Table 5

Summary of evidence of approaches to improve PHC equity

What works?Where?Why? (enablers of success)
Service delivery model
 Use of CHWs (task-shifting)
  • Myanmar (PHC)75

  • Afghanistan (midwifery)74

  • Indonesia (PHC)53

  • Community involved in selection of CHWs, deployment and retention

  • Commitment from community and families to support CHWs

  • Baseline and annual refresher training for CHWs

  • Established links between clinic-based services and mobile teams

  • Opportunities for women in rural areas—education, work in health delivery

PHC system financing
 Contracting to non-state providers
  • Afghanistan (PHC)77

  • Bangladesh (PHC)65

  • Bonus system linked to health equity targets

  • Health worker education, supervisory visits and supportive supervision; quality of care

  • NGO greater flexibility in reallocating fixed budget

  • CHWs actively referring patient to NGO-funded tertiary facilities

  • Available/improved infrastructure and medicines

  • Wider variety of service offered

  • Closer ties to community

  • Organised outreach services

Community engagement
 Community empowerment/ownership
  • Chattisgarh, India (PHC)78

  • Community-led monitoring, planning and action

  • Engagement of community leaders: village health committees, women’s leadership

  • Data shared with community, consultation on service improvement

  • Community mortality data registries available to provide evidence of health inequities

Patient management tools
 Digital health: mobile phone/tablet-based decision support tool
  • Afghanistan (mental health)76

  • CHWs able to undertake guideline-based screening in remote areas

  • Efficient referral links to facility-based services

  • Improved access to care through telehealth consultations

  • Reduction of stigma in the community

  • CHW, community health worker; PHC, primary health care.