The Primary Care Innovator's Handbook: Voices from Leaders in the Field

The World Health Organization estimates a shortage of 4.3 million health care workers globally. With this critical lack of health resources, primary care has garnered more and more attention as the key to improving health systems in low- and middle-income countries. As the first point of care for patients, primary care clinics in low- and middle-income countries play a key role as a gateway to the rest of the health system, and they provide the basic preventive and curative care that saves the most lives. Consequently, interventions at the primary care level are crucial to improving health outcomes.

Primary care leaders want and need practical knowhow. They recognize that there are not always clear solutions to tough challenges, but they have found that there is value in sharing ideas and experiences, testing new approaches, and sharing the results to enable successful innovations to spread more rapidly between organizations and across geographies.

The Primary Care Innovator’s Handbook

With that, the Center for Health Market Innovations (CHMI) is excited to announce the launch of The Primary Care Innovator’s Handbook: Voices from Leaders in the Field. The Handbook is an attempt to share knowledge between innovators in an open and informal way, and to encourage more conversations of this style among the community of innovators working to improve primary care.

The Handbook is unique in that it is co-written by implementers themselves, showcasing reflections from leaders on their experiences, and including concrete tools they have employed in their work. The Handbook reflects what these organizations have learned from their experiences thus far, and is intended to leave the reader with ideas, tools, and inspiration, that they can then immediately test, implement, or adapt to their own work.

The Handbook also includes a unique feature in the form of running comments from peer organizations that accompany each chapter. Through this running commentary, the Handbook is working to capture the conversation around primary health care delivery, rather than a one-way presentation of ideas.

The primary audience of the Handbook is managers of primary care organizations, or those who are hoping to start such organizations. Nevertheless, the knowledge shared by the primary care organizations is relevant to many others working in the health field, and the open conversation begun here is one we hope to continue with all others working to improve health systems.

The Handbook covers a range of topics that are central to the successful operation of a primary care chain or franchise. Some key questions discussed include:

  • How do you choose your clinic sites?
  • How do you best staff your clinics?
  • How do you continuously improve your model?

The Handbook should be considered a “living handbook.” It is the start of a conversation and hopefully will grow over time with new insights and experiences. We hope that others will contribute to the development of this field by sharing their experiences as innovators in primary care. Rather than see one another as competitors, let’s see one another as what we truly are: partners in building better health systems globally. We invite you to download the report here and join the dialogue at


The Primary Care Learning Collaborative

The CHMI Primary Care Learning Collaborative is a peer-learning network that enables knowledge sharing among participating organizations on challenges related to quality, sustainability, efficiency, and scale. Convened in 2013, Collaborative members share successes, jointly solve problems related to common challenges, and highlight promising practices for organizations providing primary care in low- and middle-income countries. The Collaborative consists of five organizations employing chain and franchise models to deliver primary health care in Kenya, Burundi, and India: Access Afya, LifeNet International, Penda Health, Ross Clinics, and Swasth India. Other contributing organizations for the Primary Care Innovator’s Handbook include: Care 2 Communities, Care Rural Health Mission, Rural Health Care Foundation, SughaVazhvu, Tiba Health Limited, Unjani Clinics, Viva Afya, and World Health Partners.