Priority Setting Meeting Report - Ariadne Labs · 12-13, 2017 for a Priority Setting Meeting. A...
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Priority Setting Meeting Report July 2017 Updated September 21, 2017
Transcript of Priority Setting Meeting Report - Ariadne Labs · 12-13, 2017 for a Priority Setting Meeting. A...
Priority Setting Meeting Report
July 2017
Updated September 21, 2017
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Background In collaboration with the Primary Health Care Performance Initiative (PHCPI) and the Alliance for Health Policy and Systems Research (“the Alliance”) at the World Health Organization, with funding from the Bill and Melinda Gates Foundation, Ariadne Labs is launching a Primary Health Care Measurement and Implementation Research Consortium. This Consortium will bring together researchers and policymakers from multiple disciplines representing academic institutions, government agencies, international organizations, and non-governmental organizations to accelerate progress in primary health care (PHC) research in low and middle-income countries (LMIC).
The ultimate goal of these efforts is to develop a robust primary health care global research network structure and to secure the resources needed to carry out prioritized and policy-relevant primary health care research in the four identified priority areas in LMIC. This research should support country and global efforts to build the high-quality primary health care systems that are needed to reach effective universal health coverage (UHC) and the health-related sustainable development goals (SDGs).
As an initial step towards launching the Research Consortium, Ariadne Labs and the Alliance convened a group of primary health care research, implementation, and policymaking experts in Boston, Massachusetts on July 12-13, 2017 for a Priority Setting Meeting. A list of meeting attendees can be found in Annex 1. The purpose of the July 2017 meeting was to reflect on a new evidence review of the current state of PHC research in LMIC and collectively prioritize four domains in which additional research is likely to catalyze improvements in PHC performance for future primary health care systems research. Specifically, the three objectives of the Priority Setting Meeting were to:
1. Prioritize four areas for future PHC systems research using participants’ expertise and a newly conducted rapid scoping review of the current state of primary health care research in LMIC;
2. Discuss and agree to process for choosing research teams to complete commissioned Reports 3. Receive initial feedback on Research Consortium design options, discuss second convening in October
2018, and agree to communication leading up to that event.
This report presents the proceedings and results of the meeting, organized around each of these objectives.
Figure 1: Meeting Participants
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Objective 1: Prioritize four areas for future PHC systems research
Evidence Review Ariadne Labs conducted a rapid scoping review of the literature published between 2010 and 2017 to understand the available knowledge related to PHC systems in LMIC. This review formed the evidence base for the Priority Setting Meeting.
The Primary Health Care Performance Initiative (PHCPI) Conceptual Framework (Figure 2) served as the organizational structure for the rapid scoping review. The PHCPI framework describes components of high functioning PHC systems across five domains: systems, inputs, service delivery, outputs, and outcomes.1,2
Figure 2: The Primary Health Care Performance Initiative Conceptual Framework
For the purposes of the review and the Priority Setting Meeting, only areas within the systems, inputs, and service delivery domains were assessed, based on the assumption that improvements in these domains would likely drive progress in outputs and outcomes. These domains comprise 35 research topics (Figure 3). The evidence review summarized recent available knowledge and research gaps across each of these 35 areas.
1 Bitton A, Ratcliffe HL, Veillard JH, et al. Primary Health Care as a Foundation for Strengthening Health Systems in Low- and Middle-Income Countries. J Gen Intern Med. 2016. doi:10.1007/s11606-016-3898-5. 2 http://www.phcperformanceinitiative.org/
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Figure 3: Initial list of 35 research areas
The review found that a significant amount of research had been conducted across topics within the PHCPI Conceptual Framework, but that nevertheless many areas of the Framework lacked sufficient evidence and that the evidence that did exist was often of poor quality. In particular, we noted gaps in evidence regarding how to translate policies into improvement for frontline service delivery and how to effectively scale innovative interventions within and across countries. In addition, critical gaps are present around incorporating local community perspectives into PHC policy and planning, as well as best ways to finance, train, and motivate health worker teams to provide accessible, continuous, coordinated, comprehensive, and person-centered primary health care that reliably delivers good population outcomes. Large PHC research gaps remain across many LMIC regions, especially much of sub-Saharan Africa and the Western Pacific regions.
