National and Subnational Models of Care That Support Primary Health Care: A Mixed-Methods Study

Area of Science:

• Health Services Research
• Public Health Policy
• Healthcare Management

Background:

• The World Health Assembly urged countries to shift towards primary health care (PHC) models of care (MOCs) in 2020.
• Understanding how MOCs are conceptualized and implemented is crucial for this global health reorientation.

Purpose of the Study:

• To describe the common understanding and application of the 'model of care' concept.
• To identify implemented MOCs and their components supporting PHC at national and subnational levels.

Main Methods:

• A scoping review of literature from PubMed, Global Index Medicus, and WHO publications.
• Qualitative interviews with national health planners in seven Eastern Mediterranean Region countries.

Main Results:

• Most literature implicitly defined MOCs through their components rather than explicit definitions.
• Seventy-eight papers detailed subnational MOCs, often condition-specific.
• Twelve papers and all interviewees highlighted national/large subnational MOCs prioritizing PHC, service integration, and people-centered delivery.

Conclusions:

• Key components for PHC-oriented MOCs include strengthened primary care capacity, multidisciplinary teams, robust inter-level linkages, efficient patient pathways, and longitudinal coordination.
• Explicitly defining the intended MOC and engaging in practical, coordinated planning are vital for successful national PHC reorientation.