The Strategies to Improve Primary Health Care Services: A Scoping Review
-
Farhad Habibi
,
Elham Ehsani-Chimeh
,
Alireza Olyaeemanesh
,
Sara Mohamadi
,
Sahar Salehi
,
Efat Mohamadi
,
Mohammadreza Mobinizadeh
,
Amin Zarforoush
,
Parisa Aboee
Abstract
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.
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18. Hone T, Gurol-Urganci I, Millett C, Basara B, Akdag R, Atun R. Effect of primary health care reforms in Turkey on health service utilization and user satisfaction. Health Policy Plan. 2017;32(1):57-67. [PubMed ID:27515404]. https://doi.org/10.1093/heapol/czw098.
19. March S, Torres E, Ramos M, Ripoll J, Garcia A, Bulilete O, etal. Adult community health-promoting interventions in
primary health care: A systematic review. Prev Med. 2015;76 Suppl:S94-104. [PubMed ID:25625691]. https://doi.org/10.1016/j. ypmed.2015.01.016.
20. Özçelik EA. A Case Study on the Use of Pay-for Performance Contracts in Turkey to Reduce Geographic and Social Disparities in Access to Primary Health Care. 2020. Available from: https://www.hsph.harvard.edu/wp-content/uploads/sites/2216/2020/11/Working-Paper-3-Turkey-2020.08.13.pdf.
21. Sparkes SP, Atun R, Bӓrnighausen T. The impact of the Family Medicine Model on patient satisfaction in Turkey: Panel analysis with province fixed effects. PLoS One. 2019;14(1):e0210563. [PubMed ID:30699131]. [PubMed Central ID:PMC6353549]. https:// doi.org/10.1371/journal.pone.0210563.
22. Sumer S, Shear J, Yener AL. Building an Improved Primary Health Care System in Turkey through Care Integration. 2019. Available from: https://documents1.worldbank.org/curated/ar/895321576170471609/pdf/Building-an-Improved-PrimaryHealth-Care-System-in-Turkey-through-Care-Integration.pdf.
23. Hauschild T, Berkhout E. Health-Care Reform in Georgia. CivilSociety Perspective: Country Case Study, Oxfam Study, Oxfam Res Rep. 2009;36.
24. Lozano R, Fullman N, Mumford JE, Knight M, Barthelemy CM, Abbafati C, et al. Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1250-84.
25. World Health Organization. Georgia – training initiatives on tackling diabetes: NCD stories from the field. Copenhagen: World Health Organization. Regional Office for Europe; 2022 2022 Contract No.: Document Number|.
26. Markosian C, Baghdassarian A, Best AM, Ghazaryan H, Antonyan L, Libaridian L. Self-efficacy and knowledge in pediatrics among family medicine physicians in Armenia: A survey study. J Family Med Prim Care. 2022;11(9):5369-74. [PubMed ID:36505532].[PubMed Central ID:PMC9730948]. https://doi.org/10.4103/jfmpc. jfmpc_150_22.
27. Blair I, Sharif A. Health and health systems performance in the United Arab Emirates. Geneva, Switzerland: IHF World Hospital Congress in Oslo; 2013.
28. Silva Paulo M, Loney T, Lapão L. How do we strengthen the health workforce in a rapidly developing high-income country? A case study of Abu Dhabi’s health system in the United Arab Emirates. Hum Resources Health. 2019;17. https://doi.org/10.1186/s12960-019- 0345-9.
29. Loney T, Aw TC, Handysides DG, Ali R, Blair I, Grivna M, et al. An analysis of the health status of the United Arab Emirates: the ‘Big 4’ public health issues. Glob Health Action. 2013;6:20100. [PubMed ID:23394856]. [PubMed Central ID:PMC3566378]. https://doi.org/10.3402/gha.v6i0.20100.
30. Margolis SA, Carter T, Dunn EV, Reed RL. Primary health care services for the aged in the United Arab Emirates: A comparison of two models of care. Asia Pacific Fam Med. 2003;2(2):77-82. https://doi.org/10.1046/j.1444-1683.2003.00058.x.
