Meso-level primary health care: factors influencing the extent to which planning decisions are evidence-informed and equity-oriented

Author: Alice Windle

Windle, Alice, 2021 Meso-level primary health care: factors influencing the extent to which planning decisions are evidence-informed and equity-oriented, Flinders University, College of Medicine and Public Health

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Regional primary health care organisations (PHCOs) are well placed to strengthen primary health care (PHC) and improve population health and health equity through evidence-informed planning that addresses identified local priority population health needs. Comprehensive PHC is underpinned by principles of health equity including equitable access to local primary care services, and preventive action on the social determinants of health, in partnership with local communities and other sectors. In Australia, Primary Health Networks (PHNs) are responsible for planning and commissioning PHC interventions based on local needs. Such health planning decisions should be informed by evidence to ensure effective, efficient and equitable interventions. This study, as part of a larger national study of PHCOs, aimed to examine PHNs’ use of evidence, and factors that influence evidence-informed, equity-oriented regional PHC planning in Australia. A complex range of internal and external factors and influences were explored, including values and culture, actors, interests, planning processes and organisational capacity.

This research employed a mixed methods approach. Key PHN planning documents (needs assessments, activity work plans and annual reports) from 31 PHNs were analysed to examine the use of evidence and equity considerations. Case studies were conducted with a purposive sample of 5 PHNs, drawing on 29 stakeholder interviews, secondary analysis of 36 interviews from an earlier study, and document analysis of internal policy and procedure documents regarding planning and decision-making. The ORACLe tool was employed to examine organisational capacity. Data were analysed with NVivo software, using a framework adapted from a WHO conceptual framework for evidence-informed health policy-making, and employing an institutional theory lens.

This study found that PHNs created and used a great deal of evidence to identify population health needs and service gaps, but very little to inform the development of strategies. Evidence was largely about illness prevalence and service use, and less about social determinants of health. PHNs generally demonstrated strong capacity overall for evidence-informed planning, but their planning processes were unclear and were somewhat lacking in good governance mechanisms. Their capacity to evaluate programs and generate relevant intervention evidence was limited. While most PHNs expressed good intentions about addressing health inequity, they were tightly regulated by their federal government funders to focus on clinical services and individual behaviour change approaches, with very little upstream intersectoral health promotion. Time, resource and scope constraints hinder rigorous evidence-informed, equity-oriented planning.

PHNs have good capacity and are well placed to identify and address local population health needs through evidence-informed and equity oriented comprehensive PHC approaches, however their potential to do so is undermined by the federal government constraining their scope to selective, individualistic approaches. Adequate resourcing, time and scope, and greater attention to planning process mechanisms, evaluation and equity, would improve PHNs’ ability to improve the health of their communities equitably, through evidence-informed strategies that strengthen PHC.

Keywords: primary health care, primary health care organisation, Primary Health Network, evidence, evidence-informed planning, equity, organisational capacity

Subject: Public Health thesis

Thesis type: Doctor of Philosophy
Completed: 2021
School: College of Medicine and Public Health
Supervisor: Dr Sara Javanparast