Pre-Meeting Work Prior to the meeting, participants were asked to review the evidence review and—with this knowledge as well as their own expertise—sort the 35 research topics into three tiers, as described in Box 1. The results of this initial ranking exercise can be viewed in Annex 2.
BOX 1: DEFINITION OF PRIORITY TIERS
Tier 1: Includes research topics of high potential leverage, in which more evidence is likely to have a significant impact on strengthening PHC performance
Tier 2: Includes research topics of moderate potential leverage, in which more evidence is somewhat likely to have an impact on strengthening PHC performance
Tier 3: Includes research topics of limited potential leverage, in which more evidence is unlikely to have an impact on strengthening PHC performance
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Meeting Proceedings Results of the pre-meeting survey were shared with participants in advance of the Priority Setting Meeting and further reviewed as a group on the morning of Day 1. Following a discussion of the evidence review and pre-meeting survey results, participants were divided into four groups and asked to identify “Tier 3” research topics, or those 10-15 topics that the group considered to be the lowest priority. Groups were asked to use the criteria described in Box 2 for this de-prioritization exercise.
The intention of the meeting organizers was to move from this small group de-prioritization exercise into a large group discussion that would definitively classify 10-15 research areas as Tier 3 and remove them from consideration as a top four priority area. However, during report out from the small group sessions, most groups noted that they had encountered challenges when attempting to de-prioritize research topics as many were interrelated or subsumed by others. For example, areas such as provider motivation (C4.c), provider competence (C4.b), team-based care organization (C2.a) and workforce (B5) were all considered to be interrelated, and participants were hesitant to “throw out” any component that might be critical for understanding the whole.
Instead, participants from three of the four small groups proposed grouping research topics into broader categories. Following an extensive discussion, it was agreed that grouping the original 35 research areas into broader research topics would allow for greater flexibility and crosscutting research. Next, the large group discussed exactly what these larger groupings should consist of. Based on work done during the small group session and a lively discussion, the group converged on 16 prioritized research topics:
1. Primary health care policies and governance
2. Primary health care financing 3. Market structures 4. Benefits packages 5. Community engagement 6. Priority setting 7. Social accountability 8. Innovation and learning systems
9. Quality and performance management 10. Facility fund flow/management 11. Competent workforce 12. Information systems and data use 13. Organization and models of care 14. Primary health care functions 15. Comprehensive services 16. Continuity of care
At the end of the day, all participants conducted an individual exercise in which they categorized these 16 research topics into three tiers, using the same tier definitions from the pre-meeting survey. Participants also added two additional criteria for consideration to those described in Box 2. These criteria were:
1. Can research address the gap? 2. Is another group or entity already doing this work?
BOX 2: PRIORITY SETTING CRITERIA
1. Available knowledge – What is the current level and quality of available knowledge? (Areas with lower available knowledge should be prioritized for further exploration.)
2. Leverage – What is the potential for improvements in this area to contribute to strengthening PHC performance? (Areas that are seen as key levers of improvement should be prioritized.)
3. Magnitude of need - How crosscutting is this problem across countries? 4. Equity - How likely is research on improving the areas also likely to reduce disparities 5. Innovation - How likely is the research to stimulate innovation in how PHC is strengthened or
innovation in how known interventions are implemented?
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These data were collected and shared with participants at the start of Day 2 (Annex 3). During the morning of Day 2, the large group engaged in a conversation about the six research topics that had risen to the top during the final individual categorization exercise the day before. These topics were:
1. Quality and performance management 2. Competent workforce 3. PHC policies and governance 4. Organization and models of care 5. Information systems and data use 6. PHC financing
After discussion and deliberation, it was agreed that “competent workforce” (2) and “information systems and data use” (5) could be considered a component of quality and performance management (1). Following this decision, research topics were slightly reframed to arrive at a final set of four prioritized areas, as shown in Box 3. Additionally, “innovation areas” of emphasis within each priority research area were identified for particular future research focus.
In order to further define the boundaries of these broad topics, the group then categorized the original 35 research areas into the four consolidated research topics. The complete process for arriving at four prioritized areas is shown in Figure 4.
