Evaluating UNICEF’s work in primary health care: lessons for the future
In 2024, hera partnered with UNICEF and Euro Health Group (EHG) to conduct a global evaluation of its work in strengthening Primary Health Care (PHC). Primary Health Care is central to building equitable, resilient, and people-centred health systems, and remains central to global efforts to achieve universal health coverage and the SDG 3 targets.
In recognition of this, UNICEF commissioned a global thematic evaluation to assess its support to PHC across countries and regions, and to generate evidence that would inform future strategic, policy, and programme decisions. hera was contracted to carry out this evaluation, which covered UNICEF’s PHC-related work between 2018 and 2023. The evaluation combined learning and accountability objectives, with a strong focus on identifying good practices, understanding how strategies were implemented in different contexts, and assessing how UNICEF has adapted its support over time.
Scope and purpose
The evaluation examined UNICEF’s contribution to PHC across all seven UNICEF regions, including humanitarian and fragile settings. It included both a summative component—reviewing programming under the Strategic Plan 2018–2021—and a formative component focused on early implementation under the current Strategic Plan (2022–2025).
The thematic scope reflected the breadth of PHC, covering maternal, newborn and child health and nutrition, immunisation, HIV, sexual and reproductive health, mental health, non-communicable diseases, early childhood development, violence and injury prevention, and environmental health.
A central objective was to assess the extent to which UNICEF’s PHC support:
Responded to the needs, policies, and priorities of national stakeholders, with a focus on vulnerable and excluded populations; and
Demonstrated contextual understanding and adaptability across diverse operating environments.
The evaluation also assessed coherence, effectiveness, efficiency, and sustainability of UNICEF’s strategies, investments, and activities in support of PHC.
Analytical framework and evaluation design
The evaluation was anchored in the WHO/UNICEF Operational Framework for Primary Health Care (2020). Particular attention was given to how UNICEF programmes engaged six operational levers for strengthening PHC systems:
Funding and allocation of resources
Engagement of communities and stakeholders
The primary health care workforce
Physical infrastructure
Digital technologies for health
Systems for improving quality of care
To support this analysis, the team developed two interconnected theories of change at global and country levels. These frameworks provided a structured basis for developing evaluation questions, selecting methods, and analysing results, and ensured alignment between global strategies and country-level implementation.
The evaluation design and analytical approach were reviewed and discussed with an Evaluation Reference Group during the inception phase, supporting shared understanding and methodological rigour.
Mixed methods data collection
hera applied a mixed-methods approach, combining qualitative and quantitative data sources. Evidence was generated through:
Comprehensive document reviews, including analysis of quantitative datasets
Key informant interviews at headquarters, regional, and country levels
In-depth country case studies
For the deep-dive case studies, the evaluation team conducted missions to one country in each UNICEF region: Cambodia, El Salvador, Kazakhstan, Pakistan, Sierra Leone, and Zimbabwe. In Lebanon, where access was constrained, the case study was conducted through a structured desk review.
During country missions, data collection included focus group discussions, community engagement, and visits to health facilities, allowing the team to explore how PHC strategies translated into practice at local level.
Generating evidence for future strategy
The evaluation generated evidence-based conclusions on UNICEF’s contribution to strengthening PHC, alongside practical insights to inform future programming. Its findings and recommendations are intended to support the development of UNICEF’s Strategic Plan 2025–2029, as well as ongoing refinement of policies and programmes across the organisation.
If you are interested in reading the evaluation, it can be found online here.
For hera, this assignment highlights our experience of supporting large-scale, complex evaluations that span multiple regions and operating contexts. It demonstrates how theory-based approaches and country-level inquiry can be combined to generate insights that are both credible and useful for decision-makers working to advance primary health care.
Interested in similar work?
If you are planning a complex evaluation or learning exercise in health systems or primary health care and would like to explore how hera could support you, we would be glad to hear from you. Please get in touch to start a conversation.