The report, originally published in VoxDev, shows the deployment of CHTs resulted in better-organised care, more prevention, less infectious disease and fewer patients ending up in hospital.

CHTs reduced preventable hospitalisations by 0.8 per 1,000 inhabitants – a 10.8% reduction from the pre-intervention mean, the report finds. In addition, preventive care increased by 37% to 187.6 per 1,000 inhabitants.

The number of primary care units and health staff rose by 4.1% and 10.7%, respectively, between 2009 and 2017, fuelled by an increase in nurses and support workers.

The programme was also cost-effective achieving US$1,450 per disability-adjusted life year (DALY) averted in urban municipalities, well below El Salvador's GDP per capita threshold of around US$5,200, and US $4,850 per DALY in rural municipalities.

CHTs also restructured curative care by shifting capacity towards higher-need conditions. While amenable curative consultations for communicable diseases fell by 73 per 1,000 inhabitants (8.5%), driven primarily by reductions in respiratory infections, curative consultations for NCDs rose by 44.5 per 1,000 inhabitants (17.9%), concentrated among the elderly and driven by cardiovascular disease management.

The IFS concluded: ‘This research adds large-scale causal evidence that this model can meaningfully shift the composition of care system-wide: increasing prevention, redirecting curative capacity toward chronic disease and reducing costly and preventable hospitalisations.'