(This abstract was borrowed from another version of this item.)"> (This abstract was borrowed from another version of this item.)">
[go: up one dir, main page]
IDEAS home Printed from https://ideas.repec.org/a/eee/hepoli/v70y2004i3p303-325.html
   My bibliography  Save this article

Primary health care in practice: is it effective?

Author

Listed:
  • Lewis, Maureen
  • Eskeland, Gunnar
  • Traa-Valerezo, Ximena
Abstract
Primary health care is accepted as the model for delivering basic health care to low income populations in developing countries. Using El Salvador as a case study, the paper draws on three data sets and a qualitative survey to assess health care access and utilization across public and private sector options (including NGOs). Multivariate analysis is used to estimate the quantitative determinants of health seeking behavior. Physical and financial access is generally good. Households do not value the community health workers, and prefer high cost private care, even the poorest families, because of the lower waiting times and higher probability of successful treatment. Similarly, higher level public facilities—health centers and hospitals—are preferred because they are less costly in terms of time as they offer "one stop shopping" and do not require multiple visits, and treatment success is higher than among health posts, health units or community health workers. These results combined with the small size of El Salvador suggest that alternative strategies to community health workers may be a more cost effective approach. While prevention is desirable, community health workers do not have the skills or services that the communities value, which makes them less effective in promoting prevention. Alternative modes of reaching the community could reduce costs and raise the effectiveness of public health spending.
(This abstract was borrowed from another version of this item.)

Suggested Citation

  • Lewis, Maureen & Eskeland, Gunnar & Traa-Valerezo, Ximena, 2004. "Primary health care in practice: is it effective?," Health Policy, Elsevier, vol. 70(3), pages 303-325, December.
    • Handle: RePEc:eee:hepoli:v:70:y:2004:i:3:p:303-325
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0168-8510(04)00082-X
    Download Restriction: Full text for ScienceDirect subscribers only
    ---><---

    As the access to this document is restricted, you may want to look for a different version below or search for a different version of it.

    Other versions of this item:

