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Challenges facing primary health care in federated government systems: Implementation of Primary Health Networks in Australian states and territories

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  • Freeman, Toby
  • Baum, Fran
  • Javanparast, Sara
  • Ziersch, Anna
  • Mackean, Tamara
  • Windle, Alice

Abstract

In many federated countries, there is divided health system responsibility that can affect primary health care (PHC) policy and implementation, and complicate collaboration between PHC actors. We examined an Australian policy initiative, Primary Health Networks (PHNs), which are regional PHC organisations, to examine how they collaborated with state and territory PHC actors, and what factors enhanced or constrained collaboration. For PHNs we surveyed 66 staff, interviewed 82 staff, examined board membership, and analysed documents from all 31 PHNs. We also interviewed 11 state and 5 federal health bureaucrats. We mapped the PHC system in each state, and conducted team thematic analysis of the qualitative data collected. We found variation in how well PHNs collaborated with state and territory actors, ranging from poor relationships through to strong cooperation and co-commissioning. This was affected by factors to do with the state health department, geography, PHN funding and regulations, ambiguities in the federal/state divided responsibilities for PHC, and the extent of use of collaboration mechanisms and strategies. Resourcing and supporting such collaboration mechanisms, and increasing regional funding flexibility of funding would increase the potential for regional organisations to successfully navigate ambiguities in responsibility and foster a more integrated, cohesive PHC system.

Suggested Citation

  • Freeman, Toby & Baum, Fran & Javanparast, Sara & Ziersch, Anna & Mackean, Tamara & Windle, Alice, 2021. "Challenges facing primary health care in federated government systems: Implementation of Primary Health Networks in Australian states and territories," Health Policy, Elsevier, vol. 125(4), pages 495-503.
  • Handle: RePEc:eee:hepoli:v:125:y:2021:i:4:p:495-503
    DOI: 10.1016/j.healthpol.2021.02.002
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    References listed on IDEAS

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    1. Mur-Veeman, Ingrid & van Raak, Arno & Paulus, Aggie, 2008. "Comparing integrated care policy in Europe: Does policy matter," Health Policy, Elsevier, vol. 85(2), pages 172-183, February.
    2. Toby Freeman & Sara Javanparast & Fran Baum & Anna Ziersch & Tamara Mackean, 2018. "A framework for regional primary health care to organise actions to address health inequities," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 63(5), pages 567-575, June.
    3. Sabatier, Paul A., 1986. "Top-Down and Bottom-Up Approaches to Implementation Research: a Critical Analysis and Suggested Synthesis," Journal of Public Policy, Cambridge University Press, vol. 6(1), pages 21-48, January.
    4. Baum, Fran & Ziersch, Anna & Freeman, Toby & Javanparast, Sara & Henderson, Julie & Mackean, Tamara, 2020. "Strife of Interests: Constraints on integrated and co-ordinated comprehensive PHC in Australia," Social Science & Medicine, Elsevier, vol. 248(C).
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    Cited by:

    1. Edelman, Alexandra & Taylor, Judy & Ovseiko, Pavel V & Larkins, Sarah & Topp, Stephanie M, 2022. "The population health role of academic health centres: a multiple-case exploratory study in Australia and England," Health Policy, Elsevier, vol. 126(10), pages 1051-1061.
    2. Petro G. Nzowa & Felix A. Nandonde & Somo M. L. Seimu, 2022. "Moderation effects of co-operative institutions’ capabilities on the relationship between health insurance literacy and participation in health insurance among co-operative members in Tanzania," DECISION: Official Journal of the Indian Institute of Management Calcutta, Springer;Indian Institute of Management Calcutta, vol. 49(4), pages 381-394, December.

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