Improvement Strategies

Evidence-informed strategies for improving primary health care

The Improvement Strategies are an interactive knowledge management tool. Each strategy guides users through the selection of evidence-informed improvement options based on the country’s current primary health care capacities. The strategies can be used with the PHC Vital Signs Profile to identify gaps in a country’s PHC system and select relevant opportunities for improvement.

Each Improvement Strategies module below addresses a different topic relevant to strong PHC systems and includes an evidence review, case studies, key questions, and infographics to help users identify appropriate strategies. Users can also submit their own experiences, resources, and best practices.

Find Improvement Strategies for:

Governance and leadership includes “ensuring strategic policy frameworks exist and are combined with effective oversight, coalition-building, regulation, attention to system-design, and accountability” (WHO). This strategy includes PHC Policies, Quality Management Infrastructure, and Social Accountability.

Health financing refers to how resources are raised, pooled and allocated or spent to ensure that each person has access to health services of good quality without financial hardship. Health financing impacts the entire health system’s performance, including the accessibility, quality, and efficiency of primary health care.

Adjustment to population health needs includes routine collection of information about population health status and needs, appropriate analysis and use of this information to set and implement priorities, and continual learning and adaptation based on emerging evidence and data.

Drugs and supplies are essential elements of all functioning health systems. Making sure facilities have the right drugs and supplies at the right time and that patients can access affordable products when needed is imperative to delivering high-quality primary health care.

Ensuring that all populations have timely, geographic access to care requires sufficient facility infrastructure. Facility infrastructure captures the physical availability and physical quality of facilities, including facility density and distribution, facility design, facility amenities, and safety equipment and precautions.

Information systems refers to systems used for collecting, processing, storing, and transferring data and information that is used for planning, managing, and delivering high-quality health services. Well-functioning health information systems yield high-quality and comprehensive data and information.

A country’s ability to meet the goal of universal health coverage will require a competent, motivated, and equitably distributed primary health care (PHC) workforce capable of meeting existing and emerging community and population health needs.

The “Funds” strategy addresses the availability and management of funds at health facilities to meet the recurrent and fixed costs associated with delivering health services. Facility managers’ ability to budget, manage, and track funds at the facility level can impact health care providers’ ability to be responsive to changing disease burdens and patient needs.

Effective primary health care systems integrate active outreach and engagement with their empaneled populations in care delivery.

Effectively run facilities should include multidisciplinary teams, routine collection and use of information systems, and the capabilities of managers to oversee, support, and enforce processes.

Primary heath care services should be financially and geographically accessible at convenient times and with minimal waiting times.

Availability of effective PHC services includes the presence of competent, motivated providers at a health facility or in a community when patients seek care.

High-quality primary health care systems consistently deliver services that are trusted and valued by the people they serve and improve health outcomes for all. High-quality primary health care fulfills five essential functions: first contact accessibility, continuity, comprehensiveness, coordination, and person-centeredness.

Featured case studies:

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.

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 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.

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.

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.

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.

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.

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.

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.

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 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 provide community-based care to a clearly defined group of patients.

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.

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

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.

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.