On-Going Projects

How are different LMICs implementing PHC team integration to support delivery of comprehensive PHC? A multi country mixed study – India, Mexico, and Uganda

Led by Dr Rohina Joshi is a team of researchers from India, Mexico, and Uganda studying the team integration at PHC facilities to support the delivery of CPHC in their country contexts. Below is an excerpt from this study.

It is a well-established fact that attaining and sustaining UHC is a function of comprehensive, accessible, people-centred, continuous, and coordinated comprehensive primary health care (CPHC) which is based on an empowered primary healthcare workforce. Against this backdrop, the PHCRC has commissioned a project to study how India, Mexico, and Uganda are implementing PHC team integration to support the delivery of CPHC.

This research is a convergent mixed-methods study (quantitative and qualitative) to gain an understanding of national policy to assess PHC teams and comprehensiveness on the ground. Specific objectives are:

  1. Review the national and subnational policy on PHC team composition and integration and expected comprehensiveness of PHC.
  2. Describe the actual composition and integration of PHC teams in the health services with the application of the Service Availability and Readiness Assessment (SARA) tool
  3. Evaluate the comprehensiveness of care provided by these teams.
  4. Conduct a comparative analysis of the relationship between PHC team composition and integration with the delivery of comprehensive PHC across the three LMICs.

Data will be analysed using descriptive methods and a thematic analysis approach. Outcomes will include an in-depth understanding of the health policies for PHC as well as an understanding of the team dynamics, services, performance, and workload.


Figure 1: Mixed methods methodology for studying team integration for CPHC

Current progress

Ethics approvals have been sought from relevant committees in the three countries India, Uganda and Mexico.

The team is facing difficulties and delays due to the COVID-19 situation, nevertheless, desktop reviews of relevant documents have been conducted in India, Mexico, and Uganda. The country teams have performed a review of the policy documents and policy analysis is underway. Team Mexico joined the study late due to inadvertent delays and is pursuing the review. Interesting findings so far:

  • India and Uganda have a decentralized system, but policies and guidance documents are published centrally
  • Mexico, which has a decentralized system is now planning to centralize the health system.

Next steps

Once there is some reprieve from COVID-19, the teams will resume field data collection. The immediate steps would be to validate the findings of Step 1 through facility assessment and stakeholder interviews.

Research team

Understanding the processes and use of data for primary health care performance management in low and middle-income countries: A multiple case study in El Salvador, Lebanon and Malawi

Led by Dr Wolfgang Munar, researchers from the George Washington University – El Salvador, Malawi and Lebanon is qualitatively studying how the data collected at the primary health care level is employed to make decisions on performance management.

The choice of this study topic was premised on the fact that high quality data is credited as one of the tools managers utilize to make decisions on a daily basis. This has been recognized as one aspect that facilitates the understanding of institutional functioning, its performance against set standards and identifying service delivery gaps. However, anecdotal information seems to suggest that the awareness of the tools and practices used to facilitate data aggregation, synthesis and utilization to measure PHC performance at sub-national levels in developing countries are uncertain. There seems to be a paucity of data on documenting the processes and practices in data collection, synthesis and utilization. The study hence intends to assess the way PHC data is collected, synthesized and utilized in El Salvador, Lebanon, and Malawi. The findings will assist in proposing methods of creating or modifying the strategies of data collection, analysis and utilization as a step towards improving the quality of PHC data for performance measurement management.

Current Progress/impediments/learnings

The corona virus pandemic has had a severe impact on the study timelines and as such ethics approval is still awaited in El Salvador and Lebanon.  However, Malawi received the ethics approval in March 2021 and kicked off the study with a training program for qualitative research assistants. Among other activities during training was the piloting and improvements of the data collection tools. The process of data collection started few days after the training in all the selected five districts of Malawi (Chikwawa, Balaka, Ntcheu, Dowa and Nkhatabay and MOH). Except for a few hiccups like delay in meeting with the key personnel like District Health Officers and Zonal Managers who are inundated with the current situation, the data collection is proceeding smoothly and alternate methods such as skype interviews etc are being explored to mitigate any delays.

Expected results

In Malawi, the data reveals that data collection, analysis and utilization is a norm at all levels of PHC.However, inconsistencies in this process exist. The inconsistencies appear to be emanating from various aspects. For instance, it appears there is a lack of awareness on the existence of policy guidelines on data collection, analysis and utilization. This appears to be among the reasons data management practices is not uniformly done.  Further, the scarcity of human and material resources are impacting the quality of data. For instance, a lack of registers, qualified data officers and computers/tablets have been reported. One among aspects that have been linked to poor quality data is workload among health workers which has resulted in having files not filled/edited at the facility level. The major findings of the study will be highlighted in the final qualitative report which will be released as soon as it is completed.

Research teams in El Salvador and Lebanon hope to receive the ethics approval soon, meanwhile, they have created stakeholder maps in different levels of PHC for interviews, alongwith desktop review of literature to help them understand the context better.

Research team

The effect on outcomes of country-specific strategies and primary health care strength in the COVID-19 pandemic response: an international study

The purpose of this survey is to assess the preparedness and response strategies as well as the strength of primary health care in different countries due to the coronavirus disease 2019 (COVID-19) pandemic on various health outcomes including death rates. We seek primary health care clinicians, researchers and policy-makers who can respond regarding their own countries.

Led By

An International Survey on the Integration of Public Health and Primary Care in COVID-19 Vaccination Campaigns

In collaboration with Dr David Ponka the PHCRC is engaged in a study to understand public health and primary care integration in vaccination campaigns for COVID-19.

Optimizing vaccination rates is key to preventing third and fourth waves of COVID-19 illness around the world. What is less clear is what the precise role of primary care/family medicine is in partnering with public health to deliver these vaccines. The PHCRC is seeking answers to this question and supporting a research study entitled FM Vax: An International Survey on the Integration of Public Health and Primary Care in COVID-19 Vaccination Campaigns. Sponsored by the PHCRC and led by the Besrour Centre for Global Family Medicine at the College of Family Medicine of Canada, this study will survey primary care providers around the world with a focus on low-middle income countries, where vaccination campaigns are generally still being initiated.

The lessons learned from this study will inform these fledgling campaigns as well as what are likely to become regular national COVID-19 vaccination campaigns in the future. How to reach priority populations, how to track vaccination status at the individual and populations levels, and how to ensure coverage at regional and national levels are all key questions that will inform us about the nature of public health and primary care/family medicine cooperation. We are surveying what is presently occurring, and what lessons may be transferrable across contexts.

The core team for this study comprises Drs. Sumeet Sodhi and David Ponka from the Besrour Centre for Global Family Medicine, Canada; Dr. Bob Mash from Stellenbosch University, South Africa; Dr. Praveen Devarsetty from the George Institute for Global Health, India; Dr. Marcelo Garcia Dieguez from Universidad Nacional del Sur, Bahia Blanca, Argentina ; and Dr. Felicity Goodyear-Smith from the University of Auckland, New Zealand.

For more information and to join our team to facilitate survey distribution in your country/region please contact: Dr. David Ponka, dponka@cfpc.ca

Research team