• The Ariadne Project: Identification of Research Gaps in Primary Health Care in Low- and Middle-Income Countries

    The aim of this study is to address organization and models of care (workforce and team development, scale, and new models for management) and financing (market structure, political economy, and uptake of evidence) for primary health care (PHC). We identified and prioritized the knowledge needs of PHC practitioners and researchers in low- and middle-income countries (LMIC), leveraging on the work previously conducted by Primary Health Care Measurement & Implementation Research Consortium, also further informed by a scoping literature review.

    Specific objectives

    1. Produce a list of 10-15 prioritized research questions.
    2. Produce a gap map, including areas where there is evidence of what works to improve the gap, and where there are major gaps in evidence regarding how to measure and/or improve PHC organization.
    3. Prepare research implementation plans for the top four research questions in each area.


    PHC research has predominately advanced in high-income countries (HIC).4,5 Many LMICs are still establishing family medicine as a specialty, and the relative immaturity of the discipline, combined with the dominance of research by bioscience agendas, and the greater capacity of HICs for funding and performing research, means that capacity and funding for research on LMIC PHC priorities is still limited. Research priority setting does occur in LMIC, but tends to be led by governments and international agencies with limited evidence of subsequent implementation.6


    1. Three-round expert panel consultation of LMIC PHC practitioners and academics sampled from global networks, using web-based surveys. View the top four questions »
    2. Literature review
    3. Gap Map Development 
      1. PHC Models of Care Gap Map
      2. PHC Finance Gap Map
    4. Implementation plans for research questions
      1. Brazil
      2. Croatia
      3. Kenya
      4. Malaysia
      5. Nigeria
      6. South Africa
      7. Turkey


    This novel approach towards PHC needs in LMIC, informed by local academics and professionals, created an expansive and prioritized list of critical knowledge gaps in PHC organization and financing. It resulted in research questions, offering valuable guidance to global supporters of primary care evaluation and implementation. Its source and context specificity, informed by LMIC practitioners and academics, should increase the likelihood of local relevance and eventual success in implementing research findings.

    Policy Relevance

    This study is embedded in a suite of work undertaken by Ariadne Labs to identify gaps in PHC research in LMIC, and develop research implementation plans for prioritized topics. Traditionally, policy makers often make decisions which fail to translate into effective change. The voice of health care providers and clinical academics has been badly lacking in much PHC policy to date, and yet is of immense value if initiatives are to have traction at a community level. In line with the funder’s criteria, we aimed to identify and prioritize the perceived evidence gaps for PHC practitioners and researchers about the organization of PHC, different models of care, and the ways PHC systems may be financed.

    Research Team

    This work was conducted by a coalition of family medicine researchers from around the world contributed to this research project. The study was led by Prof. Felicity Goodyear- Smith at the University of Auckland.

    • Professor Felicity Goodyear-Smith
    • Mr. Richard Fortier
    • Dr. Andrew Bazemore
    • Ms. Megan Coffman
    • Prof. Amanda Howe
    • Dr. Hannah Jackson
    • Prof. Michael Kidd
    • Prof. Robert L Phillips
    • Assoc. Prof. Katherine Rouleau
    • Prof. Chris van Weel

    Implementation Plan Authors

    • Dr. Sandro Rodrigues Batista (Brazil)
    • Prof. Shabir Moosa (South Africa)
    • Prof. Sherina Mohd-Sidik (Malaysia)
    • Dr. Aboi Madaki (Nigeria)
    • Dr. Tanja Pekez-Pavlisko (Croatia)
    • Dr. Patrick Chege (Kenya)
    • Assoc. Prof Mehmet Akman (Turkey)

    WONCA Regional President Advisers

    • Prof. Kanu Bala
    • Dr. Henry Lawson
    • Assoc. Prof. Maria Inez Padula Anderson


    Key Abbreviations

    • HIC: High-income countries
    • LIC: Low-income countries
    • LMIC: Low- and middle-income countries
    • PHC: Primary health care
    • PHCPI: Primary Health Care Performance Initiative
    • WHO: World Health Organization
    • WONCA: World Organization of Family Doctors


    This publication is based on research funded by Ariadne Labs through Brigham and Women’s Hospital, who is the recipient of a Bill & Melinda Gates Foundation grant. The findings and conclusions contained within are those of the authors and do not necessarily reflect positions or policies of the Bill & Melinda Gates Foundation.