As Governments strive to progress towards the Sustainable Development Goals (SDGs) including Universal Health Coverage (UHC), concerted efforts are being made to strengthen primary care services so that people have access to quality preventive and curative care.
“Ensuring that quality health services are available at national, provincial, district and village level is no easy task. This is made even more complex given the range of health services needed, from infectious to chronic diseases. We also have globalization and rapid, unplanned urbanization, which have created new problems, especially for low and middle-income countries, explains Dr Abdul Ghaffar, Executive Director of the Alliance for Health Policy and Systems Research (AHPSR).
“We, therefore, need the knowledge to help policy makers and health workers decide on how best to manage and provide these services when faced with financial challenges, health worker shortages, and the complexities around the health system,” added Dr Ghaffar.
Understanding how the primary care system functions across the health sector is vital for the effective allocation and distribution of often limited resources.
Evidence for better decision-making
To this end, the Alliance with support from the Bill and Melinda Gates Foundation published the first five case studies among a set of 20 on primary care systems in low and middle-income countries. These case studies are from Bangladesh, Nigeria, Pakistan, South Africa and Tanzania.
The case studies provide practical information on key aspects of the primary care system such as primary health care policies and programmes, its financing, the scope, quality and distribution of these services, including human resources of health, amongst other aspects.
“These studies bring up-to-date, policy-relevant information to guide decision-making on where the entry points are to reinforce primary health care planning, resource allocation and service delivery,” notes Dr Etienne Langlois, who leads the Alliance’s work on Primary Care Systems Profiles and Performance (PRIMASYS).
Dr Langlois elaborates saying, “The cases studies are informed by multiple data sources and based on mixed methods, participatory approach. The studies include policy considerations to strengthen primary health care systems, which emanate from key primary care stakeholders with an in-depth understanding of where the gaps exist and what would work within the specific context.”
The country case studies will be used to draw cross-cutting lessons across the different low and middle-income countries. Dr Hong Wang from the Bill and Melinda Gates Foundation notes, "The primary health care system is the frontline of the health care system responsible for carrying out a set of cost-effective and vital health interventions in an integrated approach, especially for vulnerable populations. Whilst, many countries have made great political commitments and efforts to achieve this, the performances of these systems vary greatly country by country."
"The PRIMASYS project helps us unpack the challenges and identify the best practices across countries, and therefore, find the best opportunities to improve the performance of the primary health care system at the country level,” said Dr Wang.
A new perspective for improving primary care
"PRIMASYS is a great initiative from the Alliance and the Gates Foundation. It signals a shift from research which has traditionally focused on specific disease programmes to a focus on the health system, the vehicle through which health care programmes are implemented," says Professor Helen Schneider from the School of Public Health at the University of the Western Cape in South Africa.
Commenting on the significance of this work for South Africa, Professor Schneider adds, "The case study is particularly relevant for South Africa, a country which is beset with a wide range of health challenges from maternal and child mortality, HIV and tuberculosis, chronic diseases, and injuries. To address these diseases separately would be far too costly and result in considerable duplication."
"The primary care system offers the most effective vehicle to organise a comprehensive response to health needs. The PRIMASYS case studies will strengthen policy dialogue and serve as an advocacy piece for global health actors and governments to strengthen the system for better health outcomes for all,” stressed Professor Schneider.
Next steps
The case studies are being developed and will be published over the course of 2016-2017. The case studies are from Cameroon, Colombia, Ethiopia, Indonesia, Kenya, Peru, Sri Lanka, Thailand, and Uganda. The case studies will serve as the basis for a comparative analysis across the 20 countries and develop guidance to help decision makers design better models for delivering primary health care.