A new global research agenda to advance primary health care

Effective primary health care is a critical part of ensuring health for all. To that end, leaders in many low- and middle-income countries (LMICs) are eager to build, reform, and strengthen their primary health care systems to deliver high-quality, integrated, and patient-centred care. The question is, how?

In a sweeping new effort, 76 researchers, practitioners, and policy-makers from 19 countries identified the gaps in global knowledge about what works in primary health care and how to build effective primary health care systems and prioritized a new research agenda that focuses on four key areas:

  • organization and models of care
  • quality, safety, and performance management
  • policy and governance
  • financing of primary health care systems

The findings are published in 14 articles 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 today.

The special issue has resulted from the work of the Primary Health Care Measurement and Implementation Research Consortium, which is spearheaded by the Alliance and Ariadne Labs – a joint centre of Brigham and Women’s Hospital and the Harvard T. H. Chan School of Public Health. Funding for the research studies, which were undertaken by six organizations around the world, was provided by the Bill and Melinda Gates Foundation.

Among the articles is a commentary from the Alliance, WHO, Gavi, the Vaccine Alliance, UNICEF and Johns Hopkins Bloomberg School of Public Health. The commentary focuses on the central role that three-way partnerships between grass roots citizens, local political leaders and technical health experts can play in developing and strengthening primary health care systems. The article argues that:

“The three-way partnership naturally sustains progress because the ordinary citizens of a community whose lives are most affected by the outcomes are at the table, and because the political leaders who control local purse strings are put in touch with what can be an expression of local will. The presence of a technical expert who can bring data about the size, scope, determinants, and evidence-based solutions is critical to bring 21st century breakthroughs into hands of the people and their local political leaders who can best determine how to adapt them to context.”

Part of the role that UN agencies and global NGOs can play is ensuring communities and other stakeholders are able to participate effectively in prioritization and planning of primary health care. And one of the ways the Alliance, Gavi and UNICEF have been approaching this is through championing embedded implementation research projects around the world.

The Alliance and its partners argue in a different article in the special issue that another way to support improvements in primary health care is to support a global research consortium to carry out prioritized research that bridges the divide between health policy-makers, implementers, and academic re-searchers. This consortium has the ability to ensure that the generated research is actionable and accelerates much needed cross-country learning.

The prioritization and scoping exercises highlighted in this BMJ Global Health special issue have identified critical research gaps and priority questions to address that could enable leaders in LMICs to see through the vision first outlined in Alma-Ata some forty years ago – and to which there was a re-commitment in last year’s Astana Declaration – of health and well-being for all.

Adding to the evidence base and prioritizing research questions in different regions is one reason why this special issue, and other investigations into primary health care – like the Alliance’s PRIMASYS project – are so important.