Saving Lives with Primary Care Programs in Low-Income Settings

Leslie Curry, Ph.D., GHLI researcher

Many efforts have been directed at strengthening rural primary care services for women and children in low-income settings.  But few studies have examined the sustainability of these programs or the potential long- term impact of these interventions on the mortality of women and children.

Researchers at the Yale Global Health Leadership Institute (GHLI) evaluated the impact of the Ethiopian Millennium Rural Initiative (EMRI) in terms of lives and money saved. EMRI was a systems-based intervention to improve the performance of 30 primary health care units each servicing 40,000 people living in rural areas of Ethiopia.  Their findings are published in the November 18, 2013 issue of the Public Library of Science journal.

“We found multiple areas of this program were impacted -- including the health system infrastructure, human resource capacity and utilization of HIV treatment services,” explains Leslie Curry, Ph.D., GHLI researcher and paper co-author.  “Most notably, we discovered impressive cost-effectiveness in terms of lives saved over five years of follow up.  The study found that initial investments in critical areas such as access to water and electricity and improvements to buildings, provide far-reaching benefits for health care delivery in rural settings.  The program also expanded care and treatment services for HIV patients.   In addition, investments in system-wide improvements (such as supply chains and laboratories) were shown to noticeably strengthen the capacity of the rural health care system.   If this model is scaled up, the four major regions of Ethiopia could save nearly 35,000 lives.

“This large project not only implemented and evaluated a program to improve rural health care across several sectors,” explains Curry, “it also required developing leadership capacity all across the health care system.”  The researchers hope these results will be used in Ethiopia as they continue with their plans to improve primary care systems nationally.

The analysis underscores the particular importance of sustained performance in driving cost effectiveness. Although the pay back in terms of lives saved did not translate to cost savings in the first 18 months, within five years of sustained performance, the benefits far outweigh the costs of the program.

The researchers hope these results will be used in Ethiopia as they continue with their plans to improve primary care systems nationally.