Organisation of primary health care in the Asia-Pacific region: developing a prioritised research agenda

Palagyi, Anna; Dodd, Rebecca; Jan, Stephen; Nambiar, Devaki; Joshi, Rohina; Tian, Maoyi; Abimbola, Seye; Peiris, David

â–º Available knowledge-What is the current level and quality of available knowledge? (areas with lower available knowledge should be prioritised for further exploration). â–º 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 prioritised). â–º Magnitude of need-How cross-cutting is this problem in your setting? â–º Equity-How likely is research on improving the areas also likely to reduce disparities? â–º Innovation-How likely is the research to stimulate innovation in how PHC is strengthened or innovation in how known interventions are implemented? â–º Can research address the gap? PHC, primary health care. disease programme integration; projecting healthcare needs of the future; and integrating primary, secondary and tertiary care across the health sector. There was also a clear gap in the literature in this area, with the small number of interventional studies identified being primarily focused on testing 'community consultation' as an approach to optimising coverage and responsiveness in PHC service planning. Research on how to strengthen the systems that support the organisation, management and oversight of services-for example, planning, resource allocation, performance management-was also rare. Notably, questions prioritised by the panel represent a 'big picture' framing of planning and accountability issues yet neglect mechanisms to support planning decisions (eg, use of routine health service data) and health workforce and service accountability. This may reflect stakeholder scepticism that a research study can generate practical insights into issues that essentially require improved management and leadership. Five of the top 10 research questions prioritised by the Delphi panel addressed the PHC system input category of service delivery models. Questions related to: effective service delivery models for chronic diseases; how to use task shifting (through non-physician health workers (NPHW)) to best support PHC service delivery; addressing barriers to continuity of care; determining an effective package of PHC services; and the optimum mix of health workers at primary care level. While studies on service delivery models did dominate the relatively small evidence base, the majority were narrowly focused on the delivery of a specific intervention. Again, there was a notable contrast between the discrete intervention focus of research to date and the system-focused research priorities of the regional stakeholders. Another prioritised question, on the impact on NPHWs of integrating new programmes into their work routines, also reflected stakeholder interest in determining effective workforce development strategies to optimise team-based PHC functioning. This knowledge gap converged with the findings of the evidence mapping process and has been highlighted elsewhere as a key enabler to successful integration of front-line health services. 26 Despite the void of evidence relating to improving access to essential medicines, vaccines and technologies, and health promotion, the Delphi expert panel rated only one research question in these areas as high priority: how do we ensure that essential drugs and diagnostics are always available in PHC services? This might reflect the absence of representation of PHC service providers on the expert panel, as well as the small number of government BMJ Global Health stakeholders completing the