Task-shifting from doctors to nurses and from health professionals to lay providers may contribute to achieving the Alma-Ata vision of primary health care for all. This is among the conclusions of the second in an eight paper Series in the Alma-Ata Special Issue of The Lancet, by Simon Lewin, London School of Hygiene and Tropical Medicine, UK and Medical Research Council of South Africa, and colleagues.
The authors note that while task shifting offers opportunities for expanding primary health care coverage, effective and supportive supervision of providers is also likely to be key to improving service delivery. In this overview of reviews of health systems interventions in primary health care in low-and middle-income countries, the authors say that user fees reduce usage of both essential and non-essential services and drugs, but that care must be taken if removing such fees to ensure health workers receive adequate pay. Alternative financing structures must also be sought. The authors found that financial incentives can be used to influence provider and patient behaviours, but can have undesirable effects such as the adverse selection of patients by providers.
The authors also found that quality improvement strategies, such as educational outreach and guideline dissemination, can have important effects, yet such strategies to integrate primary health-care services have not yet been assessed adequately. They conclude that a range of governance, financial, delivery and implementation strategies will be necessary to improve the delivery and performance of primary health care and achieve the Alma-Ata vision. They add that any action to improve primary health care must be "accompanied by rigorous evaluations of the strategies that are used".
Simon Lewin, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, UK and Medical Research Council of South Africa T) +44 20 79272102, E) simon.lewin@lshtm.ac.uk
Full paper: http://press.thelancet.com/AA2.pdf
Journal
The Lancet