A Framework to Determine the Extent to Which Regional Primary Healthcare Organisations Are Comprehensive or Selective in Their Approach

Document Type : Original Article

Authors

1 College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia

2 Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, SA, Australia

Abstract

Background
There is an increasing emphasis on the importance of comprehensive primary healthcare (CPHC) in improving population health and health equity. There is, therefore, a need for a practical means to determine how comprehensive regional primary healthcare organisations (RPHCOs) are in their approach. This paper proposes a framework to provide such a means. The framework is then applied to assess the comprehensiveness of Australian RPHCOs.
 
Methods
Drawing on a narrative review of the broader literature on CPHC versus selective primary healthcare (SPHC) and examples of international models of RPHCOs, we developed a framework consisting of the key criteria and a continuum from comprehensive to selective interventions. We applied this framework to Australian RPHCOs using data from the review of their planning documents, and survey and interviews with executive staff, managers, and board members. We used a spidergram as a means to visualise how comprehensive they are against each of these criteria, to provide a practical way of presenting the assessment and an easy way to compare progress over time.
 
Results
Key criteria for comprehensiveness included (1) focus on population health; (2) focus on equity of access and outcomes; (3) community participation and control; (4) integration within the broader health system; (5) inter-sectoral collaboration; and (6) local responsiveness. An examination of Australian RPHCOs using the framework suggests their approach is far from comprehensive and has become more selective over time.
 
Conclusion
The framework and spidergram offer a practical means of gauging and presenting the comprehensiveness of RPHCOs, and to identify gaps in comprehensiveness, and changes over time.