BOX 3: FINAL LIST OF FOUR PRIORITIZED RESEARCH AREAS
Prioritized Area Innovation Areas
1) Quality, Safety, and Performance Management • Data use • Quality management • Learning systems
2) PHC Policies and Governance • Community engagement • Social accountability
3) Organization and models of care • Workforce and team development • Scale • New models for management
4) PHC Financing • Market structure • Political economy • Uptake of evidence
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Figure 4: Full process for getting to four priority areas
To further specify the content and scope of these four priority areas, participants broke into small groups based on their expertise and interest to enumerate potential research questions for each of these topic areas. The full list of research questions generated for each of the four areas can be found in Annex 4.
Additional Considerations Throughout the prioritization exercises, participants discussed the need to ensure the inclusion of crosscutting themes in future PHC research. Themes that were identified during the meeting included urban primary health care, equity, value to the end user, private sector, intersectorality, systems thinking, and resilience.
Additionally, several participants noted the need to ensure that future research conducted as a part of this consortium be focused on PHC specifically, and not health systems more generally. To do so, it was suggested that proposed research in all four areas should assess the impact of improvements in the area of focus on the primary health care functions and the PHCPI Conceptual Framework: first-contact accessibility, continuity, comprehensiveness, coordination, and person-centered care.
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Finally, throughout the two days there was significant time spent discussing the different types of research that may be needed based on the types of knowledge that exists and is needed in order to make improvements in any given area. Discussed research typologies include:
• Primary research—either into the development of an intervention or the implementation and scale of an intervention
• Knowledge synthesis • Research into knowledge translation/uptake to understand how evidence/interventions can be more
effectively adopted and translated into policy and practice.
Objective 2: Refining a process for commissioning Reports The intended next steps following the Priority Setting Meeting were: to issue a Request for Proposals; solicit proposals from interested groups and select one per priority area to develop a Report; hold a second convening on the sidelines of the Health Systems Global conference in Liverpool, England in October 2018 to launch the Research Consortium and present the Reports; and finally submit Reports for peer-reviewed publication in a journal supplement after the meeting. Over the two-day Priority Setting Meeting, each of these steps was discussed in detail. The discussion and conclusions for steps relating the commissioning of Reports is described here, while steps related to the launch of the research consortium are discussed under Objective 3, below.
A theme of the discussions regarding the Reports was the tension between what can reasonably be expected from collaborators given the available funding and time constraints and the desire to produce robust deliverables that will move the field and research consortium forward. Additionally, there was general consensus among participants that the methods for and types of research generated or commissioned by the research consortium should be flexible rather than pre-specified. Methods should be informed by the current state of available knowledge and specific gaps in implementation or policy for a give research areas. The following broad considerations were identified by meeting participants to help potential grantees specify the type of research that is needed in their priority area of interest:
• What? What has worked to address the priority area in LMICs? What are the effects? • How? How were the effective interventions implemented? What are the factors that trigger
outcomes? What do we already know? What are the uptake issues and what needs better translation in to policy or action?
• Where? What works where? How do we best understand context? • Why or Why Not? Has evidence been translated into policy and practices? What types of research are
still needed: Primary intervention, implementation, translation, other?
By the end of the meeting, the following process related to developing Reports was agreed to:
1. Developing Reports: Each grantee will be asked to develop a Report by undertaking the following steps:
a. Construct a Gap Map in the priority area, noting where there is evidence of what works and how it can be implemented, as well as where there are significant research gaps.
i. If necessary, conduct a stakeholder analysis in the priority area b. Building upon the initial list of prioritized research questions (Annex 4), refine and present a
list of approximately 10-15 specific priority research questions within the topic area based on the Gap Map and stakeholder analysis
c. Select the top three priority research questions and develop a research implementation plan to define how research—whether primary, synthesis, or knowledge uptake/translation—would be conducted to answer the priority questions within a network structure. Plans should address:
i. The targeted geographic region(s) and rationale
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ii. Scoping of potential partners iii. Expected time frame iv. High-level work plan v. Budget for implementation of research vi. Plan for dissemination/uptake of research
d. Perform early analyses where possible with existing or pilot data to begin to lay out a case for future funding and analysis.
