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Measuring Gaps in Primary Health Care: Q&A with Anna Talman Rapp

Primary health care (PHC) plays a critical role in the well-being of communities and individuals. PHC goes beyond supporting immediate health needs, to also provide education, early prevention of serious diseases, and decreased maternal mortality.

Because PHC serves as a cornerstone of health systems, we need to consider how to improve it— making care more equitable, effective, and efficient for everyone.

MIT Solve and the Bill & Melinda Gates Foundation are working together to find solutions that offer novel ways of measuring primary health care performance improvement in under-resourced communities. The Novel Measurement for Performance Improvement Challenge is being led by Solve and Anna Talman Rapp, Senior Program Officer with the Bill & Melinda Gates Foundation Global Delivery Program.

Rapp’s work focuses on child health and strengthening primary health care. She shares how this Custom Challenge was developed and her hopes for the outcome.

There are many world issues to solve and never enough time. How did the Bill & Melinda Gates Foundation decide to embark on this specific Custom Challenge?

It’s one among many investments and grants we at the Gates Foundation are making in the primary health care space. Measuring systems' performance is a notoriously difficult problem. It’s really tough to know how the health system works, what actually functions, and where the gaps are. This Custom Challenge is about gaining new perspectives and receiving rapid, less-expensive—possibly more accurate—solutions to get a handle on what’s working and what's not, so that decision-makers can target where they're investing attention, energy, and funding.

Where did taking a holistic stance stem from?

It's deeply important to me to find solutions from individuals who understand what's important to local communities and what's possible to deploy in these settings. Supporting community leaders is a core value of the Gates Foundation as we think about how we allocate resources. It’s important to start by understanding what the problem is rather than with the solution. We try to learn what the problems are from people who are local to the issue. We can’t just listen to people sitting in Geneva and Seattle; we have to listen to the people on-the-ground in impacted countries and settings. People who are close to the system and the problem understand what the gaps are so their solutions and ways of addressing these health issues are much more tailored and appropriate.

What excites you about this challenge and what are the characteristics of selected solutions you are hoping to see? 

I’m looking forward to hearing from folks who are outside the health sector or the international development sector. I also hope to see creativity and new perspectives, particularly from low- and middle-income countries. 

Hopefully, the solutions will be creative and unexpected. They don’t have to be perfect or highly polished. Potential can be achieved with a little development and tinkering. It’s most important that these solutions are relevant and practical. We want a balance between creative and unusual, but also ones that make sense and can integrate where PHC needs improvement.

We would be most interested in solutions that could be adapted and configured to improve care in more than one global region. My hypothesis is that there is a lot in common across countries and settings, and with minor adjustments, we could bring the richness of solutions to any local setting.

What role do you see technology playing in improving measurement practices for primary health care outcomes in under-resourced communities? 

There is tremendous potential for entrepreneurs to capitalize on technology that is catching fire across the world regardless of income setting, however, I also don’t think it’s a necessary precondition for this challenge. I think we could have low-fidelity or even paper-based approaches towards measurement that are more creative in addressing what data we pay attention to and why. The source of data doesn’t always have to come from a computer, mobile phone, or automated system. I’m interested in the potential that technology plays in improving PHC, but also the idea that we might not need it to do a better job capturing and using data.

I think there is often a bias towards technology that analyzes and creates quantitative data because people see qualitative data as less robust. I think if we find systematic ways to capture qualitative data and understand the representativeness and rigor of those methods, it can be equally, if not more informative. Mixed methods might be even more influential. Quantitative data can show you where to look for shortcomings but qualitative can show you what’s actually going on. Health systems are fundamentally human systems. Patients and providers are just people that are both predictable and sometimes not. It’s very valuable to understand their experiences, motivations, and intentions.

If you have a unique way to measure the impact of primary health care and want to provide actionable insights to improve the system, apply for the Novel Measurement for Performance Improvement Challenge by August 9 at 8pm EDT. And if you are an organization that is looking for unique solutions to address a global issue, learn more about how Solve can work with you to develop your own Custom Challenge.

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