31. Paulo MS, Loney T, Lapao LV. The primary health care in the emirate of Abu Dhabi: are they aligned with the chronic care model elements? BMC Health Serv Res. 2017;17(1):725. [PubMed ID:29137672]. [PubMed Central ID:PMC5686807]. https://doi.org/10.1186/s12913-017-2691-4.
32. Al Saffer Q, Al-Ghaith T, Alshehri A, Al-Mohammed R, Al Homidi S, Hamza MM, et al. The capacity of primary health care facilities in Saudi Arabia: infrastructure, services, drug availability, and human resources. BMC Health Serv Res. 2021;21(1):365. [PubMed ID:33879136]. [PubMed Central ID:PMC8056511]. https://doi.org/10.1186/s12913-021-06355-x.
33. Al-Ahmadi H, Roland M. Quality of primary health care in Saudi Arabia: a comprehensive review. Int J Qual Health Care. 2005;17(4):331-46. [PubMed ID:15883128]. https://doi.org/10.1093/intqhc/mzi046.
34. Caswell A, Kenkre J. Primary Healthcare in Saudi Arabia: An Evaluation of Emergent Health Trends. Glob J Qual Saf Healthc. 2021;4(3):96-104. [PubMed ID:37261060]. [PubMed Central ID:PMC10228993]. https://doi.org/10.36401/JQSH-20-33.
35. Salah H, Kidd M. Family Practice in the Eastern Mediterranean Region: Primary Health Care for Universal Health Coverage. Boca Raton, Florida: CRC Press; 2019.
36. Gulis G, Aringazina A, Sangilbayeva Z, Kalel Z, de Leeuw E, Allegrante J. Population Health Status of the Republic of Kazakhstan: Trends and Implications for Public Health Policy. Int J Environ Res Public Health. 2021;18(22). https://doi.org/10.3390/ijerph182212235.
37. Sharman A. A New Paradigm of Primary Health Care in Kazakhstan: Personalized, Community-based, Standardized, and Technology-driven. Central Asian J Global Health. 2014;3(1). https://doi.org/10.5195/cajgh.2014.186.
38. Al-Eisa IS, Al-Mutar MS, Radwan MM, Al-Terkit AM, Al-Eisa I. Patients’ satisfaction with primary health care services at capital health region, Kuwait. Middle East J Fam Med. 2005;3(3):10-6.
39. Al-Sharhan S. Kuwait. E-Learning in the Middle East and North Africa (MENA) Region. New York City: Springer; 2018.
40. Oguoma VM, Coffee NT, Alsharrah S, Abu-Farha M, Al-Refaei FH, Al-Mulla F, et al. Prevalence of overweight and obesity, and associations with socio-demographic factors in Kuwait. BMC Public Health. 2021;21(1):667. [PubMed ID:33827711]. [PubMed Central ID:PMC8028185]. https://doi.org/10.1186/s12889-021-10692-1.
41. World Health Organization. Country cooperation strategy for WHO and Saudi Arabia 2012-2016. Geneva, Switzerland: World Health Organization; 2013. Available from: https://www.who.int/publications/i/item/WHO-EM-PME-003-E.
42. World Health Organization. WHO guideline on health policy and system support to optimize community health worker programmes. Geneva, Switzerland: World Health Organization; 2018. Available from: https://www.who.int/publications/i/item/9789241550369.
43. Primary Health Care Performance Initiative. Per capita current primary health care expenditure ($USD). 2018. Available from: https://phcperformanceinitiative.org/indicator/capita-currentprimary-health-care-expenditure-usd.
2. Evans DB, Hsu J, Boerma T. Universal health coverage and universal access. Bull World Health Organ. 2013;91(8):546-A. [PubMed ID:23940398]. [PubMed Central ID:PMC3738317]. https://doi.org/10.2471/BLT.13.125450.