2. Soliciting Proposals: Ariadne Labs, in coordination with the Alliance and the Bill & Melinda Gates Foundation, will issue a Request for Proposals (RFP) around the four identified priority areas. Each proposal should describe:
a. A motivation statement, including the team’s rationale for bidding b. The process the team will take to develop the Report, including how the team will engage
with or include policymakers and stakeholders in LMICs c. The composition and relevant expertise on the team d. How the team will contribute to and collaborate with the planned network
3. Selecting Grantees: The Ariadne Labs/Alliance/BMGF team will commission an external review of all
proposals received to select grantees. In order to be selected, experts and groups must have demonstrated expertise in the area being selected and be led by—or include substantial representation from—researchers and/or policymakers from LMIC. While participants of the Priority Setting Meeting are encouraged to apply, grantees will not be limited to this group and no priority will be given to meeting participants in the selection process. Further, there is no expectation or requirement that meeting participants must apply. Contracts will be established with a single entity with the ability to sub-contract to others. The maximum available funds for each contract are $20,000.
Objective 3: Receive initial feedback on research consortium design options and process for launching consortium
Rationale and Theory of Action for a Research Consortium Over the course of the two-day meeting, there was significant discussion about the value of a research consortium. Ariadne Labs proposed—and received widespread support for—the notion that the value of a research consortium goes beyond the generation of new knowledge by individual researchers towards building a community that works collaboratively to address current and emerging priorities. Consortia can be a more catalytic model for accelerating the development of new knowledge and can strengthen the voice advocating for more research and learning to drive quality PHC globally. Additionally, research consortia can incorporate cross-project and cross-country learning and formalize interdisciplinary approaches while building a central platform for funding and resource development. To our knowledge, a research consortium or network focused on PHC in LMIC does not currently exist in a robust form, and there is significant potential donor interest.
A particular benefit to the proposed PHC Measurement and Implementation Research Consortium that was highlighted throughout the meeting was the focus the group has adopted of soliciting and incorporating opinions, priorities, and feedback from policymakers and country stakeholders early and often to ensure that the gaps identified, research conducted, and knowledge generated are all policy-relevant. Based on discussions held during the Priority Setting Meeting, we have developed a preliminary Theory of Action for the research consortium, shown in Figure 5. Moving forward, Ariadne Labs will further refine this Theory of Action and work to define a mission statement and value proposition for the Consortium that can be shared with potential consortium members and funders.
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Figure 5: Research Consortium Theory of Action
Identify a Model for the Research Consortium Prior to the Priority Setting Meeting, Ariadne Labs conducted a review of successful research consortium models across clinical and public health spectra and found that multiple successful models exist. Key decision points in the design of a consortium are shown in Box 4. Based on these criteria and the discussion regarding the rationale and value proposition for a Research Consortium (described above), we solicited feedback from participants about the model they believe would be best.
Participants noted the need to connect with a broad network with diverse expertise and leverage within PHC. In addition to researchers, the group felt that integrating implementation scientists, policy makers, advocates, and other stakeholders into the research consortium would elevate the utility of the research generated by the consortium. Additionally, although Ariadne Labs conducted an initial scoping and did not identify any existing primary health care research
BOX 4: KEY DECISION POINTS FOR RESEARCH CONSORTIA
Governance & leadership: Eligibility to participate; timeline of the consortium and its governing body
Network model: How do member interact with core organizers and one another?
Funding: Who provides funding? How are research funds identified? How is funding distributed?
Focus areas: How are research questions identified?
Participation: How many members? Which communities are eligible? Responsibilities? Capacity strengthening?
Data Management: What are the protocols and policies for data sharing and utilization?
Dissemination and advocacy around consortium findings: What is the dissemination strategy? How does the consortium engage with community?
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networks, the group recommended a deeper dive to ensure that no elements of the research consortium are duplicative. While the group did not reach consensus on a model for the research consortium, they engaged in a rich dialogue regarding the utility and added-value of such a network. At this time, none of the potential research consortium models have been prioritized or eliminated, and we expect that the key decision points will remain useful catalysts for future discussions.
Moving forward, Ariadne Labs will conduct a more formal review of PHC research consortia and work with interested parties to identify an optimal network consortium model for achieving our goals of building a research community and securing the resources to carry out this work.
Process for Launching the Research Consortium Going into the Priority Setting Meeting, Ariadne Labs and the Alliance envisioned hosting a second convening on the sidelines of the Health Systems Global conference in Liverpool, England in October 2018 to review Reports and Research Implementation Plans amongst grantees and begin to bring potential donors into the conversation. However, participants at the Priority Setting Meeting strongly encouraged a more rapid process and suggested that the October 2018 meeting should be used to officially launch the Research Consortium. In addition to the Health Systems Global conference, participants also noted that the 40th Anniversary event for the Declaration of Alma Ata is planned for October 2018 and may be an appropriate venue for a formal launch. To accompany the formal launch of the Consortium, participants also suggested developing a high-profile Call to Action for renewed attention to PHC research.
