The future of care at First Referral Hospitals in sub-Saharan Africa - place, people, technologies and task-sharing

Our vision is that First Referral Hospitals (FRH) deliver quality care as part of Universal Health Coverage (UHC). Expectations of FRH service delivery are growing rapidly driven by research. However, expectations often confront the reality of insufficient resources, workforce numbers or skill-mix resulting in preventable mortality and morbidity, especially in ‘hardship’ areas that face increasing climate and disease risks. Technologies and task-sharing may help improve access to services but care must be high quality and safe. Our research will discover how best to align FRH roles, workforce requirements, skill-mix and use of technologies to achieve UHC. Our work addresses decades of research neglect of FRH as a key component of primary healthcare systems. Our research will: i) embrace complexity, ii) assemble a new multi- disciplinary, multi-country team, iii) employ novel methods including longitudinal studies of ‘sentinel hospitals’, iv) deliberately include diverse contexts and advance use of realist methods, and v) embed learning within the policy and practice community. Over 6 years we will learn how place, people, technologies, and task-sharing will reshape the future of FRH. We will build capacity and global and national networks so that quality essential hospital care is available to all everywhere, even in hardship areas.