Primary Health Care Progression Model

The Primary Health Care Progression Model is a mixed-methods assessment tool used to populate the Capacity pillar of the Vital Signs Profile. The “capacity” of a Primary Health Care (PHC) system refers to the foundational properties of the system that enable it to deliver high quality PHC. The Capacity pillar of the Vital Signs Profile provides information that can answer questions like, “does your system have the policies, infrastructure and other physical and human resources to deliver primary health care?” and “Are the fundamentals of PHC service delivery – such as strong population health management and effective facility management – in place?”

Key questions assessed by the PHC Progression Model:

    • Do countries have evidence-based primary health care policies and strategies in place?
    • Are there effective governance structures to implement and enforce these PHC policies?
    • Is there a robust quality management infrastructure for PHC, including quality policies and strategies, legislation and regulation, quality standards, and use of continuous quality improvement programs and methods?
    • Does the country have a system that formalizes and ensures strong social accountability mechanisms - including the systematic engagement of private sector, civil society, non-governmental organizations, and non-health actors - in the integrated planning and governance of PHC and public disclosure of performance?
    • Do countries have comprehensive and reliable surveillance systems in place to detect and respond to changing disease burden and emerging outbreaks?
    • Are national health priorities set based on disease burden, health outcomes, and user needs?
    • Does the PHC sector have a learning system that prioritizes continual reflection and improvement?
    • Are key inputs - including drugs and supplies, facility infrastructure, information systems, health workforce, and funds at the facility level - available?
    • Are these inputs equitably distributed?
    • Are these inputs of sufficiently high quality to meet population needs?
    • Are local priorities evidence-based and determined in collaboration with local communities and stakeholders?
    • Do communities have input into and impact on the way that primary health care is financed, governed, and implemented?
    • Is a system of empanelment - also known as rostering - in place to ensure that the entire population is known to the health system and that specific service providers have responsibility for specific panels of patients?
    • Is there proactive population outreach to deliver essential health services to those in need?
    • Are services organized and delivered by effective provider teams, capable of ensuring comprehensive and coordinated care?
    • Are facilities led by effective, trained managers?
    • Do facilities set performance targets, have staff capacity to capture and use data at the point of care to monitor and improve performance, and implement quality improvement activities?
    • Is supportive supervision routinely conducted?

The aim of the PHC Progression Model assessment is to systematically measure core primary health care capacities – like governance, inputs and population health management – that are insufficiently measured by existing quantitative, globally comparable data sources. Therefore, the PHC Progression Model is designed to capitalize on the wealth of information, evidence, and data that is often available in countries but rarely captured in a way that generates usable information for decision-makers or is accessible to external audiences. The goal of the PHC Progression Model assessment is to bring together stakeholders who have complementary knowledge of primary health care functioning in a country to yield an objective, comparable assessment of PHC capacity.

The PHC Progression Model is made up of 33 measures. Each measure focuses on a specific primary health care system, input, or service delivery element and is assessed using a rubric that assigns the level of performance for that measure to one of four categories, ranging from Level 1 (low) to Level 4 (high). Increasing Levels describe increasingly high capacity and states of performance.

View the PHC Progression Model rubrics here.

Results of the 33 measures of the PHC Progression Model are summarized as three scores on the Vital Signs Profile, as shown below.

 

What does a PHC Progression Model assessment look like?

PHC Progression Model assessments are designed to be participatory, and bring together diverse stakeholders who have complementary knowledge of primary health care functioning in a country. The assessment is implemented by a team of technical experts and policymakers, often including stakeholders from the Ministry of Health, development partners, and civil society organizations and non-governmental organizations.
The PHC Progression Model assessment involves three phases: Plan, Assess, and Finalize. The assessment includes extensive document review and extraction, review of existing quantitative data, and the completion of key-informant interviews; it does not involve collecting new quantitative data or conducting health facility assessments. The PHC Progression Model is scored by the in-county assessment team and results are validated by PHCPI to ensure that findings are evidence-based and comparable to other countries. The process usually takes 3-4 months to complete. PHCPI has developed an Assessment Guide to support this process; please contact us at info@improvingphc.org for more information.

Why complete a PHC Progression Model assessment?

The results of the PHC Progression Model, summarized in the Capacity Pillar of the Vital Signs Profile, can be used by country leaders and development partners to identify strengths and opportunities for improvement and direct the selection of relevant and targeted Improvement Strategies.

Countries that have completed a PHC Progression Model report that…

  • The process of implementing a PHC Progression Model Assessment made the identification of strengths and gaps glaringly obvious
  • Completion of an assessment resulted in new learnings about PHC, even for stakeholders who are deeply embedded in the system. Often, these learnings challenged pre-existing expectations of strengths and weaknesses
  • The assessment process provides a unique opportunity to holistically understand PHC capacities in a way that is difficult – if not impossible – to do otherwise
  • Completion of the assessment encouraged a joint review process involving multiple sectors and ministries, and facilitated the identification of key determinants for strengthening PHC
  • The PHC Progression Model results support a coordinated effort  to determine what metrics and areas to focus on for improving PHC, and can help create accountability for PHC spending

These countries include:

If you are interested in partnering with PHCPI to complete a PHC Progression Model assessment in your country in the future or would like more information on the assessment, please contact us at: info@improvingphc.org.