Country case studies & promising practices

Policy Experimentation and a Strong Legal and Regulatory Framework

Decentralized Approach to Improving Community-Engagement in Priority Setting

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.

Policies that go beyond politics

Prioritizing patient choice and access through geographic and voluntary empanelment

Evidence-Based Reproductive Health Policy Development for Young People

Integrating diverse community perspectives through participatory priority-setting

Integrating community-engagement activities into health reform plans

Supporting evidence-based priority setting through robust local data systems

Building community trust and participation in priority setting through Mother groups

Embedding quality improvement at all levels of the health system

Building a national community health worker programme

Maintaining access to PHC services during the Ebola Crisis

Community-based outreach for non-communicable disease care

Proactive case community management in urban settings

Improving the efficiency of health centers through time-driven activity-based costing

Strengthening hospital management capacity through educational programs

Impact of the use of information communication technology on women’s health

Balanced scorecard performance system for performance benchmarking and strategic management

Incentivizing quality and adherence to best practices via performance management

Health goals as the basis for a pay-for-performance scheme

Improving health outcomes and coverage through Family Health Teams

Improving health outcomes and efficiency of care through PHC teams

Implementing an interprofessional nursing program to bolster the health workforce

Using voucher programs to improve financial access to PHC

A multi-faceted workforce program to address geographic disparities in access to health services

Addressing transportation barriers through emergency referrals

Extending facility operational hours to improve patient access and service delivery

Using participatory planning to implement interventions related to disrespect and abuse

Improving the quality of health services through community monitoring

Focusing on Quality Management to achieve equitable access to services

Open Contracting in Primary Health Care

Using participatory budgeting to amplify patient voices

Training community-based health workers to provide team-based care

Retraining and incentivizing providers to deliver high-quality PHC

Training informal providers as a way to improve provider competence and availability

Enhancing mentoring and supervision to improve quality of services

Using the Safe Childbirth Checklist to improve provider performance

Increasing provider competency through mobile-based decision-making tools

Assessing drug safety through increased inspections

Strengthening safety systems with quality improvement practices in facilities

Morbidity and mortality conferences as a method for quality improvement

Making care more comprehensive through an integrated care management model

Achieving comprehensive PHC through intersectoral action and community engagement

Improving provider’s capacity to coordinate care through the Continuum of Care Services mobile health tool

Strengthening the delivery of integrated, continuous care across levels of care through the Portuguese National Network for Integrated Continuous Care

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.

Strengthening coordination through role delineation policies

Promoting coordination and first contact access through regional referral networks

Improving the management of NCDs through a tiered service delivery approach

Building demand for PHC via urban community health workers

Delivering person-centred, integrated PHC via the urban health extension professional model

Removing barriers to timely PHC through proactive community care management

Rebuilding PHC capacity in post-conflict settings through frontline health workers

Revitalizing PHC at the community level through Village Women’s Committees

Empowering patients through the Scotland House of Care Program

Implementing a health coverage scheme to expand access to equitable, affordable, and quality PHC

Ensuring community involvement through co-ownership and co-management of the health care system

Leveraging blended provider payment mechnisms to promote PHC

Capitation for primary care with some performance adjustments

Performance Measurement and Monitoring for Continuous Improvement

Using regulatory mechanisms to improve the quality and resilience of services

Achieving effective voluntary empanelment

Building a patient-centered model of care through multidisciplinary care teams

Targeted Reforms to Reduce Costs and Improve the Quality of Care

Establishing community participation and decision-making power in local health systems

Improving provider motivation using monetary incentives

Measuring provider motivation and satisfaction

Improving provider availability through facility infrastructure and workforce strengthening

Addressing absenteeism through performance-based financing in Uganda and Rwanda

Improving service delivery through shared medical appointment models

Using citizen charters as a facility-level intervention to increase accountability and empower patients

Improving clinical efficiency through shared appointment systems

Improving follow-up and reducing wait times through appointment systems

Delivering care to remote communities through mobile clinics

Increasing geographic access to higher levels of care through eHealth/Telemedicine

Expanding coverage of quality services through PPPs

Conditional cash transfers to improve quality and utilization of care

User fees waivers for impoverished households

Community-based health insurance

Community Health Worker-Based Surveillance in Resource-Constrained Contexts

Integrated Disease Surveillance and Response

Improving access to comprehensive care through geographic empanelment

Integrating communities into facility management decisions through leadership committees

Health information strengthening initiatives

Improving health equity through population outreach

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.

Argentina’s Plan Nacer created new payment incentives for provincial governments and frontline providers, resulting in increased service utilization and improved health outcomes

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. 

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.

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.

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.

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)

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.

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.

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.

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.

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.

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.

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.

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.

Rebuilding after Typhoon Haiyan/Yolanda towards a "new, better normal"

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.

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.

Beginning in the 1970s, Thailand has implemented a series of reforms to improve financial and geographic access and achieve universal health coverage.

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.

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.

The Community of Practice Health Service Delivery: Strengthening Health District Teams to Accelerate PHC Improvement in Africa

Greater availability of primary care services results in high patient and physician satisfaction.

Improving geographic and financial access to care & strengthening primary care in Thailand

Reducing health equity through commitment and innovation

Decentralized governance and community engagement to strengthen primary care.

Establishing family medicine as a specialty to strengthen primary health care.

Emphasis on community-based primary care in a tiered system improves outcomes.

Universal health coverage and community-based health teams create effective coverage.

A Community-Based Approach to Comprehensive Primary Health Care.

Measurement to Ensure Effective Universal Health Coverage: Plan Nacer/Programa SUMAR

Translating Research into Practice to Ensure Community Engagement for Successful Primary Health Care Service Delivery: The Case of CHPS in Ghana

Measuring Primary Health Care System Performance Using a Shared Monitoring System in Chile

8 Core Tenets of Primary Health Care Improvement in Middle and High-Income Countries

Strengthening Primary Health Care Systems to Increase Effective Coverage and Improve Outcomes in Ethiopia

Indonesia: Puskesmas and the Road to Equity and Access

Strengthening the delivery of integrated, continuous care across levels of care through the Portuguese National Network for Integrated Continuous Care

Strengthening PHC capacity in the public sector through an integrated health information system in Nepal

Ensuring universal access to PHC in Oman