Peer-reviewed article
Use of public primary care facilities, economic development, and the health service transition.
Rao KD, Schmidt A, Zhao Y ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study analyzes how children in 46 low- and middle-income countries access primary care for common illnesses like respiratory infections, diarrhea, and fever. It finds that public primary care facilities serve less than half of children seeking medical care in most countries, and this use declines as countries become wealthier. The research shows that economic development drives a shift toward private providers, but public facilities are associated with lower costs to families. The study suggests that countries in transition need to rethink how they organize and finance primary healthcare as usage patterns change.
Key points
- Public primary care facilities received less than half the patients seeking care for treatable conditions in most of the 46 countries studied
- Use of public primary care facilities declined by around 24 percentage points between average low-income and middle-income countries
- Economic development is associated with a shift toward private providers, with declining share of patients using public facilities
- Public primary care facility use was associated with lower catastrophic health expenditures for families
- Most between-country variation in public facility use was due to factors other than income level
Limitations
The study uses cross-sectional survey data and cannot establish causation or track changes within countries over time. It focuses only on three illness types (ARI, diarrhea, fever) and does not examine the quality of care or health outcomes associated with different provider types.
Abstract
Background Many low- and middle-income countries (LMICs) have large networks of public primary care facilities (PCF) to provide affordable and quality health services close to communities. Public PCFs are expected to serve as the principal source of primary care. This study documents the extent to which public PCFs are used for illnesses treatable at the primary care level, and investigates the association between public PCF use, economic development, and UHC achievement. Methods A cross-section of Demographic and Health Surveys conducted after 2014 in 46 LMICs were analysed. The sources of medical advice for children seeking care outside their home for the following illnesses were identified - acute respiratory infections (ARI), diarrhoea, and fever. Results There is considerable between-country variation in utilisation of public PCFs; in most countries public PCFs received less than half the patients seeking medical advice for conditions treatable at the primary care level. Second, economic development is associated with a 'health service transition' characterised by two related trends - decline in the share of patients seeking medical advice at public providers overall and at public PCFs, and a proportionate increase in the share of patients seeking medical advice at private providers; use of public PCFs declined by around 24 percentage points between the average low-income and middle-income country. However, most of the between-country variation in public PCF use was due to factors other than income. Third, cross-country regression analysis indicated that public PCF use was not associated with UHC achievement because a similar range of services are offered by private providers. Public PCF use was associated with lower catastrophic health expenditures. Conclusions The changes in care-seeking patterns and use of public PCFs brought about by economic development makes it critical to re-think primary health care service delivery models and financial protection mechanisms in transition countries.