A measure of whether, from the patient's perspective, patients can reach a primary health care facility and receive services in a way that is affordable, timely, and geographically convenient.
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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.
Percentage of population living within 5 km (or 1 hour) of a comprehensive primary care facility/provider and 2 hours of an emergency care unit/provider
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 determines how resources are allocated and, ultimately, if they are distributed in a way that ensures equity in financial, geographic, and timely access.
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Funding & Allocation of Resources
Increased public spending on PHC promotes equitable financial access.
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Medicines & Supplies
Availability of medicines and supplies is critical to maintaining timely access to necessary care.
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PHC Workforce
An adequately sized and competent health workforce is a precondition for ensuring geographic and timely access to health services.
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Physical Infrastructure
Facility distribution and density determines geographic access. Additionally, well-designed facility infrastructure influences efficient facility flow and shorter waiting times thereby effecting timely access.
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Policy and Leadership
Access (financial, timely, and geographic) are dependent on having a conducive set of national policies that include a costed essential service package as well as master facility plans that has determined targets for optional density and distribution of facilities based on local context and population health needs.
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Service Availability & Readiness
Geographic and timely access is dependent upon providers being present where and when they are expected to be, and available to provide necessary health services at appropriate times.
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Financial Protection
Financial coverage through risk-protection schemes is essential for ensuring financial access.
Access
COMPLEMENTARY SUBDOMAINS
Information & Technology
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Inefficiencies in financial management and forecasting may lead to bottlenecks in financial access. Telemedicine can facilitate timely access to care in areas where clinics are inaccessible but sufficient technological infrastructure is in place. Additionally, information systems innovations like appointment systems can make facility flow more efficient. Overall, improvements in technology may compliment initiatives for improved health access.
Multi-Sectoral Approach
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Social accountability mechanisms are important means of holding policymakers accountable for ensuring that the entire population can afford, reach, and access health services.
Purchasing & Payment Systems
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Adequate purchasing and payment systems help to ensure continuation of services across facilities for continued access to care.
First Contact Accessibility
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Strengthening the capacity of a primary care system to serve as the first point of contact brings PHC services closer to the people and enables timely, financial, and geographic access.
Management of Services
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Inefficiencies in financial management may lead to bottlenecks in financial access. However, team-based care strategies (e.g. staggered shifts, distribution of work) can improve timeliness of access. Additionally, facility management should take the lead in addressing barriers such as inconvenient facility hours, inefficient appointment systems and uncoordinated facility flow.
Organization of Services
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Team-based care strategies (e.g. staggered shifts, distribution of work) can improve timeliness of access.
Population Health Management
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Sub-national governance structures should have mechanisms of community engagement and participation to solicit local input to understand gaps in access to care, understand who is not accessing care due to financial barriers, and identify feasible and acceptable responses that will tangibly improve access. Establishing panels based on pre-established geographic or municipal boundaries can help stakeholders understand gaps to geographic access and begin the process of developing infrastructure to remedy these gaps. Geographic barriers can also be addressed through implementation of community-based services such as proactive population outreach.
Timeliness
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Timeliness of care refers to the ability of the health system to provide primary care services to patients when they need them and is closely related to timely access.
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.
The explainer graphic below presents a quick overview of the concept of Access. View the full Improvement Strategy on Access to learn more.
Potential Funding opportunities
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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Universal Health Coverage for Sustainable Development (Issue Brief)
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 2C: Work with countries and communities to build resilient demand, and to identify and address gender related barriers to immunisation"
Goal 3B: Promote domestic public resources for immunisation and primary health care to improve allocative efficiency
"Goal 4A: Ensure sustainable, healthy market dynamic for vaccines and immunisation-related products at affordable prices"
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Maternal and Newborn Health Thematic Fund 2018-2022
Outcome 4: Quality sexual and reproductive health information and services are accessible to prevent and treat obstetric fistula and other obstetric morbidities.
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HIV and Universal Health Coverage - A guide for civil society
