Over 40 years ago, primary health care (PHC) was defined in the Alma-Ata Declaration as a critical component of the health care system to address the basic health demand of the people. In China, the Government attaches great importance to health care at the primary level. After the launch of the historical Reform of the Medical and Health Care System in 2009, the PHC system in China has witnessed major progress and breakthroughs, especially in its steadily increased capacity, continuously improved accessibility, and betterment in equality. In this review, we summarized published literatures and official policies, synthesized data from the electronic registration information system of the National Health Commission, national statistical reports, and yearbooks in health care. The review is intended to describe the systematic development of PHC in China in the last decade. The main results include: the solid national policy foundation, increasing number of PHC institutions and workforce, better training of PHC professionals, major achievements in primary health indicators, government financial support to PHC institutions, improved PHC budgeting and insurance coverage, and the advancement of supporting technologies. Challenges and prospects are also discussed.

BACKGROUND: Given the rapid population aging in China, achieving universal health coverage (UHC) presents a primary challenge in addressing unmet healthcare needs and associated inequalities among middle-aged and older adults. Several studies have focused on healthcare utilization and its inequalities, but little attention has been paid to the inequality in unmet healthcare needs. This study aimed to analyze the inequalities in unmet the healthcare needs of middle-aged and older adults in eastern China during the progression toward UHC.
METHODS: Data were obtained from the fourth, fifth, and sixth National Health Service Survey (NHSS) of Jiangsu Province, located in eastern China, during the years 2008, 2013, and 2018, respectively. Logistic regression models were used to assess the associated factors of unmet healthcare needs. The inequality was measured according to the concentration index (CI) and its decomposition.
RESULTS: In this study, we found that 12.86%, 2.22%, and 48.89% of middle-aged and older adults reported unmet needs for outpatient and inpatient services and physical examinations, respectively. The prevalence of unmet outpatient needs increased from 2008 to 2018, while the prevalence of unmet inpatient services was lower but maintained. The prevalence of unmet needs for physical examinations among middle-aged and older adults markedly decreased since 2008. Rural areas had a higher prevalence of unmet needs for inpatient services and physical examinations than urban areas. Unmet healthcare needs were more prevalent among the poor. The pro-poor inequalities of unmet healthcare needs have been mitigated during the progression toward UHC; however, they remain predominant among rural middle-aged and older adults for outpatient and inpatient services. Socioeconomic factors significantly influenced unmet healthcare needs and contributed to their inequalities.
CONCLUSIONS: The findings characterize the prevalence and inequality of unmet healthcare need among middle-aged and older adults in eastern China during the progression toward UHC. Policy interventions should be actively advocated to effectively mitigate the unmet healthcare needs and address the associated inequalities.

BACKGROUND: Previous Ethiopian literature on surgical capacity and challenges has focused on quantitative investigations, lacking contextual understanding. This explanatory sequential mixed-methods research (MMR) aimed to assess perioperative capacity and contextual challenges at three teaching hospitals in southern Ethiopia.
METHODS: A quantitative survey assessed workforce, infrastructure, service delivery, financing, and information systems. The survey findings were explained by qualitative semi-structured interviews of twenty perioperative providers. Descriptive statistics were integrated with qualitative thematic analysis findings using the narrative waving approach. Key findings from both datasets were linked using a joint display table.
RESULTS: The survey revealed shortages in the specialist workforce (with a ratio of 0.58 per 100,000 population), surgical volume (at 115 surgeries per 100,000 population), equipment, supplies, financing, and perioperative data tracking. Hospitals\' radiology services and blood products were only available 25-50% of the time, while anesthetic agents and essential laboratory services were often available 51-75% of the time. Perioperative management protocols were used rarely (1-25% of the time). Over 90% of patients lack health insurance coverage. Qualitative data also revealed scarcity of perioperative resources and equipment; unaffordable perioperative costs, lack of health insurance coverage, and unforeseen expenses; poor patient safety culture and communication barriers across the perioperative continuum of care; workforce shortages, job dissatisfaction, and concerns of competence; and weak national governance, and sociopolitical turmoil, and global market volatility exacerbating local challenges. These challenges are linked to risks in quality of care and patient safety, according to clinicians.
CONCLUSIONS: The study identifies deficiencies in the health system and sociopolitical landscape affecting safe surgery conduct. It highlights the need for comprehensive health system strengthening to expand workforce, upgrade facilities, improve safety culture, resilience, and leadership to ensure timely access to essential surgery. Exploring external factors, such as the impact of national governance and sociopolitical stability on reform efforts is also essential.

