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Focus Areas

Primary Health Care in Low- and Middle-Income Countries

Assessing and addressing barriers to quality primary health care

The Importance of Accessible Primary Health Care

Primary health care (PHC) involves bringing prevention and treatment services closer to communities so that health care needs can be met as early as possible. Quality primary healthcare expands and improves access and availability to safe, respectful care, reinforces responsive and resilient health systems and, ultimately, achieves improved health outcomes as measured by reduced maternal, neonatal, and child mortality, and reduced morbidity from noncommunicable and infectious diseases.

Working with host country governments and local partners, we work to assess and then address policy, operational, financial, and motivational obstacles to quality PHC, recognizing the interdependency of these elements.

RTI’s Primary Health Care Framework

  • Is guided by five principles: accountability, evidence based, responsive, inclusive, and locally led.
  • Emphasizes that communities are at the center of care across the life course.
  • Delivers contextual understanding of the broader ecosystem so that PHC is equitable with a view towards universal health coverage (UHC).
  • Supports a high-quality essential, cost-effective package of preventive, promotive, treatment, rehabilitative, and palliative services that provides and protects people from health impoverishment.

Project Highlights – Primary Healthcare Approaches in Action


  • The Governance for Local Development (GoLD) project supported citizen advocacy groups to monitor services and measure performance of health facilities. These groups developed advocacy action plans for improving health service delivery and mobilizing local funds to finance the projects.
  • In Nigeria, the Leadership, Empowerment, Advocacy, and Development (LEAD) project built the capacity of local organizations to engage with the government regarding service planning, budgeting, and monitoring processes. Through participatory budgeting, the project helped Bauchi and Sokoto become the only two states in Nigeria to allocate 15% of their state budget to health.


  • The ReachHealth project is strengthening health information systems for data-based decision-making by providing trainings about data quality, analysis, and learning. Through data utilization workshops, the project built the capacity of PHC health facility representatives in adaptive management capacity, while also producing data for the program’s routine monitoring.
  • RTI developed Coconut Surveillance to enhance malaria detection, as well as response and surveillance efforts, helping program managers analyze and understand malaria transmission and response trends in real time. Coconut Surveillance has helped Zanzibar reduce its malaria prevalence from more than 30% in 2005 to less than 1% today.


  • In the Philippines, the ReachHealth project is developing the capacity of service providers and community-based family planning service providers to deliver and monitor gender-, age-, and culturally appropriate client-centric care.
  • In Senegal, USAID Senegal Owod supports participatory annual planning with active citizen engagement to ensure that citizens’ voices and needs are captured within district health plans.


  • The Act to End Neglected Tropical Diseases | East project oversaw gender, equity, and social inclusion (GESI) assessments in multiple countries that analyzed the gender dynamics of neglected tropical disease treatment, prevention, and surveillance to ensure that men and women can access mass drug administration and are counted in disease-specific assessments.
  • USAID Owod supports districts in bringing services close to populations in remote or inaccessible areas through integrated “advanced” strategies or mobile outreach with nurses or midwives who can provide a broader package of health services. The program is also focused on youth-inclusive activities that address challenges in accessibility and co-create solutions for greater inclusivity.

Locally Led

  • The StopPalu+ project strengthened community health by increasing community involvement and building local government and health provider capacity to monitor, prevent, diagnose, and treat malaria effectively.
  • The Governance, Accountability, Participation and Performance (GAPP)  project designed a transformational leadership program for local elected officials that helped to develop their skills to lead high-performing teams, improve decision making, and think creatively to address entrenched system obstacles (e.g., sustainable financing).