International Journal of Health Policy and Management

International Journal of Health Policy and Management

In-Between Policy Vision and Practical Realities of Primary Healthcare: A Case Study in Rural Northern Sweden

Document Type : Original Article

Authors
Hanna Blåhed 1, 2
Frida Jonsson 1
Anna-Karin Hurtig 1
1 Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
2 Arctic Research Centre (Arcum), Umeå University, Umeå, Sweden
10.34172/ijhpm.8372
Abstract
Background 
In the context of a broader vision for primary healthcare (PHC) informed health systems, Sweden is following international trends by introducing the national “Good Quality and Local Health Care” reform. This reform seeks to establish a health system with primary care (PC) at the centre by emphasising aspects such as interorganisational collaboration and e-Health innovation. Since translating policy into practice may be challenging in rural areas due to resource constrains and normatively urban perspectives in national policy-making, this study explores how rural PC actors navigate the PHC vision in the context of a sparsely populated area of the Swedish north.
 
Methods 
This was a single case study, focusing on a rural municipality in northern Sweden. Thematic analysis was applied to data collected through interviews and observations, resulting in the development of three themes.
 
Results 
The results indicate that the policies were suboptimally aligned with the needs of the rural municipality. The results highlighted enduring collaborations that predated the reform. These local alliances led to a resource allocation challenge, rendering the existing networks and reform efforts concurrently understaffed. Moreover, the reform’s efforts to digitise healthcare faced impediments due to challenges associated with scaling up e-Health technology. Although key reform concepts such as person-centeredness and integrated care had already been put into practice, they were insufficiently acknowledged as such by external stakeholders.
 
Conclusion 
Subjecting national health policy-making to scrutiny by different stakeholders through the use of rural proofing can lead to a more deliberate and impactful implementation of policies. Rural proofing facilitates the preemptive identification of potential shortcomings, thereby enabling the formulation of necessary adjustments that resonate with local needs. This study shows apparent misalignments between the national vision and the practical reality in rural areas, therefore calling for greater efforts to include rural perspectives in national policy-making. 
Keywords
Rural Proofing
Integrated Care
Person-Centred Care
Good Quality
Local Healthcare
Sweden
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International Journal of Health Policy and Management
Volume 13, Issue 1
2024
Pages 1-11

  • Received Date 05 December 2023
  • Revised Date 08 September 2024
  • Accepted Date 04 November 2024
  • First Published Date 05 November 2024
  • Published Date 01 December 2024