Submission ID 131868
| Issue/Objective | Despite decades of investment, primary healthcare (PHC) systems in many LMICs remain functionally weak-facilities exist but fail to deliver care. In some settings, over 50-70% of rural facilities are partially or fully non-functional, driven by absentee workforce, weak accountability, and rigid public-sector management. This persistent implementation gap undermines progress toward global health equity. Pakistan's People's Primary Healthcare Initiative (PPHI) was introduced to directly address this failure by redesigning governance of PHC delivery. This study aims to assess whether governance reform-rather than additional resources-can restore system functionality and offer a scalable model for LMICs. |
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| Methodology/Approach | A multi-provincial health systems analysis was conducted using programmatic data, policy review, and longitudinal implementation experience of PPHI. The model was analyzed across governance, workforce management, service delivery, and accountability domains. System performance before and after implementation was assessed using facility functionality, workforce presence, and service utilization as proxy indicators, with a focus on rural and underserved settings. |
| Results | PPHI led to rapid restoration of functionality in previously non-operational PHC facilities. Workforce attendance improved substantially, essential services became consistently available, and patient utilization increased-particularly for maternal and child health services. In several districts, previously non-functional facilities were converted into fully operational service delivery units within short implementation cycles. These gains were achieved without substantial increases in funding, but through operational autonomy, performance-linked accountability, and strengthened management systems. |
| Discussion/Conclusion | This study demonstrates that the primary constraint in PHC systems in LMICs is not only resource scarcity, but ineffective governance structures. By separating service delivery from rigid administrative control while maintaining public financing and oversight, PPHI provides a practical mechanism to translate policy commitments into functioning systems. At a time when global health is calling to restore commitment to action, this model shifts the focus from "how much to fund" to "how to make systems work", offering a scalable pathway to close the gap between investment and impact, particularly in fragile and decentralized contexts. |
| Presenters and Affiliations | Muhammad Asif Khan National Institute of Health Runa Khan Harvard TH Chan School of Public Health Farhan Ahsan CONTECH International |
