With pride and gratitude, the PHCPI Steering Committee has announced the conclusion of the PHCPI partnership at the end of 2022. Read the full statement here.
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With pride and gratitude, the PHCPI Steering Committee has announced the conclusion of the PHCPI partnership at the end of 2022. Read the full statement here
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Countries seeking to improve their ability to adjust to population health needs can pursue a wide array of potential improvement pathways. The short case studies below highlight promising and innovative approaches that countries around the world have taken to improve.
PHCPI-authored cases were developed via an examination of the existing literature. Some also feature key learnings from in-country experts.
Featured case studies
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Indonesia
Policy Experimentation and a Strong Legal and Regulatory Framework
Adjustment to population health needs India
Decentralized Approach to Improving Community-Engagement in Priority Setting
Medicines & Supplies Tanzania
To ensure quality and safety of medicines, Tanzanian health authorities built on existing infrastructure and undertook a long process of converting informal vendors into accredited drug dispensing outlets (ADDOs). By June 2014, this program had trained over 19,000 providers - each linked directly to local primary care facilities - in almost 6,100 shops. In December 2018, the United Republic of Tanzania became the first WHO-recognized country in Africa to achieve a well-functioning regulatory system for medical products.
Policy & leadership Peru
Policies that go beyond politics
Population Health Management Turkey
Prioritizing patient choice and access through geographic and voluntary empanelment
Policy & leadership Malawi
Evidence-Based Reproductive Health Policy Development for Young People
Adjustment to population health needs Tanzania
Integrating diverse community perspectives through participatory priority-setting
Multi-Sectoral Approach Ghana
Integrating community-engagement activities into health reform plans
Adjustment to population health needs Costa Rica
Supporting evidence-based priority setting through robust local data systems
Multi-Sectoral Approach Nepal
Building community trust and participation in priority setting through Mother groups
Policy & leadership Kenya
Embedding quality improvement at all levels of the health system
Population Health Management Brazil
Building a national community health worker programme
Primary Care Functions Liberia
Maintaining access to PHC services during the Ebola Crisis
Population Health Management Mexico
Community-based outreach for non-communicable disease care
Population Health Management Mali
Proactive case community management in urban settings
Service Quality Haiti
Improving the efficiency of health centers through time-driven activity-based costing
Management of Services Ethiopia
Strengthening hospital management capacity through educational programs
Information & Technology Brazil
Impact of the use of information communication technology on women’s health
Management of Services Afghanistan
Balanced scorecard performance system for performance benchmarking and strategic management
Management of Services Costa Rica
Incentivizing quality and adherence to best practices via performance management
Purchasing & Payment Systems Chile
Health goals as the basis for a pay-for-performance scheme
Organisation of services Brazil
Improving health outcomes and coverage through Family Health Teams
Service Quality Costa Rica
Improving health outcomes and efficiency of care through PHC teams
Health Workforce Malawi
Implementing an interprofessional nursing program to bolster the health workforce
Access Cambodia
Using voucher programs to improve financial access to PHC
Health Workforce Brazil
A multi-faceted workforce program to address geographic disparities in access to health services
Access Ghana
Addressing transportation barriers through emergency referrals
Service Quality South Korea
Extending facility operational hours to improve patient access and service delivery
Service Quality Tanzania
Using participatory planning to implement interventions related to disrespect and abuse
Service Quality Peru
Improving the quality of health services through community monitoring
Policy & leadership Malaysia
Focusing on Quality Management to achieve equitable access to services
Funding & Allocation of Resources Nigeria
Open Contracting in Primary Health Care
Adjustment to population health needs Brazil
Using participatory budgeting to amplify patient voices
Organisation of services Iran
Training community-based health workers to provide team-based care
Service Availability & Readiness Estonia
Retraining and incentivizing providers to deliver high-quality PHC
Service Availability & Readiness India
Training informal providers as a way to improve provider competence and availability
Management of Services Rwanda
Enhancing mentoring and supervision to improve quality of services
Service Availability & Readiness India
Using the Safe Childbirth Checklist to improve provider performance
Service Availability & Readiness Tanzania
Increasing provider competency through mobile-based decision-making tools
Medicines & Supplies Kenya
Assessing drug safety through increased inspections
Service Quality Rwanda
Strengthening safety systems with quality improvement practices in facilities
Management of Services Nepal
Morbidity and mortality conferences as a method for quality improvement
Primary Care Functions Malawi
Making care more comprehensive through an integrated care management model
Multi-Sectoral Approach Chile
Achieving comprehensive PHC through intersectoral action and community engagement
Primary Care Functions India
Improving provider’s capacity to coordinate care through the Continuum of Care Services mobile health tool
Primary Care Functions Portugal
Strengthening the delivery of integrated, continuous care across levels of care through the Portuguese National Network for Integrated Continuous Care
Access Afghanistan
During reconstruction in 2001, Afghanistan implemented a series of reforms to increase financial and geographic access to primary care services through partnerships with NGOs and the removal of user fees.
