Improving the core functions of primary care in a Ugandan rural district

Abstract

Background: In many countries, the core functions of primary care (PC) continue to perform poorly and therefore need improvement, guided by interventions developed in collaboration with key stakeholders.

Aim: This paper reports on the co-design of an intervention guided by the findings of the Primary Care Assessment Tool (PCAT) survey.

Setting: The setting for the study was a rural Ugandan district.

Methods: This was part of a multi-stage mixed methods study to evaluate the use of the PCAT in improving primary care performance. Key stakeholders in primary care system were purposively identified to participate in the design of the intervention. The intervention co-design involved presentation and discussion of the PCAT findings, two rounds of root cause analysis, selection of intervention focus area, design of the actual intervention and planning of implementation.

Results: Ongoing care was selected for intervention among the poorly performing primary care core functions. Community members' low awareness of the available services and low affiliation to their local primary health care (PHC) facility were identified as major contributors to the poor performance of ongoing care. Community dialogues as form of community engagement were selected as an intervention to improve the core primary care functions.

Conclusion: The PCAT can generate findings to guide the development of interventions at the facility and district level to potentially improve the core functions of primary care.Contribution: A co-design process helped to navigate the pathway from the findings to the intervention design and its implementation strategy.

Keywords: co-design; core functions; intervention development; primary care; primary health care.

FIGURE 1

Multi-stage mixed methods study design.

FIGURE 2

Logic model to guide intervention implementation.