URC started working on international health projects in the 1980s. The PRICOR team conducts an assessment in Zaire (now the Democratic Republic of the Congo). Photo credit: URC

Primary Health Care Operations Research (PRICOR)

The Challenge

While diarrhea was a major cause of preventable child deaths in many developing countries in the 1980s and a highly effective, inexpensive, and simple technology was available to prevent dehydration and death, much of the developing world faced challenges in delivering that technology to children in need.

Overview and Objectives

The PRICOR Project was established to help less developed countries (LDCs) apply practical, decision-oriented research to identify and solve operational problems in the delivery of primary health care (PHC), particularly health services vital to child survival, including oral rehydration therapy, immunizations, malaria control, management of acute respiratory infections, child spacing, and maternal health care.

The first phase of the project (1981-87) sought to develop an operations research approach that country decisionmakers and local program managers in LDCs could use to create and test cost-effective solutions to problems impeding the delivery of PHC services at the community level.  Through six competitive solicitation cycles, the project stimulated the development of over 400 concept papers and proposals in four areas that were a priority for USAID: community health workers, community financing of PHC, community organization of PHC, and commodity distribution for PHC (focused primarily on distribution of oral rehydration salts). PRICOR II (1985-1991) was tasked with developing a systematic approach to analyzing how well health workers carry out high quality PHC service tasks and to use the findings of these in-depth systems analyses as the basis for selecting operational problems to be addressed through rapid and focused operations research studies.

Achievements

PRICOR I funded 49 studies in 32 countries and developed five guides on PHC operations research methods and issues, distributing over 11,000 copies in English, French, and Spanish.  PRICOR staff analyzed the results of the individual studies and prepared comparative analyses of the evidence generated around community financing of PHC, the delivery of oral rehydration therapy, and the effective deployment of community health workers. 

PRICOR II developed the Primary Health Care Thesaurus, which defined non-professional or lower-level health worker tasks for seven key PHC services – immunization, oral rehydration therapy, acute respiratory infections, growth monitoring, malaria, maternal health, and child spacing – in quantifiable operational terms and with indicators of performance.  The PHC Thesaurus also defined tasks and performance indicators for the support activities needed to assure high quality performance for each of the seven PHC services: planning, training, supervision, community organization, logistics, financial management, and information systems, monitoring, and evaluation. PRICOR II collaborated with major primary health care and child survival service delivery agencies and institutions to conduct PHC systems analyses in 12 countries using direct observations, limited household surveys, key informant interviews, and other rapid assessment methods and to carry out over 80 operations research studies to address gaps identified in the systems analyses.

Duration
1981–1991

Countries
Bangladesh, Benin, Bolivia, Brazil, Colombia, Costa Rica, Democratic Republic of the Congo, Dominica, Dominican Republic, Ecuador, Egypt, Eswatini, Grenada, Haiti, Honduras, India, Indonesia, Jamaica, Liberia, Mali, Mexico, Niger, Nigeria, Pakistan, Papua New Guinea, Peru, Philippines, Senegal, Sierra Leone, Somalia, South Korea, Tanzania, Thailand, and Uruguay

Regions
Africa, Asia, Eurasia, Latin America and the Caribbean, and Middle East

Expertise
Community Health, Health Service Delivery, Health Workforce, Malaria, Maternal, Newborn, and Child Health, Nutrition, Quality Health Systems, and Reproductive Health and Family Planning

Funders
USAID

Partners
Harvard Institute for International Development, Logical Technical Services, PRISM, and Western Consortium