Change in culture from specialty care to primary care will take time and attention from the Ministry of Health.

Time lags for funding impact project momentum, supply chain, and reinforcement of new practice patterns.

Lack of system-wide health statistics on which to base our outcome data makes true outcome data very difficult to collect and rely on.

Care processes that do not include systematic follow-up or preventive care reflect ongoing cultural change challenges that will take time and attention from providers and the healthcare system of the country.

Changes in leadership within the family medicine centers led to interruption of progress in improvements made and threatened to move the family medicine centers back to previous standards.

Lack of funding for the healthcare system overall, including for supplies and professional salaries, has had a tremendous impact on the project. Professionals are unable to live at current salary levels and must have second/third jobs to survive. This had led to many requests for additional payment for work done within the project and increased tension. It has also led to a lack of basic supplies of equipment and medications necessary to care for the population.