Enhancing Primary Health Care with innovative Improvement Strategies

We know that primary health care is the cornerstone of a country’s overall health status. For the past several years, the Primary Health Care Performance Initiative (PHCPI), a partnership dedicated to improving and transforming the global state of primary health care, has worked on developing strategies and tools to improve primary health care around the globe. This includes the innovative PHC Vital Signs Profile which creates a snapshot of a country’s primary health care system. Through measurement, we can better understand system strengths and weaknesses, making the previously invisible gaps visible. However, measurement alone cannot improve a health care system.

So PHCPI, under the leadership of Ariadne Labs, has developed and launched the Improvement Strategies, an interactive knowledge management tool that will support program planners and policy makers to select relevant opportunities for improvement. In effect, the Improvement Strategies help answer the question of “What next?” after compiling a Vital Signs Profile by providing a compilation of pragmatic and useful evidence-informed strategies relevant to strong PHC systems.

Let’s explain further.

What’s the point of the Improvement Strategies? Why don’t health planners just Google this information themselves?

While Google and other web-based resources are certainly helpful, the Improvement Strategies aim to collate the best available evidence from all over the world, curating it in ways that are quickly digestible and topically relevant to colleagues in low- and middle-income health systems. Previously, much of this information existed in disparate places, including the “grey literature” or lay-press, which can be difficult and time-consuming for busy health workers and policy makers to find on a day-to-day basis. Additionally, the existing information wasn’t necessarily mapped to the concepts in the Vital Signs Profile, which made it challenging for users to identify the information they needed to act on specific gaps identified through PHCPI’s measurement efforts. Accordingly, we have worked to build a user-friendly, pragmatic set of tools and resources that are directly linked to the concepts in the Vital Signs Profile and which can be quickly accessed and serve as a first point of engagement, linking to much deeper sets of resources. That way, users can decide what is most helpful to them and dig more as they need to.

How did you organize information in an intuitive and accessible way?

We worked with our colleagues in the PHCPI partnership and colleagues from around the world to first identify a user-friendly interface. Using a lens of human-centered design, we wanted to develop something accessible, engaging, and easy to use. We also wanted to balance the tension of too-much vs. not-enough, finding the appropriate sweet spot of meaningful and actionable knowledge, while also not writing a text-book-length resource that would be impenetrable and not particularly useful to our colleagues.

What are some of the topics/areas you cover?

The topics covered by the Improvement Strategies are directly mapped to the PHCPI conceptual framework, which includes five overarching domains: system, inputs, service delivery, outputs, and outcomes. The Improvement Strategies focus on the first three domains, helping to drive up-stream change to impact the downstream outputs and outcomes.

Are these topics interrelated?

Absolutely. There is one component of the Improvement Strategies model that we call “how to succeed.” This is where we highlight what parts of a PHC system should be in place to support or enable improvements in another. For instance, in order for a PHC system to conduct thorough proactive population outreach in communities and homes, there should be robust information systems in place with the ability to track and locate patients and provide information on their medical needs.

How do you hope people will use the Improvement Strategies?

The Improvement Strategies were designed to support users along the measurement to improvement journey. We anticipate that many users, though the process of interpreting their Vital Signs Profile results, will come to the Improvement Strategies as a means to better diagnose and understand critical gaps in their system and begin to understand how these areas can be improved by diving into the best available evidence and case studies on each topic.

Once users get to the website, they’ll see that we’ve broken up the majority of modules into four different sections to help guide them through often quite dense topics. Users can then learn about a topic in a targeted way, such as in the “how to get started” section, where we offer a series of questions that users can use to help determine whether a given topic is an appropriate area of focus. In the “what others have done” tab, we feature dozens of case studies from countries representing different regions and income groups to support cross country learning. The Improvement Strategies are really structured so that users can pick and choose the topics and level of detail that they are most interested in.

It's also important to note that the Improvement Strategies are not meant to be improvement plans that users can implement “off-the-shelf.” We recognize that context is paramount, and must be deeply incorporated into planning processes. For example, what works for birth registries in India may not be the best idea in the Central African Republic or Palestine. By focusing on core principles and offering a diversity of information, we expect the Improvement Strategies to provide a base level of information and creative ideas that users can adapt into context-specific action plans.

Where are you going from here? Are you finished?

We’re just getting started. Because the Improvement Strategies are designed to be a living resource, we’ll continue to keep the modules up to date with the best available global evidence. We’re developing tools to guide users in understanding their Vital Signs Profile, and linking them directly to relevant areas within the Improvement Strategies. We are also working to develop other ways of summarizing and presenting the information so that it can be communicated to different audiences via workshops and policy dialogues. To maximize the utility and reach of the Improvement Strategies for our users we’ve made a concentrated effort to solicit and integrate as much feedback as possible and are excited for more opportunities to do this! Users can give feedback by filling out the “share your experience” tab in the Improvement Strategies pages. If you are interested in learning more about the Improvement Strategies, please contact us at

This blog was written by Jess Wiken, a research assistant on the Primary Health Care team at Ariadne Labs; Jocie Fifield, Senior Research Assistant on the Delivery Decisions Initiative team at Ariadne Labs, and Dan Schwarz, Director of Primary Health Care at Ariadne Labs. Edited by Stephanie Schorow, Ariadne Labs writing coordinator.