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  • 4 - Health Service Delivery

  • from Section II
  • Edited by Jo. M. Martins, Indra Pathmanathan, David T. Tan, Shiang Cheng Lim, Pascale Allotey
  • Book:
    Systems Thinking Analyses for Health Policy and Systems Development
    Published online:
    04 September 2021
    Print publication:
    26 August 2021, pp 65-115
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  • Summary

    Primary health care (PHC) evolved during the 60-year period, driven by political priorities, shaped by the health needs and demands of a population that experienced social and economic development and moved from largely rural to 70% urban. This chapter analyses the key characteristics of the strong publically funded Rural Health Service (RHS), which was established relatively early in the development process and which improved access to care and reduced inequities in health outcomes. Ambulatory care services provided in urban and rural hospitals complemented the RHS. The analysis covers the factors that contributed to the growth of primary care provided by private sector medical doctors that patients paid for out of pocket. Subsequently, the chapter analyses how the system responded to the challenges of remodelling PHC to meet new needs created by epidemiological and demographic evolution, changes in the population’s socio-economic profile, evolving medical and information technology, and growing concerns for quality of care.