Comparative cross national analysis of healthcare service provision in community health centers based on policies and regulations from 13 international models

Community Health Centers (CHCs) are crucial for delivering primary healthcare services. Their structure, objectives, and service offerings vary significantly across countries, reflecting different policy frameworks, population needs, and organizational models. Understanding how CHCs are defined and regulated is essential to assess their public health impact and to identify best practices for improving local healthcare access at the community level. This study aims to compare how CHCs are structured and positioned within different National Healthcare Systems (NHSs), by analysing their regulatory and policy frameworks. It also wants to explore how CHCs are defined in official documents, the types of services they provide, and the territorial scope of their application. A targeted web-based search led to the selection of twenty-two (22) official sources included in the analysis. This study consists of a cross-national comparative analysis of the range and typology of services offered by a selected pool of models of CHCs worldwide, using a structured service-mapping framework applied to CHC models in 13 countries. The analysis was performed applying a comparison matrix that mapped the service provision of each facility type through a binary coding system (0 = service not provided; 1 = service provided). A similarity matrix was then calculated to identify potential shared patterns in their health supply. A total of 97 services has been mapped. The results show that the most mentioned services in the regulations involved in the study are the basic instrumental diagnostic services (92%), and Screening and Health Promotion activities (85%). Conversely, some services are only found in a very limited number of facilities, suggesting that they are rarely included or prioritized in current CHC policy frameworks. Specifically, 29 services (28% of the 97 single services mapped) are present in only 1 facility (or 8%), and most of them are related to specialized outpatient visits (21 of 29). In conclusion, the data gathered confirm that these facilities represent a setting with variable service offerings, characterized by a shared minimum core and a range of additional services whose spread is uneven.