Primary Health Care Performance Initiative (PHCPI): Strong Health Systems via Stronger Measurement

The Challenge

The last five decades have seen great improvements in the health of populations worldwide. Yet, too many people still suffer or die from largely preventable causes, and too many people lack access to quality and affordable health care.

Strengthening health systems — especially at the primary health care (PHC) level — is central to addressing these challenges, and achieving the Sustainable Development Goals, especially the goal of quality universal health coverage.

Despite its importance, PHC is all too often the weakest link in the health system. The Ebola epidemic both exacerbated and was partially fueled by broken PHC systems. Even in the absence of emergencies, the need for stronger PHC is clear, as most child deaths under age 5 are preventable through effective PHC.

The Opportunity

To improve primary health care, adequate funding and data are critical. Many countries have identified primary health care as an urgent priority, but they lack comprehensive data to pinpoint specific weaknesses, understand their causes, and strategically direct resources to address the areas of greatest need.

Countries often lack performance data about the important processes required to convert inputs, like vaccines, to outputs such as a vaccinated child—critical to producing strong health outcomes.

We call the processes and experiences that occur in the system, between inputs and outputs, the “black box” of primary health care because they are not well understood and have not received enough attention. This “black box” of PHC includes questions such as:

  • 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?

With better information on how PHC services get delivered, countries and their development partners can understand where change will have the biggest impact.

Our Work

The Primary Health Care Performance Initiative (PHCPI) is a new partnership that brings together country policymakers, health system managers and other development partners to catalyze improvements in primary health care in low- and middle-income countries through better measurement, knowledge-sharing, and deploying data for improvement.

PHCPI will help countries

  • track key performance indicators for their PHC systems, identifying which parts of the system are working well and which ones aren’t
  • enhance accountability and provide decision-makers with essential information to drive health system improvements
  • provide a platform for countries to make data actionable, share lessons and best practices.

As a founding member of the PHCPI partnership, R4D is leading efforts to help policymakers use data for improvement. In Rwanda, PHCPI, led by R4D, is working with the Ministry of Health to create performance management dashboards that will be used to track performance of the health system on a daily basis. R4D is collaborating with the Joint Learning Network for Universal Health Coverage (JLN) through a country-led effort to unearth current indicators used to measure primary health and put that data into action.  Finally, R4D is working closely with all PHCPI partners to expand global data availability for primary health care.

Visit to explore key PHC performance indicators, download country datasets, and learn more about how PHC data can drive policy improvements. PHCPI was officially launched by the Bill & Melinda Gates Foundation, World Bank Group, and World Health Organization, in partnership with Ariadne Labs and Results for Development, at the UN General Assembly in September 2015.

Photo: A child receives polio drops during routine immunization outside the Anganwadi Centre in Roti Mushahari village, Saharsa district, Bihar, India. © Gates Foundation

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