year-old Timorese female, presented to the hospital with a mass on the left periocular region. It appeared as a mole in the lower left eyelid and extended to the surrounding tissues over nine years. As a farmer, she was frequently sun-exposed. A blackish mass was found at the left orbit, buccal, and entire nose (8 x 7.5 cm) with an ulcerated surface and attached firmly. The right eye had bedside visual acuity >6/60, with palpebral edema, free eye movement, hyperemia nasal conjunctiva, and transparent cornea. The left eye is difficult to examine. Two submandibular lymphadenopathies were palpated. A Head CT scan showed a suspected malignant soft tissue mass with irregular thickening of soft tissue with ill-defined borders. Histopathology examination revealed a nodulocystic type of basal cell carcinoma.
 Discussion : Locally advanced BCC cases need a multidisciplinary approach. In a limited resources setting, the treatment highlights are histological diagnosis, complete surgical excision, and exenteration with margin control. From a broader perspective, the role of primary health care in educating and revering for early treatment is paramount.
 Conclusion : Prevention and early treatment are the most important factors in managing locally advanced BCC.

Mapping and analysing community health worker programmes in the Eastern Mediterranean region.

Community health worker (CHW) programmes are increasingly being recognized as an important strategy that can help to strengthen comprehensive primary health care (PHC), as the foundation of work towards achieving universal health care (UHC) and meeting the Sustainable Development Goals (SDGs). The WHO Regional Office for the Eastern Mediterranean undertook a situational analysis of CHW programmes in the Region to better understand the current situation and the issues involved. A two-step process was employed: a review of available literature on CHWs in the Region was conducted, followed by a survey of CHW programmes in the region, focussing on programmes that were country-led and country-wide. Thirteen countries were found to have community health worker programmes with varying governance and programmatic structures. Broadly, two categories can be distinguished: (a) several countries have well established and mature national CHW programmes that are in most cases supported by external donors but driven and coordinated by national governments; (b) a greater number of countries that have smaller, emerging government or partner led projects and programmes. A few countries have deliberately opted for other models to strengthen primary care and community outreach, for example, through community nursing. CHW programmes play an increasingly important role in primary health care in the Eastern Mediterranean Region, providing promotive, preventive, and emergency services. This bodes well for efforts to strengthen and embed comprehensive primary health care as the foundation of national health systems, to improve health emergency preparedness, achieve UHC and meet the SDGs. Nonetheless, all but a few programmes face challenges of weak governance, fragmentation and unreliable support, similar to those in other countries. However, the main finding of the analysis was that the role of CHWs in countries' health service delivery is woefully under-researched in almost all countries in the region, and more research to better understand and support programmes in the context of local health system contexts is urgently needed.

The Role of Primary Healthcare in Improving the Maternal and Infant Mortality in Pakistan

Background: Maternal and neonatal mortality remains a significant public health challenge globally, particularly in countries like Pakistan, which exhibit some of the highest rates of such mortalities. Effective primary healthcare interventions are crucial for mitigating these rates, focusing on enhancing the quality of care provided to mothers and newborns. Understanding the scope and impact of these interventions can inform future strategies to improve maternal and neonatal health outcomes. Objective: This review aims to evaluate the existing literature on primary healthcare interventions targeting maternal and neonatal mortality, identifying the types of interventions employed, their focus areas, and the outcomes achieved, with a specific interest in the context of Pakistan. Methods: A scoping review methodology was employed, analyzing studies that investigated primary healthcare interventions designed to reduce maternal and neonatal mortality. The review included studies published in English, utilizing a mix of research methodologies, and focused on interventions such as morbidity and mortality review processes, healthcare worker training, and community engagement strategies. Databases searched included Google Scholar, OVID, and the WHO Global Health Library, among others. Results: Out of 25 studies reviewed, a majority concentrated on healthcare team and program-level interventions rather than systemic healthcare reforms. Key areas of focus included enhancing review processes for maternity and neonatal care, training and education for healthcare workers, and community development initiatives. However, there was a noted lack of interventions directly improving the healthcare experiences of mothers and newborns. Mixed methods were the most common research approach, aligning with the complexity of evaluating health system interventions. Conclusion: To improve maternal and neonatal health outcomes in Pakistan, a comprehensive approach addressing the entire health system is required. This involves not only focusing on the delivery of healthcare services but also incorporating community insights, continuous education programs, and leadership modifications in healthcare services. Future strategies should prioritize the application of standardized and relevant methods to enhance the quality of maternity and newborn care initiatives, aiming for scalable improvements in healthcare outcomes.

An Explainable and Personalized Cognitive Reasoning Model Based on Knowledge Graph: Toward Decision Making for General Practice.