UNASSIGNED: Community involvement depends on the level of linked and targeted activities for health by community members. This study examines the collaborations employed within communities to ensure sustainable access and improved use of healthcare in the community.
UNASSIGNED: This study was conducted in rural and urban local government areas in Anambra, Kano, and Akwa-Ibom, Nigeria. About 90 in-depth interviews and 12 focus group discussions were conducted with community stakeholders and service users. The findings were transcribed and coded via thematic analysis, guided by the Expanded Health Systems framework.
UNASSIGNED: Various horizontal collaborations in communities foster increased use of PHC services; promoting community health. Major horizontal collaborations in these communities were community-led, primary health facility-led, and Individual-led collaborations. Their actions revolved around advocacy, building and renovating PHC centers, equipping facilities, and sensitization to educate community members on the need to utilize services at PHC centers.
UNASSIGNED: Strategic involvements and collaborations of local actors within communities give rise to improvements in the utilization of primary healthcare centres, reportedly resulting in improved access to PHC healthcare services for community members.

UNASSIGNED: To reduce maternal mortality by 2030, Benin needs to implement strategies for improving access to high quality emergency obstetric and neonatal care (EmONC). This study applies an expert-based approach using sub-national travel specificities to identify and prioritize a network of EmONC maternities that maximizes both population coverage and functionality.
UNASSIGNED: We conducted a series of workshops involving international, national, and department experts in maternal health to prioritize a set of EmONC facilities that meet international standards. Geographical accessibility modeling was used together with EmONC availability to inform the process. For women in need of EmONC, experts provided insights into travel characteristics (i.e., modes and speeds of travel) specific to each department, enabling more realistic travel times estimates modelled with the AccessMod software.
UNASSIGNED: The prioritization approach resulted in the selection of 109 EmONC maternities from an initial group of 125 designated maternities. The national coverage of the population living within an hour\'s drive of the nearest EmONC maternity increased slightly from 92.6% to 94.1% after prioritization. This increase in coverage was achieved by selecting maternities with sufficient obstetrical activities to be upgraded to EmONC maternities in the Plateau and Atlantique departments.
UNASSIGNED: The prioritization approach enabled Benin to achieve the minimum EmONC availability, while ensuring very good geographical accessibility to the prioritized network. Limited human and financial resources can now be targetted towards a smaller number of EmONC facilities to make them fully functioning in the medium-term. By implementing this strategy, Benin aims to reduce maternal mortality rates and deliver effective, high-quality obstetric and neonatal care, especially during emergencies.

