Primary Health Care Performance Improvement Platform

The Primary health care system is a fundamental point of health service provision due to its ability to promptly address the immediate health needs of people. This point of care caters to about 70% of the population and it is the foundational basis for achieving Universal Health Coverage. In sub-Saharan Africa particularly Nigeria where the disease burden particularly pertaining to Maternal and Child health is yet to be considerably reduced, the PHC plays a vital role in providing preventive and curative services and unfortunately, over time it has received the least funding and investment among the 3 tiers of health care provision.

In order for the PHC system to be strengthened considerable investment has to be made across various focus areas such as Infrastructure, Human resources, Provision of essential medicines, provision of health insurance, and governance. Although some investments that have been made over time have not necessarily translated to improvement in the PHC performance. 

There is currently a gap in having a system that can objectively measure and evaluate PHC performance at the National and Subnational levels along with the various indices of service delivery and utilization which can then be measured alongside the impact and outcomes on the health of the populace.

Our Solution is the Primary Health Care Performance Improvement Platform (PHCPIP). This platform will provide 3 State Government Primary Health Care development agencies in Nigeria (Lagos, Kano, and Niger State) to assess their level of PHC performance based on selected indices that categorize health investment, human resource, service delivery, and quality of service in a ranking system. This will further support the Nigerian Federal government to have verifiable information on these 3 State's levels of PHC improvement with the possibility of scaling this solution for adoption in the remaining 33 States. This solution also has the potential to improve Universal Health coverage and accessibility of quality health care in the most populous nation in Sub-Saharan Africa.

Currently, the solution is at the stage of inception. We will be utilizing the Human-Centered Design process to develop and implement the solution with the identification of key stakeholders in the primary health care system in Nigeria. 

The solution will be relevant to key stakeholders in the State health system that contribute significantly to policy development and program implementation at the PHC level. These stakeholders will be categorized at the National and Sub-National levels, State and Local Government agencies, executives, legislative and public health officials, civil society organizations, and relevant private sector organizations. 

This solution has the potential to positively impact the Primary health care system in Nigeria by providing verifiable indicators that support improvement in health outcomes. This further translates to improved access to quality health services for the citizens and a more healthy productive workforce.

Co-creation Hub (CcHUB) is a Pan-African innovation organization established to accelerate the application of social capital and technology for economic prosperity. CcHUB has a thriving Design for Health practice, that aims to address public health challenges on the African continent using innovation, technology, and Human Centred Design (HCD). 

As a practice we have considerable experience in providing technical expertise in Public Health and research, building a community of practice in Epidemiology, providing Public health advisory to organizations new to the Public health space in Africa, and building impactful health innovations. We have a team of public health experts who have considerable experience in implementing Primary Health care policies and interventions at the State, National, and Multinational levels, particularly in Nigeria. We have executed a number of novel solutions which are but are not limited to Smiles for Mothers, NIMCURE, and COVID PMS.  In the execution of these projects, we have had to engage stakeholders in the public and private sectors and in most cases stimulate relationships that didn’t exist previously.

Our application to Solve is spurred given the track record of the organization to support novel first-rate solutions geared towards health system strengthening especially in low and middle-income countries.

Little or no solution has been done in Nigeria with the primary focus on involving the PHC performance leveraging the use of unconventional data. Additionally,  the available solutions have been channeled using the traditional dataset and indices. Against this backdrop, our solution would be the first-rate solution geared toward improving PHC using unconventional methods and indices in  Nigeria.

Over the next year, we aim to implement this solution in the three states of the country, and evidently, the platform would have identified the bottlenecks in PHC performance in the states using unconventional methods. On top of that, the generated indices and constant evaluation of these results would birth improved PHC service delivery.

Successful implementation of this program will be in line with the project teams' aim to achieve the following; 

1. Identify and actively engage with relevant stakeholders at the National and State Ministry of health levels by meetings and strategy workshops 

2. Foster potential collaboration between the private sector, development partners, and the public sector on program implementation support in the PHC performance improvement process.

3. Co-develop and co-create a performance improvement indicator list and solutions. 

4. Printing and Dissemination of the co-developed advocacy tool to relevant stakeholders for adoption and sustainability. 

5. Conduct PHC PI assessment exercises to validate the platforms findings. 

6. Support the States to utilize the PHC performance improvement platform to develop strategy documents for PHC revitalization.

This solution will ensure that States have evidence based data and information to make informed decisions in identifying areas of improvement in the State health system at the Primary health Care (PHC) level.

The foreseeable impact of this project will drive sustainable actions and accountability thereby fostering intersectoral stakeholder engagement and dialogue through the workshops and co-development sessions that will improve engagement and collaboration among PHC stakeholders within the system on policies and programs aimed to achieve Primary health care revitalization.

The Primary Health Care Performance Improvement platform aims to utilize applications and software technology that would be accessible on computer and mobile/smart devices. These solutions will enable ease of data compilation, collection and administrative data analysis/interpretation. 

The design lab which consists of the research team, product team and design team of the organization will primarily be collecting and analyzing the data using a Human-centered design approach as our focus.

Data collection officers at the State level will be responsible for liasing with State health systems to compile primary data.

Co-creation Hub has a thriving organizational culture that incorporates consideration for diversity, equity, and inclusion in its recruitment strategy and personnel engagement.

The PHC PI platform will leverage on using unconventional data sources indicators along 4 main areas; 

1. Access to Service delivery (Financial and Geographical access)

2. Supply Chain

3. Human Resource for Health

4. Data management

These unconventional data sources will range from; 

1. Image sensory

2. Population density

3. Social connectedness

4. Socio-economic index

5. Heat map

6. Movement range map 

This sources will provide a machine learning relationship that will  

1. Cross-reference data sources with the number of patients accessing services in PHC catchment areas.

2. Linking outreach services in the PHC catchment area to population density or movement range map.  

3. Comparison of wealth index data with utilization rate

4. Link between Consumption and Purchasing patterns with the utilization of essential drugs in PHC catchment area.

5. Cross-reference number of health workers against population density to indicate HRH workload. 

The key beneficiaries will be the State Government ministries and agencies, development partners, the private sector, and mainly organizations that contribute to health service at the policy and program implementation level with the overall beneficiaries being the General public who get to benefit from the improved decision making by State health actors in addressing key PHC identified challenges.

The project aims to provide social impact. In order to be sustainable, it would leverage on grants and Government adoption for expansion to ensure the performance improvement platform is utilized as a standard for PHC measurement by National and State Governments in Nigeria. 

Co-creation Hub has implemented programs that were grant funded in the public health space. The Organization has a growing relationship with international and national funders like Bill and Melinda Gates Foundation-currently implementing a project on the Pharmaceutical supply chain in Nigeria, Kenya and South Africa; Meta - Organizing a Design for Epidemiology hackathon for health startups; MIT and Ekiti State Government- Governance innovation challenge project; MSD for Mothers- Smiles for Mothers project in 3 States in Nigeria (Lagos, Niger, Kano).