This output intends to strengthen PHC services in the targeted 4 provinces of Central, North Central, Sabaragamuwa, and Uva with a special focus on the socially, economically and geographically disadvantaged populations. The PHC services are defined as primary health care services that are provided via curative facilities (Primary Medical Care Units and the Divisional Hospitals), and via the preventive health network led by the Medical Officers of Health.
Output 1 will support four sets of activities:
(1). Development of primary medical care services
Under this output, the project supports the development of curative PHC facilities (this includes DHs and PMCUs). Approximately, 29% (135/469) of all PMCUs and DHs in the four provinces will be developed under this output. The infrastructure designs will be based on a MOHNIM approved physical space norm for PHCs. This output will also support to purchase the immediate medical equipment needs which were identified by carrying out a stocktaking of gaps against current guidelines. The additional equipment that would be needed to address the essential service package (ESP) at the PHC level will be procured from the second year of project implementation. The additional services may include services for elderly care, services for mental health, and more comprehensive non-communicable diseases and risk factor prevention related care at the PHC level, rehabilitation and disability care services and additional laboratory services.
(2). Development of primary preventive care services
Under this output, the project intends to renovate and refurbish at least one field health center per medical officer of health area (approximately 127 field health centers in the four provinces). The project will enhance the mobility levels of the field health staff, especially the medical officers to expand and further improve and better supervise the preventive health services. Approximately 40 vehicles will be provided to medical officers of health and to regional level medical officers for maternal and child health services for supporting improved preventive and promotive health services in the four provinces. In addition, this output will support the within district drug distribution system with the purchase of 9 covered trucks for each of the regional medical supplies divisions under the districts. This output also supports to expand the targeted nutrition related services available to the mothers and children in the four provinces with a special focus of more vulnerable populations in the estate and rural areas.
(3). Public awareness and behavior change communication for increasing PHC utilization
The objective of this output is to create demand and support a behavior change of health seekers who regularly bypass PHC services. This output will also support to encourage utilization of nutrition services and wellness and healthy living promotion in the community. Moreover, the campaign will also promote the nine selected clusters and the related MOH areas for (i) wellness and healthy lifestyle; (ii) integrated services such as nutrition, NCDs, and elderly care; and (iii) for convergence with other vertical programs (malaria, HIV, tuberculosis, leprosy, sexually transmitted diseases, etc.).
(4). Strengthen PHC management for continuity of care
This output will support to strengthen mechanisms to establish continuity of care and provide a higher quality, more comprehensive, package of care primarily to PHC level health seekers in the target provinces. As part of this effort, on a pilot basis, each of the 9 districts identified a cluster of PHC level hospitals that will be functionally linked to one apex secondary care level facility. This sub-output will support the provincial and regional health staff to propose and implement strategies to improve continuity of care in these clusters via district specific proposals submitted to each of the PIUs. In addition, to activities related to clusters, province and district health staff are encouraged to develop proposals (which will include detailed activity plans) to further support better delivery of PHC services under five broad areas: (i) improving PHC management; (ii) human resources development; (iii) information technology for better patient management and disease control; (iv) scaling up curative and preventive services; and (v) rehabilitation of facilities.