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

In 2020, the World Health Assembly called on countries to reorient their models of care (MOCs) toward primary health care (PHC). This study's objectives were to (a) describe common use of the concept of MOC; and (b) identify implemented MOCs and their components that support PHC at national and subnational levels. A scoping review charted data on national and subnational level MOCs from literature reviews in PubMed and Global Index Medicus databases and WHO publications. Qualitative interviews about current MOCs were conducted with national-level health planners in seven Eastern Mediterranean Region countries. 2189 abstracts were screened and 98 papers included. Few papers explicitly defined 'model of care'; most instead referred to particular models of care and their components, implicitly including processes of care, organization of providers and management of services. Seventy-eight papers described small subnational (e.g., district or municipal) MOCs focused on care groups or conditions. Twelve papers and all interviewees described national or large subnational (e.g., provincial or regional) MOCs intended to prioritize primary care services, service integration and people-centred service delivery. Key components included: strengthening primary care capacity to coordinate and deliver services; implementing multidisciplinary, team-based service delivery; building robust linkages (e.g., referral, communication and transportation) across all care levels; designing pathways to efficiently guide people's journeys through a health system; and ensuring longitudinal health care coordination. Findings suggest that reorienting a national MOC toward PHC is facilitated by explicit articulation of the intended MOC and practical, coordinated planning for its incremental implementation, financing and monitoring.