Taking primary care from the sidelines to the front line in the developing world

About a third of the world’s population still lacks adequate access to quality health care. Despite primary care being proven to be associated with enhanced access to and overall better health care, in most low- and middle-income countries (LMICs), the delivery of quality, affordable primary care is poorly developed.

T-HOPE and its partners want to change this. The T-HOPE (Toronto Health Organization Performance Evaluation) team is a University of Toronto research group composed of medical residents based at the Department of Family & Community Medicine and MBA students from the Rotman School of Management, managed by anthropologists, and led by professors from both faculties. The aim of T-HOPE is to use varying points of views to find new and innovative ways to address global health challenges.

In collaboration with the International Centre for Social Franchising, and donors such as the Bill and Melinda Gates Foundation, T-HOPE researched what works and what doesn’t when trying to expand primary care in LMICs, while still providing a high quality of care to a large population.

“For us it’s a given that primary care is of tremendous value,” says Dr. Onil Bhattacharyya, lead of T-HOPE, researcher at the Centre for Child Nutrition & Health, and associate professor in the Department of Family & Community Medicine at the University of Toronto. “But for many countries they don’t see it that way – both government and the public feel that specialist care is better. To expand, it’s partly an exercise of marketing primary care to both funders and patients: it needs to be seen as a necessary part of a high-functioning health care system, as it is in the West.”

The study — Rapid Routes to Scale — identified key actions that can be undertaken to create and expand higher quality primary care programs, including focusing on strong patient relationships, implement marketing campaigns, finding new sources of funding, engaging in staffing innovations and leadership training, and supporting promising new primary care programs.

As part of the study, researchers interviewed representatives from 37 primary care programs operating in over 25 countries, and also visited a number of primary care clinics in Kenya and India.

“They’re very different countries,” says Bhattacharyya. “Both countries have good examples of primary care, however, each face very different challenges in expanding.”

India, for instance, has more access to funds and technology; yet, due to its historic emphasis on specialized care, primary care lacks the prestige of other specialties. In Kenya, on the other hand, programs face a major dearth of trained physicians and a population that can’t afford care (half of Kenyans live below the poverty line).

Yet researchers found programs in each country that are finding creative ways to address these barriers, such as innovative staffing solutions, forming new partnerships, and promoting primary care.

“It’s challenging to expand primary care because it is intrinsically small – family physicians and health care professionals are patient-focused and care is primarily provided out of small clinics,” says Bhattacharyya. “Research shows, though, that by applying basic management principles, we can scale up primary care for those who need it most.” Bringing family physicians together with management and strategy experts will help us find the best way to do this.