UNASSIGNED: The private healthcare sector is a critical stakeholder in the provision of health care services, including noncommunicable diseases (NCDs), and engagement with the sector is increasingly being advocated in efforts to achieve Universal Health Coverage.
UNASSIGNED: This study was conducted to explore the role of the private health sector in delivering NCD-related primary care services in selected countries of the WHO Eastern Mediterranean Region (EMR): Jordan, Oman, Pakistan, Sudan, and the Syrian Arab Republic.
UNASSIGNED: We adapted the analytical framework for this study from the \"Framework for action to implement the United Nations political declaration on noncommunicable diseases\". We conducted a desk review to gather evidence, identify gaps and provide direction for the subsequent stakeholder interviews. Key informant interview respondents were selected using the snowball sampling method. Data from the interviews were analysed using MAXQDA, version 2020.
UNASSIGNED: We reviewed 26 documents and interviewed 19 stakeholders in Jordan, Oman, Pakistan, Sudan and the Syrian Arab Republic. Our results indicated increasing advocacy at the regional and national levels to align the private and public health sectors, just as there were efforts to reduce the risk factors for NCDs by implementing tobacco laws, introducing food labelling guidelines, increasing taxes on soft drinks, and promoting the healthy cities approach. NCDs health information systems varied widely among the countries, from being organized and developed to having poor recordkeeping. The private health sector is the predominant provider of care at primary level in most of the EMR countries.
UNASSIGNED: Increased collaboration between the public and private sectors is essential for better management of NCDs in the EMR. Governments need to strengthen regulation and defragment the private health sector and harness the sector\'s strengths as part of efforts to achieve national health targets, NCD goals and Universal Health Coverage.
مشاركة قطاع الرعاية الصحية الخاص في التصدي للأمراض غير السارية على المستوى الأوّلي في إقليم شرق المتوسط.
ميشا إقبال، رومينا إقبال، ثمين صديقي، سليم سلامة، بي بي فيو، آية ثابت، أزموس همريتش، هشام البري.
UNASSIGNED: يعد قطاع الرعاية الصحية الخاص أحد الأطراف المعنية البالغة الأهمية في تقديم خدمات الرعاية الصحية، ومنها خدمات الأمراض غير السارية، وتتردد دعوات متزايدة إلى المشاركة مع القطاع في الجهود الرامية إلى تحقيق التغطية الصحية الشاملة.
UNASSIGNED: هدفت هذه الدراسة الى استكشاف دور القطاع الصحي الخاص في تقديم خدمات الرعاية الأولية المتعلقة بالأمراض غير السارية في بلدان مختارة من إقليم منظمة الصحة العالمية لشرق المتوسط: الأردن، وعُمان، وباكستان، والسودان، والجمهورية العربية السورية.
UNASSIGNED: اقتبسنا الإطار التحليلي لهذه الدراسة من \"إطار العمل لتنفيذ الإعلان السياسي للأمم المتحدة بشأن الأمراض غير السارية\". كما أجرينا استعراضًا مستنديًّا لجمع الأدلة والتعرف على الثغرات وتقديم التوجيه للمقابلات اللاحقة مع أصحاب المصلحة. وجرى اختيار المشاركين في مقابلات المصادر الرئيسية للمعلومات باستخدام طريقة الإحالة المتسلسلة (كرة الثلج) لأخذ العينات. وخضعت أيضًا البيانات المستمدة من المقابلات للتحليل ببرنامج MAXQDA، إصدار 2020.
UNASSIGNED: استعرضنا 26 وثيقة، وأجرينا مقابلات مع 19 من أصحاب المصلحة المعنيين في الأردن وعُمان وباكستان والسودان والجمهورية العربية السورية. وتشير نتائجنا إلى تزايد الدعوات على الصعيدين الإقليمي والوطني للمواءمة بين القطاعين الصحيين الخاص والعام، وبُذلت في الوقت نفسه جهود للحد من عوامل الخطر الخاصة بالأمراض غير السارية من خلال تطبيق قوانين مكافحة التبغ، وإدخال مبادئ توجيهية لتوسيم الأغذية، وزيادة الضرائب على المشروبات الغازية، وتعزيز نهج المدن الصحية. وتباينت نُظم المعلومات الصحية المتعلقة بالأمراض غير السارية تباينًا كبيرًا بين البلدان، فتراوحت من نظم منظمة ومتطورة إلى نظم يشوبها سوء حفظ السجلات. والقطاع الصحي الخاص هو المقدم الأوسع انتشارًا للرعاية على المستوى الأوَّلي في معظم بلدان إقليم شرق المتوسط.
UNASSIGNED: إن زيادة التعاون بين القطاعين العام والخاص أمر ضروري لتحسين علاج الأمراض غير السارية في إقليم شرق المتوسط. ويتعيََّّن على الحكومات تعزيز تنظيم القطاع الصحي الخاص ومكافحة تشرذمه، وتسخير مَواطن قوة هذا القطاع في إطار الجهود الرامية إلى تحقيق الغايات الصحية الوطنية، وأهداف التصدي للأمراض غير السارية، والتغطية الصحية الشاملة.
Participation du secteur privé des soins de santé à la lutte contre les maladies non transmissibles au niveau primaire dans la Région de la Méditerranée orientale.
UNASSIGNED: Le secteur privé des soins de santé est une partie prenante essentielle dans la prestation de services de soins de santé, notamment pour les maladies non transmissibles (MNT), et la collaboration avec ce secteur est de plus en plus souvent préconisée dans le cadre des efforts déployés pour instaurer la couverture sanitaire universelle.
UNASSIGNED: La présente étude a été menée pour étudier le rôle du secteur privé des soins de santé dans la prestation de services de soins primaires liés aux MNT dans certains pays de la Région OMS de la Méditerranée orientale : Jordanie, Oman, Pakistan, République arabe syrienne et Soudan.
UNASSIGNED: Nous avons adapté le cadre analytique de la présente étude à partir du « Cadre d\'action pour la mise en œuvre de la déclaration politique des Nations Unies sur les maladies non transmissibles ». Nous avons effectué un examen documentaire afin de recueillir des données probantes, de cerner les lacunes et de fournir une orientation pour les entrevues subséquentes avec les intervenants. Les répondants aux entrevues avec les informateurs clés ont été sélectionnés à l\'aide de la méthode d\'échantillonnage en boule de neige. Les données issues des entretiens ont été analysées en recourant au logiciel MAXQDA, version 2020.
UNASSIGNED: Nous avons examiné 26 documents et interrogé 19 parties prenantes en Jordanie, à Oman, au Pakistan, en République arabe syrienne et au Soudan. Nos résultats indiquent une sensibilisation accrue aux niveaux régional et national afin d\'aligner les secteurs privé et public de la santé ; de même, des efforts ont été déployés pour réduire les facteurs de risque des MNT en mettant en œuvre des lois sur le tabac, en introduisant des directives sur l\'étiquetage des denrées alimentaires, en augmentant les taxes sur les boissons gazeuses et en promouvant l\'approche des Villes-santé. Les systèmes d\'information sanitaire sur les MNT variaient considérablement entre les pays : certains étaient organisés et développés tandis que d\'autres étaient caractérisés par une mauvaise tenue des dossiers. Le secteur privé de la santé était le principal prestataire de soins au niveau primaire dans la plupart des pays de la Région de la Méditerranée orientale.
UNASSIGNED: Une collaboration accrue entre les secteurs public et privé est essentielle pour une meilleure gestion des MNT dans la Région de la Méditerranée orientale. Les gouvernements doivent renforcer la réglementation, défragmenter le secteur privé de la santé et exploiter les atouts de ce secteur dans le cadre des efforts visant à atteindre les cibles nationales en matière de santé, à réaliser les objectifs de lutte contre les maladies non transmissibles et instaurer la couverture sanitaire universelle.

