Trustees of Boston University

Primary healthcare Reducing Inequities through Multilateral Asian-African Regional Initiatives (PRIMAARI) Highly Ranked

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Project Summary

While the world has made great strides in addressing specific diseases, half the population remains marginalized and lacks access to essential health services. Millions still die from preventable, treatable conditions because many low-resourced countries lack high-quality, community-based primary healthcare (PHC) systems - proven essential to reducing health inequities and ensuring healthy lives and promoting well-being for all at ages. Using our comprehensive PHC playbook in a regional strategy to apply a family-oriented and patient-centered approach to curative and preventive care across the entire life course, we will advance six countries on two continents towards nationwide scale-up of high quality PHC. We begin by building human capital – both national PHC champions and grassroots providers. Then we empower these champions to establish new flagship models of care and secure alliances with government and aid agencies to support national expansion of their work, setting improved, equitable and sustainable foundations for health for all.

Problem Statement

Despite successes in the fight against specific diseases such as HIV, many countries still have weak health systems - thus half the world’s population cannot access essential health services, and millions continue to die from preventable and treatable conditions.Believing that “if you can’t measure it, you can’t manage it,” the global health community has tended to avoid addressing the complex challenges of re-ordering and strengthening entire healthcare systems and making them more equitable in favor of focusing on narrower problems and easy-to-measure solutions. However, when the foundation of primary health care (PHC) in both urban centers and rural communities is neglected, health systems become distorted and disjointed, patients seek care wherever they can find it—traditional healers, pharmacies, sub-specialist clinics, or tertiary hospitals—and health inequities grow. Patients shouldn’t have to choose between treatment for their acute infection or chronic disease—comprehensive care lays the groundwork for equitable care. When patients access care, they want to know their primary problem will be dealt with – whatever it is - and they can get care for more than one issue or if another family member is sick. PHC is equipped to manage the complexities of a whole person, and IS measurable measurable and proven to save lives from ALL causes. This begins with a competent workforce capable of providing comprehensive care, equipped to deliver new models of care, and supported with policies promoting PHC. Applied in parallel, this sets the necessary foundation for health for all.

Solution Overview

Lack of access to essential health services is the single biggest worldwide problem in urgent need of a transformative solution, and establishing strong foundations for health systems built on PHC is the clear solution. Research shows quality PHC saves lives - not just from the horrors of HIV or heart disease or tragic complications of childbirth - but from all diseases for everyone, everywhere to promote true health equity. Sustainably adding just one more skilled and properly equipped PHC provider to a community has the potential to save more lives than eradicating infectious disease. Our PHC playbook ensures communities have such providers by preparing PHC champions for success with skill and tools to train thousands of front-line health workers. Simultaneously, we support their creation of new flagship service delivery models and partner with political leadership and PHC advocates to create and revise national health policies. Applied together and through mutually reinforcing regional partnerships, health systems for all populations across six nations on two continents will show improvements in process and outcomes.Global stakeholders have aligned in conceptualizing PHC and identifying potential measures to monitor PHC system performance – such as from the primary healthcare Performance Initiative’s Vital Signs Profile ( - although neglect of PHC has still left many data gaps. At GHC, we have piloted and applied multiple methods of measuring quality PHC in low and middle income settings. We will align these with those promoted by PHCPI, to determine baseline PHC performance and monitor anticipated improvements in health for all.

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Project Funders

  • Atlantic Philanthropies 2006 - 2012
  • W. K. Kellogg Foundation 2007 - 2011
  • Abbott Fund 2009 - 2013

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