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Impact assessment of primary care delivery models
 

Research study to assess how an integrated community life center approach compares to other models of primary care delivery in access, utilization and quality of care

    About

     

    It is widely recognized that strengthening primary healthcare is the most efficient, fair and cost- effective way to organize a health system and achieve the goal of universal healthcare access. Philips has developed a platform for strengthening primary and community healthcare, empowering the community itself to sustain it. The Community Life Center (CLC) is a collaborative, holistic solution that provides infrastructure, digital innovations, technological equipment improvements, staff and management training, and community engagement and support. 


    Philips Foundation commissioned the KIT Royal Tropical Institute to conduct an impact assessment study to establish how this integrated approach performed compared to more traditionally set up primary healthcare facilities on aspects such as access, utilization of services, and perceived and realized quality of care.

     

    Partners

    How

     

    The study evaluated the effects of CLCs in three settings across Kenya and South Africa. A mixed- methods approach was used in this cross-sectional study that compared CLCs to control facilities. Client exit interviews, in-depth interviews, focus group discussions, key informant interviews, and facility and consultation observations evaluated the relevance of services offered, healthcare-seeking behaviour, perceived and observed quality of care, and the appropriateness of support and management functions. The study was conducted between September 2019 and December 2020.

    Results

     

    Overall, the primary care services were appreciated by CLC clients, well-aligned with national health priorities and the local burden of disease, and of sufficient quality. Improvements in physical assets and technologies contributed to an attractive and safe primary care experience for CLC clients. Process aspects of the CLC concept, such as community outreach and engagement, monitoring, and training and supervision, were less clearly defined and varied across study settings.


    The community health worker/volunteer (CHW/V) outreach component of the CLC concept focused mainly on the use of a community outreach backpack, while other aspects of community engagement such as health literacy and dialogue on health needs were less apparent in the locations studied.

    Learnings and next steps

     

    Differences were observed in how the CLC concept added most value in Kenya vs South African contexts. In Kenya, improved quality was mostly through structural improvements, while in South Africa it was more through attitudes and staff behavior. KIT suggests this may be related to overall higher level of health expenditure and, therefore, availability of resources in South Africa. The contextual situation should therefore be considered in further developing and positioning the CLC concept.

     

    For the CLC concept to succeed, it is important to establish a clear formal co-creation process that specifies the roles and responsibilities of local governments, implementing organizations, target communities, and Philips. These aspects are all important in order to optimally utilize the holistic set up and meet expectations of all stakeholders. 

     

    KIT notes that the CLC model has great potential to align with the three interrelated and synergistic components of the renewed definition of primary healthcare as defined by global health experts and world leaders in the Astana Declaration on Primary Health Care. These components include:

     

    1. Meeting people’s health needs through comprehensive promotive, protective, preventive, curative, rehabilitative, and palliative care; 
    2. Systematically addressing the broader determinants of health; and
    3. Empowering individuals, families, and communities to optimise their health.

     

    The synthesis study reports includes a more detailed assessment of the current CLC deployments related to these components.

    When

    2019 - 2021

    Status

    Concluded

    Where
    Kenya and South Africa

    Middle East & Africa, Kenya and South Africa

    Care to collaborate, or want to learn more about this project?  
    Do not hesitate to contact us.

    In line with Sustainable Development Goal 17 (partnerships for the goals), we believe we can make a real difference in providing access to quality healthcare if we work together.

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