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December 2017 (Volume 95)
Quarterly Article
Jeremy Veillard
Krycia Cowling
Asaf Bitton, MD, MPH
Hannah Ratcliffe
Meredith Kimball
Shannon Barkley
Laure Mercereau
Ethan Wong
Chelsea Taylor
Lisa R. Hirschhorn
Hong Wang
December 2024
Dec 19, 2024
Back to The Milbank Quarterly
Policy Points:
Context: The Primary Health Care Performance Initiative (PHCPI), 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, was launched in 2015 with the aim of catalyzing improvements in primary health care (PHC) systems in 135 low- and middle-income countries (LMICs), in order to accelerate progress toward universal health coverage. Through more comprehensive and actionable measurement of quality PHC, the PHCPI stimulates peer learning among LMICs and informs decision makers to guide PHC investments and reforms. Instruments for performance assessment and improvement are in development; to date, a conceptual framework and 2 sets of performance indicators have been released.
Methods: The PHCPI team developed the conceptual framework through literature reviews and consultations with an advisory committee of international experts.We generated 2 sets of performance indicators selected from a literature review of relevant indicators, cross-referenced against indicators available from international sources, and evaluated through 2 separate modified Delphi processes, consisting of online surveys and in-person facilitated discussions with experts.
Findings: The PHCPI conceptual framework builds on the current understanding of PHC system performance through an expanded emphasis on the role of service delivery. The first set of performance indicators, 36 Vital Signs, facilitates comparisons across countries and over time. The second set, 56 Diagnostic Indicators, elucidates underlying drivers of performance. Key challenges include a lack of available data for several indicators and a lack of validated indicators for important dimensions of quality PHC.
Conclusions: The availability of data is critical to assessing PHC performance, particularly patient experience and quality of care. The PHCPI will continue to develop and test additional performance assessment instruments, including composite indices and national performance dashboards. Through country engagement, the PHCPI will further refine its instruments and engage with governments to better design and finance primary health care reforms.
Keywords: primary health care, measurement, health systems, performance assessment.
Read on Wiley Online Library
Volume 95, Issue 4 (pages 836-883) DOI: 10.1111/1468-0009.12301 Published in 2017
