New global research agenda to advance PHC and achieve UHC

Primary care researchers have conducted studies to identify the gaps in global knowledge about what works in primary health care and prioritised a new research agenda that focuses on four key areas:
• organisation and models of care;
• quality, safety, and performance management;
• policy and governance;
• and financing of primary care systems.

The project was funded by the Bill & Melinda Gates Foundation to further the work of the Primary Health Care Performance Initiative, a partnership led by the Gates Foundation, the World Bank Group and the WHO, with Ariadne Labs and Results for Development.

A WONCA research team, led by Working Party on Research Chair, Felicity Goodyear-Smith, won two of the grants and therefor conducted two of the studies (on organisation and on financing of primary care). Other members of the research team include WONCA past presidents Amanda Howe, Chris van Weel and Michael Kidd.

The findings of the project are published in a special issue of BMJ Global Health, “Strengthening Primary Health Care Through Research: Prioritized knowledge needs to achieve the promise of the Astana Declaration,” released online August 15.

The WONCA study on organisation of primary health care in low and middle income countries (LMICs) can be found online. The results were four priority research questions to inform decisions on implementing or improving primary health care organization models:

• What are the factors to be considered and negotiated for successful referral from primary to secondary care and back?
• How should care be horizontally integrated and coordinated among the multidisciplinary team?
• How can the public and private sectors work more collaboratively to improve and integrate coverage and prevent segmentation of the services?
• How can different stakeholders (e.g. policymakers, health system managers, health workforce organisations, academic institutions, and communities) support and assist the primary health care workforce and successful team functioning?

The free link to the WONCA financing primary health care in LMICs paper is here.

The knowledge gaps potentially critical to improving PHC financing were distilled into the following four prioritised research needs:
• What is the most appropriate payment system to increase access and availability of quality primary health care?
• What are the mechanisms for effective persuasion of governments to invest in primary health care?
• What is the ideal proportion of the total health care budget to guarantee development of quality care?
• What are the factors and incentives to improve distribution of the primary care workforce for access equity?

Seven teams of researchers, many of them members of the WONCA Working Party on Research, developed implementation plans as to how these questions on organisation and financing might be implemented in their own countries.

The funders, Ariadne Labs, are working towards creation of a global research consortium to carry out prioritised research that bridges the divide between health policymakers, implementers, and academic researchers. Initial member organisations of this consortium will be the six organisations that received support to conduct the research: the World Organization of Family Doctors (WONCA); the Family Medicine Education Network (Primafed) in sub-Saharan Africa (led by member of the WP-R Bob Mash); the American University of Beirut; the George Institute for Global Health; the George Washington University, and the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b).

Felicity Goodyear-Smith
Chair WONCA Working Party on Research