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How to Measure the Improvement of Primary Health Care Performance Around the World

What good is primary health care if the main people who need care can't access it? And what happens when health care providers can't determine the best ways to help the most vulnerable people live their healthiest lives?

Primary health care is a cornerstone of health care systems across the globe. In high-income countries, the majority of health care is delivered through primary health care. This type of care focuses on disease prevention, early detection, diagnosis, treatment, rehabilitation, and palliative care.

We already know that countries with strong primary health care systems report lower health care costs, better health outcomes in patients and fewer hospital visits. We know that better primary care services reduce common illnesses in people by up to 70%. We also know that effective primary health care is the key to attaining universal health coverage, which is a target defined in the UN Sustainable Development Goals.

So why is it still so difficult to measure primary care performance around the world, especially in low- and middle-income countries, where it is needed the most?

Here's the main problem: Since the Alma Ata declaration was established more than 40 years ago, many countries have identified primary health care as an urgent priority. But they often lack complete data to pinpoint specific weaknesses and understand their causes.

There always seems to be a gap between tracking the data about what primary care providers have—things such as the total number of health care workers, medicines, and supplies available—and understanding whether patients are actually getting the quality of care they need, when they need it.

That's why efforts such as the Primary Health Care Performance Initiative—a collaboration between the Bill and Melinda Gates Foundation, the World Bank, and the World Health Organization, in partnership with Ariadne Labs and Results for Development—were established to bring together country policymakers, health system managers, advocates, and other development partners. Together, the organizations have been able to get more governments to support people-centered care through better measurement, knowledge-sharing, and deploying data for improvement.

What organizations concerned about primary health care services have discovered is that there is little quality data on how often primary healthcare workers are present and how accurately they diagnose and treat patients. There is even less information on the experience of patients who receive care.

As a result, several social enterprises have put resources into getting countries and development partners more and better information to understand what is standing in the way of people getting the care they need and what is needed to drive innovation.

The good news is that we know more about what strong primary health care should look like, and how it can be measured, than ever before.

For example, the Primary Health Care Performance Initiative has developed what it has called 38 Core Indicators that provide a better snapshot of primary health care performance based on existing, globally comparable data. The indicators allow researchers and innovators to easily compare how countries are performing.

The Core Indicators answer five main questions to determine how a country's primary healthcare system is performing:

  • Is primary health care prioritized in the country's health system?
  • Does the primary health care system offer sufficient facilities, healthcare professionals, and supplies?
  • Are services accessible and effectively organized, managed, and coordinated to deliver high quality care?
  • Does the primary healthcare system provide the essential services a person needs throughout each phase of life?
  • Does the primary healthcare system deliver better health outcomes and greater equity?

The bottom line is this: As leaders everywhere face tough choices to ensure that health systems protect everyone in the pandemic and beyond, we must all understand that investments in primary health care can't wait.

These investments in health care infrastructure and services are just as important now as they will be in the future. They will help ensure that we have the tools we need to respond effectively to any future public health crises. They will also help us build resilience so that we don't suffer from the consequences of another crisis. And they will give everyone access to the health care services they need without financial hardship.

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