Optimising the secondary analysis of primary health care country case studies: qualitative meta-analysis of 52 country cases through a sexual and reproductive health and rights lens

Background: Primary health care (PHC) country case studies provide valuable insights into PHC-oriented transformations. This analysis developed a method for secondary analysis of these country case studies focused on sexual and reproductive health and rights (SRHR), examining: (1) how and where SRHR been prioritised in country PHC-oriented transformations; (2) the impact of the COVID-19 pandemic on SRHR; and (3) emerging SRHR policy priorities. Methods: We conducted a meta-analysis of SRHR themes in a sample of 52 country case studies 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 was used to explore the findings by research question. Results: Policy interventions 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 also 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 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. Conclusions: While SRHR has been central to PHC-oriented health system transformations, the analysis reveals uneven implementation of interventions across SRHR areas and components of PHC. This secondary analysis of case studies using a tracer policy priority like SRHR offers a high-level overview of the policy landscape across countries. While reliant on the quality of the original case studies and limited by the data that lies within, methods like that applied here, can facilitate crosscountry learning and policy transfer beyond individual cases and merits further application.