In preparation for the formal launch of the Consortium, Ariadne Labs—in partnership with grantees—will begin engaging with potential donors during the spring and summer of 2018 to build interest in the Reports and Research Implementation Plans being developed.
Conclusions and Next Steps Over the course of the two-day Priority Setting Meeting, participants offered valuable feedback and rich discussion on PHC priority research areas, the process for commissioning and developing Reports and Research Implementation Plans, and the structure of the research consortium. Together, the group converged on four priority research topics for future PHC research and began to identify potential research questions within each of these areas. Based on the meeting discussions described above, we have identified the following next steps:
• September 2017: Ariadne Labs and the Alliance will issue a Request for Proposals • September 2017 – December 2017: Ariadne Labs will work to conduct network and stakeholder
mapping and develop mission statement, theory of action, and value proposition for the consortium. • November 2017: Proposals from grantees due + external review initiated • December 2017: Decisions made for grants + Evidence Review submitted for publication • December 2017 – May 2018: Grantees develop the reports and research implementation plans +
Ariadne Labs and the Alliance create a network structure and options document for review and initiate donor engagement
• May - July 2018: Donor engagement continued + Feedback to grantees + Potential small meeting of grantees to further define network structure
• October 2018: Launch of Research Consortium: Final Research Implementation Plans presented at 2nd convening in Liverpool, England at Health Systems Global Meeting and Call to Action released. Note, may also consider a small, closed-door session for working groups and donors in Liverpool and a formal Consortium launch at the Alma Ata 40th Anniversary Event
• November - December 2018: Submit Papers for publication as journal supplement + Secure funding for next steps
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Annexes
Annex 1: Meeting Participants
Name Title Affiliation Email
Koku AWOONOR-WILLIAMS
Director, Policy, Planning, Monitoring & Evaluation (PPME)
Ghana Health Services [email protected]
Peter BERMAN Professor of the Practice of Global Health Systems and Economics
Harvard T.H. Chan School of Public Health
Asaf BITTON Director of Primary Health Care
Ariadne Labs [email protected]
Nathan BLANCHET
Program Director Results for Development (R4D)
Jishnu DAS Lead Economist The World Bank Group [email protected]
Benjamin DANIELS
Data Manager and Statistical Analyst
The World Bank Group [email protected]
Jean-Paul DOSSOU
Medical Doctor and PhD Candidate
Centre de Recherche en Reproduction Humaine et en Démographie, Benin
Fadi EL-JARDALI Chairman of Health Policy and Management Department; Professor of Health Policy and Systems
American University of Beirut, Lebanon
Jocelyn FIFIELD Research Assistant Ariadne Labs [email protected]
Ian FORDE Program Lead, Health Systems Quality and Outcomes
Organization for Economic Co-Operation and Development
Atul GAWANDE Executive Director Ariadne Labs [email protected]
Abdul GHAFFAR Executive Director, Alliance for Health Policy and Systems Research
World Health Organization [email protected]
Christian GOODWIN
Intern Ariadne Labs [email protected]
Lisa HIRSCHHORN Affiliate Faculty Member Ariadne Labs [email protected]
Brooke HUSKEY Program Manager Ariadne Labs [email protected]
Jean KAGUBARE Deputy Director of Global Primary Health Care team
The Bill & Melinda Gates Foundation
Chloe KENZIG Intern Ariadne Labs [email protected]
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Kendra KIM Intern Ariadne Labs [email protected]
Meredith KIMBALL Program Director Results for Development (R4D)
Margaret KRUK Associate Professor of Global Health
Harvard T.H. Chan School of Public Health
Jack LANGENBRUNNER
Health Economist The Bill & Melinda Gates Foundation
Etienne LANGLOIS
Technical Officer, Alliance for Health Policy and Systems Research
World Health Organization [email protected]
Lyn MACARAYAN Primary Health Care Postdoctoral Research Fellow
Ariadne Labs [email protected]
James MACINKO Professor, Department of Community Health Sciences and Department of Health Policy and Management