Organisation of services Solomon Islands
Strengthening coordination through role delineation policies
Primary Care Functions Costa Rica
Promoting coordination and first contact access through regional referral networks
Organisation of services China
Improving the management of NCDs through a tiered service delivery approach
Primary Care Functions Iran
Building demand for PHC via urban community health workers
Primary Care Functions Ethiopia
Delivering person-centred, integrated PHC via the urban health extension professional model
Service Quality Mali
Removing barriers to timely PHC through proactive community care management
Resilient Facilities & Services Liberia
Rebuilding PHC capacity in post-conflict settings through frontline health workers
Population Health Management Samoa
Revitalizing PHC at the community level through Village Women’s Committees
Primary Care Functions Scotland
Empowering patients through the Scotland House of Care Program
Funding & Allocation of Resources Kenya
Implementing a health coverage scheme to expand access to equitable, affordable, and quality PHC
Multi-Sectoral Approach Alaska, United States
Ensuring community involvement through co-ownership and co-management of the health care system
Purchasing & Payment Systems Estonia
Leveraging blended provider payment mechnisms to promote PHC
Purchasing & Payment Systems Indonesia
Capitation for primary care with some performance adjustments
Management of Services Costa Rica
Performance Measurement and Monitoring for Continuous Improvement
Ethiopia
Using regulatory mechanisms to improve the quality and resilience of services
Organisation of services Alaska, United States
Achieving effective voluntary empanelment
Primary Care Functions United States
Building a patient-centered model of care through multidisciplinary care teams
Purchasing & Payment Systems United States
Targeted Reforms to Reduce Costs and Improve the Quality of Care
Multi-Sectoral Approach India
Establishing community participation and decision-making power in local health systems
Service Availability & Readiness Costa Rica, Estonia, & Thailand
Improving provider motivation using monetary incentives
Service Availability & Readiness Burkina Faso, Ghana, India, Kenya, & Tanzania
Measuring provider motivation and satisfaction
Service Availability & Readiness Brazil, Cuba, Ghana, Kenya, & Nepal
Improving provider availability through facility infrastructure and workforce strengthening
Service Availability & Readiness Uganda & Rwanda
Addressing absenteeism through performance-based financing in Uganda and Rwanda
Service Availability & Readiness Ghana, New Zealand, & USA
Improving service delivery through shared medical appointment models
Primary Care Functions Kenya & Nepal
Using citizen charters as a facility-level intervention to increase accountability and empower patients
Service Quality Ghana & USA
Improving clinical efficiency through shared appointment systems
Service Quality Kenya, Nigeria, Rwanda, & Tanzania: Service Quality
Improving follow-up and reducing wait times through appointment systems
Access Iraq, Jordan, Syria, Ukraine, & Yemen
Delivering care to remote communities through mobile clinics
Access Project Echo & Ghana
Increasing geographic access to higher levels of care through eHealth/Telemedicine
Access Afghanistan & Lesotho
Expanding coverage of quality services through PPPs
Access India & Mexico
Conditional cash transfers to improve quality and utilization of care
Access Afghanistan, Burundi, & Kenya
User fees waivers for impoverished households
Access Laos & Rwanda
Community-based health insurance
Adjustment to population health needs Kenya, Nepal, & Malawi
Community Health Worker-Based Surveillance in Resource-Constrained Contexts
Adjustment to population health needs AFRO Region
Integrated Disease Surveillance and Response
Organisation of services Brazil, Costa Rica, & Ghana
Improving access to comprehensive care through geographic empanelment
Management of Services Kenya, Peru, Uganda, & Zimbabwe
Integrating communities into facility management decisions through leadership committees
Information & Technology Ghana, Mozambique, Rwanda, Tanzania, & Zambia
Health information strengthening initiatives
Service Quality Brazil & Costa Rica
Improving health equity through population outreach
Information & Technology Bangladesh
In 2009, Bangladesh introduced DHIS2 as the national health information management system to improve the integration and interoperability of different health information systems and to make the data produced by these systems more accessible and reliable to both data producers and users.
Purchasing & Payment Systems Argentina
Argentina’s Plan Nacer created new payment incentives for provincial governments and frontline providers, resulting in increased service utilization and improved health outcomes
Service Quality Alaska, United States
The Southcentral Foundation in Alaska, United States, has developed a system where patients are co-owners of the health system and are involved in all aspects of decision-making.
Population Health Management Brazil
The Family Health Program was established in Brazil in the 1990s. Under this program, Family Health Teams are responsible for a geographically empaneled group of households.
Population Health Management Costa Rica
Costa Rica’s primary health care system is supported by robust care teams that provider community-based care to an empaneled population. As a result, health outcomes in Costa Rica are consistently strong and improving.
Organisation of services Costa Rica
Costa Rica's primary health care system is supported by robust care teams that provide community-based care to a clearly defined group of patients.
Primary Care Functions Costa Rica
Costa Rica’s primary health care system is supported by robust integrated care teams that provide comprehensive, coordinated, continuous, and person-centered care to empaneled populations. As a result, health outcomes in Costa Rica are consistently strong and improving. (Spanish subtitles)
Medicines & Supplies Dominican Republic
After creating a Single System for Managing Medicines and Medical Supplies (SUGEMI, in Spanish), the Dominican Republic has decreased the frequency of stock-outs and waste of unused, expired commodities and has decreased overall purchasing prices for drugs and supplies.
