Venturini et al. BMC Infectious Diseases 2014, 14(Suppl 1):S5 http://www.biomedcentral.com/1471-2334/14/S1/S5
                                                            
                         
                     
                                                        
                        
                        
                            
                            
                                                                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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