    References listed on IDEAS

    as
    1. Robinson, Sheila A. & Larsen, Donald E., 1990. "The relative influence of the community and the health system on work performance: A case study of community health workers in Colombia," Social Science & Medicine, Elsevier, vol. 30(10), pages 1041-1048, January.
    2. Kloos, Helmut, 1990. "Utilization of selected hospitals, health centres and health stations in Central, Southern and Western Ethiopia," Social Science & Medicine, Elsevier, vol. 31(2), pages 101-114, January.
    3. Bentley, Chris, 1989. "Primary health care in Northwestern Somalia: A case study," Social Science & Medicine, Elsevier, vol. 28(10), pages 1019-1030, January.
    4. Germano Mwabu & Martha Ainsworth & Andrew Nyamete, 1993. "Quality of Medical Care and Choice of Medical Treatment in Kenya: An Empirical Analysis," Journal of Human Resources, University of Wisconsin Press, vol. 28(4), pages 838-862.
    5. Woelk, Godfrey B., 1994. "Primary health care in Zimbabwe: Can it survive?: An exploration of the political and historical developments affecting the implementation of PHC," Social Science & Medicine, Elsevier, vol. 39(8), pages 1027-1035, October.
    6. Akin, John S. & Guilkey, David K. & Hazel?Denton, E., 1995. "Quality of services and demand for health care in Nigeria: A multinomial probit estimation," Social Science & Medicine, Elsevier, vol. 40(11), pages 1527-1537, June.
    7. Stone, Linda, 1992. "Cultural influences in community participation in health," Social Science & Medicine, Elsevier, vol. 35(4), pages 409-417, August.
    8. Walsh, Julia A., 1988. "Selectivity within primary health care," Social Science & Medicine, Elsevier, vol. 26(9), pages 899-902, January.
    9. Rifkin, Susan B. & Walt, Gill, 1986. "Why health improves: Defining the issues concerning 'comprehensive primary health care' and 'selective primary health care'," Social Science & Medicine, Elsevier, vol. 23(6), pages 559-566, January.
    10. Stock-Iwamoto, Christel & Korte, Rolf, 1993. "Primary health workers in North East Brazil," Social Science & Medicine, Elsevier, vol. 36(6), pages 775-782, March.
    11. Akbar Zaidi, S., 1994. "Planning in the health sector: For whom, by whom?," Social Science & Medicine, Elsevier, vol. 39(9), pages 1385-1393, November.
    12. Sherraden, Margaret Sherrard & Wallace, Steven P., 1992. "Innovation in primary care: Community health services in Mexico and the United States," Social Science & Medicine, Elsevier, vol. 35(12), pages 1433-1443, December.
    13. Lewis, Maureen A. & La Forgia, Gerald M. & Sulvetta, Margaret B., 1996. "Measuring public hospital costs: Empirical evidence from the Dominican Republic," Social Science & Medicine, Elsevier, vol. 43(2), pages 221-234, July.
    14. Alderman, H. & Gertler, P., 1989. "The Substitutability Of Public And Private Health Care For The Treatment Of Children In Pakistan," Papers 57, World Bank - Living Standards Measurement.
    15. Stanton, Bonita & Wouters, Annemarie, 1992. "Guidelines for pragmatic assessment for health planning in developing countries," Health Policy, Elsevier, vol. 21(3), pages 187-209, July.
    16. Lewis, Maureen & Eskeland, Gunnar S. & Traa-Valerezo, Ximena, 1999. "Challenging El Salvador's rural health care strategy," Policy Research Working Paper Series 2164, The World Bank.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Adam Wagstaff, 2010. "Social health insurance reexamined," Health Economics, John Wiley & Sons, Ltd., vol. 19(5), pages 503-517, May.
    2. Korotaev, Andrey (Коротаев, Андрей) & Shulgin, Sergey (Шульгин, Сергей) & Zinkina, Yulia (Зинькина, Юлия), 2017. "Country Risk Analysis Based on Demographic and Socio-Economic Data [Анализ Страновых Рисков С Использованием Демографических И Социально-Экономических Данных]," Working Papers 031715, Russian Presidential Academy of National Economy and Public Administration.
    3. Green, Andrew & Ross, Duncan & Mirzoev, Tolib, 2007. "Primary Health Care and England: The coming of age of Alma Ata?," Health Policy, Elsevier, vol. 80(1), pages 11-31, January.
    4. Katarzyna Miszczyñska, 2013. "Healthcare Expenditures Vs. Health Of The Population," "e-Finanse", University of Information Technology and Management, Institute of Financial Research and Analysis, vol. 9(2), pages 47-56, October.
    5. repec:rze:efinan:v:9:y:2012:i:2:p:47-56 is not listed on IDEAS
    6. Anam Javaid & Atif Akbar & Shahbaz Nawaz, 2018. "A Review on Human Development Index," Pakistan Journal of Humanities and Social Sciences, International Research Alliance for Sustainable Development (iRASD), vol. 6(3), pages :357-369, September.
    7. Chukwuani, Chinyere Mercellina & Olugboji, Akindeji & Akuto, Edward Erdorga & Odebunmi, Akim & Ezeilo, Ezenta & Ugbene, Emmanuel, 2006. "A baseline survey of the Primary Healthcare System in South Eastern Nigeria," Health Policy, Elsevier, vol. 77(2), pages 182-201, July.
    8. Kendall, Kathleen & Wiles, Rose, 2010. "Resisting blame and managing emotion in general practice: The case of patient suicide," Social Science & Medicine, Elsevier, vol. 70(11), pages 1714-1720, June.
