Send to

Choose Destination
BMJ Glob Health. 2019 Sep 13;4(5):e001822. doi: 10.1136/bmjgh-2019-001822. eCollection 2019.

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

Author information

Ariadne Labs, Brigham and Women's Hospital & Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Secretaria de Gobierno de Salud, Ministerio de Salud y Desarrollo Social, Buenos Aires, Argentina.
Directorate of Planning, Research and Statistics, Ministry of Health and Social Action, Dakar, Senegal.
Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina.
Ministry of Health, Kigali, Rwanda.
Bill & Melinda Gates Foundation, Seattle, Washington, USA.
Ministry of Health, Community Development, Gender, Elderly, and Children, Dodoma, United Republic of Tanzania.
Results for Development, Washington, District of Columbia, USA.
Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
Division of Policy, Planning, Monitoring and Evaluation, Ghana Health Service, Accra, Ghana.
Health Section, UNICEF Tanzania, Dar es Salaam, United Republic of Tanzania.
Global Health Issues and Solutions, Kigali, Rwanda.
Health, Nutrition and Population Global Practice, World Bank Group, Washington, District of Columbia, USA.


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.


Primary care; capacity; global health; measurement; primary health care; universal health coverage

Supplemental Content

Full text links

Icon for BMJ Publishing Group Icon for PubMed Central
Loading ...
Support Center