# Co-creating a decision-making framework for primary healthcare models in conflict-affected Cameroon and Nigeria

## TL;DR

This paper presents a framework and toolkit to help choose primary healthcare models in conflict-affected areas of Cameroon and Nigeria, ensuring quality care.

## Contribution

The novel contribution is a co-created decision-making framework and quality toolkit for selecting healthcare models in conflict zones.

## Key findings

- A co-creation process involving stakeholders led to a decision-making framework for healthcare models.
- A quality-of-care checklist was developed through workshops in Nigeria.
- Guiding questions were created to assess advantages and disadvantages of healthcare models.

## Abstract

Several models of care are used in conflict-affected settings; however, existing guidance on service delivery in humanitarian settings primarily focuses on improving the delivery of services. There remains a crucial gap in providing guidance in the selection and use of models of care while considering key aspects of quality of care.

A co-creation approach was used involving various stakeholders to develop a framework and quality of care toolkit to support the selection of models of care used to deliver primary healthcare services in conflict-affected settings. A four-phase process was used. Findings from the first three phases will be published elsewhere. However, the four phases included: conducting a desk review and survey mapping models of care and humanitarian organisations, followed by in-depth interviews of organisations and focus group discussions with displaced populations. Further in-depth interviews were conducted exploring coverage and gaps in relation to seven domains of quality of care. Finally, two stakeholder workshops brought together humanitarian health experts and community representatives.

The two co-creation workshops with 60 humanitarian, Ministry of Health, academic institutions and community representatives were organised in Cameroon and Nigeria from 31 May to 14 June 2023. Key outputs from the Cameroon workshop were the development and consensus on the advantages and disadvantages of each model of care and the development of a collection of guiding questions to assist in model of care selection. A key output from the Nigerian workshop was the development of a quality-of-care checklist.

This decision-making framework and quality toolkit can be used by programmers to guide model of care selection and use, while considering quality aspects. This decision-making framework and toolkit provide a structured and logical approach to model of care selection and can be refined and made accessible to others for widespread application.

NCT05279105.