General practice plays a prominent role in primary health care (PHC). However, evidence has shown that the quality of PHC is still unsatisfactory, and the accuracy of clinical diagnosis and treatment must be improved in China. Decision making tools based on artificial intelligence can help general practitioners diagnose diseases, but most existing research is not sufficiently scalable and explainable. An explainable and personalized cognitive reasoning model based on knowledge graph (CRKG) proposed in this article can provide personalized diagnosis, perform decision making in general practice, and simulate the mode of thinking of human beings utilizing patients' electronic health records (EHRs) and knowledge graph. Taking abdominal diseases as the application point, an abdominal disease knowledge graph is first constructed in a semiautomated manner. Then, the CRKG designed referring to dual process theory in cognitive science involves the update strategy of global graph representations and reasoning on a personal cognitive graph by adopting the idea of graph neural networks and attention mechanisms. For the diagnosis of diseases in general practice, the CRKG outperforms all the baselines with a precision@1 of 0.7873, recall@10 of 0.9020 and hits@10 of 0.9340. Additionally, the visualization of the reasoning process for each visit of a patient based on the knowledge graph enhances clinicians' comprehension and contributes to explainability. This study is of great importance for the exploration and application of decision making based on EHRs and knowledge graph.

Interpersonal patient-therapeutic team communication during COVID-19 pandemic – selected problems

Introduction. Interpersonal communication is an important element of effective cooperationbetween a patient and therapeutic team. Patients ill with COVID-19 during the pandemicespecially needed a direct contact with medical staff. Introduction of modern technologiesduring COVID-19 pandemic enabled interpersonal communication between a patient andtherapeutic team.Objective: The aim of the study was presentation of the selected elements of interpersonalcommunication in the work of a nurse between a patient and therapeutic team during COVID-19 pandemic.Material and Methods. The problem of interpersonal communication between a patient andtherapeutic team during COVID-19 pandemic was analyzed based on the results of scientificstudies and perceptual experiences.Results. COVID-19 pandemic was a new challenge for therapeutic teams in patient care intreatment facilities, to provide an effective interpersonal communication. In order to improvethe quality of interpersonal communication alternative forms of communication with patientswere applied. During the COVID-19 pandemic social media played a special role in primaryhealth care. Efforts undertaken by medical staff also had to be focused on safe environment ofcare and safe work conditions.Conclusions. Interpersonal communication between a patient and therapeutic team should beimproved during the pandemic considering the provision of a high quality services for patientsin a state of threat to health and life. An improvement of the effectiveness of interpersonalcommunication is conditioned by the implementation of alternative forms of communicationwith a patient, efficient functioning of social media, provision of safe environment of patientcare and safe work conditions for medical staff.

Congenital Zika virus syndrome: the role of primary health care and healthcare network

Resumo O artigo objetiva compreender a rede de atenção e os desafios que as crianças com síndrome congênita do Zika vírus (SCZ) e seus cuidadores enfrentam para garantir o cuidado integral. Trata-se de estudo qualitativo, parte de pesquisa desenvolvida no Hospital das Clínicas da Universidade Federal de Pernambuco, que acompanhou 151 crianças com suspeita para SCZ. Foram realizados dois grupos focais, um com trabalhadores de saúde e outro com cuidadores. As crianças com SCZ percorrem longas distâncias, frequentando diversos serviços da rede. Observou-se a dificuldade de condução e de reconhecimento do papel de equipe de referência da APS, resultando em um cuidado fracionado, com obstáculos à comunicação entre serviços e ausência de atenção às cuidadoras. Percebeu-se uma rede fragilizada, com encontros fragmentados e olhar reduzido. É fundamental que os esforços priorizem o fortalecimento do vínculo entre os nós da rede de atenção e apoio. Os atributos essenciais e derivados da APS são determinantes para a rede de serviços e a oferta de cuidados às crianças com a SCZ e seus familiares.

Mentors Supporting Nurses Transitioning to Primary Healthcare Roles: A Practice Improvement Initiative.

