Rai Anjana, Khatri Resham B, Assefa Yibeltal
School of Public Health, University of Queensland, Herston, QLD 4006, Australia.
School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia.
Int J Environ Res Public Health. 2024 Nov 30;21(12):1601. doi: 10.3390/ijerph21121601.
Primary health care (PHC) systems and their successes and challenges vary between and within countries. We elucidate the role of PHC on health status and universal health coverage (UHC) by describing the achievements and challenges of PHC systems in seven countries representing the three economic levels: high-income (Belgium, Australia), middle-income (South Africa, Thailand), and low-income countries (Cambodia, Ethiopia, and Nepal).
We adopted a mixed-methods approach and (a) extracted quantitative data on the key health and universal health coverage index of countries and (b) conducted a scoping review of the PHC systems in these countries. We used key terms related to the following eight domains: service delivery, health workforce, health information system, health financing, medicines, and leadership and governance (the WHO's building blocks for national health systems) and community participation and multisectoral actions (other pillars of PHC) to identify the relevant literature and searched six databases: PubMed, Scopus, Embase, PsycINFO, CINAHL, and Cochrane Library. A total of 58 articles were identified and included in this review; data were charted and synthesised narratively.
There is variation in health services coverage and health status across the three economic levels. Countries expanded access to PHC services using strategies like telehealth and CHWs but faced challenges in sustainability, workforce retention, and service quality. Community engagement and multisectoral actions helped, though gaps in governance, resources, and essential medicines hindered progress towards UHC.
By addressing the challenges and leveraging successful strategies, countries can move closer to achieving the goal of universal health coverage and improving health outcomes for all.
初级卫生保健（PHC）系统及其成功与挑战在不同国家之间以及国家内部存在差异。我们通过描述代表三个经济水平的七个国家的初级卫生保健系统的成就和挑战，阐明初级卫生保健在健康状况和全民健康覆盖（UHC）方面的作用：高收入国家（比利时、澳大利亚）、中等收入国家（南非、泰国）以及低收入国家（柬埔寨、埃塞俄比亚和尼泊尔）。
我们采用了混合方法，（a）提取各国关键健康和全民健康覆盖指数的定量数据，（b）对这些国家的初级卫生保健系统进行了范围审查。我们使用了与以下八个领域相关的关键术语：服务提供、卫生人力、卫生信息系统、卫生筹资、药品以及领导与治理（世卫组织国家卫生系统的基本要素）和社区参与与多部门行动（初级卫生保健的其他支柱）来识别相关文献，并检索了六个数据库：PubMed、Scopus、Embase、PsycINFO、CINAHL和Cochrane图书馆。共识别出58篇文章并纳入本综述；数据进行了图表绘制并进行了叙述性综合。
三个经济水平的国家在卫生服务覆盖和健康状况方面存在差异。各国通过远程医疗和社区卫生工作者等策略扩大了初级卫生保健服务的可及性，但在可持续性、劳动力保留和服务质量方面面临挑战。社区参与和多部门行动有所帮助，尽管治理、资源和基本药物方面的差距阻碍了全民健康覆盖的进展。
通过应对挑战并利用成功策略，各国可以更接近实现全民健康覆盖的目标并改善所有人的健康结果。
