Comparing Primary Health Care Delivery Models in Conflict Affected Settings of Cameroon and Nigeria

What did the study set out to achieve?

There is sparse evidence to guide the selection and design of primary health care (PHC) services that improve and maintain quality care in humanitarian settings. The Northwest and Southwest regions of Cameroon, and Northeast Nigeria have protracted humanitarian crises. Various models of PHC are used in these settings; ensuring quality of PHC models of care is essential to improve health outcomes. This study set out to explore how PHC models are selected by humanitarian organisations, and through stakeholder engagement, design a toolkit for evaluation of quality in PHC delivery across different models.

The formative research was exploratory in nature and to generate learning on the range of PHC services offered using different models of care, key drivers behind the selection of models of care and quality interventions applicable to models of care in conflict settings of Cameroon and Nigeria.

A cross-sectional survey of 160 humanitarian organisations, and qualitative interviews with 127 key informants in Cameroon and Nigeria were conducted. Two co-creation workshops were also conducted to develop a framework for selecting and implementing PHC models in conflict settings.

What were the key findings?

• Nine PHC delivery models were identified. The most common models include health facilities, community-based interventions, and mobile clinics, each with limitations.
• The choice of model is influenced by several factors including stakeholders, services, outer and inner organisational setting factors, coordination and assessment of advantages/disadvantages.
• There is significant clustering of service providers in geographic proximity, with national and community-based organisations playing a prominent role. However, humanitarian organisations reported challenges with service quality and maintaining standards, despite most providers having quality frameworks in place.
• The findings suggest there is value in further research exploring outcomes of integrated approaches to delivering comprehensive PHC, which can address unmet mental health and non-communicable disease (NCD) needs. Hybrid models of care (using two or more modalities) could be considered for service delivery in one geographical area, to expand service coverage and quality. The humanitarian reporting matrix could be improved, to reflect which models of care are used to deliver services in a geography, and enable coordinated planning to address identified gaps with complementary models of care.

What does this mean for policymakers and practitioners?

Humanitarian actors must adopt a coordinated, evidence-based approach to PHC service delivery in conflict-affected settings. This research highlights the importance of delivering services using hybrid models of care (a combination of two or more models) which can allow for a wide range of services to be offered and improve access to quality care. Evidence suggests the value of enhanced community involvement in service delivery and coordination. The study team developed a decision-making framework that can guide the selection of appropriate PHC models in complex environments like Cameroon and Nigeria, which will be presented in a forthcoming publication.

Future implementation science studies should focus on field testing the practical application of framework for choice of model of care and quality toolkit in different conflict-affected regions to assess its effectiveness and scalability.