Connecting care: exploring Sweden’s innovative PHC model

6 January 2025

In the serene meadows and forests of southern Lapland in Sweden, where the air is crisp and reindeers roam freely, local residents still face real-world challenges. Beneath its idyllic surface, the region has spent a century finding ways to deliver primary health care (PHC) to its ageing population, combat the loss of skilled health workers and professionals to urban centres, and overcome the vast distances that limit accessibility. In the 1990s, Sweden reinvented their sjukstugor (also known as PHC cottage hospitals) to address these challenges, transforming them into the outstanding health-care delivery model they are today.

The success of Sweden's PHC model in southern Lapland can be attributed to an approach that recognizes the connected nature of physical, mental and social health issues and addresses them through multidisciplinary teams, professional role development and task optimization. The collaborative efforts of local stakeholders, coupled with innovative organizational transformations, have positively impacted workforce development, recruitment and retention.

Since October 2022, Georgia, Kazakhstan and Latvia have sent delegations to Sweden to learn from this model. During a recent visit, Ieva Špironoka, a senior expert at Latvia’s Health Ministry, shared how empowering it is to expand the roles of nurses and support them in achieving their full potential: “This, coupled with the value of sharing experiences and learning from progressive practices, strengthens our belief that meaningful change is possible.”

The WHO European Centre for PHC and Västerbotten regional and local health authorities introduced a sjukstuga into a WHO PHC Demonstration Platform, which allows countries with similar challenges to gain insights into the solutions that can be adapted to different contexts. The Centre for Rural Medicine in Storuman Municipality, soon to become a WHO collaborating centre, is the main partner in organizing these visits. It leads research and innovation in rural PHC with a focus on serving remote communities and the indigenous Sami population. Sweden’s model stands as an inspiring testament to the transformative power of effective PHC delivery.

“Visits like this can truly make a difference because they ignite change,” stressed Melitta Jakab, Head of the WHO European Centre for PHC. “Reading about a country’s policies is one thing, but witnessing how they work in action is an entirely different experience.”

 

WHO/Sofia Berggren
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Reindeers roaming in the forest near settlements in the Västerbotten region in southern Lapland, Sweden.

Västerbotten is a vast area located in southern Lapland, Sweden. It is one of Europe’s most sparsely populated regions, with just 5 inhabitants per square kilometre. Although larger than Denmark, the Netherlands or Switzerland, the landscape here remains largely untouched, with vast stretches of wilderness separating small, isolated villages. Despite these significant challenges, Västerbotten has implemented innovative solutions and become a model for delivering health care to remote villages.

Nilsson Carl-Oskar, Storuman - Storumans kommun
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Staff outside the cottage hospital in Stensele (archival photo).

To bring health care closer to remote communities, the first sjukstugor (cottage hospitals) were introduced in 1901. Sjukstugor function as primary health care (PHC) centres run by family doctors and nurses. While most of the care they provide is on an outpatient basis, they also admit patients when necessary for health or social reasons, and provide palliative care.

Over the years, as sjukstugor began facing global trends of population ageing and the loss of skilled professionals to urban centres, these facilities started to grapple with staffing shortages and struggled to access the resources needed to meet local health-care demands.

WHO/Sofia Berggren
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A nurse uses telemedicine tools at a sjukstuga in Vilhemlina, a small town in Västerbotten.

Västerbotten began revitalizing the century-old concept of sjukstugor in the 1990s. While these cottage hospitals had always delivered PHC to smaller settlements in remote areas, the introduction of teleconsultations and other digital tools has significantly enhanced access to and quality of care. This innovative approach combines in-person consultations, digital solutions, and home visits by nurse assistants and social workers to ensure personalized and consistent health care for the community.

WHO/Aidana Yergaliyeva
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Local nurse Henrik engages in a scenario at the sjukstuga in Storuman Municipality.

Eager to learn from Sweden’s success, a Kazakh delegation travelled to the region to explore how these solutions could be adapted to their own health-care systems, which face similar challenges.

From an emergency room in the sjukstuga, the delegation watched as nurse Henrik started a teleconsultation with Miriam, a general practitioner (GP) who was 1000 kilometres away. They discussed a scenario involving a middle-aged woman with cold burns and a wrist injury. Henrik gathered health information, conducted tests and reviewed the results with Miriam, who confirmed that hospitalization was not necessary. However, the woman's social file revealed that she lives in isolation and has cognitive difficulties. The team decided to keep her overnight at the cottage hospital to ensure her well-being.

WHO/Aidana Yergaliyeva
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Local nurse Henrik starts a teleconsultation with Miriam, a GP.

Henrik used a crane-mounted camera to show the severity of the patient’s cold burns and injuries. Together, Henrik and Miriam collaboratively decided on the best course of action for the patient.

The scenario demonstrated how the sjukstuga manages emergencies and empowers nurses. Rural GPs also receive an extra year of training to handle a broader range of services, as they often manage cases independently without referral options. This is a win–win approach: Henrik expressed that he appreciates the opportunity “to collaborate with doctors and specialists to treat patients with more complex needs”, while Miriam shared that she finds it fulfilling “to provide the same standard of care throughout the country and meet patients where they are”.

WHO/Aidana Yergaliyeva
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Older individuals engage in a ball game with a nurse at the Storuman nursing home.

The Storuman nursing home emphasizes person-centred care in a home-like environment. Run by nurses and nursing assistants, it adapts to residents’ diverse needs, respecting individual boundaries and habits. The warm atmosphere highlights the power of empathy in health care.

“For us, rurality is not a problem to solve. It is our way of life, and we love it,” stressed Isabell Danielsson-Zemrén, Head of the Health-care District of South Lapland.

Västerbotten’s model of care depends on the collaboration of local stakeholders, both in health and social care, and their coordination with regional institutions. The region adopted digital solutions and workforce strategies driven by social cohesion and cooperation.

WHO/Sofia Berggren
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A nurse demonstrates medical equipment in a local library.

Slussfors is a small settlement of just 300 residents. At the Slussfors School Library, a community room serves as a hub equipped with digital health tools, some of which residents can use without a nurse’s assistance.

Andreas Lundqvist, Head of Unit at the Centre for Rural Medicine, highlighted that this initiative empowers residents to use digital solutions independently, fostering self-sufficiency in maintaining their health. “This brings health as close as possible to a rural population while encouraging patients to take greater responsibility for their own care.”

WHO/Aidana Yergaliyeva
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The PHC cottage hospital in Tärnaby is an entirely nurse-led facility.

A PHC unit in Tärnaby, in Storuman Municipality, showcases the expanded roles of nurses in meeting basic health needs. This remote, mountainous locality is home to just over 1600 residents, but must serve a population that grows 25-fold during ski season.

Roza Abzalova, a Kazakh delegate and Chair of the Kazakh National Association for PHC, was impressed by the significant responsibilities of the nurses. She highlighted their universal expertise and critical role in health management, and noted the high level of respect they receive from the local community. By the end of the tour, it was clear that a sjukstuga is a well organized system of compassion and care enhanced by digital solutions.

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