Integration of public health policies as a means of strengthening primary healthcare: A case study of five countries and their healthcare integration strategies

Abstract

Background: Primary healthcare (PHC) is a crucial entry point for health prevention and continuity of care. The public health sector faces challenges in providing equitable, accessible and comprehensive care, particularly those affected by non-communicable diseases. The current rise in the burden of disease is a present-day reality, threatening population health outcomes and placing strain on the health system. Aim: This review assessed how integrating healthcare strategies into public health policies contributes to improving the PHC model in South Africa. Setting: This review assessed the implementation of healthcare integration strategies in low- and middle-income countries (LMICs). Method: This review mapped World Health Organization (WHO) policy documents, South African NCD health policies, and peer-reviewed literature retrieved from electronic databases PubMed and Google Scholar, covering the period from 2000 to 2024. The search focused on evidence from LMICs on how health interventions, through innovative and integrated care models, can strengthen primary care systems to address existing challenges. Results: The findings from the country case studies suggested that implementing integrated public health policies to strengthen primary care could reduce health inequalities among the identified disadvantaged communities and improve health outcomes. Integrated models of care strengthened service coordination, improved continuity of care and enhanced accessibility of health services at the community level. Reducing health inequalities is not achieved by policy design alone, but by the extent to which integration is supported through governance, financing, workforce and system-wide coordination. Conclusion: An integrated approach may help to bridge the gap between public health policies and primary care. Contribution: Insights from this review will inform evidence-based recommendations for policymakers to reorient and redesign PHC to promote integrated and continuous care.