ArticleBMJ global health2025
Reducing fragmentation of primary healthcare financing for more equitable, people-centred primary healthcare.
Article in BMJ global health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 1 of them a synthesis that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
23 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Understanding pathways from primary health care to universal health coverage outcomes: a realist review.Frontiers in public health · 2026Pooled it
- Strengthening Primary Health Care for Improved Population Health and Health Equity in Somalia: A Narrative Review.Public health challenges · 2026Review
- The AI-Driven Healthcare Value Framework-Rethinking Traditional Care Models in the Age of Automation.Healthcare (Basel, Switzerland) · 2026Article
- When health systems invest matters: temporal imbalance and the case for life-course reorientation.Journal of global health · 2026Article
- Primary Care or Primary Problem? Aligning Access Pathways with Patient Needs Across the Care Continuum.Journal of market access & health policy · 2026Article
- The expectation-perception gap in primary healthcare quality: a study of Iranian older adults.BMC geriatrics · 2026Article
- Readiness for interprofessional learning among undergraduate health discipline students: A multisite study.Curationis · 2026Article
- Association of modified 5C scale and influenza vaccine hesitancy among the elderly population in Ningbo, China: a cross-sectional study.BMC public health · 2026Article
- The rising tide of opioid use disorder: analyzing 30 years of epidemiological trends and socioeconomic factors in the U.S.Naunyn-Schmiedeberg's archives of pharmacology · 2026Article
- Health worker support for early learning, responsive caregiving, and safety and security: a scoping review.BMC health services research · 2026Article
- Health financing inequality in fragmented health systems: evidence from Mexico, 2000-2023.International journal for equity in health · 2026Article
- Fragmented healthcare and effective maternal coverage in Mexico, 2009-2023.BMC medicine · 2026Article
- Global Health Initiatives and Universal Health Coverage in Pakistan-Aligned for the Future?The International journal of health planning and management · 2026Article
- Fragmentation in health system financing: a major challenge for improving effectiveness, efficiency, equity and choice within health systems.BMJ public health · 2026Review
- Barriers and enablers in implementing integrated primary health care: A qualitative assessment in West Sumbawa District, Indonesia.PLOS global public health · 2026Article
- Evaluating Honduras' health financing system: a comprehensive application of the WHO Health Financing Progress Matrix.Revista panamericana de salud publica = Pan American journal of public health · 2026Article
- Changes in primary health care service experiences and urban-suburban disparities among Shanghai residents: a two-year comparative study.International journal for equity in health · 2025Article
- Co-Production, Co-Creation and Co-Design in Primary Health Care: A Scoping Review of Design, Implementation, Impact and Sustainability.Health expectations : an international journal of public participation in health care and health policy · 2025Article
- Unlocking the blueprint to eliminating neglected tropical diseases: A review of efforts in 50 countries that have eliminated at least 1 NTD.PLoS neglected tropical diseases · 2025Review
- Understanding challenges of primary healthcare financial resource allocation in Iran.Health research policy and systems · 2025Article
Corrections and comments
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Authors and funding
8 authors.
Funding
Abstract
Despite primary healthcare (PHC) being recognised in global declarations-Alma Ata in 1978 and Astana in 2018-and prioritised in national health strategies, chronic under-resourcing of PHC persists in most low-income and middle-income countries. More public spending is needed for PHC, but macrofiscal and political constraints often limit the ability of governments to allocate more public resources to PHC. Under-resourcing has been compounded by fragmented and rigid funding flows, which are inefficient and may erode equity, quality of care and public trust in PHC.This article explores the drivers of fragmentation in PHC financing-low public spending, which results in over-reliance on external sources to fund critical health interventions, and the proliferation of new financing schemes that do not take a system-wide view or adhere to the principles of universality. It then highlights some of the possible consequences of this fragmentation for the efficiency, equity and effectiveness of service delivery.Four countries-Argentina, Burkina Faso, Indonesia and Tanzania-are used to illustrate practical steps that may be taken to minimise the consequences of fragmentation in PHC financing: (1) consolidating multiple coverage schemes, (2) avoiding further fragmentation, (3) harmonising health purchasing functions and (4) streamlining funding flows to the provider level.The country examples reveal lessons for policy-makers grappling with the consequences of fragmented PHC financing. The paper concludes with a research agenda to generate additional evidence on what works to address fragmentation.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.