Performance Measurement and Management Strategies Put in Place Without Sufficient Evidence on Effectiveness, New Study Says

In 2015, the United Nations created a set of Sustainable Development Goals, including one to achieve good health and well-being for all, by the year 2030.  Not surprisingly, an effective primary health care system is crucial to the achievement of those goals, especially for low and middle-income countries. Yet a new study suggests that attempts to transform or redesign primary health care systems often deploy unproven strategies that often lack the underlying scientific evidence of effectiveness.

Wolfgang Munar, MD, an associate professor of global health systems at the George Washington University Milken Institute School of Public Health (Milken Institute SPH), and his colleagues set out to map the available evidence on performance measurement and management strategies in primary health care systems. The team conducted a literature search and looked at 38,088 publications – selecting 155 studies that met the inclusion criteria for the final analysis.

Munar and his colleagues found that two-thirds of the studies done on this topic were conducted in sub-Saharan Africa and South Asia. Other regions had major gaps in terms of studies done on this topic, despite the great need for such evidence, Munar said.

At the same time, the researchers found that studies typically focused on two types of strategies: implementation strategies such as in-service training of health care professionals or continuing education, and performance-based financing. With this strategy, health care providers are given financial incentives to provide high-quality, cost-effective care.

Yet this study found most of the studies were conducted on relatively simple interventions unlikely to achieve transformation of a primary health care system.

“Our study suggests that most performance and management strategies are implemented without sufficient knowledge of their impact,” said Munar. “Future efforts to redesign primary health care systems must be undertaken armed with the knowledge of what works and what doesn’t.”

Munar said that such evidence is urgently needed in order to help low and middle income countries effectively prepare for climate change, environmental disasters, pandemics of infectious diseases and other serious threats to the public health.

“Researchers, policymakers and others must get behind a research agenda aimed at finding effective, evidence-based strategies to strengthen primary health care systems,” Munar said. “Strong primary health care systems are the first line of defense in health care, and the key to saving and improving millions of lives around the world.”

The study, “Evidence gap map of performance measurement and management in primary healthcare systems in low-income and middle-income countries,” was part of a series of articles published online Aug. 15 in a special issue of BMJ Global Health.

The BMJ Global Health Special Issue culminates a two-year collaborative effort led by Ariadne Labs, a joint center of Brigham and Women’s Hospital and the Harvard T. H. Chan School of Public Health. The Bill & Melinda Gates Foundation funded the project.