National keynote lecture: Establishing primary care, Turkey and Azerbaijan primary care organization

ABSTRACT

Health systems built based on primary health care are fundamental to succeeding universal health coverage. Well-organised primary healthcare services can play a basic role in improving population health as well as the well-being of the population. Although significant improvements in the health outcomes of the global population during the era of the Millennium Development Goals, nearly half of the population cannot access the health services, they need. Health is central to the 2030 Agenda for Sustainable Development as it relates to many of the Sustainable Development Goals and is the specific focus of Goal 3. Outbreaks of global pandemics or emergencies like COVID-19 are the biggest challenges to the 'resilience' of primary care systems. Therefore, countries need to establish a regular system of facility assessments to provide objective measures for evaluating the health services' availability, readiness, quality, including measures to evaluate preparedness and response capacities. Barbara Starfield was the first author to explore the context of primary care organisation (PCO). She mentioned that organisation of primary care includes four main primary care domains first-contact care, comprehensiveness, continuity, and coordination. In 2008 Hogg et al., proposed that the conceptual framework for PCO consists of structural and performance domains and this domain classification influenced new authors on the subject until today. The structural domain includes three components;the health care system, the practice context and the organisation of the practice;and the performance domain includes two components;healthcare service delivery and technical quality of clinical care. According to Kringos et al., the structure of primary care consists of three dimensions primary care governance, financing of primary care and primary care workforce development. They determined the primary care process by four dimensions accessibility of primary care, comprehensiveness of primary care;continuity of primary care;and coordination of primary care. Senn et al., proposed a consolidated framework, which is particularly beneficial for primary care organisations designing and implementing well-defined monitoring activities. With the addition socio-cultural, economic and biological contexts, the framework became multidimensional and in-depth. Inclusion of needs and outcomes of patients and the population has the potential to cover the productivity of the given organisation. Strong primary care requires well-developed organisational planning between levels of care. Primary care-oriented health systems are required to effectively handle the unmet health needs of the population. An efficient primary care organisation is very important for achieving a primary care-oriented health system. In this keynote, PCO's key aspects and benchmarks will be explored based on previously mentioned frameworks and domains. As an example of health systems in transition, Turkey and Azerbaijan are reforming their health systems, including primary care services. Turkey has completed the implementation of several interventions in the structural component of primary care, however, there is still room for development in the process components. Azerbaijan has established a state health insurance scheme and set up family health centres as primary care facilities serving a defined population. However, serious structural reforms are still needed for a functional primary care service accessible to the whole nation. This keynote will also cover more information on recent primary care reforms in both countries. The frameworks provided above will serve as tools for analysing primary care in these countries.