Keywords


  1. Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q. 2005;83(3):457-502. doi:10.1111/j.1468-0009.2005.00409.x
  2. World Health Organization (WHO). The World Health Report 2008 - Primary Health Care: Now More Than Ever. Geneva: WHO; 2008.
  3. World Health Organization (WHO). Declaration of Alma-Ata. In: International Conference on Primary Health Care. Alma Ata: USSR; 1978.
  4. World Health Organization (WHO). Closing the Gap in A Generation: Health Equity through Action on the Social Determinants of Health. Geneva: WHO; 2008.
  5. Walsh JA, Warren KS. Selective primary health care: an interim strategy for disease control in developing countries. N Engl J Med. 1979;301(18):967-974. doi:10.1056/nejm197911013011804
  6. Baum F. The New Public Health. 3rd ed. Oxford: Oxford University Press; 2015.
  7. World Health Organization (WHO), United Nations Children’s Fund (UNICEF). Declaration of Astana. In: Global Conference on Primary Health Care. Astana, Kazakhstan: WHO, UNICEF; 2018.
  8. World Health Organization (WHO). Primary Health Care on the Road to Universal Health Coverage: 2019 Monitoring Report: Executive Summary. Geneva: WHO; 2009.
  9. Baum F. Primary health care: can the dream be revived? Dev Pract. 2003;13(5):515-519. doi:10.1080/0961452032000125884
  10. Baum F, Fry D, Lennie I. Community Health Policy and Practice in Australia. Sydney: Pluto Press Australia; 1992.
  11. WHO. Decentralization in health care: Strategies and outcomes, in European Observatory on Health Systems and Policies Series. WHO;  2007.
  12. Barron P, Monticelli F. Lessons Learnt in the Implementation of Primary Health Care: Experiences from Health Districts in South Africa. Durban: Health Systems Trust; 2003.
  13. Dodd R, Palagyi A, Jan S, et al. Organisation of primary health care systems in low- and middle-income countries: review of evidence on what works and why in the Asia-Pacific region. BMJ Glob Health. 2019;4(Suppl 8):e001487. doi:10.1136/bmjgh-2019-001487
  14. Smith J, Goodwin N. Towards Managed Primary Care: The Role and Experience of Primary Care Organizations. Aldershot: Ashgate; 2006.
  15. Pegram R, Sprogis A, Buckpitt J. Divisions of general practice: a status review. Aust Health Rev. 1995;18(4):78-94. doi:10.1071/ah950078
  16. Australian Government. Background Paper: Medicare Locals Health Needs Assessment and Planning. Canberra: DoHA; 2011.
  17. Australian Government. Primary Health Networks: Grant Programme Guidelines. Canberra: DoH; 2016.
  18. Department of Health. Shifting the Balance of Power within the NHS - Securing Delivery. London, UK: NHS; 2001.
  19. New Zealand Ministry of Health. A Guide for Establishing Primary Health Organisations. Wellington, New Zealand: Ministry of Health; 2002.
  20. Ministry of Health and Long-term Care. Health Results Team First Annual Report 2004-2005. Ministry of Health; 2005.
  21. Scottish Executive Health Department. Community Health Partnerships: Statutory Guidance. http://www.scotland.gov.uk/Resource/Doc/26800/0012672.pdf. Published 2004.
  22. Bywood P.T, Ermy-Albrecht K., Regionalisation of health services: Benefits and impact. Primary Health Care Research & Information Service (PHCRIS), 2016.
  23. World Health Organization (WHO). Primary Care Evaluation Tool. Europe: WHO; 2010.
  24. Fracolli LA, Gomes MF, Nabão FR, Santos MS, Cappellini VK, de Almeida AC. Primary health care assessment tools: a literature review and metasynthesis. Cien Saude Colet. 2014;19(12):4851-4860. doi:10.1590/1413-812320141912.00572014
  25. Hurley C, Baum F, Johns J, Labonte R. Comprehensive primary health care in Australia: findings from a narrative review of the literature. Australas Med J. 2010;1(2):147-152. doi:10.4066/amj.2010.201
  26. phcpi. The PHCPI Conceptual Framework. https://improvingphc.org/phcpi-conceptual-framework. Accessed April 15, 2020. Published 2018.
  27. Greenhalgh T, Thorne S, Malterud K. Time to challenge the spurious hierarchy of systematic over narrative reviews? Eur J Clin Invest. 2018;48(6):e12931. doi:10.1111/eci.12931
  28. Cohen D, Huynh T, Sebold A, Harvey J, Neudorf C, Brown A. The population health approach: a qualitative study of conceptual and operational definitions for leaders in Canadian healthcare. SAGE Open Med. 2014;2:2050312114522618. doi:10.1177/2050312114522618
  29. Keleher H. Population health planning for health equity. Aust J Prim Health. 2011;17(4):327-333. doi:10.1071/py11044
  30. Naylor C, Curry N, Holder H, Ross S, Marshall L, Tait E. Clinical Commissioning Groups: Supporting Improvement in General Practice? London: The King’s Fund and Nuffield Trus; 2013.
  31. Department of Health. Shifting the Balance of Power within the NHS - Securing Delivery. London, UK: Department of Health; 2001.
  32. Ministry of Health. A Guide for Establishing Primary Health Organisations. Wellington, NZ: Ministry of Health; 2002.
  33. Cashin C. New Zealand: Primary Health Organiation (PHO) Performance Program. The World Bank; 2011.
  34. Ministry of Health and Long-term Care. Board of Health and Local Health Integration Network Engagement Guideline, 2018. Ontario: Population and Public Health Division, Ministry of Health and Long-Term Care; 2018.
  35. Waterloo Wellington Local Health Integration Network (LHIN). Addressing Social Determinants of Health in the Waterloo Wellington Local Health Integration Network Area: A Public Health Perspective on Local Health, Policy, and Program Needs. Region of Waterloo Public Health; 2011.
  36. Magnussen L, Ehiri J, Jolly P. Comprehensive versus selective primary health care: lessons for global health policy. Health Aff (Millwood). 2004;23(3):167-176. doi:10.1377/hlthaff.23.3.167
  37. Baum F, Freeman T, Lawless A, Labonte R, Sanders D. What is the difference between comprehensive and selective primary health care? evidence from a five-year longitudinal realist case study in South Australia. BMJ Open. 2017;7(4):e015271. doi:10.1136/bmjopen-2016-015271
  38. Central East Local Health Integration Network (LHIN). A Framework for Community Engagement & Local Health Planning. Ontario, Canada: LHIN; 2006.
  39. Barnett P, Smith J, Cumming J. The Roles and Functions of Primary Health Organisations. Wellington: Health Services Research Centre; 2009.
  40. Valentijn PP, Schepman SM, Opheij W, Bruijnzeels MA. Understanding integrated care: a comprehensive conceptual framework based on the integrative functions of primary care. Int J Integr Care. 2013;13:e010. doi:10.5334/ijic.886
  41. Ministry of Health. Health Results Team First Annual Report 2004-2005. Ontario: Ministry of Health; 2005.
  42. World Health Organization (WHO). Health Equity Through Intersectoral Action: An Analysis of 18 Country Case Studies. Geneva: WHO; 2008.
  43. World Health Organization (WHO), United Nations Children’s Fund (‎UNICEF)‎. A Vision for Primary Health Care in the 21st Century: Towards Universal Health Coverage and the Sustainable Development Goals. Geneva: WHO, UNICEF; 2018.
  44. Bhasin K, Williams AP. Understanding LHINs: A Review of the Health System Integration Act and the Integrated Health Services. Ontario: Canadian Research Network for Care in the Community; 2007.
  45. Dillman, D, Smyth J, Melani Christian L. Internet, Phone, Mail, and Mixed-Mode Surveys: The Tailored Design Method. Hoboken, New Jersey: John Wiley & Sons Inc; 2009.
  46. Rifkin SB, Muller F, Bichmann W. Primary health care: on measuring participation. Soc Sci Med. 1988;26(9):931-940. doi:10.1016/0277-9536(88)90413-3
  47. Draper AK, Hewitt G, Rifkin S. Chasing the dragon: developing indicators for the assessment of community participation in health programmes. Soc Sci Med. 2010;71(6):1102-1109. doi:10.1016/j.socscimed.2010.05.016
  48. Baum F, Freeman T, Sanders D, Labonté R, Lawless A, Javanparast S. Comprehensive primary health care under neo-liberalism in Australia. Soc Sci Med. 2016;168:43-52. doi:10.1016/j.socscimed.2016.09.005
  49. Freeman T, Baum F, Labonté R, Javanparast S, Lawless A. Primary health care reform, dilemmatic space and risk of burnout among health workers. Health (London). 2018;22(3):277-297. doi:10.1177/1363459317693404
  50. Baum F, Ziersch A, Freeman T, Javanparast S, Henderson J, Mackean T. Strife of Interests: Constraints on integrated and co-ordinated comprehensive PHC in Australia. Soc Sci Med. 2020;248:112824. doi:10.1016/j.socscimed.2020.112824
  51. Navarro V. Neoliberalism and its consequences: the world health situation since Alma Ata. Glob Soc Policy. 2008;8(2):152-155. doi:10.1177/14680181080080020203
  52. Javanparast S, Freeman T, Baum F, et al. How institutional forces, ideas and actors shaped population health planning in Australian regional primary health care organisations. BMC Public Health. 2018;18(1):383. doi:10.1186/s12889-018-5273-4

Articles in Press, Corrected Proof
Available Online from 05 October 2020
  • Receive Date: 06 December 2019
  • Revise Date: 18 September 2020
  • Accept Date: 19 September 2020