ArticleHealth research policy and systems2019
The impact of governance in primary health care delivery: a systems thinking approach with a European panel.
Article in Health research policy and systems, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 1 of them a synthesis that pooled it.
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Who cites it
18 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Primary healthcare reform for chronic conditions in countries with high or very high human development index: A systematic review.Chronic illness · 2022Pooled it
- Primary health care transformation and health equity in ageing societies: lessons from Singapore.BMC health services research · 2026Article
- Public administration and health system strengthening in low- and middle-income countries: exploring strategies to improve healthcare delivery and health governance.Frontiers in health services · 2026Review
- Diffusion of community heart failure service innovation in Northamptonshire, England: a qualitative study.Primary health care research & development · 2025Article
- Contribution of health system governance in delivering primary health care services for universal health coverage: A scoping review.PloS one · 2025Article
- Mixed method program impact evaluation: Reducing economic barriers to accessing health services (REBAHS) long-term primary healthcare subsidization protocol (LPSP) II action in Lebanon.PLOS global public health · 2025Article
- Article
- Routine health data use for decision making and its associated factors among primary healthcare managers in dodoma region.BMC health services research · 2024Article
- Can the allocation of primary health care system resources affect efficiency? A spatial Dubin model study in China.BMC primary care · 2024Article
- Do community health committees participate in governing health workers in primary healthcare facilities under fiscal decentralization?-An explanatory qualitative study from Tanzania.Health science reports · 2024Article
- Selection of primary health care quality indicators in Europe: A Delphi study protocol.PloS one · 2024Article
- Nurturing an organizational context that supports team-based primary mental health care: A grounded theory study.PloS one · 2024Article
- Successes, weaknesses, and recommendations to strengthen primary health care: a scoping review.Archives of public health = Archives belges de sante publique · 2023Article
- Organization of primary care.Primary health care research & development · 2022Review
- Article
- Modified scoping review of the enablers and barriers to implementing primary health care in the COVID-19 context.Health policy and planning · 2021Article
- PRIMASYS: a health policy and systems research approach for the assessment of country primary health care systems.Health research policy and systems · 2021Review
- Alignment of Perceived Competencies and Perceived Job Tasks among Primary Care Managers.Healthcare (Basel, Switzerland) · 2019Article
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Authors and funding
4 authors.
Funding
Abstract
backgroundEnhancing primary health care (PHC) is considered a policy priority for health systems strengthening due to PHC's ability to provide accessible and continuous care and manage multimorbidity. Research in PHC often focuses on the effects of specific interventions (e.g. physicians' contracts) in health care outcomes. This informs narrowly designed policies that disregard the interactions between the health functions (e.g. financing and regulation) and actors involved (i.e. public, professional, private), and their impact in care delivery and outcomes. The purpose of this study is to analyse the interactions between PHC functions and their impact in PHC delivery, particularly in providers' behaviour and practice organisation.
methodsFollowing a systems thinking approach with data obtained through a three-round European Delphi process, we developed a framework that captures (1) the interactions between PHC functions by analysing correlations between PHC characteristics of participating countries, (2) how actors involved shaped these interactions by identifying the actor and level of devolution (or fragmentation) in the analysis, and (3) their potential effect on care delivery by exploring panellists' opinions.
resultsA total of 59 panellists from 24 countries participated in the first round and 76% of the initial panellists (22 countries) completed the last round. Findings show correlations between governance, financing and regulation based on their degree of decentralisation. This is supported by panellists, who agreed that the actors involved in health system governance determine the type of PHC financing (e.g. ownership or payment mechanisms) and regulation (e.g. competences or gatekeeping), and this may impact care delivery and outcomes. Governance in our framework is an overarching function whose impact in PHC delivery is mediated through the degree of decentralisation (both delegation and devolution) of PHC financing and regulation.
conclusionsThe application of this approach in policy implementation assessment intends to uncover limitations due to poor accountability and commitment to shared objectives. Its application in the design of health strategies helps foresee (and prevent) undesired or unexpected effects of narrow interventions. This approach will assist in the development of the realistic and long-term policies required for health systems strengthening.
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