Equity in primary health care delivery: an examination of the cohesiveness of strategies relating to the primary healthcare system, the health workforce and hepatitis C
Authors: Scarborough Jane , Eliott Jaklin , Miller Emma , Aylward Paul 
Published: December 2014

Objective
To suggest ways of increasing the cohesiveness of national primary healthcare strategies and hepatitis C strategies, with the aim of ensuring that all these strategies include ways to address barriers and facilitators to access to primary healthcare and equity for people with hepatitis C.

Methods
A critical review was conducted of the first national Primary Healthcare System Strategy and Health Workforce Strategy with the concurrent Hepatitis C Strategy. Content relating to provision of healthcare in private general practice was examined, focussing on issues around access and equity.

Results
In all strategies, achieving access to care and equity was framed around providing sufficient medical practitioners for particular locations. Equity statements were present in all policies but only the Hepatitis C Strategy identified discrimination as a barrier to equity. Approaches detailed in the Primary Healthcare System Strategy and Health Workforce Strategy regarding current resource allocation, needs assessment and general practitioner incentives were limited to groups defined within these documents and may not identify or meet the needs of people with hepatitis C.

Conclusions
Actions in the primary healthcare system and health workforce strategies should be extended to additional groups beyond those listed as priority groups within the strategies. Future hepatitis C strategies should outline appropriate, detailed needs assessment methodologies and specify how actions in the broad strategies can be applied to benefit the primary healthcare needs of people with hepatitis C.

What is known about the topic?
Australian general practitioners in private practice are important providers of primary healthcare. The Australian federal government has policy and funding responsibility for primary healthcare. In 2010–11 the Australian Federal Labour Government launched three policy strategies in the areas of the primary healthcare system, health workforce and hepatitis C. Each included the aims of addressing equity and access issues. Hepatitis C is a significant health issue in Australia. GPs are well placed to play a part in diagnosing, managing and treating hepatitis C; however, there are barriers to the provision of appropriate care. There appears to be no recognition of the value of cohesion across the broad strategies and the Hepatitis C Strategy, and no framework for this to occur.

What does this paper add?
This paper provides an analysis of the cohesiveness of the concurrent Hepatitis C Strategy and national primary healthcare strategies by examining the content relating to the provision of healthcare in private general practice, with an emphasis on issues of access and equity. This analysis forms the basis for recommendations as to how to increase the cohesiveness among these strategies, and address barriers and facilitators to access to primary healthcare and equity for people with hepatitis C.

What are the implications for practitioners?
Cohesiveness between related strategies should be considered by policy makers when formulating strategies with related content. This analysis can be used as a basis to analyse and direct future primary healthcare strategies and disease-specific strategies.