Effective primary healthcare services have been identified by the World Health Organization as the most equitable approach to enhancing universal healthcare. Robust models of mentoring for registered nurses (RNs) transitioning to primary healthcare roles have yet to be described in the Australian context. A robust mentoring model can support RNs to fulfill their potential, bridging the gap between theory and practice. In 2015, the peak body for nurses in primary health care (PHC) began developing a transition to practice program, including embedded mentoring to support newly graduated and more experienced registered and enrolled nurses. This quality improvement study reports the experiences and perspectives of nurses participating as mentors in two separate offerings of the program delivered between 2019 and 2021. A two-phase concurrent mixed methods evaluation utilized data from pre- and post online surveys and post program meetings. Quantitative items underwent descriptive analyses. Thematic analysis of free-text responses and comments was conducted independently by two researchers. Mentors voluntarily provided self-report data and were informed that data is routinely collected to support continuous quality improvement processes for all programs. An Information Sheet informed mentors of data usage, confidentiality, and options to withdraw without penalty from the program at any time. Seventy-nine mentors were recruited to support two groups of nurses (N = 111). Mentor self-rated overall satisfaction with program participation was 86.67% (very or extremely satisfied). Mentors described being "witness to mentee growth," "having facilitated access to learning" and receiving "unexpected benefits" including personal and professional growth and enhanced enthusiasm for their role in PHC. The embedded mentoring reported in this article combined a focus on skills acquisition and professional identity with the provision of a range of resources and support activities. Sustainable mentoring programs will be an important mechanism for supporting the expanding roles required of nurses working in primary health.

"Even if we are the caring hand": Black doctors and structural racism in the context of primary health care.

This study scrutinizes structural racism's influence on the training and work of Black professionals in primary health care (PHC) in Rio de Janeiro, particularly focusing on the experiences of Black female physicians. Employing a qualitative approach via a Focus Group, conducted in November 2022, we adopted symbolic interactionism to interpret racism-related experiences. Our findings encompass two primary dimensions: the manifestation of structural and institutional racism within the Unified Health System (SUS), and how racism permeates health work processes and consequences. Results highlight enduring impacts, spanning education to PHC roles, hindering healthcare process recalibration. Participants identify institutional and structural racism, from managerial neglect to territorial violence and physician scarcity, constraining comprehensive care. It is crucial to unveil and grasp racism's structural essence within healthcare, aligned with the vision of health as a fundamental right.

Therapeutic Uses of Gum-Resin Yielding Plants of India

IntroductionPlants hold significant cultural and medicinal importance in indigenous communities across India. Gum-resin derived from plants plays a crucial role in primary healthcare within the Indian pharmacopeia. MethodsA cross-cultural study was conducted to explore the therapeutic uses of gum-resin yielding plants in five Indian states: Maharashtra, Gujarat, Uttarakhand, Uttar Pradesh, and Madhya Pradesh. A total of 43 participants were interviewed using a semistructured questionnaire to document the ethnomedicinal uses of these plants. The data obtained from these interviews were subsequently analysed using quantitative tools, including use value, informant consensus factor, and preference ranking. ResultsIn this study, researchers identified a total of 19 gum-resin yielding plant species spanning across 11 different families. These plants were employed for treating a variety of 55 human ailments. The most prevalent category of diseases in the study area was gastrointestinal disorders, followed by dermatological disorders. Notably, Butea monosperma emerged as the most highly preferred plant species, with Sterculia urens and Commiphora wightii also ranking prominently. ConclusionsThe study highlights the significant role of gum-resin yielding plants in traditional medicine within the indigenous communities of India. It demonstrates their importance in treating various common ailments, with a particular focus on gastrointestinal and dermatological disorders. Most of the species are not explored phytochemically as well as pharmacologically; action is needed for the isolation of novel compound, which will be useful for curing human ailments.

The role of primary health care in improving health status, financial protection and health equity in the context of China's health system reform.

Stronger primary health care (PHC) is critical to achieving the United Nations' Sustainable Development Goals. However, there is scarce evidence on the impact of PHC on health system performance in developing countries. Since 2009, China has implemented an ambitious health system reform, among which PHC has received unprecedented attention. This study investigates the role of PHC resource in improving health status, financial protection and health equity. We obtained province-level and individual-level data to conduct a longitudinal study across the period of China's health system reform. The dependent variables included health outcomes and financial protection. The independent variables were the number of PHC physicians and share of PHC physicians in all physicians. Mixed-effect models were used for adjusted associations. From 2003 to 2017, the number of PHC physicians slightly increased by 31.75 per 100,000 persons and the share of PHC physicians in all physicians increased by 3.62 percentage points. At the province level, greater PHC physician density was positively associated with life expectancy, negatively associated with age-standardized excess mortality, infectious disease mortality, perinatal mortality low birth weight, as well as the share of health expenses in total consumption expenses. At the individual and household level, greater PHC physician density was positively associated with self-assessed health, and negatively associated with incidence of catastrophic health expenditures. Compared to other quintiles, the poorest quintile benefited more from PHC physician density. In China, an increased PHC physician supply was associated with improved health system performance. While China's PHC system has been strengthened in the context of China's health system reforms, further effective incentives should be developed to attract more qualified PHC workers.