Towards Primary Health Care Systems That Produce Impact

Janet Michel; Kimberly Green; Marcel Tanner

Abstract

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.

References

1.
PAHO/WHO|Declaration of Alma-Ata. Pan American Health Organization/World Health Organization 2017. Available online: https://www3.paho.org/hq/index.php?option=com_content&view=article&id=13774:declaration-of-alma-ata&Itemid=0&lang=en#gsc.tab=0 (accessed on 23 November 2025).
2.
Gholipour, K.; Shokri, A.; Yarahmadi A.A.; et al. Barriers to community participation in primary health care of district health: A qualitative study. BMC Prim. Care. 2023, 24, 117.
3.
Boum, Y.; Kwedi-Nolna, S.; Haberer, J.E.; et al. Traditional healers to improve access to quality health care in Africa. Lancet Glob. Health. 2021, 9, e1487–e1488.
4.
Kapologwe, N.A.; Kengia, J.T.; van Praag, E.; et al. Primary Health Care in Tanzania through a Health System Lens: A History of the Struggle for Universal Health Coverage; CAB International: Oxfordshire, UK , 2023.
5.
Thomas, S.; Sagan, A.; Larkin, J.; et al. Strengthening Health Systems Resilience: Key Concepts and Strategies; Policy Brief 36; European Observatory on Health Systems and Policies: Copenhagen, Denmark; 2020.
6.
Michel, J.; Evans, D.; Tediosi, F.; et al. Lest we forget, primary health care in Sub-Saharan Africa is nurse led. Is this reflected in the current health systems strengthening undertakings and initiatives? J. Glob. Health Rep. 2018, 2, e2018001.
7.
Michel, J.; Datay, M.I.; Motsohi, T.J.; et al. Achieving universal health coverage in sub-Saharan Africa: The role of leadership development. J. Glob. Health Rep. 2020, 4, e2020037.
8.
Barasa, E.W.; Cloete, K.; Gilson, L. From bouncing back, to nurturing emergence: Reframing the concept of resilience in health systems strengthening. Health Policy Plan. 2017, 32, iii91–iii94.
9.
Schneider, P.H. Reimagining Health in the Eastern Cape: A Dysfunctional Public Health System Is not Inevitable. Spotlight 2020. Available online: https://www.spotlightnsp.co.za/2020/11/20/reimagining-health-in-the-eastern-cape-a-dysfunctional-public-health-system-is-not-inevitable/ (accessed on 23 November 2025).
10.
How and Why Policy-Practice Gaps Come about: A South African Universal Health Coverage Context. Available online: https://www.joghr.org/article/12185-how-and-why-policy-practice-gaps-come-about-a-south-african-universal-health-coverage-context (accessed on 23 November 2025).
11.
Michel, J.; Mohlakoana, N.; Bärnighausen, T.; et al. Testing the contextual Interaction theory in a UHC pilot district in South Africa. BMC Health Serv. Res. 2022, 22, 343.
12.
Ready for the Next Crisis? Investing in Health System Resilience|OECD. Available online: https://www.oecd.org/health/ready-for-the-next-crisis-investing-in-health-system-resilience-1e53cf80-en.htm (accessed on 23 November 2025).
13.
Michel, J.; Mohlakoana, N.; Bärnighausen, T.; et al. Varying universal health coverage policy implementation states: Exploring the process and lessons learned from a national health insurance pilot site. J. Glob. Health Rep. 2020, 4, e2020036.
14.
Boyle D. The Great Debate: Checklists Versus Tick Box. New Weather Institute 2020. Available online: https://www.newweather.org/2020/01/22/the-great-debate-checklists-versus-tickbox/ (accessed on 22 June 2023).
15.
McKee, M. Bridging the Gap Between Research and Policy and Practice. Int. J. Health Policy Manag. 2019, 8, 557–559.
16.
Hudson, B.; Hunter, D.; Peckham, S. Policy failure and the policy-implementation gap: Can policy support programs help? Policy Des. Pract. 2019, 2, 1–14.
17.
10 Districts Announced for NHI Pilot. SA News 2012. Available online: https://www.sanews.gov.za/south-africa/10-districts-announced-nhi-pilot (accessed on 22 June 2023).
18.
Michel, J.; Evans, D.; Tanner, M.; et al. Identifying Policy Gaps in a COVID-19 Online Tool Using the Five-Factor Framework. Systems 2022, 10, 257.
19.
AfricaCDC. Communique: Outcome Statement by Africa CDC’s Primary Health Care (PHC) Digitalization Expert Committee; AfricaCDC: Addis Ababa, Ethiopia, 2025.

Scilight Press

Author Information

Abstract

Keywords

References

About Scilight

Journals

Publishing Policies

Contact Us