Stronger Primary Health Care, Healthier Communities: How Local Leaders Are Driving Change 

Strong primary health care (PHC) is the foundation of every health system—and essential for helping people lead healthier lives. Strengthening PHC doesn’t always require major new investments, products, or technologies; it can be achieved through practical, proven solutions that maximize existing resources. What works is clear: PHC systems that are well-staffed, well-managed, data-driven—and critically, led by those closest to the communities they serve.

In many countries, subnational health leaders and managers are often overburdened yet expected to improve health outcomes without sufficient autonomy, resources, accountability, or support. The PHC Performance Management (PHC-PM) Activity, funded by the Gates Foundation and led by Management Sciences for Health (MSH) and partners, is shifting that dynamic. One year into implementation in Ghana and Rwanda, the evidence proves that when local teams are trusted, equipped, and accountable to their roles, they can deliver measurable results.

A Locally Led Model for Sustainable PHC

The project strengthens subnational performance management through the PHC Leadership Development Program (PHC-LDP), which unlocks the full potential of district health management teams (DHMTs). Drawing on MSH’s decades of experience in leadership development, the program reinforces leadership systems to improve PHC performance, equipping local leaders with the tools and resources they need to deliver better care in their own communities. The model helps teams define a shared vision, identify root causes of performance gaps, and take targeted action using local data.

Key components include:

• Leadership development through hands-on coaching and performance improvement cycles that blend adaptive problem-solving with data-informed planning. Teams use the Challenge Model to define a shared PHC vision, measurable results, analyze root causes, and develop targeted actionable plans.

• Use of operational data and integrated dashboards, built on national platforms, to identify service gaps, guide realistic planning, and track progress. Designed alongside DHMT members, data dashboards support more informed decision-making and foster a culture of shared accountability.
• A reflective approach to monitoring, evaluation, and learning (MEL), that enables districts to assess what’s working, what’s not, and why—fueling continuous improvement, peer learning, and evidence-based policy dialogue.
• Catalytic grant funding gives teams the flexibility and financial autonomy to act on what their data shows. DHMTs manage this funding stream to accelerate implementation of prioritized, results-driven activities including outreach, training, and procurement of essential equipment.

This is a model built for lasting change: rooted in national systems, aligned with country priorities, and designed to strengthen, not replace, existing institutions.

 “[The PHC-LDP] gives us a better chance of ensuring quality service delivery—because PHC is all about continuous improvement. By conducting root cause analysis and implementing priority actions, we’re seeing real progress.”

— Dr. Moses Ahabwe, Director of Building Systems for Health in Rwanda.

Local Teams, Tangible Results

When local teams lead with data and decision-making power, they focus on what matters most in their communities. Over the past year, DHMTs in Ghana and Rwanda have addressed persistent challenges through targeted, data-informed actions:

• In Gicumbi, Rwanda, the DHMT is prioritizing improving antenatal care by training health workers and equipping facilities with tools to improve early antenatal care (ANC) attendance and provider capacity gaps. Preliminary data show that catalytic grant funding used to provide health worker training on ANC protocols and expanded service delivery at clinics and outreaches are improving coverage of the first ANC visit in the district.
• In North Tongu, Ghana, district leaders are working to strengthen maternal health services by expanding access to anemia testing and improving how facilities track and follow up with pregnant women. These efforts, which included procuring hemoglobin testing kits and supporting better ANC tracking, have improved diagnosis of anemia in pregnancy in the district.
• In Akwapim South, Ghana, DHMT members tackled frequent stockouts of essential medicines through improved supervision and by enhancing delivery readiness. This included renovating midwife accommodations and building storage shelves for better supply management. These efforts contributed to drops in medicine stockouts in the district, with ongoing tracking being maintained.
• In Bugesera, Rwanda, the team focused on strengthening the quality and use of facility-level data—ensuring decisions and actions were grounded in timely, accurate information. These efforts improved service coordination and boosted community outreach and referral systems. Trends also suggest declines in neonatal mortality during this implementation cycle, though further analysis is underway to better understand the drivers and significance of these changes.

These outcomes were driven primarily by more effective and accountable local leadership—rooted in national systems and priorities and catalyzed by targeted grant funding. While early signs point to promising progress, we are actively reviewing district-level data to assess the full impact on measurable health outcomes.

Why It Matters Now

With global health financing under strain, it’s more important than ever to double down on PHC. Our model shows that even in resource-limited settings, real progress is possible when local leaders are empowered and held accountable. In Ghana and Rwanda, DHMTs are using their own data to set priorities, strengthen access to essential services, and maximize available resources.  

For Margaret Donkye, a Health Improvement Officer in Ghana’s Akwapim South District, the difference is tangible:

“Before, pregnant women struggled to access midwives. Now, with tricycles funded by the project, midwives reach them directly—and we provide transport for emergencies. Babies are born safely, infections are prevented, and outcomes improve.”

She adds: “We’re also redefining roles for community health nurses, allowing them to specialize—like in adolescent health—so they deliver higher-quality, focused care.”

Goka Elagbe, a Public Health Nurse in North Tongu, Ghana, shares another success that captures the project’s impact: “One facility lacked resuscitation equipment. Through the project, we provided it—and that same week, two newborns’ lives were saved. Without this support, we would have lost them.”

The momentum is building. As Gicumbi’s Vice Mayor, Mbonyintwari Jean Marie Vianney, affirms: “By the end of this project, we expect even greater improvements in health outcomes. What we’re seeing isn’t just theoretical—it’s proven by data and lives saved. This is the foundation for lasting change.”