Service delivery and challenges in healthy life centers: lessons for strengthening primary health care from Turkey

Primary health care (PHC) is central to universal health coverage, yet delivery performance varies across settings. This study examines Turkey’s Healthy Life Centers (HLCs)—a nationwide PHC-strengthening initiative—by including all 11 HLCs in Konya to identify service delivery strengths, operational challenges, and improvement priorities with lessons relevant to other upper-middle-income contexts. A mixed-methods design was applied. The quantitative element utilized a cross-sectional design involving 208 participants, while the qualitative element followed a phenomenological approach with 44 participants. The participants were physicians in charge of HLCs and staff delivering services to applicants. Data were collected using two separate forms. Quantitative data were analyzed using chi-square tests (p < 0.05). Qualitative transcripts were coded to identify themes. Quantitative results showed that 77.9% of participants found the range of services satisfactory and 92.8% considered them beneficial. More than half of health professionals rated HLC conditions positively. Significant differences were identified by location and building status, largely reflecting physical conditions. Qualitative findings highlighted service gaps, perceptions of service delivery, physical conditions, community awareness, patients/applicants’ needs, referrals from other institutions, appointment system, and safety needs. This is one of the few studies examining HLCs in Turkey from the provider perspective. A mixed-methods design enabled a more comprehensive evaluation. Findings can guide targeted improvements in infrastructure, service delivery models, and referral mechanisms within HLCs and provide actionable insights for policymakers and managers to strengthen primary health care, with relevance to other upper-middle-income settings.