The Measurement Gap

Many countries have identified primary health care (PHC) as an urgent priority, but they lack comprehensive data to pinpoint specific weaknesses, understand their causes, and strategically direct resources to address them.

Vaccination record
© CHMI/Andre Fanthome

Health system managers typically have data on inputs such as total number of health workers, medicines, and supplies available. They also measure outputs like the percent of children vaccinated and the percent of pregnant women who deliver in facilities. These are crucial to measure, but they are not sufficient.

What countries often lack is performance data about the important processes required to convert inputs to high-quality care delivery and coverage outputs critical to producing strong outcomes. For example, health system managers usually don’t have good data on how often health workers are present and how accurately they diagnose and treat patients. Even fewer managers have data on the experience of patients who receive care.

We call the processes and experiences that occur in the system, between inputs and outputs, the “black box” of PHC because they are not well understood and have not received enough attention. With better information on how PHC services get delivered, countries and their development partners can understand where change will have the biggest impact.

Black Box

A New Way of Measuring Primary Health Care

PHCPI developed a Conceptual Framework that describes important components of a strong PHC system. It is intended to guide what should be measured to inform and drive efforts to improve PHC. The Framework is based on evidence about the key characteristics and determinants of strong PHC systems, building on existing frameworks for health systems performance. The selection of PHC Vital Signs indicators was informed by this Framework. Download Our Methodology.

The PHCPI Conceptual Framework includes the key inputs, service delivery processes, and goals of an effective PHC system. It flows from left to right, similar to other input-process-output-outcome logic models. A focus on service delivery (the “black box”) sets this Framework apart from previous frameworks. The following areas of the Framework will be the focus of efforts to develop practical new ways for countries to measure PHC service delivery. 

  • Access - Do patients have affordable, timely access to PHC that is geographically convenient?
  • Availability of effective PHC services - Are PHC facilities functioning, with workers who are motivated, competent, and equipped to provide PHC services?
  • People-centered care - Does the system offer the well-established key functions of PHC including, first contact accessibility (from the user perspective), coordination, comprehensiveness, continuity, and safety?
  • Organization and Management - Does the system appropriately organize and manage important elements of PHC delivery, including team-based care, supportive supervision, population health management, and use of information systems that aid in monitoring services and continually improve quality?
PHCPI Conceptual Framework

This Conceptual Framework defines what is important to measure. While some areas are the focus of ongoing measurement work, data are currently limited for some of the critical components of the Framework. PHCPI will address these knowledge gaps by developing new indicators and data collection tools that can be useful for countries trying to improve the performance of their PHC system. 

In order to strengthen PHC, we need data that are routinely available and comparable within and across countries. PHCPI aspires to significantly increase the availability of data on the important areas of PHC performance reflected in the Framework. 

Learn more about Our Indicators, including the PHC Vital Signs on this website and a complementary set of Diagnostic indicators under development.

Dive into the details of Our Methodology.