Health systems vary from country to country, but the backbone of each one—people’s first and main source of care—is primary health care (PHC). When grounded in an understanding of the context, challenges, and priorities of local communities, PHC can meet the vast majority of people’s health needs at all stages of life.
Communities can count on PHC providers for the majority of services they need, ranging from checkups during pregnancy and vaccines for children to management of chronic conditions or care at the end of life. With the necessary technology and equipment, welltrained PHC providers can track people’s health over time; refer them, when necessary, to more specialized care; and proactively engage with them to foster physical, mental, and social well-being. Achieving universal health coverage (UHC)—in which all people can obtain highquality health care without risk of financial hardship—depends on effective PHC.
Comprehensively tracking population health and monitoring the delivery of PHC services is critical to improving PHC and achieving UHC. And yet, health programs have historically taken a “vertical” approach, focusing on achieving rapid results in priority areas such as family planning, tuberculosis, or malaria. This has resulted in fragmented service delivery and information systems, which can compromise patient care and outcomes. Weak measurement systems are both a cause and a result of system fragmentation: when care is not coordinated across facilities, providers struggle to track patient progress over time, and when historical data are not readily available, providers may make decisions without a complete understanding of the patient’s health. Moreover, a lack of coordinated information systems often leads to duplicative data collection. Many countries indicate that they are both overburdened with data collection and reporting requirements for vertically oriented programs and simultaneously lacking key information that would provide a more holistic view of PHC performance and help inform evidence-based decisions at the community, facility, district, and national levels.
In contrast, when data are effectively captured and communicated from the community or facility level to district, regional, and national levels, policymakers, health system managers, and frontline providers can more easily diagnose problems, strategically direct investments, and monitor improvements. They can identify changing population needs and make needed adjustments in policy and practice in response. From the patient perspective, integrated data systems that build on and link information from different health programs can increase continuity of care and ensure that PHC is the entry point for addressing the health and well-being of the whole person, serving as the first and main source of care for individuals throughout their lifetime.
Translating data into potent policy solutions that align with changing population health needs requires a culture of data use. Many countries recognize the valuable role that data can play in supporting responsive, person-centered PHC and have used data to address challenges in both system organization and service delivery. This report, prepared by the Primary Health Care Performance Initiative, features a collection of case studies that detail how countries have used data to spur innovations in PHC and accelerate progress toward UHC. These examples demonstrate that the core characteristics of high-performing PHC—including serving as people’s first and main point of entry into the health system, person-centeredness, comprehensiveness, continuity, accessibility, and coordination—can be supported and improved through better data collection, analysis, dissemination, and use. They also show that generating evidence and using information strategically are crucial to realizing the promise of PHC.
Case Studies: Key Themes
The seven case studies in this document represent five diverse countries—Argentina, Ghana, Rwanda, Senegal, and Tanzania—and demonstrate a broad range of ways that data can be used to improve PHC. Although these countries span a range of income levels and contexts, the case studies highlight a number of common themes:
- Incorporating local, regional, and national-level data into priority setting can help ensure that practices are sustainable and scalable while remaining relevant and appropriate at the community level. Communicating information about local challenges and priorities to district, regional, and national health system managers helps ensure that solutions are responsive, scalable, and sustainable and can contribute to the national and global knowledge base. Case studies from Ghana, Argentina, and Tanzania describe how countries are balancing the use of both local and national data in their efforts to improve population health.
- Integrated data systems provide a comprehensive view of system performance and can help ensure that care is available when and where patients need it. Effective PHC service delivery requires not only that care be geographically and financially accessible to patients and delivered in a timely manner but that providers have the requisite information to respond effectively to each patient’s health needs. This means that countries must work to overcome “siloed” information systems, in which data on patients and programs is collected but not communicated across providers or between initiatives. Case studies from Senegal and Tanzania describe how health system managers overcame siloed information systems to better track how people and commodities move through the system.
- Coordinated and continuous care depends not only on technology solutions to connect patients across providers and levels of care but also on effectively collecting and disseminating data. Telehealth technologies, including mobile devices, are allowing patients in remote areas to access high-quality medical advice and enabling community volunteers to convey health danger signs easily and effectively to higher levels of care. These methods of collecting data and providing care are fueled by strong data systems that allow patient information to be collected, aggregated, and analyzed easily and securely. Two case studies describe how Rwanda is using telehealth technologies and digital health solutions, along with robust data collection and sharing mechanisms, to redefine the gathering of patient information and the provision of care.
- Strengthening PHC as the foundation for achieving UHC depends not only on the generation of new data but on the better analysis and use of existing data to identify areas of weakness and develop innovative solutions. Strategies for data use range from measuring underprioritized elements of service delivery to linking patient data across providers and facilities to enhance coordination of care. The final section of this document describes a tool pioneered by these five countries that helps identify strengths, diagnose challenges, and monitor progress in strengthening PHC.
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