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Review
. 2024 Jan;12(1):e134-e144.
doi: 10.1016/S2214-109X(23)00513-2. Epub 2023 Dec 11.

Primary health care in practice: usual source of care and health system performance across 14 countries

Kevin Croke  1 , Mosa Moshabela  2 , Neena R Kapoor  3 , Svetlana V Doubova  4 , Ezequiel Garcia-Elorrio  5 , Damen HaileMariam  6 , Todd P Lewis  3 , Gloria N Mfeka-Nkabinde  7 , Sailesh Mohan  8 , Peter Mugo  9 , Jacinta Nzinga  10 , Dorairaj Prabhakaran  11 , Ashenif Tadele  12 , Katherine D Wright  3 , Margaret E Kruk  3
Affiliations
Review

Primary health care in practice: usual source of care and health system performance across 14 countries

Kevin Croke et al. Lancet Glob Health. 2024 Jan.

Abstract

Primary health care (PHC) is central to attainment of the Sustainable Development Goals, yet comparable cross-country data on key aspects of primary care have not been widely available. This study analysed data from the People's Voice Survey, which was conducted in 2022 and 2023 in 14 countries. We documented usual source of care across countries and examined associations of usual source of care with core PHC services, quality ratings, and health system confidence. We found that 75% of respondents had a usual source of care, and that 40% of respondents accessed usual care in the public sector at primary level. 44% rated their usual source of care as very good or excellent. Access to PHC-linked screenings and treatments varied widely within and across countries. Having any usual source of care was associated with higher take-up of preventive services, greater access to treatment including mental health services, and greater health system endorsement. Strengthening links between health system users and primary care providers could improve take-up of preventive care and increase user satisfaction with health system performance.

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Conflict of interest statement

Declaration of interests We declare no competing interests.

Figures

Figure 1
Figure 1
Usual source of care by (A) facility ownership and (B) level
Figure 2
Figure 2
Association between quality rating and characteristics of respondents' usual source of care, by country The outcome is a binary variable that captures whether or not the respondent rates usual source of care quality as very good or excellent. Control variables include gender, survey mode, urban or rural location, secondary education (0 or 1), age categories (seven), income categories (three), health insurance (0 or 1), patient activation (0 or 1), and self-reported good health (0 or 1). Vertical lines are placed where OR=1. OR=odds ratio.
Figure 3
Figure 3
Associations between usual source of care and preventive care or screenings ORs for associations between any usual source of care (Yes=1) and receipt of various preventive services and screenings. The outcome variables are whether or not the respondent has received a given screening or service. Control variables include gender, survey mode, urban or rural, secondary education (0 or 1), age categories (seven), income categories (three), health insurance (0 or 1), patient activation (0 or 1), and self-reported good health (0 or 1). Vertical lines are placed where OR=1. OR=odds ratio. USC=usual source of care.
Figure 4
Figure 4
Usual source of care and other factors associated with health system confidence, endorsement, and health security ORs for associations between USC (Yes=1) and measures of health system confidence, endorsement, and security. Control variables include gender, survey mode, urban or rural, secondary education (0 or 1), age categories (seven), income categories (three), health insurance (0 or 1), patient activation (0 or 1), and self-reported good health (0 or 1). Vertical lines are placed where OR=1. OR=odds ratio. USC=usual source of care.
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References

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