    9. Kruk, Margaret Elizabeth & Porignon, Denis & Rockers, Peter C. & Van Lerberghe, Wim, 2010. "The contribution of primary care to health and health systems in low- and middle-income countries: A critical review of major primary care initiatives," Social Science & Medicine, Elsevier, vol. 70(6), pages 904-911, March.
    10. Linnala, Aarno & Aromaa, Arpo & Mattila, Kari, 2006. "Specialist consultations in primary health care--A possible substitute for hospital care?," Health Policy, Elsevier, vol. 78(1), pages 93-100, August.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Lewis, Maureen & Eskeland, Gunnar S. & Traa-Valerezo, Ximena, 1999. "Challenging El Salvador's rural health care strategy," Policy Research Working Paper Series 2164, The World Bank.
    2. Hammer, Jeffrey S, 1997. "Economic Analysis for Health Projects," The World Bank Research Observer, World Bank, vol. 12(1), pages 47-71, February.
    3. Ather H. Akbari & Wimal Rankaduwa & Adiqa K. Kiani, 2009. "Demand for Public Health Care in Pakistan," The Pakistan Development Review, Pakistan Institute of Development Economics, vol. 48(2), pages 141-153.
    4. Lindelow, Magnus, 2002. "Health care demand in rural Mozambique," FCND discussion papers 126, International Food Policy Research Institute (IFPRI).
    5. Magnus Lindelow, 2003. "Understanding spatial variation in the utilization of health services: does quality matter?," Economics Series Working Papers WPS/2004-12, University of Oxford, Department of Economics.
    6. Kasirye, Ibrahim & Ssewanyana, Sarah & Nabyonga, Juliet & Lawson, David, 2004. "Demand for health care services in Uganda: Implications for poverty reduction," MPRA Paper 8558, University Library of Munich, Germany.
    7. Trani, Jean-Francois & Bakhshi, Parul & Noor, Ayan A. & Lopez, Dominique & Mashkoor, Ashraf, 2010. "Poverty, vulnerability, and provision of healthcare in Afghanistan," Social Science & Medicine, Elsevier, vol. 70(11), pages 1745-1755, June.
    8. Appleton, S., 2000. "Education and Health at the Household Level in Sub-Saharan Africa," Papers 33, Chicago - Graduate School of Business.
    9. Laura Anselmi & Mylène Lagarde & Kara Hanson, 2015. "Health service availability and health seeking behaviour in resource poor settings: evidence from Mozambique," Health Economics Review, Springer, vol. 5(1), pages 1-13, December.
    10. Christelle Grobler & Ian C. Stuart, 2007. "Health Care Provider Choice," South African Journal of Economics, Economic Society of South Africa, vol. 75(2), pages 327-350, June.
    11. Anta TA DIAL & Moussa DIENG & Martine AUDIBERT & Jean-Yves LE HESRAN, 2014. "Déterminants de la demande de soins en milieu péri-urbain dans un contexte de subvention à Pikine, Sénégal," Working Papers 201415, CERDI.
    12. Erlyana, Erlyana & Damrongplasit, Kannika Kampanya & Melnick, Glenn, 2011. "Expanding health insurance to increase health care utilization: Will it have different effects in rural vs. urban areas?," Health Policy, Elsevier, vol. 100(2), pages 273-281.
    13. Magnus Lindelow, 2004. "The Utilization of Curative Health Care in Mozambique: Does Income Matter?," Development and Comp Systems 0409057, University Library of Munich, Germany.
    14. Christopher J. Cronin & David K. Guilkey & Ilene S. Speizer, 2019. "Measurement error in discrete health facility choice models: An example from urban Senegal," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 34(7), pages 1102-1120, November.
    15. Soumitra Ghosh, 2015. "Socio-economic Patterns in Inpatient Care Utilisation in India: Is the Income Effect Withering?," Margin: The Journal of Applied Economic Research, National Council of Applied Economic Research, vol. 9(1), pages 39-60, February.
    16. Magnus Lindelow, 2004. "Understanding spatial variation in the utilization of health," Development and Comp Systems 0409058, University Library of Munich, Germany.
    17. NDA, Koffi C. & AKA, BEDIA F., 2018. "Households’ Therapeutic Behavior: An Empirical Study For Cote D´Ivoire," Applied Econometrics and International Development, Euro-American Association of Economic Development, vol. 18(1), pages 105-120.
    18. Moussa Dieng & Martine Audibert & Jean-Yves Le Hesran & Anta Ta Dial, 2015. "Déterminants de la demande de soins en milieu péri-urbain dans un contexte de subvention à Pikine, Sénégal," CERDI Working papers halshs-01027504, HAL.
    19. Stekelenburg, Jelle & Kyanamina, Sindele Simasiku & Wolffers, Ivan, 2003. "Poor performance of community health workers in Kalabo District, Zambia," Health Policy, Elsevier, vol. 65(2), pages 109-118, August.
    20. Lawson, David, 2004. "Determinants of Health Seeking Behaviour in Uganda - Is It Just Income and User Fees That Are Important?," Development Economics and Public Policy Working Papers 30553, University of Manchester, Institute for Development Policy and Management (IDPM).

    More about this item

    JEL classification:

    • H4 - Public Economics - - Publicly Provided Goods
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • D1 - Microeconomics - - Household Behavior

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:hepoli:v:70:y:2004:i:3:p:303-325. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu or the person in charge (email available below). General contact details of provider: http://www.elsevier.com/locate/healthpol .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.