The way services are managed at the facility level. This includes: 1) organization and management of facility operations, including facility budgets; 2) routine collection and use of data to monitor quality and progress; 3) capability of managers to oversee, support, and enforce these processes; and 4) supportive supervision for staff.
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Timeliness
The ability of the health system to provide primary care services to patients when they need them, with acceptable and reasonable wait times and at days and times that are convenient to them.
The ability of the health system to provide primary care services to patients when they need them, with acceptable and reasonable wait times and at days and times that are convenient to them.
Efficiency refers to the ability of a health system to attain its desired objective(s) with the available resources, while minimizing waste and maximizing capacities to deliver care to those who need it.
The ability of a health system to attain its desired objective(s) with the available resources, while minimizing waste and maximizing capacities to deliver care to those who need it.
People-centeredness means organizing the health system around the comprehensive needs of people rather than individual diseases.
People-centeredness means organizing the health system around the comprehensive needs of people rather than individual diseases. This involves engaging with people, families, and communities as equal partners in promoting and maintaining their health - including through communication, trust, and respect for preferences, as well as ongoing education and support so that they can participate in health care decisions.
The capacity of a primary care system to serve as the first point of contact, or a patient's entry point to the health system, for most of a person's health needs.
The capacity of a primary care system to serve as the first point of contact, or a patient's entry point to the health system, for most of a person's health needs.
Coordination of care refers to the system's ability to oversee and manage patient care over time and across levels of care to ensure appropriate follow-up, minimize the risk of error, and prevent complications.
The system's ability to oversee and manage patient care throughout the course of treatment and across various sites of care to ensure appropriate follow-up, minimize the risk of error, and prevent complications. Coordination of care happens across levels of care and over time, and often requires proactive outreach on the part of health care teams and consistent tracking and communication of progress.
Continuity is the degree to which a patient experiences a series of discrete healthcare events as coherent and consistent with their medical needs and personal context.
The degree to which a patient experiences a series of discrete healthcare events as coherent and consistent with their medical needs and personal context. This requires fostering trusted relationships between health care providers and patients over time (relational continuity), ensuring information is communicated from one event to the next (informational continuity), and ensuring the process is managed in a timely, complementary, and effective way across providers (management continuity).
The provision of holistic and appropriate care across promotive, preventive, curative, rehabilitative, chronic and palliative service needs.
The provision of holistic and appropriate care across a broad spectrum of health needs, ages, and solutions. Comprehensive primary health care is able to address a majority of promotive, preventive, curative, rehabilitative, chronic and palliative service needs.
The conditions are in place nationally (and subnationally) to ensure professionalised management and leadership in health care organization, including key criteria (see technical specifications)
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Percentage of facilities with systems to support quality improvement
Percentage of health facilities with systems to support and implement quality improvement, measured against key criteria (see technical specifications in metadata)
Percentage of facilities with a manager/management team that has decision-making responsibilities in key areas
Related Concepts
Delivering high-quality primary health care requires many elements of the health system working effectively together. This mapping explores how different concepts with the framework relate to one another.
Upstream elements are those that are required to develop or improve a particular concept. Absence or poor performance of an upstream element is expected to negatively impact the performance of the concept of focus.
Complementary elements are those where improvements or developments in this area will be mutually beneficial to the concept of focus but not required for improvement.
UPSTREAM CONCEPTS
COMPLEMENTARY CONCEPTS
UPSTREAM SUBDOMAINS
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Adjustment to Population Health Needs
Priority setting is needed to appropriately allocate and distribute funds across the health system. In addition, development of an innovation and learning agenda helps to cultivate a collaborative and improvement-oriented work culture.
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Funding & Allocation of Resources
Investments in PHC ensures sufficient funds are available for PHC facilities in decentralized contexts, where relevant
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Multi-Sectoral Approach
Social accountability mechanisms are an upstream factor that can help ensure financial accountability and accountability to populations served at the facility level.
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PHC Workforce
There must be an adequate supply of appropriately trained, reliable, and available providers to implement and manage effective team-based care models. Additionally, facility leaders must be appropriately trained and capacitated to manage facilities effectively. Finally, systems for registration, licensing, and accreditation of PHC workforce can be a key mechanism of quality management infrastructure.
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Policy and Leadership
Policies should determine how and which types of funds should be managed at the facility level and establish criteria for effective management and use. Policies also establish national QMI standards which are implemented by management at the facility level to cultivate a culture of quality improvement and provide nationally-endorsed measures and targets for performance improvement.
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Purchasing & Payment Systems
Systems for strategic purchasing of goods and payment of PHC workforce ensures sufficient funds are available for PHC facilities in decentralized contexts, where relevant.
Management of Services
COMPLEMENTARY SUBDOMAINS
Information & Technology
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Efficient management practices are often supported by robust information systems for recording, transferring, and analyzing individual provider performance data. Information systems support data collection, transfer, and analysis and can help facility managers and leaders track progress towards targets and changes in performance over time. In addition, robust financial management information systems enable facilities to track and manage funds effectively.
Coordination
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Care coordination is a strategy that would be complimentary to the effective management of team-based care organization.
Population Health Management
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Community engagement mechanisms ensure community needs are taking into account in all aspects of service delivery and facility functioning. Additionally, local priority setting can improve use of funds in line with community needs, although it is not essential for funding allocation to be managed at the facility level.
Service Availability & Readiness
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Provider competence supports care teams to develop clinical competencies and qualities that make them likely to be strong team members. Provider motivation helps to ensure that team members reliably show up to work and fulfill their team responsibilities. Provider motivation mechanisms such as incentives and continuing professional development, among others, can support the successful implementation of performance measurement and improvement efforts. Finally, staff should be involved in and capacited to understand performance targets and gaps and support data interpretation and quality improvement efforts.
Improvement Strategies
Each PHCPI Improvement Strategy is designed to help decision-makers begin to plan and enact reforms within their own context by providing additional resources and evidence on the topic, as well as practical recommendations for action.
Interested in understanding how this topic intersects with investment opportunities from major funding streams? The Global Frameworks Mapping provides a starting point to help identify and make connections between key PHC topics, relevant funding initiatives, and investment cases.
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Walking the Talk: Reimagining Primary Health Care After COVID-19
Goal 2A: Help countries extend immunisation services to regularly reach under-immunised and zero-dose children to build a stronger primary health care platform
"Goal 2B: support countries to ensure immunisation services are well-managed, sustainable, harness innovation and meet the needs of caregivers"
Goal 3A: Strengthen national and subnational political and social commitment to immunisation
"Outcome 1: Midwifery - Midwives deliver right based quality sexual and reproductive health information and services that are women centered, equitable, accountable, and accessible."
"Outcome 2: EmONC: Referral maternity facilities are staffed with skilled attendants at birth and monitored to deliver quality and accessible essential sexual and reproductive healthcare, including EmONC. "
Outcome 3: MPDSR: Causes of maternal and perinatal deaths are identified and addressed through MPDSR programmes.
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HIV and Universal Health Coverage - A guide for civil society
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