Table 1

Summary of evidence of interventions to improve PHC quality

What works?Where?Why? (enablers of success)
Workforce development
 Short-course/in-service training

  •  Goa, India (mental health)24

  •  Bangladesh (paediatric TB)24

  •  Nepal (neonatal/child health)22 23

  •  Builds/maintains skills and knowledge of providers

  •  Refresher training supports motivation, especially of lay workers

  •  Linked to success of task-shifting

 Peer-mentoring and supportive supervision

  •  Karnataka, India (maternal and neonatal health)34

  •  Karnataka, India (essential obstetric care)33

  •  Odisha, India (immunisation)35

  •  Dedicated (employed) nurse mentors

  •  Rapport/trust between mentors and PHC staff

  •  Support visits from trainers for mentors linked to training

  •  Team-based self-assessment

Patient management tools
 Decision-support system, for example standard treatment guidelines evidence-based care guidelines

  •  Telangana, India (hypertension)58

  •  Karnataka, India (maternal and neonatal health)33

  •  Nepal (neonatal/child health)22

  •  Timor-Leste (eye care medication)27

  •  Rajasthan, India (maternal and neonatal health)100

  •  Malaysia (medical errors)36

  •  Uttar Pradesh, India (maternal and perinatal health)101

  •  Providers (re-)trained in use of decision-support tools

  •  Simple visual aid to support use of care guidelines

  •  Opportunistic screening by CHWs

  •  Functional referral system between outreach and facility-based care

  •  Regular supply of medicines/free medicines

  •  Supervisory support, coaching: cycle of regular assessment, feedback, training and action

 Digital health: mobile phone/tablet-based decision-support tool

  •  Himachal Pradesh, India (hypertension, diabetes)31

  •  Haryana, India; Tibet, China (CVD)30

  •  Afghanistan (mental health)76

  •  Andhra Pradesh, India (CVD)102

  •  Ability to tailor patient care based on algorithm

  •  Easy to follow clinical management guidelines

  •  Links to virtual consultations (telehealth)

  •  Enhanced CHW capabilities and motivation

  •  Clear team structure

  •  Improved access to screening at home

Outreach and community engagement
 Digital health: text messaging

  •  Afghanistan (mental health)76

  •  Malaysia (chronic diseases)103

  •  Community acceptance of technology

  •  Message content targeted and easy to understand

 Participatory problem identification and solving

  •  Vietnam (maternal and neonatal health)104

  •  Community mobilisation

  •  Participatory action

  •  Continuous improvement cycle (plan-do-study-act)

Systems of care
 Introduction of CQI systems and ‘structured process change’

  •  Malaysia36

  •  Australia (and Fiji)37

  •  Training of health staff

  •  Regular coaching (supervision and mentoring)

  •  Patient education

  •  Re-formatted case sheets reduced documentation errors

  •  Presence of local champion

  • CHW, community health worker; CQI, continuous quality improvement; CVD, cardiovascular disease; PHC, primary health care.