by Sharon Atieno
Half of the world’s people still lack access to essential health services, the majority of which can be delivered through strong primary care; this is according to a 2017 joint World Bank and World Health Organization (WHO) report. Statistics from a 2018 Lancet Global Health Commission on high quality health systems in Sustainable Development Goals (SDG) Era indicate that, 8.6 million people die yearly from conditions that are treatable by primary care and the rest of the health system.
Lack of data has resulted in less attention being given to primary health care (PHC) as there was no way to fully assess the performance of the sector. For this reason, Primary Health Care Performance Initiative (PHCPI) through partnership with 11 trailblazing countries has released the first set of Vital Signs Profiles (VSP). This is a measurement tool that provides essential data on various aspects of PHC thus making assessment of the sector possible for low and middle income countries.
“The profiles shine a light where systems are strong and where they are weak. They compile and analyze multiple quantitative and qualitative data sources helping to build a richer and more detailed picture of a country’s PHC system than what has been previously available,” said Beth Tritter, Executive Director, PHCPI. She was speaking at a media telephone briefing alongside other speakers in light of the new commitment by countries around the world to strengthen PHC systems in Astan, Kazakhstan.
Though PHC plays a vital role in ensuring that universal health care is reached, lack of or inadequate data has hindered countries from gauging the sector’s overall performance and knowing which areas need improvement thus, slowing the progress towards health care for all.
“There is significant data gap that makes it difficult to say where and why PHC falls short. Data that does exist is often old, of poor quality or generally difficult to understand and compare,” laments Asaf Bitton, Director, Ariadne Labs.
In addition, he pointed out that only a few countries globally have comparable data on the delivery of primary health care including information on whether patients see providers that are well trained, whether they get the right diagnosis and whether systems are working well and managed correctly.
“Data gap is a significant weakness in PHC and is making it difficult to increase investment and to really understand where and how health systems are falling short to drive targeted improvements,” stated Tritter.
The VSP focuses on four main areas: finance, capacity, performance and equity. In finance, it indicates the amount of money the government spends on PHC. For capacity, it provides information on policies that prioritize PHC as well as evaluating whether the system has enough drugs, supplies and health care providers. Moreover, it assesses performance on whether people are able to get the care they need without financial or geographic barriers and whether the care being given is of high quality. It also provides information on equity whether there is effective service to the most marginalized and disadvantaged groups.
The VSP is a measurement tool that multiple stakeholders can use to better understand and ultimately improve health care globally. Policy makers can use the profiles to drive deeper conversations and data gathering on PHC and set an agenda for concrete improvement as well as ensuring that health providers are accountable. Donors and development partners can use the VSP to drive resources where they are needed and to ensure investment for global health goal are achieving their intended effects. Citizens and civil society can use the profiles to hold policy makers accountable for global and national commitments, and to advocate for the types of policies and investments that make health accessibility for all a reality.
“The VSP is an important step to making information on PHC more accessible but it is as accurate as the underlying data that got into it. More investment has to be made to complement the data gap that we are seeing ,”Dr. Jeremy Veillard, Program Manager, PHCPI, World Bank.
The VSP contains data from numerous national surveys such as the Service Delivery Indicators (SDI) from the World Bank Group, the Service Provision Assessment (SPA) and Demographic and Health Surveys (DHS) from USAID, the Service Availability and Readiness Assessment (SARA) from WHO, and the Multiple Indicator Cluster Surveys (MICS) from United Nations International Children’s Emergency Fund (UNICEF). Additional data was collected and reported by countries. Sources were chosen after several rounds of review with global experts on the monitoring and evaluation of PHC.
Globally, similar data sources were preferred, when available, in order to promote international comparability as a potential mechanism for enhancing accountability and cross-country learning. While indicators and globally comparable data sources were preferred to populate areas of the VSP, in many cases such data does not exist. In these cases, PHCPI has worked with countries to find alternative data sources for the profile that are consistent with the PHCPI framework, even when such sources are not globally comparable.
Improving PHC requires availability of more and better data on PHC that will be used to drive decisions that make people’s life better thus achieving universal health care and SDG 3 which advocates for good health and well-being. Measurement is key to accountability and improvement through capturing the essential processes and outcomes that matter to individuals.