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IntroductionThe global commitment to reform primary care systems was reaffirmed in the 2018 Astana Declaration on Primary Health Care. The World Health Organization framework on the Integrated People-Centered Health Services (IPCHS) was designed to implement this agenda, while accelerating progress towards health-focused Sustainable Development Goal (SDG) 3, drive economic growth (SDG 8), and achieve SDGs 1, 2, 4, 5, and 16.However, with the advent of the 'digital revolution', emerging socio-technical systems are disrupting existing economic and political systems, producing the 'Fourth Industrial Revolution', and potential legitimation crises. Being structurally coupled to major social systems, resilient primary health systems need to incorporate sustainable economic, political and technical solutions: these are social enterprise, citizen engagement and digital health, respectively. This review aimed to develop a preliminary conceptual framework for using Digital Health, Social Enterprise and Citizen Engagement for Integrated People-Centred Health Services.Theory/MethodsWe conducted a hermeneutic systematic review of theoretical (published & grey) literature to build a comprehensive understanding of digital health, social enterprise and citizen engagement, and their application in health service delivery. Initial searches were used to identify key terms to inform iterative literature searches. Search results were screened and only studies making original theoretical contributions were selected. Coding followed principles of qualitative data analysis, followed by critical interpretive synthesis. The resulting framework was organised within a combination of Donabedian's 'structure-process-output', and Pawson & Tilley's 'context-mechanism-outcome' configurations.Results & Discussion21 full-text papers were included after screening. The framework that was developed outlined the organisational elements and components required to incorporate digital health, citizen engagement and social enterprise within integrated primary care systems. Existing frameworks contained several mutual elements and conceptual overlaps, such as organisational features (governance, leadership, ecosystem factors), the need for sustainable financing mechanisms, and the pervasive role of digital technology. Digital financial solutions in social enterprise can make health services more inclusive and accessible at the bottom of the economic pyramid; 'e-participation' can facilitate citizen engagement in health service design and delivery; and digital health systems are essential to coordinating integrated care services. Citizen engagement and social enterprise are also both crucial for ensuring 'person-centredness' of IPCHS.ConclusionsThere is considerable scope for the integration of Digital Health, Social Enterprise and Citizen Engagement to guide the development of Integrated People-Centred Health Services. While a variety of approaches are possible, the specific combination of interventions will depend on the context of their application.Limitations & Lessons learnedAs with any framework, this one does not seek to be comprehensive, but to provide an overarching view of how these concepts interact in an organisational context. As this framework is based on secondary data, it requires to be field-tested to ensure its validity. Future research: Next stepsThe framework that we have developed will be tested and refined by using a series of primary and secondary case studies; i.e. social enterprises that use digital health and citizen engagement interventions to deliver IPCHS. These findings will enable enhancement of the framework for future testing further afield.

Information and communication technologies (ICTs) have become an element of strategic importance to all countries. Researchers argue that ICTs may open up new avenues for economic growth, competitiveness and human development. It is widely recognised that ICTs have the potential of overcoming many of the barriers faced by people with visual impairment (VI). Based on an interpretive study using the narrative interview method, this article contributes to this literature by presenting perceptions and understandings of how the use of ICTs can be used to promote the 'development' of people with VI in Bangladesh. We approached this study through the economist and Nobel Laureate Amartya Sen's work on 'development as freedom' that focuses on, among other themes, five dimensions of freedom - social, economic, protective, political and transparency. We collected stories from 18 people with VI who had received ICTs training and support from resource centres, and from some disability rights activists and leaders who use ICTs. Our findings suggest that ICTs can be used as tools for improving the wellbeing of people with VI by enhancing different aspects of freedom suggested by Sen. ICTs tools assist people with VI by providing them with educational and work opportunities, and thus increase the potential for social inclusion and economic development. We conclude that governments, nongovernment organisations and development partners in countries such as Bangladesh may use ICTs to expand different types of 'freedom' for marginalised groups such as people with VI and persons with disabilities in general.

Objective In Africa, mortality due to non-communicable diseases (NCDs) is projected to overtake the combined mortality from communicable, maternal, neonatal, and nutritional diseases by 2030. To address this growing NCD burden, primary health care (PHC) systems will require substantial re-orientation. In this study, we reviewed the progress of African countries towards integrating essential NCD services into PHC. Methods A review of World Health Organization (WHO) reports was conducted for all 47 countries in the WHO African Region. To report each country's progress, we used an a priori framework developed by the WHO regional office for Africa (AFRO). Twelve indicators were used to measure countries' progress. The proportion of countries meeting each indicator was tabulated using a heat map. Correlation between country income status and attainment of each indicator was also assessed. Findings No country met all the recommended indicators to integrate NCD services into PHC and seven countries met none of the indicators. Few countries (30%) had nationally approved guidelines for NCD management and very few reported availabilities of all essential NCD medicines (13%) and technologies (11%) in PHC facilities. There was no overall correlation between a country's GDP per capita and the aggregate of targets being met (rho = 0.23; P = .12). There was, however, a modestly negative correlation between out-of-pocket expenditure and overall country progress (rho = -0.58; P < .001). Conclusion Progress by AFRO Member States in integrating NCD care into PHC is variable across the region. Enhanced government commitment and judicious resource allocation to prioritize NCDs are needed. Particular areas of focus include increasing the uptake of simplified guidelines for NCDs; increasing workforce capacity to manage NCDs; and removing access barriers to essential medicines and basic diagnostic technologies.

Objective In Africa, mortality due to non-communicable diseases (NCDs) is projected to overtake the combined mortality from communicable, maternal, neonatal, and nutritional diseases by 2030. To address this growing NCD burden, primary health care (PHC) systems will require substantial re-orientation. In this study, we reviewed the progress of African countries towards integrating essential NCD services into PHC. Methods A review of World Health Organization (WHO) reports was conducted for all 47 countries in the WHO African Region. To report each country's progress, we used an a priori framework developed by the WHO regional office for Africa (AFRO). Twelve indicators were used to measure countries' progress. The proportion of countries meeting each indicator was tabulated using a heat map. Correlation between country income status and attainment of each indicator was also assessed. Findings No country met all the recommended indicators to integrate NCD services into PHC and seven countries met none of the indicators. Few countries (30%) had nationally approved guidelines for NCD management and very few reported availabilities of all essential NCD medicines (13%) and technologies (11%) in PHC facilities. There was no overall correlation between a country's GDP per capita and the aggregate of targets being met (rho = 0.23; P = .12). There was, however, a modestly negative correlation between out-of-pocket expenditure and overall country progress (rho = -0.58; P < .001). Conclusion Progress by AFRO Member States in integrating NCD care into PHC is variable across the region. Enhanced government commitment and judicious resource allocation to prioritize NCDs are needed. Particular areas of focus include increasing the uptake of simplified guidelines for NCDs; increasing workforce capacity to manage NCDs; and removing access barriers to essential medicines and basic diagnostic technologies.