TABLE 1.

Key messages to decision-makers

The target of PHC changes should not be solely accessibility but rather a balance between continuity and accessibility. The implementation of integrated health services should seek quality improvement of services rather than cost reduction, at least in the short term. Strategies for implementing such changes should centre primarily on professional practices rather than solely on organizational structures. It is essential to create a climate of trust and respect between concerned actors. Whereas a general framework is necessary at the central level to ensure coherence, sufficient room must be left for autonomy and initiative at the local level. Participation of physicians in these projects is essential and deserves special attention and effort.