Strengthening Primary Health Care through Primary Care and Public Health Collaboration

Full Report (PDF, 2 MB)

Overall Program Lead: Ruta Valaitis, McMaster University


  • Interest in collaboration between Primary care (PC) and Public Health (PH), and how it can improve the health of populations and quality and effectiveness of health care systems, has grown substantially over the past four years.
  • Evidence supports the benefits of collaboration between PC and PH in the following areas: maternal‐child programs; communicable disease prevention and control; health promotion and health protection; chronic disease prevention and management; youth health; women’s health; and working with vulnerable populations.
  • Collaboration between PC and PH increases accessibility to health promotion and illness prevention programs and services, and decreases the cost of immunization programs through reduced wastage.
  • Social ecological theory, upon which our conceptual framework for collaboration is based, would suggest that determinants of collaboration at one level of the framework can enhance or suppress determinants at another level (systems, organizational, interpersonal, and intrapersonal levels).
  • When developing strategies to facilitate collaboration, we not only need to base strategies on factors from various levels of the framework, but we need to do this in an integrated way. The effectiveness of collaboration will be increased when actions are coordinated across the levels of influence in the ecological framework.
  • For collaboration to be successful, it is important for PC and PH to have clearly articulated and well understood separate and shared mandates within the healthcare system.
  • Collaboration between PC and PH is facilitated when the vision and goals are jointly determined and systematically communicated across all levels, from executive directors to senior managers to front‐line practitioners.
  • More formalized approaches, including policies, are needed to support and endorse collaboration between PC and PH, so that collaboration is a deliberate action rather than one that occurs on an ad hoc basis.
  • Organizational cultures that have inclusive, transparent communication and decision‐making processes can support collaboration.
  • Collaboratively developed work plans that incorporate a mix of population and individual approaches can work synergistically to address local community health needs.
  • Champions to initiate and sustain collaboration need to be identified and supported at system, organizational, and interpersonal levels.
  • Specified financial, information, material, space and human resources need to be allocated, reallocated or shared to initiate as well as to maintain collaboration.
  • Investments in shared information technologies across health sectors should include PC and PH particularly with respect to immunization, well‐child care, and aspects of chronic disease prevention and management.
  • Fee‐for‐service remuneration can deter healthcare providers such as family physicians and family practice nurses from participating in collaboration. Compensation models need to be considered that support PC physicians and nurses in collaborative work.
  • Educational institutions and accreditation bodies can influence the preparation of professionals for collaboration between PC and PH.
  • Ongoing evaluation of collaborations is important to ensure an effective continuous quality improvement process.