Primary health care (PHC) country case studies provide valuable insights into PHC-oriented transformations. This policy-oriented secondary analysis of country case studies focused on sexual and reproductive health and rights (SRHR), examining: how and where SRHR has been prioritised in country PHC-oriented transformations; the impact of the COVID-19 pandemic on SRHR; and emerging SRHR policy priorities. We conducted a multi-country synthesis through an SRHR lens on three case study series; 52 country case studies total from 42 countries. The sequence of steps included: sampling PHC country case studies; developing and piloting an assessment instrument guided by 8 SRHR areas and PHC levers clustered by structures, inputs and processes; extracting data; analyzing and validating the findings. Elaborative coding and thematic analysis were used to explore the findings by research question. Policy interventions reported were skewed towards specific SRH services including HIV/STIs, family planning and reproductive health over other services like reproductive cancers and cross-cutting issues like gender-based rights. Policy interventions were predominately related to structures (governance and financing), followed by processes (models of care). The pandemic caused several disruptions across SRHR areas investigated by exacerbating gender inequalities, increasing gender-based violence, changing service utilization patterns, and suspending services. Common priority areas included extending coverage, implementing integrated models of care, addressing workforce shortages, improving supply management and enhancing engagement with target groups. While SRHR has been central to PHC-oriented health system transformations, the analysis suggests uneven implementation of interventions across SRHR areas and dimensions of PHC. This secondary analysis of case studies using SRHR as a tracer policy priority offers a high-level overview of the policy landscape across countries. While reliant on the quality and depth of the original case studies and limited by the data that lies within, methods like that applied here, can facilitate cross-country learning and policy transfer beyond individual cases and merits further application.
Barbazza et al. (Sat,) studied this question.