In Ethiopia, even though there is an effort to increase ART services, different challenges remain in the provision of HIV/AIDS treatment and care services, and little has been done to evaluate patient satisfaction levels. The purpose of this study is to assess the determinants of HIV/AIDS treatment and care service quality. A facility-based cross-sectional study was conducted during from October 2023 to November 2023 in Woliso Town. The total sample size was generated using a systematic random sampling method from the source population. The results of the study showed that client satisfaction with HIV/AIDS treatment and care service quality was 272 (81.4%) with 95% CI: 76.9-85.3%. Government employees were 67% less likely to be satisfied with HIV/AIDS treatment and care service quality (AOR = 0.33 95% CI: 0.11, 0.99) when compared to unemployed clients. The odds of client satisfaction were 6.72 times higher among study participants who do not have health insurance membership cards (AOR = 6.72 95% CI: 3.42, 13.91) compared to those who have health insurance membership cards. The odds of client satisfaction were 2.77 times higher among study participants who reported the availability of community referral for any social support (AOR = 2.77 95% CI: 1.12, 6.84) when compared to those who did not report. Those study participants for whom privacy was kept during the examination were 8.67 times higher to be satisfied (AOR = 8.67 95% CI: 2.53, 29.68) compared to those for whom privacy was not kept during the examination. In conclusion, the client satisfaction on HIV/AIDS treatment and care service quality was relatively high in the study area. Occupational status, health insurance membership cards, availability of community referral for any social support and keeping privacy during examination have significant associations with HIV/AIDS treatment and care service quality in terms of client satisfaction.

