Review the Effectiveness of Community-based Primary Health Care in Improving Child and Maternal Health: Leveraging Results for Advocacy ENRIC JANE

1. COMMUNITY BASED PRIMARY HEALTH CARE
© 2014 Bill & Melinda Gates Foundation
CORE Group’s Global Health Practitioner Conference
May 18, 2016
Enric Jané, MD, PhD
Program Officer
Integrated Delivery

2. © Bill & Melinda Gates Foundation | 2
INTEGRATED DELIVERY TEAM’S ROLE IN THE
FOUNDATION
Discovery & Translational Sciences
Integrated Development
Integrated Delivery
Vaccine Delivery
TB NIDHIV Pneumo Malaria EDD FSP
Family
Planning
Ag Dev WSHPolio NutritionMNCH
Vaccine Development
Global Policy & Advocacy
Programs
Functions
GLOBAL HEALTH GLOBAL DEVELOPMENT
Life Sciences Partnerships
Multilateral Partnerships

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A1.a. Primary health care
polities
A1.b Quality management
infrastructure
A1. Governance & Leadership
A2.a Spending on primary
health care
A2.b Financial coverage
A2. Health Financing
A3.a Surveillance
A3.b Priority Setting
A3.c Innovation & Learning
A3. Adjustment to Population
Health Needs
C2.a Provider Absence Rate
C2.b Provider Competence
C2c Provider Motivation
C2. Availability of Effective PHC
Services
C3.a First contact accessibility
C3.b Coordination
C3.c Comprehensiveness
C3.d Continuity
C3.e Safety
C3. People Centered Care
C4.a Facility management capability and leadership
C4.b Team-based care organization
C4.c Supportive supervision and professional development
C4.d Population health management, including community-based
approaches
C4.e Information system use
C4.f Monitoring and continuous quality improvement
C4. Organization & Management
C1.a Financial
C1.b Geographic
C1.c Timelines
C1. Access
D1.a health promotion
D1.b Disease prevention
D1.c RMNCH
D1.d Childhood illness
D1.e Infectious disease
D1.f NCDs & Mental Health
D1.g Palliative care
D1. Effective Service Coverage
E1.a. Reduced morbidity
E1.b Reduced mortality
E1. Health Status
E2. Responsiveness to people
E3. Equity
E4. Efficiency
B1. Drugs & Supplies
B2. Facility Infrastructure
B3. Information Systems
B4. Workforce
B5. Funds
E5. Resilience of Health Systems
INTEGRATED DELIVERY IS FOCUSING ON HIGH-IMPACT LEVERS TO
INFLUENCE GLOBAL AND COUNTRY-LEVEL PHC IMPROVEMENT
High priority levers
E. OUTCOMESD. OUTPUTSC. SERVICE DELIVERYB. INPUTSA. SYSTEM
“Black box”
Creation of global public goods Transformative innovation across multiple geographies
Country-level systems strengthening in India, Ethiopia and Nigeria Advocating for national PHC public goods.
Medium priority levers

4. • Evidence shows that CHW are key element of effective PHC systems
• However, just a few examples of effectively scaled CHW models exist, and evidence exists mostly
for smaller scale programs
• By working at country and global levels, we want to test, evaluate, and learn from different
approaches to building effective CHW platforms at scale (quality and quantity of interventions,
inequities addressed, contacts per CHW, etc.)
• Our long-term goal is for CHW platforms to be scaled-up, demonstrate stronger performance, and
impact the coverage and quality of health service delivery
© 2014 Bill & Melinda Gates Foundation | 4
KEY ELEMENTS OF OUR STRATEGY FOR CBPHC

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CHOICES MADE IN OUR STRATEGY DEVELOPMENT
“Support government as a steward ”
 Planning, mobilization of resources,
implementation, and management of national
CHW programs at scale
 Engagement with the private sector
 Leveraging communities to improve access to
services, behavior change, and accountability
Focus on six key themes
Establish CHWs as a global priority
Strengthen planning & policy
Ensure effective performance
management and accountability
Improve service delivery
Increase community engagement
Country
Global
“Build enabling environment”
 Support efforts designed to diffuse learnings
and mobilize global resources for CHWs
Increase availability and use of best
practices

6. Advocate for CHWs
as a global priority
Deep Engagement
Tanzania
© Bill & Melinda Gates Foundation | 6
OUR PRIORITY COUNTRIES FALL ON A SPECTRUM OF CHW PLATFORM MATURITY
Developing Implementation ongoing Scaled-up Optimization
Ethiopia
India
(UP/Bihar)
Nigeria
Senegal
In partnership with government, develop a national CHW
program, pilot implementation of CHW platform in 1 – 2
regions and catalyze others to take platform to scale
Leverage and optimize the productivity of existing CHW
platforms to test and take new interventions to scale
nationally
Model for Global
Learning
PHC priority countries Other priority countriesKEY:
Pathways to
Action
& Approach
Optimize & Scale
In-County : 80% Global : 20%
Influence & Mobilize

7. • Innovations
• Targeting
• Patient/customer engagement
• Provider performance
• Getting to scale
• Evaluation & learning
© Bill & Melinda Gates Foundation | 7
SOME REFLECTIONS…