Challenges in the implementation of primary health care reforms: a qualitative analysis of stakeholders’ views in Turkey
File(s)
Published version
Author(s)
Espinosa Gonzalez, Ana
Normand, Charles
Type
Journal Article
Abstract
Objectives: This study aims to assess the implementation of the Family Medicine Programme (FMP), which took place in Turkey from 2005 to 2010 as a set of comprehensive primary health care (PHC) reforms and involved changes in professional organisation (e.g., family medicine specialisation) and service provision (e.g., patients’ registration list). Our particular interest is to identify the challenges and limitations that PHC physicians and academicians encountered in the implementation of the FMP, which could have influenced the delivery of care and utilisation of services.
Design: We applied the framework method to analyse data obtained through semi-structured interviews conducted in the field. This qualitative approach involved the categorisation of raw data into a predefined framework, which comprised challenges and limitations identified in the literature, and the emergence of a new framework, whose categories corresponded to challenges and limitations identified through thematic analysis of our data.
Setting: PHC centres and academic departments from five Turkish provinces.
Participants: PHC physicians and academicians involved in training and/or research were invited to participate. 20 participants agreed to take part and, due to schedule limitations, 15 participants (seven PHC physicians and eight academicians) completed the interviews.
Results: Shortcomings in the planning of the reforms, inadequate commitment to integration of PHC in the system and collateral effects of a market model in health care emerged as limitations to successful FMP implementation. Uncertainty about care quality and physicians’ ethical values as well as perceptions of organisational injustice among health care workers were contributing challenges.
Conclusions: A systems thinking approach in the FMP design and implementation could help foresee and address these limitations. In decentralisation processes, such as FMP, shared governance by including PHC stakeholders in policy making and planning could alleviate misalignment of interests and positively affect PHC performance, for example, by removing barriers to gatekeeping implementation.
Design: We applied the framework method to analyse data obtained through semi-structured interviews conducted in the field. This qualitative approach involved the categorisation of raw data into a predefined framework, which comprised challenges and limitations identified in the literature, and the emergence of a new framework, whose categories corresponded to challenges and limitations identified through thematic analysis of our data.
Setting: PHC centres and academic departments from five Turkish provinces.
Participants: PHC physicians and academicians involved in training and/or research were invited to participate. 20 participants agreed to take part and, due to schedule limitations, 15 participants (seven PHC physicians and eight academicians) completed the interviews.
Results: Shortcomings in the planning of the reforms, inadequate commitment to integration of PHC in the system and collateral effects of a market model in health care emerged as limitations to successful FMP implementation. Uncertainty about care quality and physicians’ ethical values as well as perceptions of organisational injustice among health care workers were contributing challenges.
Conclusions: A systems thinking approach in the FMP design and implementation could help foresee and address these limitations. In decentralisation processes, such as FMP, shared governance by including PHC stakeholders in policy making and planning could alleviate misalignment of interests and positively affect PHC performance, for example, by removing barriers to gatekeeping implementation.
Date Issued
2019-07-19
Date Acceptance
2019-07-01
Citation
BMJ Open, 2019, 9, pp.1-11
ISSN
2044-6055
Publisher
BMJ Journals
Start Page
1
End Page
11
Journal / Book Title
BMJ Open
Volume
9
Copyright Statement
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
Identifier
https://bmjopen.bmj.com/content/9/7/e027492
Publication Status
Published
Date Publish Online
2019-07-19