Findings from the Field

Adapting What Works: A guide for program managers, from program managers

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Why Primary Care?

For many communities in low- and middle- income countries, primary health care is the first point of care for patients, and often the only source of care.  Programs and interventions at the primary care level are crucial to improving health outcomes. In these countries, many primary care services are delivered by private providers. While the private sector can be a source for new approaches and innovations, it also comes with its risks. Private providers are often unregulated, and quality and accessibility can vary.

As the foundation of cost-effective health care for individuals and their families, primary care is the core of a well-functioning health system. However, there are significant challenges to delivering primary care at scale. Primary care delivery organizations face day-to-day challenges of running and growing their businesses, like staffing clinics and attracting patients. Most of the health programs profiled on the Center for Health Market Innovations are addressing operational hurdles and are steadily working to improve quality and accessibility. Indeed, many health market innovators are both savvy entrepreneurs and dedicated to the fight for equitable care for the poor. And yet, the challenges faced in this sector are great, and few can make it on their own.

Peer-Learning and Adaptation to Improve Care Delivery with CHMI

For five years, CHMI has worked with private providers to identify promising innovations in health care service delivery for the poor. We’ve seen that program managers are searching for opportunities to adapt, learn, and grow their business models. We’ve also observed the struggle to the implement new ideas or practices. CHMI’s learning activities offer program managers the chance to collaborate with their peers in other countries or service delivery sectors. Through these learning and adaptation activities, we’ve brought together dozens of primary care organizations to tackle shared operational and strategic challenges. Together, program managers provide each other with practical ideas and solutions which are grounded in their experience delivering care. Through these exchanges, managers share strategies for improving primary care quality and increasing access for the poor, and improving innovators’ business models and operations.

The Primary Care Adaptation Partnership

In the fall of 2015, CHMI brought together three pairs of organizations to explore and test the adaptation of “what works” in primary care.  Building off CHMI’s Adaptation Framework for Global Exchange of Innovation, six organizations partnered to identify the ‘active ingredients’ of their program models, then to adapt them in new geographies together. The tools from the Adaptation Framework supported program managers to crack open a promising model and examine the core attributes crucial to achieving their goals. These ‘active ingredients’ are distinct practices and methods that can be isolated, adapted, and replicated outside of their original context. Over a six-month learning initiative, program managers learned from each other during site visits where they jointly unpacked promising practices and strategized to adapt these practices in new contexts. The Primary Care Adaptation Partnership included these six programs located in 10 countries:

Jacaranda Health: Kenya

Ross Clinics: India

Healthy Entrepreneurs: DRC, Rwanda, Burundi, Uganda, Ghana, Tanzania and Haiti

Hindustan Latex Family Planning Promotion Trust (HLFPPT): India

Quinta Bonita: Mexico

Safe Mothers Safe Babies: Uganda


Adapting What Works in Primary Care: A Getting Started Resource for Program Managers

The latest guide from CHMI summarizes the learnings and active ingredients identified through the Primary Care Adaptation Partnership. Developed in collaboration with the participating programs, this guide builds off the knowledge they’ve accumulated over years of providing health care for the poor. The program managers ‘opened their playbooks’ to share how they work to improve care delivery, and how they’ve grown their business models.

Program managers can use the resource guide to examine specific challenges in improving quality and access in primary care. The resource guide shares actionable tips to get started on a variety of ‘active ingredients,’ including:

Task shifting for quality improvement; helping address gaps in care delivery

Standardizing care delivery with operational tools; providing protocols and data-dashboards to audit clinical processes

Logistics technologies to improve access; reducing supply chain costs of medicines through better operations


Programs in the CHMI network have demonstrated that innovative ideas can be adapted across geographic and cultural borders. Thanks to the participating organizations’ commitment to transparency and collaboration, lessons learned in primary care delivery over years of testing and adaptation can be shared widely through CHMI and other channels. We hope you find the resource guide useful and applicable to your work, and invite you to download the report here and contact us with further questions.