Often, there is a lack of clarity for the district-level health systems to know which schemes, activities or programs to prioritize. Our PHC4UHC model is crucial for identifying localized gaps within the health system, thereby guiding resource allocation, shaping targeted interventions, and pushing sub-national units towards UHC through a context-specific strategy.
Our PHC4UHC model allows us to talk about district specific pathways that can help the District Collector to prioritize which PHC specific activities that can have the largest impact on the district’s UHC. We believe that in the long-term this can be the way all District Collectors will look at how they will engage with their district’s health systems.
We design and implement a PHC inputs - UHC outcomes analytical framework, the PHC4UHC model (based on our PHC4UHC consortium), to measure PHC and study the PHC-UHC relationship at a district-level across Karnataka and Jharkhand, both from a data perspective, and through individual/community driven interventions. The two states selected are ones with distinct health systems priorities and challenges.
Our approach follows the PHC4UHC model and is three-dimensional, comprising of evidence synthesis from peer-reviewed research, secondary analysis of existing datasets, and detailed case studies of interventions situated at the interface of PHC and UHC, focusing on districts of Karnataka and Jharkhand.
We conducted a realist review of evidence on UHC outcomes – population, service, and financial risk protection – to identify the contribution and role of PHC approaches, unpacking the processes and contexts through which PHC mechanisms have yielded impact.
Broadly, the synthesis found that most research has focused on PHC service delivery and barriers to implementation, and limited linkages to UHC outcomes. Further, there were fewer insights on successful practices or how to address challenges by learning across contexts or through comparative analyses.
We compiled and analyzed relevant secondary data across multiple national sources, to examine the status of primary healthcare service coverage by developing a district-level PHC inputs index, with a focus on Karnataka and Jharkhand, and also correlating it with a district-level UHC index, thereby understanding the pathways of influence.
This allowed us to track inputs or investments in PHC and explore how they achieve UHC. This is possible by looking at the structural relationship between PHC and UHC that is operationalized through nearly two dozen indicators for PHC and separate, non-overlapping indicators for UHC.
The findings reveal a positive correlation, with higher PHC input scores associated with stronger UHC outcomes.
