A realist synthesis of staff-based primary health care interventions addressing universal health coverage

Background Universal Health Coverage (UHC) can be achieved by universal access to a solid and resilient people-centred health care system, with Primary Health Care (PHC) as its foundation and strategy. Increased access to PHC occurs when health care services are available, affordable, accessible, acceptable, and perceived appropriate by users. Many studies highlight that health care workers are critical in helping people access, navigate, and interact with PHC services. How the interventions involving health care staff work and under what circumstance remains unclear. Methods Through a systematic review and a realist synthesis, we identified and described staff-based interventions impacting UHC through PHC. We conducted the systematic review from inception to June 2021, searching for peer-reviewed studies published in English, using quantitative methods for evaluating interventions. Results We identified three Context-Mechanism-Outcome (CMO) configurations: inserting culturally sensitive ad hoc bridge figures, tailoring staff practices to the needs of specified populations, and training as a means for staff reskilling. Inserting ad hoc bridge figures in health care services was successful when they were familiar with the contextual culture and the users' needs. The second configuration entails interventions where the staff was asked to consider the needs of targeted populations and differentiate strategies by the detected conditions. Finally, the third one consists of specific, ad hoc, and context-based training targeting several stakeholders. Central to this intervention was training for health care bridge figures, since they were explicitly trained before performing their duties to cope with the health care and social needs of the specific groups they intended to serve. Conclusions The review highlights that the context and contextual factors should be considered for an intervention to be successful. Hence, it provides policymakers with practical indications for designing staff-based interventions for reaching UHC within PHC services in a given context. Healthcare bridge figures, an umbrella term embracing a variety of selected community health workers, often trained and working in the communities from which they come, increase access to PHC services as they respond to local societal and cultural norms and customs, ensuring community acceptance and ownership.

Automated summary

The study identified staff-based interventions that impact Universal Health Coverage through Primary Health Care, including culturally sensitive ad hoc bridge figures, tailoring staff practices to specific populations' needs, and training for staff reskilling. Context and contextual factors are crucial for the success of these interventions as they aim to reach UHC within the given context. Healthcare bridge figures, trained to respond to local societal and cultural norms, play a key role in increasing access to PHC services by ensuring community acceptance and ownership.