In a survey of regional health directorates regarding their support to primary health care (PHC) services comanaged by community nonprofit organizations, good regional management practices were significantly correlated with improved PHC service performance.

Specific management practices that were linked to better performance of comanaged PHC services included: formal appointment of regional management team leadership, vigorous financial oversight (periodic site visits for document review and external audits), provision of training and information to the community nonprofit committee and PHC staff, supervision visits by program specialists, and inclusion of health promotion in local health plans.

Policymakers should intentionally design regional management structure and roles that are aligned with and hold accountable PHC services with community-comanaged PHC.

Policymakers need to carefully design and support the structure, roles, and institutionalization of community-comanaged PHC facilities to include legally enforced accountability mechanisms for human resources and local purchasing that have been shown to improve quality, equity, and coverage of PHC services.

Health sector officials and functionaries need to oversee implementation and continuous evaluation of regional management practices that support and hold accountable redesigned PHC with community roles for collaborative management.

Increasing prioritization of quality primary health care (PHC) includes community engagement as a key element to improve PHC performance. We assessed the correlation of good regional management practices with PHC performance in Peru in community-comanaged PHC that is designed with multiple accountability mechanisms.

We conducted a secondary analysis of a survey of Dirección Regional de Salud (regional health directorates, DIRESAs) regarding their management of public PHC services with collaborative community involvement by a Comunidad Local de Administración de Salud (Local Community for Health Administration, CLAS). CLAS-run facilities have previously shown evidence of superior performance over standard PHC services. We classified survey questions on 5 management functions of the Primary Health Care Performance Initiative: leadership, information system, financial control, transfer of management and leadership skills to health facilities, and supervision. An expert panel designated management practices as “good” or “less effective.” The outcome, PHC service performance, was the percentage of CLAS comanaged facilities in each DIRESA achieving coverage and utilization goals. We correlated frequency of good management practices with PHC service performance. DIRESAs were divided into Group 1, “higher performance,” and Group 2, “lower performance,” to identify specific practices linked to better performance.

We identified 32 good management practices among 52 response options to 17 questions. Correlation between good management practice and good service performance was significant (r=.7266; 12 df; P<.01). An average of 91.1% and 37.6% of CLAS facilities achieved service goals in Groups 1 and 2, respectively. Of all good management practices identified, an average of 40.6% and 24.0% were used by Groups 1 and 2, respectively. Group 1 used 11 specific good practices more frequently than Group 2.

Regional management and community-comanaged PHC services designed with accountability mechanisms should be intentionally aligned, incorporating these into policies, budgets, processes, and capacities to strengthen PHC services.

This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited. To view a copy of the license, visit https://creativecommons.org/licenses/by/4.0/. When linking to this article, please use the following permanent link: https://doi.org/10.9745/GHSP-D-23-00402