Table 4

Summary of evidence of approaches to improve PHC responsiveness

What works?Where?Why? (enablers of success)
Service delivery model
 Use of non-physician health workers

  • India and Nepal (mental health)67

  • Thailand (PLHIV ART)68

  • American Samoa (diabetic control)69

  • Afghanistan (basic package of MCH, disease prevention)70

 

  • Positive relationship between CHWs and community

  • Convenience of accessing services: home visits, patient choice of service location

  • Affordability of services

  • Availability of medicines

  • Individualised care plans

  • Paired male/female CHWs removes gender barriers to access

Community engagement
 Patient/community engagement

  • Thailand (diabetes prevention; family nurses)41 72

  • Mangalore, India (family folders)71

  • Nepal (maternal and child health)43

  • Local ownership: community groups and local organisations define local problems and are involved in programme design

  • Involvement of village/local leaders

  • Enhanced healthcare worker trust increases service utilisation

  • Health education sessions and materials in local language

  • Partnerships with traditional healers to integrate ‘new’ and traditional knowledge

 Family-centred care

  • Thailand (family nurses)72

  • Mangalore, India (family folders)71

  • Facilitating change in social context

  • Strengthens interpersonal/family relationships

  • Continuity of services

  • ART, anti-retroviral therapy; CHW, community health worker; MCH, maternal and child health; PHC, primary health care; PLHIV, persons living with HIV.