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What kind of evidence do we need to strengthen primary healthcare in the 21st century?
  1. Lisa R Hirschhorn1,2,
  2. Etienne V Langlois3,
  3. Asaf Bitton4,5,
  4. Abdul Ghaffar3
  1. 1 Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  2. 2 Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  3. 3 Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
  4. 4 Ariadne Labs, Boston, Massachusetts, USA
  5. 5 Division of General Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
  1. Correspondence to Lisa R Hirschhorn; lisa.hirschhorn{at}

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The increased recognition of the critical importance of quality primary healthcare (PHC) to achieve effective universal health coverage (UHC) and contribute to the sustainable development goals (SDGs) has reignited global interest in strengthening PHC systems and delivery.1 However, this focus has also highlighted the implementation gaps between evidence-informed interventions and their delivery to all people everywhere. These gaps include how to better measure PHC to identify and address challenges and how to adapt and scale effective interventions to bridge three main transitions: evidence to policy, policy to implementation and implementation to system quality and its maintenance. Recent global evidence has shown that system quality failures are now responsible for more deaths than lack of access to care, and greater still than the burden of HIV, tuberculosis and malaria combined.2

While there is a growing attention to measuring and improving access to quality primary care, the state of PHC research in low-income and middle-income countries (LMICs) is currently fragmented, uncoordinated and underfinanced. Most PHC research in LMICs comes from a few high-performing middle-income countries; entire regions of the world have little comparable and available PHC systems, quality and outcome data.3 Furthermore, a large proportion of PHC research pertaining to LMICs is still conducted and led by high-income country researchers, raising ethical and practical issues of ownership and research relevance.4 Too often this work is focused on measuring and improving inputs to care—including supplies, infrastructure and financing—while ignoring the core functions of service delivery as experienced by users of the system, and the upstream challenges of PHC policymaking and PHC system reforms. While a plethora of research exists on different facets of PHC globally, the confluence of a global agenda on PHC revitalisation is generating an urgent need to prioritise disparate research efforts. Further efforts are needed to …

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