Helena Marie L. Alvior, Mary Camille T. Samson
Background: Universal health coverage (UHC) implementation faces challenges in achieving integrated primary care delivery, particularly in resource-constrained settings where fragmented service networks undermine service coverage and quality. Primary care facilities (PCFs) often lack systematic assessment mechanisms and collaborative governance structures necessary for effective care coordination and sustainable health system strengthening. This intervention enhanced Guimaras Unified Health Network’s capacity for UHC implementation through: (I) comprehensive facility assessments using systems thinking frameworks; (II) design thinking approaches for evidence-based solutions and improved care coordination; and (III) building local leadership capacity for sustainable and integrated health system governance.
Methods: We implemented a 15-month technical assistance intervention using an integrated Input-Process-Output-Outcomes framework combined with human-centered design principles. The methodology included deploying a comprehensive Primary Care Facility Assessment Tool across five PCFs examining service delivery, financing, and governance dimensions; multi-stakeholder engagement through Project Core Teams and Community Advisory Groups; and participatory workshops and collaborative solution development through patient journey mapping and care pathway redesign.
Results: Facility assessments revealed specific capacity constraints affecting service integration and care coordination within the province-wide network. Non-health determinants, including leadership, financing, and human resource capacity, significantly impacted service delivery capacity. Participatory workshops generated evidence-informed solutions addressing identified bottlenecks, including reimagined patient pathways for vulnerable populations and strengthened referral mechanisms. This methodology enhanced stakeholder ownership, established sustainable feedback mechanisms, and aligned local priorities with UHC requirements while building adaptive governance capacity.
Conclusions: This integrated systems and design thinking approach demonstrates effective strategies for strengthening primary care networks essential for UHC implementation. The methodology provides a replicable framework combining systematic assessment with collaborative innovation, offering actionable guidance for health facility heads, system managers, and technical assistance providers seeking to enhance care coordination, improve service quality, and build sustainable governance capacity for UHC.
