Supply-side and demand-side factors affecting allopathic primary care service delivery 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
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Publication date
2025-05
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Abstract
Most people in low-income and middle-income countries (LMICs) now live in cities, as opposed to rural areas where access to care and provider choice is limited. Urban health-care provision is organised on very different patterns to those of rural care. We synthesise global evidence to show that health-care clinics are plentiful and easily accessible in LMIC cities and that they are seldom overcrowded. The costs that patients incur when they seek care are highly variable and driven mostly by drugs and diagnostics. We show that citizens have agency, often bypassing cheaper facilities to access preferred providers. Primary care service delivery in cities is thus best characterised as a market with a diverse range of private and public providers, where patients make active choices based on price, quality, and access. However, this market does not deliver high-quality consultations on average and does not provide continuity or integration of services for preventive care or long-term conditions. Since prices play a key role in accessing care, the most vulnerable groups of the urban population often remain unprotected.
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. Supply-side and demand-side factors affecting allopathic primary care service delivery in low-income and middle-income country cities. Lancet Glob Health. 2025 May;13(5):e942-e953. doi: 10.1016/S2214-109X(24)00535-7.
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Article