3. Ghebreyesus TA. All roads lead to universal health coverage. Lancet Glob Health. 2017;5(9):e839-e40. [PubMed ID:28728920]. https://doi.org/10.1016/S2214-109X(17)30295-4.
4. World Health Organization. A vision for primary health care in the 21st century: towards universal health coverage and the Sustainable Development Goals. Geneva, Switzerland: World Health Organization; 2018 2018 Contract No.: Document Number|.
5. Dodd R, Palagyi A, Jan S, Abdel-All M, Nambiar D, Madhira P, et al. Organisation of primary health care systems in low- and middleincome countries: review of evidence on what works and why in the Asia-Pacific region. BMJ Glob Health. 2019;4(Suppl 8):e001487. [PubMed ID:31478026]. [PubMed Central ID:PMC6703302]. https://doi.org/10.1136/bmjgh-2019-001487.
6. Esmaeili R, Hadian M, Rashidian A, Shariati M, Ghaderi H. Family medicine in Iran: facing the health system challenges. Glob J Health Sci. 2014;7(3):260-6. [PubMed ID:25948450]. [PubMed Central ID:PMC4802109]. https://doi.org/10.5539/gjhs.v7n3p260.
7. Mahfoozpour S, Masoudi Asl I, Doshmangir L. [Iran’s primary health care challenges in realizing public health coverage: a qualitative study]. Nurs Midwifery J. 2020;18(2):166-79. Persian.
8. Zanganeh Baygi M, Seyadin SH, Rajabi Fard Mazrae No F, Kouhsari Khameneh A. [Adaptation Of Goals And Organizational Structure In Iran’s Primary Healthcare System, A Systematic Review]. Payavard Salamat. 2016;9(5):446-58. Persian.
9. Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19-32. https://doi.org/10.1080/1364557032000119616.
10. Al-Zaidan M, Mohamed Ibrahim MI, Al-Kuwari MG, Mohammed AM, Nawaz Mohammed M, Al Abdulla S. Qatar’s Primary Health Care Medication Home Delivery Service: A Response Toward COVID-19. J Multidiscip Healthc. 2021;14:651-7. [PubMed ID:33762825]. [PubMed Central ID:PMC7982792]. https://doi.org/10.2147/JMDH.
S282079.
11. Syed MA, Al Mujalli H, Kiely CM, HA AQ. Development of a model to deliver primary health care in Qatar. Integr Healthc J. 2020;2(1):e000040. [PubMed ID:37441307]. [PubMed Central ID:PMC10327457]. https://doi.org/10.1136/ihj-2020-000040.
12. Al-Mahrezi A, Al-Kiyumi M. Primary Health Care in Oman: Shaping the Future. Oman Med J. 2019;34(6):479-81. [PubMed ID:31745410]. [PubMed Central ID:PMC6851060]. https://doi.org/10.5001/omj.2019.89.
13. Alshishtawy MM. Four Decades of Progress: Evolution of the health system in Oman. Sultan Qaboos Univ Med J. 2010;10(1):12-22. [PubMed ID:21509077]. [PubMed Central ID:PMC3074664].
14. Anwar H, Batty H. Continuing Medical Education Strategy for Primary Health Care Physicians in Oman: Lessons to be learnt. Oman Med J. 2007;22(3):33-5. [PubMed ID:22400090]. [PubMed Central ID:PMC3294157].
15. Al Farsi M, West DJ. Use of electronic medical records in Oman and physician satisfaction. J Med Syst. 2006;30(1):17-22. [PubMed ID:16548410]. https://doi.org/10.1007/s10916-006-7399-7.
16. Halim LB, Alajmi F, Al Lamki S. Ensuring universal access to primary health care in Oman. 2020. Available from: https://p4h.world/en/documents/ensuring-universal-access-to-primaryhealth-care-in-oman/.