University of California - Los Angeles, Field School of Public Health
Hernan MONTENEGRO
Coordinator, Services Organization and Clinical Interventions Unit Service Delivery and Safety Department
World Health Organization [email protected]
Wolfgang MUNAR Research Professor, Department of Global Health
George Washington University, Milken Institute School of Public Health
Humphreys NSONA
Head, Integrated Management of Childhood Illness
Ministry of Health - Malawi [email protected]
Yongyuth PONGSUPAP
Senior Expert National Health Security Office, Thailand
Hannah RATCLIFFE
Primary Health Care Research Specialist
Ariadne Labs [email protected]
Kabir SHEIKH Senior Research Scientist Public Health Foundation of India
Lina STOLYAR Administrative Coordinator Ariadne Labs [email protected]
Beth TRITTER Executive Director Primary Health Care Performance Initiative (PCHPI)
Innocent TURATE Director Rwanda Biomedical Center (RBC) / Institute of HIV/AIDS Disease
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Prevention and Control (IHDPC)
Rajani VED Advisor Advisor, National Health Systems Resource Center, and Member - Secretary, Task Force on Primary Health Care, Ministry of Health and Family Welfare, Government of India
Wendy VENTER Coordinator, Services Organization and Clinical Interventions Unit Service Delivery and Safety Department
World Health Organization [email protected]
Jeremy VEILLARD Program Manager, Primary Health Care Performance Initiative
The World Bank Group [email protected]
Hong WANG Senior Program Officer The Bill & Melinda Gates Foundation
Mariam ZAMEER Associate Program Officer The Bill & Melinda Gates Foundation
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Annex 2: Pre-Meeting Survey Results Research Topic Tier 1 Tier 2 Tier 3
Modal response: Tier 1
Performance measurement and management (C2.d) 70.59% 29.41% 0%
Payment systems (A2.a) 64.71% 11.76% 23.53%
Information systems (B3) 52.94% 23.53% 23.53%
Facility management capability and leadership (C2.b) 52.94% 41.18% 5.88%
Quality management infrastructure (A1.b) 47.06% 29.41% 23.53%
Community engagement (C1.b) 47.06% 35.29% 17.65%
Information systems use (C2.c) 47.06% 35.29% 17.65%
Workforce (B4) 41.18% 35.29% 23.53%
Person-centered (C5.e) 41.18% 35.29% 23.53%
Innovation and learning (A3.c) 41.18% 41.18% 17.65%
Local priority setting (C1.a) 35.29% 35.29% 29.41%
Provider competence (C4.b) 35.29% 29.41% 35.29%
Coordination (C5.d) 41.18% 17.65% 41.18%
Modal response: Tier 2
Proactive population health outreach (C1.d) 29.41% 58.82% 11.76%
Safety (C4.e) 23.53% 58.82% 17.65%
Patient-provider respect and trust (C4.d) 17.65% 52.94% 29.41%
Spending on primary health care (A2.b) 35.29% 47.06% 17.65%
Surveillance (A3.a) 17.65% 47.06% 35.29%
Team-based care organization (C2.a) 35.29% 47.06% 17.65%
First contact accessibility (C5.a) 17.65% 47.06% 35.29%
Priority setting (A3.b) 35.29% 41.18% 23.53%
Continuity (C5.b) 35.29% 41.08% 23.53%
Modal Response: Tier 3
Facility infrastructure (B4) 0% 17.65% 82.35%
Provider availability (C4.a) 5.88% 23.53% 70.59%
Funds (B5) 17.65% 17.65% 64.71%
Geographic access (C3.b) 11.76% 23.53% 64.71%
Drugs and supplies (B1) 17.65% 29.41% 52.94%
Provider motivation (C4.c) 35.29% 11.76% 52.94%
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Research Topic Tier 1 Tier 2 Tier 3
Timeliness (C3.c) 11.76% 35.29% 52.94%
Comprehensiveness (C5.c) 11.76% 35.29% 52.94%
Financial coverage (A2.c) 17.65% 35.29% 47.06%
Primary health care policies (A1.a) 29.41% 29.41% 41.18%
Social accountability (A1.c) 29.41% 29.41% 41.18%
Empanelment (C1.c) 23.53% 35.29% 41.18%
Financial access (C3.a) 35.29% 23.53% 41.18%
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Annex 3: Day 1 Ranking Results
Mean Tier Tier 1 (%) Tier 2 (%) Tier 3 (%)
Quality and performance management 1.33 72% 22% 6%
Competent workforce 1.50 56% 39% 6%
PHC policies and governance 1.56 61% 22% 17%
Organization and models of care 1.56 61% 22% 17%
Information systems and data use 1.61 56% 28% 17%
PHC financing 1.72 44% 39% 17%
Market structure 2.06 28% 39% 33%
Community engagement 2.11 22% 44% 33%
Innovation and learning systems 2.17 28% 28% 44%
Social accountability 2.28 22% 28% 50%
Continuity of services 2.28 6% 61% 33%
Comprehensive services 2.39 11% 39% 50%
Benefits package 2.44 11% 33% 56%
Priority setting 2.61 0% 39% 61%
PHC function 2.61 17% 6% 78%
