Improvement Strategies User Guide
What is the Improvement Strategies?
The Improvement Strategies is an interactive knowledge management tool for primary health care (PHC) improvement. The Improvement Strategies is designed and aligned with the Primary Health Care Performance Initiative’s (PHCPI) Conceptual Framework and the Vital Signs Profile, a measurement tool created by PHCPI to provide a snapshot of a country’s PHC performance.
The Improvement Strategies is made up of a collection of modules, each of which addresses a topic that is critical for strong PHC systems, inputs, or service delivery. Each module includes curated evidence on PHC improvement to help users identify appropriate strategies, relate these to other parts of the health system, and begin improvements. Within each module, users can navigate to the content most relevant to their role within the health system and country context. There will eventually be thirteen Improvement Strategies modules, mapped to the PHCPI Framework; the first six are currently available and more will be continually added throughout 2019.
Each module guides users through evidence-informed improvement options for PHC and provides practical recommendations for adapting these strategies to their context. The bulk of the content within each module is mapped to smaller subsections: what it is, what others have done, how to get started, and how to succeed. More information on the content users will find within these various sections of a module are found in Figure 1. To facilitate cross-country learning, within each module, users can learn about relevant improvement efforts from a diverse range of country case studies and submit their own experience using the "share your experience" tab.
Figure 1: Improvement Strategies module section overview
In order to select relevant improvement strategies, country stakeholders will need to identify performance gaps and relevant areas for improvement through an inclusive and evidence-based priority setting process informed by robust data. For countries that have developed a PHC Vital Signs Profile with PHCPI, this measurement tool will be a valuable resource for identifying relevant performance gaps and selecting areas to prioritize for improvement.
Once stakeholders have identified relevant areas for improvement, users can navigate to the Improvement Strategies to learn more about the topic and explore solutions to fill the gaps that have been identified. The strategies are not intended to provide a singular recommended approach for all users. The topics are intentionally broad and require significant contextualization to translate to tangible improvements in-country. For this reason, the relevance of different topics and solutions will depend on the context of a country’s health system including factors such as its organizational, policy, legal, and financing frameworks; its clinical and service delivery requirements; the availability of financial and political resources; and its embedded norms and values. More details on moving from measurement to improvement are discussed below in: how does PHC measurement relate to the Improvement Strategies?
Users of the Improvement Strategies may include but are not limited to: national health committees and regional or district health officers, development partners, facility managers, and private or other non-governmental actors. Each user will find different components of the Improvement Strategies useful depending on their role and responsibilities within their health system, and users’ navigation through the Improvement Strategies will depend on their needs and preferences. Certain strategies may be applicable to stakeholders at all levels of the health system and require targeted, collaborative efforts across sectors and regions while others may only be relevant to specific levels and sectors within the health system.
The PHCPI Vital Signs Profile helps stakeholders diagnose strengths and weaknesses in their health system by compiling and analyzing multiple quantitative and qualitative data sources, helping to build a richer and more nuanced picture of a country’s PHC system. Stakeholders can use the information in their Vital Signs Profile to identify priorities for improvement. Drawing from the content within the Improvement Strategies, stakeholders can identify and adapt strategies to their local context, working with the relevant stakeholders in their country - including the end users of the health system - to identify interventions and develop realistic, context-specific implementation plans.
While better measurement is the first step to improvement, users need not have a Vital Signs Profile with PHCPI to utilize the Improvement Strategies. Users from countries that have not developed a Vital Signs Profile can use PHCPI’s Core Indicators or other data sources relevant to PHC (such as SARA, SDI, DHS, SPA, or other relevant country-based sources of information) to evaluate their PHC performance and select relevant Improvement Strategies modules for exploration. An important consideration when prioritizing areas for improvement is what other elements of a health system should be in place or strengthened to effectively support improvements in the target areas. For instance, countries that seek to empanel (or roster) their populations to a PHC provider or team must have reliable information systems to track patients. The “how to succeed” section within each module identifies these various dependencies and enablers.
The Improvement Strategies offer users an interactive knowledge-base mapped to the key components of strong PHC systems. Users can learn about strategies for improving PHC and find practical recommendations for adapting these strategies to their context. Used alongside relevant indicators and measurement tools, these strategies can help users better diagnose understand critical gaps in their health system and select relevant opportunities for improvement.
The available Improvement Strategies modules include:
Population Health ManagementPopulation health management is an approach to primary health care (PHC) provision that integrates active outreach and engagement with the community in care delivery. This approach shifts primary care service delivery from reactive to proactive management of a segment of the population. Effective population health management typically occurs both in established clinics and in the community.
Facility Organization and ManagementFacility organization and management includes: the effective organization of facility operations; deployment of human resources in multidisciplinary teams; routine collection and use of information systems to establish targets, monitor progress, and implement ongoing quality improvement initiatives; and the capability of managers to oversee, support, and enforce these processes.
AccessThis subdomain measures whether patients have affordable, timely access to a PHC facility that is geographically convenient. The basic structural availability of facilities is a starting point for understanding effective service delivery and is measured under inputs. By contrast, this subdomain is considered from the point of view of the patient when trying to access care or at the point of care. By this definition, in order for services to be considered accessible, patients must face no actual or perceived barriers to receiving services. Ensuring access from the users’ perspective can help enable patients to receive the right care at the right place at the right time.
Availability of Effective PHC ServicesThe subdomain Availability of Effective PHC Services includes the presence of competent, motivated health workers at a health facility or in a community when patients seek care. Effective PHC also requires that providers and their patients build participatory relationships and a foundation of trust and respect. Health worker motivation is critical as it is associated with technical and experiential quality as well as effectiveness. Finally, effective PHC also requires safe practices routinely followed in the delivery of care.
High-Quality Primary Health CareHigh-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 is the outcome of strong service delivery and the result of well organized and managed services, backed by a strong system and adequate inputs, such as human resources, infrastructure, and drugs and supplies. This module focuses on what systems, policies, and infrastructure should be in place to ensure the delivery of high-quality primary health care services. Within the PHCPI framework, five core functions underpin high-quality care delivery in primary health care systems. These include first contact accessibility, coordination, continuity, comprehensiveness, and person-centeredness. Improving the delivery of these functions is central to obtaining the benefits of person-centered primary care systems.
Adjustment to Population Health NeedsAdjustment 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. This module covers three specific areas: surveillance, priority setting, and innovation and learning.