Mehta, Akriti;
Kaur, Prabhjeet;
Schleiff, Meike J;
Patenaude, Bryan N;
Rao, Krishna D;
(2026)
Implementing large-scale primary health care workforce reforms: a narrative literature review of middle-income country experiences.
Social Science & Medicine
, 388
, Article 118717. 10.1016/j.socscimed.2025.118717.
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Abstract
A competent, adequate, motivated health workforce is key to strengthening primary health care (PHC). This study examined PHC workforce reform experiences of five middle income countries to deepen understanding and identify lessons for other countries as they strengthen PHC to meet emerging, diverse health needs. The study was limited to five countries that have undertaken PHC workforce reforms, selected for maximum geographic variability, availability of published evidence and service coverage. A narrative literature review was conducted; peer reviewed and grey literature were searched in 2022, screened and relevant data extracted in a template. The WHO's operational framework for PHC was used to organize and describe reforms pertaining to PHC workforce and provider payment systems. The study included 54 articles for Thailand, Brazil, Turkey, Iran and China. PHC reforms were introduced to address health inequities and workforce challenges. Reforming the PHC workforce was one component of broader reforms to achieve Universal Health Coverage. All countries introduced a set of mutually reinforcing reforms. To rapidly enhance supply of PHC workforce, countries employed short term strategies like task sharing and training of existing workforce alongside long term reforms to the education system. They used a mix of financial and non-financial incentives to motivate and redistribute their workforce. Countries leveraged a combination of provider payment systems to defined objectives. Key implementation considerations included sustained political will and public expenditure, adequate funding to implement reforms at scale and incentivize desired provider behavior, careful selection of indicators for performance based incentives and coordination across powerful stakeholders.
| Type: | Article |
|---|---|
| Title: | Implementing large-scale primary health care workforce reforms: a narrative literature review of middle-income country experiences |
| Location: | England |
| DOI: | 10.1016/j.socscimed.2025.118717 |
| Publisher version: | https://doi.org/10.1016/j.socscimed.2025.118717 |
| Language: | English |
| Additional information: | This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10217795 |
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