U PDATE ON P RIMARY C ARE S YSTEMS P ROFILES AND P ERFORMANCE (PRIMASYS) Dr Etienne V. Langlois Alliance for Health Policy and Systems Research World Health Organization Primary Health Care Improvement Global Stakeholder Meeting 7 April 2016 | Geneva

Health Systems Research Perspective Mission: To promote the generation and use of health policy and systems research as a means to strengthen the health systems in low- and middle-income countries.

P RIMARY C ARE S YSTEMS P ROFILES AND P ERFORMANCE (PRIMASYS) Aim: Bridge the knowledge gap on primary care systems at national and subnational levels in LMICs, and provide insights on the entry points into healthcare systems in order to improve implementation, effectiveness and efficiency of health programmes.

P RIMARY C ARE S YSTEMS P ROFILES AND P ERFORMANCE (PRIMASYS) PRIMASYS Expert Consultation (July 2015)  Case studies on LMIC primary care systems 20 case studies (Gates Foundation funding for )  Drawing cross-cutting lessons across countries to inform the performance of primary care systems

PRIMASYS Methodology  Summarise key aspects of structures and processes of PHC systems  Describe specific pathways contributing to successes and failures of PHC in LMICs  Set of key “fixed elements”: health financing, governance, PHC policies, PHC information systems, etc.  Mixed methods approach to PHC system assessment  “Flexible tracers” selected by countries  Strong country ownership

 Outputs: 20 “abridged” and “full fledged” case studies Phase 1 Bangladesh, Nigeria, Pakistan, South Africa, Tanzania Phase II Brazil, Cuba, Ethiopia, Indonesia, Iran, Kenya, Kyrgyzstan, Namibia, Peru, Thailand Phase III - TBD Synthesis: cross-country lessons learned across PHC systems PRIMASYS Outputs

National Health Council Local Councillor for Health Hospital Board District Health Council Provincial Consultative Health Forum National Consultative Health Forum Provincial Health Council Community Health Centre/Clinic Committee Hospital chains, specialists, general practitioners and allied workers, pharmacists, traditional healers Funders: Third party payers Members Out-of- pocket payers Suppliers Regional hospitals District Hospital Outreach community- based care Community Health Centres & Clinics Community- based services, including hospital step- down and home-based care Provincial Department of Health District Management Team National Department of Health Private for-profit service delivery, access requiring payment, patients move across to district health system when funds are exhausted Not-for-profit service delivery, access by referral across levels of care Environmental Health Community Health Centres & Clinics* Public service delivery, with referral up levels of care and down to homebased care * In large metros some ambulatory health services are administered by local government, with referral across to provincially administered district health system Local government Not-for-profit GOVERNANCE (in white and blue blocks) ARCHITECTURE OF SERVICE DELIVERY (in circles) PUBLICLY FUNDEDPRIVATELY FUNDED Office for Health Standards Compliance South African Health Products Regulatory Authority Medical Schemes Council Parallel to public with little hierarchical structure Health professionals councils Central hospitals

Primary Health Care Financing South Africa Increased per capita PHC expenditure… …driven by major vertical programmes on access to ART 39.8% of total PHC spending at provincial level in 2013/14

Examples of key priorities for action identified by countries Tanzania Access to quality medicines in private sector: National and district level stakeholders identified key challenges with sustaining quality of medicines in the private sector in rural areas through the Accredited Drug Dispensing Outlet (ADDO) Programme e.g. illegal selling of non-authorised, stolen or poor quality medicines; Health training in PHC institutions: - Poor coordination/oversight of health professional training Nigeria Health financing Main challenge: no clearly defined policy on financing of PHC services

Challenges and Opportunities  Summarising complex PHC systems (e.g. Pakistan, Nigeria)  Moving towards PHC improvements and addressing: PHC health systems failures & barriers to implementation of PHC policies Sustainability in PHC improvements Avenues of potential collaboration:  Knowledge management  PHC Research Consortium  Workplan on improved action: Better understanding of the PHC systems underpinnings will contribute to the roadmap for improved PHC performance measurement and improvement efforts Research of less documented aspects of quality PHC How to incorporate these findings into measurement platforms & real world improvements?

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