17. Espinosa-Gonzalez AB, Normand C. Challenges in the implementation of primary health care reforms: a qualitative analysis of stakeholders’ views in Turkey. BMJ Open. 2019;9(7):e027492. [PubMed ID:31326929]. [PubMed Central ID:PMC6661696]. https://doi.org/10.1136/bmjopen-2018-027492.
18. Hone T, Gurol-Urganci I, Millett C, Basara B, Akdag R, Atun R. Effect of primary health care reforms in Turkey on health service utilization and user satisfaction. Health Policy Plan. 2017;32(1):57-67. [PubMed ID:27515404]. https://doi.org/10.1093/heapol/czw098.
19. March S, Torres E, Ramos M, Ripoll J, Garcia A, Bulilete O, etal. Adult community health-promoting interventions in
primary health care: A systematic review. Prev Med. 2015;76 Suppl:S94-104. [PubMed ID:25625691]. https://doi.org/10.1016/j. ypmed.2015.01.016.
20. Özçelik EA. A Case Study on the Use of Pay-for Performance Contracts in Turkey to Reduce Geographic and Social Disparities in Access to Primary Health Care. 2020. Available from: https://www.hsph.harvard.edu/wp-content/uploads/sites/2216/2020/11/Working-Paper-3-Turkey-2020.08.13.pdf.
21. Sparkes SP, Atun R, Bӓrnighausen T. The impact of the Family Medicine Model on patient satisfaction in Turkey: Panel analysis with province fixed effects. PLoS One. 2019;14(1):e0210563. [PubMed ID:30699131]. [PubMed Central ID:PMC6353549]. https:// doi.org/10.1371/journal.pone.0210563.
22. Sumer S, Shear J, Yener AL. Building an Improved Primary Health Care System in Turkey through Care Integration. 2019. Available from: https://documents1.worldbank.org/curated/ar/895321576170471609/pdf/Building-an-Improved-PrimaryHealth-Care-System-in-Turkey-through-Care-Integration.pdf.
23. Hauschild T, Berkhout E. Health-Care Reform in Georgia. CivilSociety Perspective: Country Case Study, Oxfam Study, Oxfam Res Rep. 2009;36.
24. Lozano R, Fullman N, Mumford JE, Knight M, Barthelemy CM, Abbafati C, et al. Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1250-84.
25. World Health Organization. Georgia – training initiatives on tackling diabetes: NCD stories from the field. Copenhagen: World Health Organization. Regional Office for Europe; 2022 2022 Contract No.: Document Number|.
26. Markosian C, Baghdassarian A, Best AM, Ghazaryan H, Antonyan L, Libaridian L. Self-efficacy and knowledge in pediatrics among family medicine physicians in Armenia: A survey study. J Family Med Prim Care. 2022;11(9):5369-74. [PubMed ID:36505532].[PubMed Central ID:PMC9730948]. https://doi.org/10.4103/jfmpc. jfmpc_150_22.
27. Blair I, Sharif A. Health and health systems performance in the United Arab Emirates. Geneva, Switzerland: IHF World Hospital Congress in Oslo; 2013.
28. Silva Paulo M, Loney T, Lapão L. How do we strengthen the health workforce in a rapidly developing high-income country? A case study of Abu Dhabi’s health system in the United Arab Emirates. Hum Resources Health. 2019;17. https://doi.org/10.1186/s12960-019- 0345-9.
29. Loney T, Aw TC, Handysides DG, Ali R, Blair I, Grivna M, et al. An analysis of the health status of the United Arab Emirates: the ‘Big 4’ public health issues. Glob Health Action. 2013;6:20100. [PubMed ID:23394856]. [PubMed Central ID:PMC3566378]. https://doi.org/10.3402/gha.v6i0.20100.
30. Margolis SA, Carter T, Dunn EV, Reed RL. Primary health care services for the aged in the United Arab Emirates: A comparison of two models of care. Asia Pacific Fam Med. 2003;2(2):77-82. https://doi.org/10.1046/j.1444-1683.2003.00058.x.
