As Governments strive to progress towards the Sustainable Development Goals (SDGs) including Universal Health Coverage (UHC), concerted efforts are being made to strengthen primary health 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 levels is no easy task, made even more complex given the range of health services needed to address both infectious and chronic diseases, especially for low- and middle-income countries (LMICs).” explains Dr Abdul Ghaffar, Executive Director of the Alliance for Health Policy and Systems Research (AHPSR).
“We need more knowledge based on evidence to help policy-makers and health workers decide how best to manage and provide health services when faced with financial challenges, health worker shortages, and the complexities around any 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
With support from the Bill and Melinda Gates Foundation the Alliance has published 18 case studies on primary care systems in low- and middle-income countries: Bangladesh, Colombia, Ethiopia, Georgia, Ghana, Indonesia, Kenya, Lebanon, México, Mongolia, Nigeria, Pakistan, Peru, Sri Lanka, Thailand, South Africa, Uganda and United Republic of Tanzania. (An additional 2 case studies on Cameroon and Rwanda are forthcoming).
The case studies provide practical information on key aspects of the primary care system such as primary health care policies and programmes, financing, human resources of health, quality and distribution of services, among other aspects.
Dr Etienne Langlois, who leads the Alliance’s work on Primary Care Systems (PRIMASYS) explains, “These case studies bring up-to-date, policy-relevant information to guide decision-making on the entry points to reinforce primary health care planning, resource allocation, and service delivery in various LMICs.”
“The studies include policy considerations to strengthen primary health care systems suggested by key PHC stakeholders with an in-depth understanding of the gaps and solutions that would work within specific country contexts,” adds Dr Langlois.
The case studies will be used to draw cross-cutting lessons across the various countries. Dr Hong Wang from the Bill and Melinda Gates Foundation commented that "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. Despite many countries having 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.
"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 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.