Policy and service delivery proposals to improve primary care services in low-income and middle-income country cities
Lilford, Richard J Daniels, Benjamin McPake, Barbara Bhutta, Zulfiqar A Mash, Robert Griffiths, Frances Omigbodun, Akinyinka Pinto, Elzo Pereira Jain, Radhika Asiki, Gershim
Lilford, Richard J
Daniels, Benjamin
McPake, Barbara
Bhutta, Zulfiqar A
Mash, Robert
Griffiths, Frances
Omigbodun, Akinyinka
Pinto, Elzo Pereira
Jain, Radhika
Asiki, Gershim
Affiliation
University of Birmingham; Harvard University; University of Melbourne; Aga Khan University; Hospital for Sick Children Toronto; University of Stellenbosch; University of Warwick; University of the Witwatersrand; University of Ibadan; Oswaldo Cruz Foundation-Brazil; University College London; African Population and Health Research Center Nairobi; University Hospitals Birmingham NHS Foundation Trust; Makerere University; Drexel University; University of Hong Kong; Georgetown University
Other Contributors
Publication date
2025-05
Collections
Research Projects
Organizational Units
Journal Issue
Abstract
The landscape of primary care services in low-income and middle-income country cities is diverse and dynamic, yet the quality of care received is too often low and the financial cost to the patient high. In the second Paper in this Series, we argue that shaping the primary care market is likely to provide larger returns to scale than individual quality improvement initiatives. Among other things, the market can be shaped by regulation and targeted public investment to crowd out poor providers and motivate those that remain to improve. Additional supply-side initiatives for which there is evidence include measures to educate and motivate the workforce, skill substitution and formation of clinical primary care teams, information technology, and improving the supply of medicines and diagnostics. Demand-side measures include reducing out-of-pocket expenses and promoting health literacy and user advocacy. Research is urgently needed into access for people who are unregistered (eg, those who sleep on the streets), those in peri-urban areas and towns, and on cost-effectiveness, and sustainability of beneficial interventions.
Citation
Lilford RJ, Daniels B, McPake B, Bhutta ZA, Mash R, Griffiths F, Omigbodun A, Pinto EP Jr, Jain R, Asiki G, Webb E, Scandrett K, Chilton PJ, Sartori J, Chen YF, Waiswa P, Ezeh A, Kyobutungi C, Leung GM, Machado C, Sheikh K, Watson SI, Das J. Policy and service delivery proposals to improve primary care services in low-income and middle-income country cities. Lancet Glob Health. 2025 May;13(5):e954-e966. doi: 10.1016/S2214-109X(24)00536-9.
Type
Article