UNASSIGNED: The concerns of inaccessibility to essential medicines in India are well-studied and documented. Pradhan Mantri Bhartiya Janaushadhi Priyojana (PMBJP) is one of the policy initiatives to address the inaccessibility of essential medicine. Janaushadhi Kendra (People\'s Medicine Centre), which is part of PMBJP is being enquired in a limited way to understand its effectiveness. The province of Odisha has been chosen as the study area for the evaluation of People\'s Medicine Centres.
UNASSIGNED: The present study intends to inquire into the nature of People\'s Medicine Centre ownership, pharmacists\' motivations and incentives to engage in business, perceived customers\' trust and satisfaction, scheme beneficiaries, and challenges.
UNASSIGNED: A qualitative research approach has been adopted to evaluate the broader subjective accounts of the pharmacists and People\'s Medicine Centre. An open-ended interview guide was used. The topics of ownership, motivation, incentives, trust, satisfaction, perceived benefits, and challenges has been recorded from the participants. A total of seventeen in-depth interviews were conducted in the province of Odisha, India.
UNASSIGNED: The study found that the ownership of People\'s Medicine Centre was of two types in the province of Odisha: public-NGO-owned People\'s Medicine Centres and public-private-owned People\'s Medicine Centres. The financial incentive provisions in the scheme attracted the private pharmacists. Pharmacists highlighted about the lower price of generic medicines compared to branded medicines, which is very popular among patients. They also pointed out that there is no difference in the efficacy of both medicines. The attitude of physicians, especially private physicians, were considered problematic for popularity and acceptance.
UNASSIGNED: The People\'s Medicine Centres in Odisha established themselves as trusted outlets despite physicians\' unfavourable attitudes. Although the centres have not reached the required geographical coverage, economically developed regions have large number of centres, while backward regions have minimal presence. The scheme needs to be more conducive to the welfare of the masses living in remote and rural areas.

UNASSIGNED: Universal health coverage and social protection are major global goals for tuberculosis. This study aimed to investigate the effects of an expanded policy to guarantee out-of-pocket costs on the treatment outcomes of patients with tuberculosis.
UNASSIGNED: By linking the national tuberculosis report and health insurance data and performing covariate-adjusted propensity-score matching, we constructed data on health insurance beneficiaries (treatment group) who benefited from the out-of-pocket payment exemption policy and medical aid beneficiaries as the control group. Using difference-in-differences analysis, we analyzed tuberculosis treatment completion rates and mortality in the treatment and control groups.
UNASSIGNED: A total of 41,219 persons (10,305 and 30,914 medical aid and health insurance beneficiaries, respectively) were included in the final analysis (men 59.6%, women 40.4%). Following the implementation of out-of-pocket payment exemption policy, treatment completion rates increased in both the treatment and control groups; however, there was no significant difference between the groups (coefficient, -0.01; standard error, 0.01). After the policy change, the difference in mortality between the groups increased, with mortality decreasing by approximately 3% more in the treatment group compared with in the control group (coefficient: -0.03, standard error, 0.01).
UNASSIGNED: There are limitations to improving treatment outcomes for tuberculosis with an out-of-pocket payment exemption policy alone. To improve treatment outcomes for tuberculosis and protect patients from financial distress due to the loss of income during treatment, it is essential to proactively implement complementary social protection policies.

In India, rural-urban health disparities have been persisting over a period. Migration of patients from rural to urban is an integral part of population dynamics thereby creating an additional burden on urban hospitals. Over the decade, India has made significant advances in health in reducing the rural-urban gap. The article highlights how the strengthening of rural healthcare facilities has reduced the burden of urban hospitals. Secondary data on the usage of public and private healthcare facilities from two rounds of the National Family Health Survey (NFHS) conducted in 2016 and 2021 and the Rural Health Statistics 2021-2022 were analyzed. The proportion of beneficiaries seeking care from public health facilities has increased from 41.9% to 45.7% in rural areas and 31% to 35.3% in urban areas between 2014 to 2017. The institutional deliveries have increased from 56% to 69.2% in rural areas and from 42% to 48.3% in urban areas. The State and local level interventions such as the upgradation of existing physical infrastructure, human resources, regular supply of medicines and consumables, development of referral linkages, patient transportation, and enhancing community participation have strengthened the rural healthcare system. Adequate utilization of the resources is crucial to addressing the lag and alleviating the rural-urban divide.