Towards Primary Health Care Systems That Produce Impact

Community and primary health care facilities are the first level of contact with the conventional health systems, thereby bringing health care close to where people live. Primary health care (PHC) is defined as essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community, through their full participation and at a cost that the community and country can afford to maintain, at every stage of their development in the spirit of self-reliance and self-determination. PHC is therefore the bedrock of a country’s health system and the overall social and economic development of the community. To strengthen and build health systems that produce positive patient and community outcomes, we recognize the need to design and implement interventions differently. Existing data is often poorly utilized and many service and intervention designs are based on historical practice. To avoid a repeat of historical outcomes and to design and implement interventions that are relevant and suited to contexts, we propose to start with a bottom-up participatory approaches from project inception, co-design, co-implementation and co-evaluation as the directionality of research determines the themes of focus. Research that starts by engaging national Ministry of health actors going down to province, district, sub-district to facility level is shaped by the themes that matter to the top health system actors, themes that emerge in the data analysis and in turn shape the interview guide as data collection cascades down. We would like to argue that bottom-up research that starts by engaging with the community, is shaped by the themes of focus, the themes that matter to the community, captured during analysis and in turn shape the interview guide as data collection proceeds to higher health system levels. To that end, we propose a bottom-up approach to data collection in research and programs to facilitate responsive primary health care systems.