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.
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Policy Experimentation and a Strong Legal and Regulatory Framework
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.
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.
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.
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 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.
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.
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.
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.