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Primary Health Care in Practice: Is It Effective?

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  • Maureen Lewis

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  • Gunnar Eskeland
  • Ximena Traa-Valerezo

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.

Suggested Citation

  • Maureen Lewis & Gunnar Eskeland & Ximena Traa-Valerezo, 2005. "Primary Health Care in Practice: Is It Effective?," Working Papers 55, Center for Global Development.
  • Handle: RePEc:cgd:wpaper:55
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    File URL: http://www.cgdev.org/content/publications/detail/2733
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    References listed on IDEAS

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    Cited by:

    1. Adam Wagstaff, 2010. "Social health insurance reexamined," Health Economics, John Wiley & Sons, Ltd., vol. 19(5), pages 503-517.
    2. 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.
    3. 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.
    4. 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.
    5. repec:rze:efinan:v:9:y:2012:i:2:p:47-56 is not listed on IDEAS
    6. 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.
    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. 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.

    More about this item

    Keywords

    health care; El Salvador; public health spending;

    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

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