PHC Progression Model: A novel mixed-methods tool for measuring primary health care system capacity

High-performing primary health care (PHC) is essential for achieving universal health coverage. However, in many countries, PHC is weak and unable to deliver on its potential. Improvement is often limited by a lack of actionable data to inform policies and set priorities. To address this gap, the Primary Health Care Performance Initiative (PHCPI) was formed to strengthen measurement of PHC in low-income and middle-income countries in order to accelerate improvement. PHCPI´s Vital Signs Profile was designed to provide a comprehensive snapshot of the performance of a country´s PHC system, yet quantitative information about PHC systems´ capacity to deliver high-quality, effective care was limited by the scarcity of existing data sources and metrics. To systematically measure the capacity of PHC systems, PHCPI developed the PHC Progression Model, a rubric-based mixed-methods assessment tool. The PHC Progression Model is completed through a participatory process by in-country teams and subsequently reviewed by PHCPI to validate results and ensure consistency across countries. In 2018, PHCPI partnered with five countries to pilot the tool and found that it was feasible to implement with fidelity, produced valid results, and was highly acceptable and useful to stakeholders. Pilot results showed that both the participatory assessment process and resulting findings yielded novel and actionable insights into PHC strengths and weaknesses. Based on these positive early results, PHCPI will support expansion of the PHC Progression Model to additional countries to systematically and comprehensively measure PHC system capacity in order to identify and prioritise targeted improvement efforts.Fil: Ratcliffe, Hannah L.. Brigham And Women's Hospital; Estados Unidos. Harvard T.H. Chan School of Public Health; Estados UnidosFil: Schwarz, Dan. Harvard T.H. Chan School of Public Health; Estados Unidos. Brigham And Women's Hospital; Estados UnidosFil: Hirschhorn, Lisa R.. Northwestern University; Estados UnidosFil: Cejas, Cintia. Ministerio de Desarrollo Social; Argentina. Ministerio de Salud de la Nación; ArgentinaFil: DIallo, Abdoulaye. Ministry Of Health And Social Action; SenegalFil: Garcia Elorrio, Ezequiel. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Fifield, Jocelyn. Brigham And Women's Hospital; Estados Unidos. Harvard T.H. Chan School of Public Health; Estados UnidosFil: Gashumba, DIane. Ministry of Health; RuandaFil: Hartshorn, Lucy. Harvard T.H. Chan School of Public Health; Estados Unidos. Brigham And Women's Hospital; Estados UnidosFil: Leydon, Nicholas. Bill And Melinda Gates Foundation; Estados UnidosFil: Mohamed, Mohamed. Ministry Of Health And Social Welfare Dar Es Salaam; TanzaniaFil: Nakamura, Yoriko. Results For Development; Estados UnidosFil: Ndiaye, Youssoupha. Ministry Of Health And Social Action; SenegalFil: Novignon, Jacob. Kwame Nkrumah University Of Science And Technology; GhanaFil: Ofosu, Anthony. Ghana Health Service; GhanaFil: Roder Dewan, Sanam. Organización de las Naciones Unidas. Unicef. Fondo de las Naciones Unidas para la Infancia; ArgentinaFil: Rwiyereka, Angelique. Global Health Issues and Solutions; Estados UnidosFil: Secci, Federica. The World Bank Group; Estados UnidosFil: Veillard, Jeremy H.. The World Bank Group; Estados UnidosFil: Bitton, Asaf. Harvard T.H. Chan School of Public Health; Estados Unidos. Brigham And Women's Hospital; Estados Unido