Primary health care offers a cost–effective route to achieving universal health coverage (UHC). However, primary health-care systems are weak in many low- and middle-income countries and often fail to provide comprehensive, people-centred, integrated care. We analysed the primar...y health-care systems in 20 low- and middle-income countries using a semi-grounded approach. Options for strengthening primary health-care systems were identified by thematic content analysis. We found that: (i)despite the growing burden of noncommunicable disease, many low- and middle-income countries lacked funds for preventive services; (ii)community health workers were often under-resourced, poorly supported and lacked training; (iii)out-of-pocket expenditure exceeded 40% of total health expenditure in half the countries studied, which affected equity; and (iv)health insurance schemes were hampered by the fragmentation of public and private systems, underfunding, corruption and poor engagement of informal workers. In 14 countries, the private sector was largely unregulated. Moreover, community engagement in primary health care was weak in countries where services were largely privatized. In some countries, decentralization led to the fragmentation of primary health care. Performance improved when financial incentives were linked to regulation and quality improvement, and community involvement was strong. Policy-making should be supported by adequate resources for primary health-care implementation and government spending on primary health care should be increased by at least 1% of gross domestic product. Devising equity-enhancing financing schemes and improving the accountability of primary health-care management is also needed. Support from primary health-care systems is critical for progress towards UHC in the decade to 2030.
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Les documents d’orientation sont révisés en fonction de l’évolution permanente
de la recherche. Les énoncés des compétences essentielles de l’ICM sont également évalués et modifiés au fur et à mesure que des preuves pertinentes concernant les soins de santé sexuelle, génésique, ...maternelle et néonatale et les pratiques sages-femmes émergent. Les compétences présentées dans ce document ont été mises à jour dans le cadre d’un tel processus de révision
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This Communications Toolkit is intended to provide practical guidance and support to staff and partners who are looking to increase their communications capacity. It has been developed as a resource for project staff who work at field-level, to help them communicate responsibly, creatively, and effe...ctively about their work
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This real-time learning process was carried out in order to identify the gaps and needs within World Vision’s current Ebola Virus Disease (EVD) response in Sierra Leone and to inform World Vision on how other surrounding countries (specifically those with national offices such as Mali, Ghana, Nig...er, Mauritania, Senegal and Chad) should prepare for a possible Ebola outbreak.
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This special issue on Newborn Health in Global Health Action is being launched to share the experience of how to scale up a cost-effective package of newborn care that involves families, community health workers and health facilities. The results of this community randomized trial, the Uganda Newbor...n Study (UNEST), show that home visits in pregnancy and soon after delivery resulted in improved breastfeeding practices, skin-to-skin care immediately after birth, delaying a baby’s first bath, and hygienic care of the baby’s umbilical cord among the poorest households with lowest access to care.
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