Management of Services Ethiopia
Ethiopia has implemented a series of reforms over the last several decades intended to improve service delivery and specifically improve care through stronger hospital management practices.
Population Health Management Ghana
The Community Health Planning and Strategy (CHPS) program began as a pilot in 1994 and has since been scaled across Ghana, increasing access to community-based primary health care services.
Information & Technology Ireland
Ireland launched its national eHealth Strategy in 2013 to transform its health information system and keep pace with the rapid global proliferation of technology using patient-centered, information-based eHealth solutions. Key eHealth initiatives at the core of Ireland’s reform seek to leverage the potential of innovative digital technologies to empower patients and healthcare workers by way of greater transparency, access to services, and information.
Population Health Management Jordan
Since 2019, the United Nations Refugee Works Agency has introduced various community-based programs to improve access to comprehensive primary health care (PHC) for the Palestinian refugee population in Jordan. These programs leverage digital technologies and proactive population outreach strategies to improve their implementation and spread in the refugee community as well as the quality, efficiency, and effectiveness of primary care services for these populations.
Access Mongolia
The Health Sector Development Program started in 1997 has supported various geographic and financial reforms that have worked to improve access to quality primary health care in both rural and urban areas.
Health Workforce Nepal
Since 2009, the Government of Nepal has been working in a public-private partnership (PPP) with the non-governmental organization Possible to expand access to high-quality health care in remote areas throughout the country. The partnership has developed a novel community health worker (CHW) program, to strengthen human resources for health and accelerate progress toward universal health coverage.
Service Quality Nigeria
The Nigeria Health Investment Program – which provided operating funds directly to frontline providers to spend as needed – has improved quality and coverage in three states in Nigeria. The approach is now being scaled nation-wide.
Resilient Facilities & Services Philippines
Rebuilding after Typhoon Haiyan/Yolanda towards a "new, better normal"
Physical Infrastructure Senegal
In Senegal, a proactive approach to gathering data through nationally representative assessments has helped the country determine priorities for implementing changes to facility infrastructure and amenities.
Physical Infrastructure Sri Lanka
In Sri Lanka, a focus on equitable access to health care has led to comparatively high provision of basic health services, but at the expense of consistent quality of care – leading patients to bypass community health services. Facility infrastructure assessments and investment are helping to bring users back into the primary health care system.
Access Thailand
Beginning in the 1970s, Thailand has implemented a series of reforms to improve financial and geographic access and achieve universal health coverage.
Health Workforce Vietnam
In 2013, the Ministry of Health of Vietnam launched the Health Professionals Education and Training for Health Systems Reform Project (HPET) for Health Systems Reform Project to execute a more sustainable and effective human resources for health development strategy. In particular, the project has made targeted efforts to improve the quality of workforce education and training to strengthen PHC capacity at the local level.
Funding & Allocation of Resources Uganda
Primary health care facilities in Uganda face challenges in having sufficient funds available to deliver a comprehensive set of PHC services. Analyzing the flow of primary care funds from national to facility-level helped to reveal some root causes of these challenges.
Adjustment to population health needs Multi-country
The Community of Practice Health Service Delivery: Strengthening Health District Teams to Accelerate PHC Improvement in Africa
Service Availability & Readiness Turkey
Greater availability of primary care services results in high patient and physician satisfaction.
Access Thailand
Improving geographic and financial access to care & strengthening primary care in Thailand
Access Namibia
Reducing health equity through commitment and innovation
Governance India
Decentralized governance and community engagement to strengthen primary care.
Organisation of services Estonia
Establishing family medicine as a specialty to strengthen primary health care.
Population Health Management Cuba
Emphasis on community-based primary care in a tiered system improves outcomes.
Access Costa Rica
Universal health coverage and community-based health teams create effective coverage.
Population Health Management Brazil
A Community-Based Approach to Comprehensive Primary Health Care.
Purchasing & Payment Systems
Measurement to Ensure Effective Universal Health Coverage: Plan Nacer/Programa SUMAR
Adjustment to population health needs Ghana
Translating Research into Practice to Ensure Community Engagement for Successful Primary Health Care Service Delivery: The Case of CHPS in Ghana
Adjustment to population health needs Chile
Measuring Primary Health Care System Performance Using a Shared Monitoring System in Chile
Primary Care Functions Multiple countries
8 Core Tenets of Primary Health Care Improvement in Middle and High-Income Countries
Policy & leadership
Strengthening Primary Health Care Systems to Increase Effective Coverage and Improve Outcomes in Ethiopia
Organisation of services Indonesia
Indonesia: Puskesmas and the Road to Equity and Access
Organisation of services Portugal
Strengthening the delivery of integrated, continuous care across levels of care through the Portuguese National Network for Integrated Continuous Care
Information & Technology Nepal
Strengthening PHC capacity in the public sector through an integrated health information system in Nepal