Between 2000 and 2018, the PHC Exemplar countries—Zambia, Ghana, Bangladesh, Rwanda, and Peru—implemented a range of interventions aimed at improving the efficiency, equity, and quality of their PHC systems. Together, these interventions fall into three key categories, or pathways:
- Spending enough, and spending well, on PHC
- Implementing systems for performance management, accountability, and community engagement
- Improving access to care and facility readiness, boosting utilization rates
Components within each pathway often overlapped with and reinforced one another. So did the pathways themselves. Together, these interactive pathways to PHC performance improved health system efficiency, equity, and quality more comprehensively than individual interventions might have done on their own.
PHC Exemplars taxonomy
Pathway 1: Spending enough, and spending well, on PHC
Drivers and interventions within Pathway 1 aimed to improve the level, flow, and allocation of funds to and within the PHC system.
All five Exemplar countries consistently allocated a substantial percentage of their total health expenditure to PHC. In some cases, this was because of a clear statement of goals for PHC in a government’s political commitments. The countries also worked to ensure a stable and sufficient flow of funds to the lower levels of the health system where PHC is typically delivered. High budget execution rates suggest that Exemplar countries managed and used the resources they allocated to PHC effectively and efficiently.
Pathway 2: Implementing systems for performance management, accountability, and community engagement
Drivers and interventions within Pathway 2 aimed to connect system managers, providers, and communities with the information they needed to manage and hold the system accountable for strong PHC system performance.
All five Exemplar countries aligned their PHC systems with local needs and priorities by fostering data and information availability and other mechanisms to facilitate community input and participation. Exemplar countries also built formal mechanisms for performance management and accountability to manage and make transparent core functions of PHC delivery.
Pathway 3: Improving access to care and facility readiness, boosting utilization rates
Drivers and interventions within Pathway 3 aimed to improve PHC utilization rates by making health services more affordable and available to users in or close to their communities.
All five Exemplar countries increased use of PHC services by reducing financial and physical barriers to access. Exemplar countries also improved the readiness of PHC facilities to respond to increased demands for health services, such as by ensuring the availability of essential medicines and supplies. All five PHC Exemplar countries grew and improved training and retention schemes for their health workforces, particularly community health workers and nurses.
Exemplar countries interactive pathways
Drivers
Between 2000 and 2018, the PHC Exemplar countries—Zambia, Ghana, Bangladesh, Rwanda, and Peru—implemented a range of interventions aimed at improving the efficiency, equity, and quality of their PHC systems. Together, these interventions fall into three thematically related pathways composed of 18 interconnected drivers, or groups of interventions that worked together within and across pathways to influence outcomes.