Facility fund flow/management 2.67 6% 22% 72%
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Annex 4: Research questions by priority research area
Priority Area 1: Quality, safety, and performance management Facility management
1. What is the current “state” of facility management? 2. What are individual competencies at the individual, facility, and system levels for effective
leadership/management at PHC facility levels? How do we measure these three levels? 3. How do we understand how context impacts how well good management can result in targeted
outcomes including PHC functions? 4. How do you improve management?
Competence (technical and social)
Assuming we know the areas of competency needed…
1. What is the minimum skill set and competency with new delivery models/systems 2. How does a PHC systems ensure a growing “degree of fit” between need and competency required? 3. How can competent HCWs be recruited and retained? 4. What changes are needed to ensure newly graduated HCWs are competent?
Priority Area 2: PHC policies and governance 1. What are good models of mixed health systems for PHC? 2. How do we build governance models to support mixed health systems? 3. What is the real situation with rural and urban workforce management? Is there a shortage of
workforce in rural areas or an overflow in urban? 4. How can we assess social accountability? 5. How do we improve both internal and external accountability? 6. What tools are needed to effectively set priorities at the local level? 7. How are priorities being designed and executed? Can there be new ways of gaining resources while
decreasing dependence on external aid? 8. How can we improve strategic purchasing at the local level? 9. What information is needed to address corruption at the local level?
Priority Area 3: Organization and models of care 1. What is the taxonomy of models of care across different settings?
a. Range of effective service delivery models in urban areas? b. Use patterns in PHC for a set of functions/conditions? c. Referrals/transitions of care? How do we measure these?
2. What does a PHC maturity model look like? 3. What is the taxonomy of PHC service delivery models? Setting, provider, user, integration 4. What are dynamic empanelment models? Insured; risk stratification linked with information systems 5. What are better team structures? How to help teams work together? How do they work together?
Priority Area 4: PHC financing Private Sector
1. How does the presence of private sector provider influence the quality of public sector providers (and vise versa)?
2. What are requirements for successful PPPs that allow scaling up of quality care in LMIC? Need implementation science.
3. What is role of private sector in scaling up quality in PHC in LMIC?
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4. What do we know about best practices to level the playing field for quality and safety of PHC services between public and private sector?
5. Is there knowledge and evidence about how to mobilize private sector to reach “last mile populations?”
6. How do we make sure private sector is able to receive payment? 7. How to best improve managerial capacity in ministries of health for contract management?
Demand-Side Financing
8. How do different UHC schemes affect health equity? 9. Does PHC need pooled funds against financial risk in LMICs?
Payment Systems
10. What are appropriate payment systems for quality PHC depending on maturity model of PHC system and capacity to manage and implement payment systems with different levels of complexity? Relates to organization/models of care
11. How to develop provider payment mechanisms to promote vertical integration of care?
Supply-Side Financing
12. How do we make supply-side financing from governments more efficient? 13. What commodities can be deemed cost-efficient?
Political Economy
14. Why do countries not scale/implement what they’ve identified as policy or best practices?
Financial Management
15. Alignment of incentives at facility level. Should facilities have a bank account? Should they have the autonomy to use it? Linked to accountability agenda
16. What are the funding flows for PHC? How to ensure flow of funding to facilities are efficiently used?
PHC Spending
17. Is there a minimum level of spending for PHC that should be an international benchmark?
