Cross-Country Synthesis: Primary Health Care
AUTHORS:
Barasa E, Bozzani FM, Amboko, B, Madriz-Montero A, Muthuri RN, Arora N, Akhter Huda F, Akhter S, Affram A, Aryeetey G, Chewe M, Ferdous T, Hangoma P, Huayanay-Espinoza C, Huicho L, Humuza J, Kasumba E, Koduah A, Masiye F, Michelo T, Nyawira L, Uddin Mahmud M, Reinstein S, Umuhoza SM, Valladares R, Balabanova D, Vassall A.
Overview
This cross-country synthesis provides the highest-level insights from our primary health care research across all Exemplar countries. For policymakers, funders, and implementers seeking to understand what has worked to improve primary health care efficiency, this is a central repository of knowledge on our website.
Here, we have highlighted the most critical lessons and recommendations in primary health care based on insights across all the Exemplar countries. The hyperlinks on this page serve as a useful tool for locating corresponding background and illustrative examples that support our findings within each country narrative.
Primary health care (PHC) is essential health care that’s accessible and acceptable to individuals and families in the community, at a cost that the community and the country can afford.
Experts say PHC is essential to achieve universal health coverage worldwide, one of the UN Sustainable Development Goals, and can spur progress toward other WHO goals for promoting health, keeping the world safe, and helping the vulnerable.
(For further detail, see the accompanying Topic Page.)
The PHC Exemplar countries had higher levels of effective coverage relate to peers who spent the same amount on health—a proximate measure of system performance that indicates comparative efficiency as well as high quality (see Figure 1).
In the context of health systems, efficiency means getting the most care out of limited resources by ensuring those limited resources are directed to the right things.
Meanwhile, equity means minimizing differences in health access and outcomes among different population groups and ensuring everyone has access to the care they need.
As the world confronts growing health challenges with fewer financial resources in the post-COVID-19 pandemic era, it is important to draw lessons from these countries that have made impressive strides in achieving more health for each dollar spent.
In addition to driving equity in health coverage, the Exemplar countries each made progress in building PHC systems that generally outperformed their peers in expanding basic PHC coverage, as indicated in Figure 4.
As noted earlier, strong PHC systems are associated with improved health outcomes. Figure 5 shows how improvements in PHC coverage in Exemplar countries between 2000 and 2018 led to improvements in under-five mortality, maternal mortality, and overall disability-adjusted life years.
Exemplar countries' focus on improvements in PHC coverage alongside vertical disease programs translated to improved outcomes, measured by DALYs, or the sum of premature mortality and years lived with disability; one DALY equals one lost year of healthy life. As Figure 6 shows, DALYS across all five countries declined significantly over the past two decades for HIV, tuberculosis, malaria, maternal neonatal disorders, nutritional deficiencies and neglected tropical diseases.
Figure 9: PHC Exemplars allocations to PHC
Source: Institute for Health Metrics and Evaluation; GHED (2018), Rwanda HRTT (2014-15)
Overall, our research identified the common reform strategies all the Exemplar countries used to varying degrees that enabled them to provide more efficient, equitable, and higher-quality health care for less.
The takeaways below explain how research was developed and synthesized.
Analysis was informed by the WHO Measurement Framework for PHC
- Integrated, people-centered health services. Providing comprehensive integrated health services, composed of promotive, protective, preventive, curative, rehabilitative, and palliative care, through all stages of life.
- Multisectoral policy and action. Systematically executing evidence-informed policies and actions that focus on broader factors that affect health. These include social, economic, and environmental circumstances, as well as a person’s character and behavior.
- Empowered people and communities generating demand. Empowering individuals, families, and communities to advocate for policies that support their health and well-being.
Figure 7 shows the WHO framework that helped to identify the key reform strategies in each country that improved efficiency in these domains, and the subsystems driving positive change.
Figure 7: WHO Measurement Framework for PHC
To understand how we selected the countries we studied, see the Zambia, Peru or Ghana methodology pages. To understand how we arrived at cross-country findings, see the cross-country methodology page.