Primary Health Care as a Foundation for Strengthening Health Systems in Low- and Middle-Income Countries

Asaf Bitton,Jaime Bayona,Lopa Basu,Meredith Kimball,Federica Secci,Gina Lagomarsino,Hong Wang,Jeremy H Veillard,Lisa R Hirschhorn,Ethan Wong,Daniel H Kress,Chelsea Taylor,Hannah L Ratcliffe,Shannon Barkley

doi:10.1007/s11606-016-3898-5

Abstract

Primary health care (PHC) has been recognized as a core component of effective health systems since the early part of the twentieth century. However, despite notable progress, there remains a large gap between what individuals and communities need, and the quality and effectiveness of care delivered. The Primary Health Care Performance Initiative (PHCPI) was established by an international consortium to catalyze improvements in PHC delivery and outcomes in low- and middle-income countries through better measurement and sharing of effective models and practices. PHCPI has developed a framework to illustrate the relationship between key financing, workforce, and supply inputs, and core primary health care functions of first-contact accessibility, comprehensiveness, coordination, continuity, and person-centeredness. The framework provides guidance for more effective assessment of current strengths and gaps in PHC delivery through a core set of 25 key indicators (“Vital Signs”). Emerging best practices that foster high-performing PHC system development are being codified and shared around low- and high-income countries. These measurement and improvement approaches provide countries and implementers with tools to assess the current state of their PHC delivery system and to identify where cross-country learning can accelerate improvements in PHC quality and effectiveness.

Highlights

In 1920, the British government commissioned a report to suggest ways to structure their expanding health system investments
A profound evolution has occurred toward understanding the central role of primary health care (PHC) in ensuring individual and population health, transforming PHC from responsibility for the lowestlevel basic tasks toward becoming the heart of an integrated, people-centered system of care
The development of community-oriented primary care in South Africa, India, and the US in the mid-twentieth century showed the early potential of strong PHC systems to produce promising population health results, but these vanguard programs were not met with uniform support for a common conceptual understanding or even shared definition of PHC

Summary

INTRODUCTION

In 1920, the British government commissioned a report to suggest ways to structure their expanding health system investments. The commission chairman, Lord Bertrand Dawson, borrowing from previous experience in education, proposed three hierarchical levels of care locations (primary, Received August 17, 2016 Revised September 26, 2016 Accepted September 30, 2016 Published online December 9, 2016 secondary, tertiary) He and the commission first identified Bprimary care^ as the most basic level of a structured health system (akin to primary or elementary education), concerned with caring for simple, common problems in outpatient settings (Fig. 1).[1]. The development of community-oriented primary care in South Africa, India, and the US in the mid-twentieth century showed the early potential of strong PHC systems to produce promising population health results, but these vanguard programs were not met with uniform support for a common conceptual understanding or even shared definition of PHC. This framework describes the components necessary for building strong PHC systems, informs better assessment, and identifies modifiable gaps in performance

A CONCEPTUAL FRAMEWORK FOR GLOBAL PHC

Findings

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