31. Paulo MS, Loney T, Lapao LV. The primary health care in the emirate of Abu Dhabi: are they aligned with the chronic care model elements? BMC Health Serv Res. 2017;17(1):725. [PubMed ID:29137672]. [PubMed Central ID:PMC5686807]. https://doi.org/10.1186/s12913-017-2691-4.
32. Al Saffer Q, Al-Ghaith T, Alshehri A, Al-Mohammed R, Al Homidi S, Hamza MM, et al. The capacity of primary health care facilities in Saudi Arabia: infrastructure, services, drug availability, and human resources. BMC Health Serv Res. 2021;21(1):365. [PubMed ID:33879136]. [PubMed Central ID:PMC8056511]. https://doi.org/10.1186/s12913-021-06355-x.
33. Al-Ahmadi H, Roland M. Quality of primary health care in Saudi Arabia: a comprehensive review. Int J Qual Health Care. 2005;17(4):331-46. [PubMed ID:15883128]. https://doi.org/10.1093/intqhc/mzi046.
34. Caswell A, Kenkre J. Primary Healthcare in Saudi Arabia: An Evaluation of Emergent Health Trends. Glob J Qual Saf Healthc. 2021;4(3):96-104. [PubMed ID:37261060]. [PubMed Central ID:PMC10228993]. https://doi.org/10.36401/JQSH-20-33.
35. Salah H, Kidd M. Family Practice in the Eastern Mediterranean Region: Primary Health Care for Universal Health Coverage. Boca Raton, Florida: CRC Press; 2019.
36. Gulis G, Aringazina A, Sangilbayeva Z, Kalel Z, de Leeuw E, Allegrante J. Population Health Status of the Republic of Kazakhstan: Trends and Implications for Public Health Policy. Int J Environ Res Public Health. 2021;18(22). https://doi.org/10.3390/ijerph182212235.
37. Sharman A. A New Paradigm of Primary Health Care in Kazakhstan: Personalized, Community-based, Standardized, and Technology-driven. Central Asian J Global Health. 2014;3(1). https://doi.org/10.5195/cajgh.2014.186.
38. Al-Eisa IS, Al-Mutar MS, Radwan MM, Al-Terkit AM, Al-Eisa I. Patients’ satisfaction with primary health care services at capital health region, Kuwait. Middle East J Fam Med. 2005;3(3):10-6.
39. Al-Sharhan S. Kuwait. E-Learning in the Middle East and North Africa (MENA) Region. New York City: Springer; 2018.
40. Oguoma VM, Coffee NT, Alsharrah S, Abu-Farha M, Al-Refaei FH, Al-Mulla F, et al. Prevalence of overweight and obesity, and associations with socio-demographic factors in Kuwait. BMC Public Health. 2021;21(1):667. [PubMed ID:33827711]. [PubMed Central ID:PMC8028185]. https://doi.org/10.1186/s12889-021-10692-1.
41. World Health Organization. Country cooperation strategy for WHO and Saudi Arabia 2012-2016. Geneva, Switzerland: World Health Organization; 2013. Available from: https://www.who.int/publications/i/item/WHO-EM-PME-003-E.
42. World Health Organization. WHO guideline on health policy and system support to optimize community health worker programmes. Geneva, Switzerland: World Health Organization; 2018. Available from: https://www.who.int/publications/i/item/9789241550369.
43. Primary Health Care Performance Initiative. Per capita current primary health care expenditure ($USD). 2018. Available from: https://phcperformanceinitiative.org/indicator/capita-currentprimary-health-care-expenditure-usd.
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| Issue | Vol 8 No 4 (2024) | |
| Section | Review Article | |
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| Primary Health Care Health Equity Community Participation Inter-Sectoral Collaboration | ||
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How to Cite
1.
Habibi F, Ehsani-Chimeh E, Olyaeemanesh A, Mohamadi S, Salehi S, Mohamadi E, Mobinizadeh M, Zarforoush A, Aboee P. The Strategies to Improve Primary Health Care Services: A Scoping Review. Health Tech Ass Act. 2024;8(4).
