Status, and pathways to implementing the revitalised PHC approach in the WHO African Region: a mixed-methods study

The revitalised primary healthcare (PHC) approach aims to enhance attainment of health results. However, implementation challenges persist, due among other issues, to different ways its different drivers are interpreted and applied in practice. In this study, we explore the status, and most appropriate ways the PHC approach drivers need to be applied. Through this, we propose country-specific priorities and optimal pathways for its implementation.

We develop a measure of the status of its different drivers-3 components, 4 strategic and 10 operational levers-in each country of the WHO African Region, using perspectives from stakeholders in each country. We use this information to derive specific indices for each driver, which are then used to construct a relative measure of PHC implementation. We apply structural equation modelling to analyse the optimal pathway these different drivers use to best impact the health results chain.

On a scale of 0-1, representing no-full relative implementation of the revitalised PHC approach drivers, the scores of the countries in the region range from 0.37 to 0.90. Similarly, the scores for the constituent PHC drivers ranged from 0.71 for the PHC components average, down to 0.60 for the operational levers. The optimal pathway to achieving health results is one where the PHC components influence the status of the strategic levers, which influence health investments either by focusing on the operational levers specifically or the functionality of the system to achieve desired results.

The study shows that the adoption of the revitalised PHC approach should go beyond policy rhetoric and focus on integrating and sequencing its drivers and constructs into targeted areas of the results chain for maximal impact on health results.