PHC measurement framework and indicators (2024)

Political commitment & leadership*

Health in All Policies with multisectoral coordination Existence of right to health legislation

Governance & policy frameworks*

Existence of national health policy oriented to PHC and UHC Existence of policy, strategy or plan for improvement of quality and safety Existence of health emergency and disaster risk management strategies Institutional capacity to meet essential public health functions and operations

Engagement with communities and other stakeholders*

Coordination mechanisms with multistakeholder participation and community engagement National, sub-national and local strategies for community participation

Engagement with private sector providers*

Evidence of effective stewardship of mixed health systems

Monitoring and evaluation*

Priority setting is informed by data & evidence Existence of an M&E framework or plan for national health plan meeting criteria

PHC oriented research

Total net official development assistance to medical research and basic health sector Percentage of public research funding for primary care research

Funding and allocation of resources*

Current expenditure on health (total and PHC-specific) as a percentage of gross domestic product (GDP) Government PHC spending as percentage of government health expenditure Per capita total health expenditure (and PHC specific) Sources of expenditure on health (& PHC-specific) Contingency funds available for emergencies

Purchasing & payment systems*

Services included in health benefits package (including primary care) Purchasing and provider payment methods are in place (including primary care) Health financing follows established guidelines

Information systems

Completeness of reporting by facilities Percentage of facilities using comprehensive patient records Regular system of facility and patient surveys Functional national human resource information system Completeness of birth registration Completeness of death registration Regular system of population-based health surveys

Surveillance

Existence of effective surveillance system

Selection and planning of services

Service package meeting criteria Roles and functions of service delivery platforms and settings defined

Service design

Existence of an empanelment system System to promote first contact accessibility Protocols for patient referral, counter-referral and emergency transfer Existence of care pathways for tracer conditions

Organization and facility management

Professionalization of management Management capability and leadership Multidisciplinary team-based service delivery Existence of supportive supervision system Existence of facility budgets and expenditures meeting criteria

Community linkages and engagement

Collaboration between facility-based and communitybased service providers Community engagement in service planning and organization Proactive population outreach Services for self-care and health literacy in primary care

Accessibility, affordability, acceptability

Geographical access to services Perceived barriers to access due to (distance, cost, sociocultural) Access to emergency surgery Existence of a system for post-crash care

Service availability and readiness

Percentage of facilities offering core services according to national defined service package Provider availability (absence rate) Percentage of facilities meeting minimum standards to deliver tracer services Percentage of facilities compliant with infection prevention and control (IPC) measures

Utilization of services

Outpatient visits Emergency unit visits Hospital discharges Leading diagnoses (primary care/outpatient visits, inpatient diagnoses at discharge)

Core primary care functions

(first-contact accessibility, continuity, comprehensiveness, coordination, people-centredness)

Patient-reported experiences People’s perceptions of health system and services

Effectiveness

Diagnostic accuracy (provider knowledge) Adherence to clinical standards for tracer conditions 30-day hospital case fatality rate (for acute myocardial infarction or stroke) Avoidable complications (lower limb amputation in diabetes) Hospital readmission rates for tracer conditions Admissions for ambulatory care sensitive conditions Institutional mortality

Safety

Prescribing practices for antibiotics Proportion of people 65 years and over prescribed antipsychotics Caesarean section rate Postoperative sepsis Postoperative pulmonary embolism Postoperative deep vein thrombosis Perioperative mortality rate Hospital-acquired infections

Efficiency

Provider caseload Bed occupancy

Timely access

Cancer stage at diagnosis (by cancer) Coverage of timely emergency resuscitation at first-level hospitals Waiting time to elective surgery

Family planning demand satisfied with modern methods [SDG 3.7.1] ANC4 Child immunization coverage (DTP3) [SDG 3.b.1] Care-seeking for suspected pneumonia TB treatment HIV ART Use of insecticide-treated nets (ITN) Children receiving ACT among those with fever Population with basic water, sanitation and hygiene (WASH) Hypertension treatment coverage Diabetes treatment coverage Cervical cancer screening Availability of essential medicines Skilled birth attendance [SDG 3.1.2] Number of people requiring interventions against NTDs [SDG 3.3.5] Coverage of interventions for substance-abuse disorders [SDG 3.5.1] AMR blood stream infections Patterns of antibiotic consumption