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Review
. 2022 May;10(5):e715-e772.
doi: 10.1016/S2214-109X(22)00005-5. Epub 2022 Apr 4.

The Lancet Global Health Commission on financing primary health care: putting people at the centre

Kara Hanson  1 , Nouria Brikci  2 , Darius Erlangga  2 , Abebe Alebachew  3 , Manuela De Allegri  4 , Dina Balabanova  2 , Mark Blecher  5 , Cheryl Cashin  6 , Alexo Esperato  7 , David Hipgrave  8 , Ina Kalisa  9 , Christoph Kurowski  10 , Qingyue Meng  11 , David Morgan  12 , Gemini Mtei  13 , Ellen Nolte  14 , Chima Onoka  15 , Timothy Powell-Jackson  2 , Martin Roland  16 , Rajeev Sadanandan  17 , Karin Stenberg  18 , Jeanette Vega Morales  19 , Hong Wang  20 , Haja Wurie  21
Affiliations
Review

The Lancet Global Health Commission on financing primary health care: putting people at the centre

Kara Hanson et al. Lancet Glob Health. 2022 May.

Erratum in

  • Correction to Lancet Glob Health 2022; 10: e715-72.
    [No authors listed] [No authors listed] Lancet Glob Health. 2023 Apr;11(4):e504. doi: 10.1016/S2214-109X(23)00035-9. Epub 2023 Jan 13. Lancet Glob Health. 2023. PMID: 36646101 Free PMC article. No abstract available.
No abstract available

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Conflict of interest statement

Declaration of interests KH, DB, NB, DE and TP-J were funded by a grant from the Bill & Melinda Gates Foundation. DH has received funding from the Bill & Melinda Gates Foundation for various activities at UNICEF, including on health system strengthening and community health, both of which are mentioned in this report. In the period during which the report was developed, AE and HWa were employed by the Bill & Melinda Gates Foundation and were involved in data analysis, interpretation and writing of the report. All other authors declared no conflict of interest.

Figures

Figure 1
Figure 1
Out-of-pocket household spending as a share of total spending for PHC and non-PHC in 2018, by country income Out-of-pocket share of PHC is calculated as out-of-pocket spending on PHC as a share of total PHC spending. Out of pocket share of non-PHC is calculated as out-of-pocket spending on non-PHC as a share of total non-PHC spending. The box represents IQR; the ends of the whiskers represent the minimum and maximum value; the bold horizontal line represents the median. PHC=primary health care.
Figure 2
Figure 2
Components of PHC spending by financial source in low-income to high-income countries in 2018 Figures exclude dental care and home care. Medical goods only include medicines and other medical goods purchased outside of outpatient facilities. Private spending includes individuals paying out of pocket and other domestic private sources, such as private insurance (voluntary and compulsory). External spending includes the use of grants, concessional loans, and aid in kind from outside the country. PHC=primary health care
Figure 3
Figure 3
Government spending on PHC versus UHC index, 2018 PHC=primary health care. UHC=universal health coverage.
Figure 4
Figure 4
Organisation and governance of public PHC providers Data indicate the proportion of countries with each organisational and governance arrangement in place. Data are disaggregated by country income group. PHC=primary health care.
Figure 5
Figure 5
Degree of autonomy for public PHC providers Data indicate the proportion of countries in which public PHC providers have autonomy in how they function. Data are disaggregated by country income group. PHC=primary health care.
Figure 6
Figure 6
Formal and informal user fees at public PHC providers Data indicate the user fee policy in place in public PHC providers across surveyed countries (categories are mutually exclusive). Data are disaggregated by country income group. PHC=primary health care.
Figure 7
Figure 7
Provider payment mechanisms for public PHC providers Data indicate the type of payment system used in public PHC providers across surveyed countries (categories are mutually exclusive). Data are disaggregated by country income group. Population payment refers to capitation. Input-based payment refers to global budget, line item budget, and direct payment of salaries by government. Service-based payment refers to fee-for-service, case-based payment and pay-for-performance. PHC=primary health care.
Figure 8
Figure 8
Paying community health workers Data indicate how community health workers delivering services on behalf of the government are remunerated in surveyed countries (categories are mutually exclusive). Data are disaggregated by country income group.
Figure 9
Figure 9
Policy tools to increase and protect resource allocations to PHC PHC=primary health care.
Figure 10
Figure 10
Health and public finance management system capacities needed to exercise public finance management policy levers PFM=public finance management. *Direct facility funding also requires individual facility bank accounts.
Figure 11
Figure 11
Strategic pathway for moving to a blended, capitation-based payment
Figure 12
Figure 12
Estonia's blended PHC payment system in 2003 and 2019 PHC=primary health care.
Figure 13
Figure 13
A political economy analysis conceptual framework for health financing reform
Figure 14
Figure 14
Framework for people-centred financing of PHC
See this image and copyright information in PMC

Comment in

References

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