Identification of Priority Health Topics at the Primary Care Level in the Dominican Republic

Abstract

Introduction: The Sustainable Development Goals (SDGs), especially SDG 3, aim to ensure healthy lives and promote well-being through universal health coverage, which includes equitable access to essential health services and medicines. The Primary Health Care (PHC) strategy, endorsed since 1978 and reaffirmed in the Astana Declaration, is pivotal for achieving these goals by strengthening the first level of care. However, in the Dominican Republic, the first level of care remains inadequate due to constraints in human resources, supplies, and technology, impacting the health system’s effectiveness and leading to higher costs and poorer health outcomes. Coordinated efforts and evidence-based policies are crucial for improving primary care and addressing the country's epidemiological needs to progress towards universal health coverage. Objective: To identify priority themes for evidence-based decision-making for primary health care professionals in the Dominican Republic. Methods: An electronic survey was conducted with a stratified sampling and comparison with epidemiological data. A total of 475 individuals providing services at the first level of care within the National Health Service (SNS) of the Dominican Republic participated during the period from October 2022 to July 2023. Results: High-demand services included pharmaceutical care (52.2%), general medicine consultations (56.0%), and vaccination (37.3%). The most challenging conditions to diagnose were seizures and loss of consciousness in children (38.1%), seizures and loss of consciousness in adults (32.2%), ear problems (29.9%), vision changes (25.7%), and chest pain (22.4%). The diagnoses with the greatest difficulty in formulating a treatment plan and/or intervention were airway obstruction due to a foreign body (27.4%), threatened abortion/abortion (19.8%), organophosphate poisoning (19.4%), acute myocardial infarction (18.8%), and bacterial meningitis (16.7%). Conclusions: To enhance the primary health care system in the Dominican Republic and address priority needs, it is essential to expand the service portfolio, strengthen the competencies of health professionals, and provide technological tools and support for evidence-based decision-making.