A comprehensive review of the evidence regarding the effectiveness of community-based primary healthcare in improving maternal, neonatal and child health: Summary and recommendations of the Expert Panel

Tags: Poster
Black R1, Taylor (deceased) C1, Bhutta Z2, Victora C3, Sacks E1, Perry H1
1Johns Hopkins University, 2Aga Khan University, 3Federal University Pelotas

Background: The contributions that community-based primary healthcare (CBPHC) and engaging with communities as valued partners can make to the improvement of maternal, neonatal and child health (MNCH) is not widely appreciated. This unfortunate reality is one of the reasons why so few priority countries failed to achieve the health-related Millennium Development Goals by 2015. This article provides a summary of a series of articles about the effectiveness of CBPHC in improving MNCH and offers recommendations from an Expert Panel for strengthening CBPHC that were formulated in 2008 and have been updated on the basis of more recent evidence.

Methods: An Expert Panel convened to guide the review of the effectiveness of community-based primary healthcare (CBPHC). The Expert Panel met in 2008 in New York City with senior UNICEF staff. In 2016, following the completion of the review, the panel considered the review’s findings and made recommendations. The review consisted of an analysis of 659 unique reports, including 581 peer-reviewed journal articles, 12 books/monographs, 4 book chapters, and 72 reports from the grey literature. The analysis consisted of 698 assessments since 39 were analysed twice (once for an assessment of improvements in neonatal and/or child health and once for an assessment in maternal health).

Results: The Expert Panel recommends that CBPHC should be a priority for strengthening health systems, accelerating progress in achieving universal health coverage, and ending preventable child and maternal deaths. The panel also recommends that expenditures for CBPHC be monitored against expenditures for primary healthcare facilities and hospitals and reflect the importance of CBPHC for averting mortality. Governments, government health programmes, and NGOs should develop health systems that respect and value communities as full partners and work collaboratively with them in building and strengthening CBPHC programmes – through engagement with planning, implementation (including the full use of community-level workers), and evaluation. CBPHC programmes need to reach every community to achieve universal coverage of evidence-based interventions.