Quality of primary health care in China: challenges and recommendations.

China has substantially increased financial investment and introduced favourable policies for strengthening its primary health care system with core responsibilities in preventing and managing chronic diseases such as hypertension and emerging infectious diseases such as coronavirus disease 2019 (COVID-19). However, widespread gaps in the quality of primary health care still exist. In this Review, we aim to identify the causes for this poor quality, and provide policy recommendations. System challenges include: the suboptimal education and training of primary health-care practitioners, a fee-for-service payment system that incentivises testing and treatments over prevention, fragmentation of clinical care and public health service, and insufficient continuity of care throughout the entire health-care system. The following recommendations merit consideration: (1) enhancement of the quality of training for primary health-care physicians, (2) establishment of performance accountability to incentivise high-quality and high-value care; (3) integration of clinical care with the basic public health services, and (4) strengthening of the coordination between primary health-care institutions and hospitals. Additionally, China should consider modernising its primary health-care system through the establishment of a learning health system built on digital data and innovative technologies.

Strengthening health systems in low-income countries by enhancing organizational capacities and improving institutions.

BACKGROUND: This paper argues that the global health agenda tends to privilege short-term global interests at the expense of long-term capacity building within national and community health systems. The Health Systems Strengthening (HSS) movement needs to focus on developing the capacity of local organizations and the institutions that influence how such organizations interact with local and international stakeholders. DISCUSSION: While institutions can enable organizations, they too often apply requirements to follow paths that can stifle learning and development. Global health actors have recognized the importance of supporting local organizations in HSS activities. However, this recognition has yet to translate adequately into actual policies to influence funding and practice. While there is not a single approach to HSS that can be uniformly applied to all contexts, several messages emerge from the experience of successful health systems presented in this paper using case studies through a complex adaptive systems lens. Two key messages deserve special attention: the need for donors and recipient organizations to work as equal partners, and the need for strong and diffuse leadership in low-income countries. An increasingly dynamic and interdependent post-Millennium Development Goals (post-MDG) world requires new ways of working to improve global health, underpinned by a complex adaptive systems lens and approaches that build local organizational capacity.

Rethinking health systems strengthening: key systems thinking tools and strategies for transformational change.

While reaching consensus on future plans to address current global health challenges is far from easy, there is broad agreement that reductionist approaches that suggest a limited set of targeted interventions to improve health around the world are inadequate. We argue that a comprehensive systems perspective should guide health practice, education, research and policy. We propose key 'systems thinking' tools and strategies that have the potential for transformational change in health systems. Three overarching themes span these tools and strategies: collaboration across disciplines, sectors and organizations; ongoing, iterative learning; and transformational leadership. The proposed tools and strategies in this paper can be applied, in varying degrees, to every organization within health systems, from families and communities to national ministries of health. While our categorization is necessarily incomplete, this initial effort will provide a valuable contribution to the health systems strengthening debate, as the need for a more systemic, rigorous perspective in health has never been greater.

An interactive integrative approach to translating knowledge and building a "learning organization" in health services management.

This paper proposes a basic approach to ensuring that knowledge from research studies is translated for use in health services management with a view towards building a "learning organization". (A learning organization is one in which the environment is structured in such a way as to facilitate learning as well as the sharing of knowledge among members or employees.) This paper highlights various dimensions that determine the complexity of knowledge translation, using the problem-solving cycle as the backbone for gaining a better understanding of how different types of knowledge interact in health services management. It is essential to use an integrated and interactive approach to ensure that knowledge from research is translated in a way that allows a learning organization to be built and that knowledge is not used merely to influence a single decision in isolation from the overall services and management of an organization.

The system of care for the elderly in Thailand: capitalizing from an integrated community-based health system through reform.

Thailand is facing a dramatic challenge of how to ensure good health and quality of life for its rapidly increasing number of elderly citizens. The modern health services system established a century ago has a larger proportion of public providers, but only 35-40% share public spending on health. The health services administration, its infrastructure and health policies underwent a number of reforms resulting in a system that emphasizes community-based comprehensive health services with a multi-sectoral approach to health. There has been remarkable concern over the health and well-being of the elderly for the last two decades, leading to the introduction of specific policies and programs, both in health and social sectors. The health service infrastructure has better coverage compared to social services, with a varying degree of integration between the two depending partly on existing resources and management in each locality. Among many other social services, there are homes for the elderly and income support for the poor elderly. However, health services and institutions for the elderly are not being created separately, but rather by adding new services and programs to the existing comprehensive and integrated system of service delivery. The changing political and socio-economic environment provides a great opportunity to make the health and social services more responsive to the needs of the elderly, now and in the future. Decentralization and the universal health insurance policy of the new government with an emphasis on strong primary care providers will give a great push forward to the presently community-oriented nature of the extensive health service infrastructure.