The PMCIs and the GN within the district are listed. Thus, we conducted a mixed-methods assessment of the empanelment process under the PSSP project in Sri Lanka to assess the extent of registration and understand the contextual challenges in implementing this activity. Such a study requires both quantitative and qualitative methods for comprehensively understanding the outcomes of the activity and associated challenges. This first operational research study assessed the early experiences and challenges in empanelment and registration of the population to help guide future scale-up of empanelment in the country. In Sri Lanka, as the first phase of PSSP, the empanelment process including registration was initiated in 63 PMCIs from June 2019 and the project plans to empanel the entire population in 550 PMCIs by December 2023. Though empanelment is considered to be a successful strategy for building PHC systems, there is relatively little information on the experiences around implementing empanelment in primary care settings from LMICs. In brief, this entailed (i) demarcation of geographic catchment areas for each PMCI and mapping of referral facilities with PMCI, (ii) registering each individual residing in the catchment area by assigning a unique personal health number (PHN), and (iii) ensuring that personal health records of these individuals are continuously updated at every encounter with the health system. Empanelment of the population to a Primary Medical Care Institution (PMCI) was one of the first steps undertaken under this project towards re-organisation of PHC. This project, launched in 2018, aims to increase the utilization and quality of PHC services, with an emphasis on detection and management of non-communicable diseases (NCD) in the country. Sri Lanka, a LMIC in the Southeast Asian region, has been going through a process of re-organisation of PHC under the World Bank supported Primary Health Care System Strengthening Project (PSSP). Moving forward, there is an urgent need to address these challenges to improve registration coverage and ensure that all individuals are empaneled before the close of the project for it to have a meaningful impact.Įmpanelment is becoming a key part of recent reforms in primary health care in different parts of the world, including lower-middle income countries (LMICs). Poor registration coverage was due to a lack of dedicated staff for registration, misconceptions of health care workers about individuals needing to be registered, reliance on opportunistic or passive registration, and lack of monitoring mechanisms these were further compounded by the COVID-19 pandemic. Awareness activities regarding registration were conducted in most of the PMCIs, but awareness in the community was low. Proportions of those aged <35 years and males among those registered were lower compared to their general population distribution. At this rate, only 50% coverage would be achieved by the end of the project (December 2023). We conducted an explanatory mixed-methods study to assess the extent of registration at nine selected PMCIs and understand the challenges therein. The registration of individuals with designated primary medical care institutions (PMCIs) is a key step towards their empanelment with these PMCIs, supported by the Primary Health Care System Strengthening Project in Sri Lanka.
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