Table 2

Summary of evidence of interventions to improve PHC coverage

What works?Where?Why? (enablers of success)
Service delivery model
 Community-based service delivery by lay and other non-physician health workers
  • Nepal (pneumonia)23

  • Afghanistan (PHC)70

  • Nepal (female community health volunteer programme)105

  • India, Nepal (mental health)67

  • India (maternal, antenatal care)106

  • Afghanistan, Nepal (maternal, child, reproductive health)45

  • Jamkhed, India (neonatal/postnatal health)107

  • West Bengal, India (PHC)108

  • Goa, India (mental health)109

  • Pakistan (maternal and reproductive health)50

  • Indonesia (maternal and neonatal health)49

  • Long-term programme development and maintenance

  • Strong integration with national health system, including functional referral system and access to medicines

  • Tailored training package (baseline+refresher)

  • Regular monitoring and supervision

  • Immediate feedback

  • Standardised checklists

  • Community oversight; local ownership

  • Paired male/female CHWs and peer support

  • Maintaining CHW motivation through financial and non-financial incentives (social respect, community standing)

  • Cultural acceptance of CHW

Outreach and community engagement
 Community-based behaviour change intervention
  • American Samoa (diabetes)38

  • China (CVD, diabetes)39

  • Pakistan (immunisation)40

  • Thailand (diabetes prevention)41

  • American Samoa (prenatal care)110

  • Education sessions with household heads

  • Reminder services

  • Cultural connexion between CHW and patients to enhance trust

  • Participatory design, tailored to needs

  • Offer of free care for uninsured increased demand

 Community education, awareness raising, campaigns
  • Bangladesh (TB)26

  • Kerala, India (adolescent sexual and reproductive health)111

  • Nepal (maternal health)43

  • Cambodia, India, Nepal (TB)44

  • Training of health workers in use of national guidelines

  • Targeting mothers, teachers, students, religious and community leaders

  • House-to-house screening

  • Referral to accessible, culturally appropriate clinics

  • Sustained supply of test reagents and pharmaceuticals

  • Consultative, needs-based intervention design

  • CHW, community health worker; CVD, cardiovascular disease; PHC, primary health care.