Service availability and readiness is a measure of whether a person, upon accessing care, encounters a provider who is present, competent, and motivated to provide safe, high-quality, and respectful care, and has the resources to do so.
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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.
Facility meets standards (inadequate, basic, intermediate, advanced) based on the eight core components of the Infection Prevention and Control Assessment Framework (IPCAF)
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Percentage of facilities meeting minimum standards to deliver tracer services
Percentage of facilities offering services that meet minimum standards including availability of Staff and guidelines Equipment Diagnostics Medicines and commodities
Percentage of clinical staff who are expected to be at facility but are not present at a facility during an unannounced visit compared to the expected number of staff at a given time
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Percentage of facilities offering services according to national defined service package
Percentage of primary care facilities/units offering services according to national defined service package
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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Medicines & Supplies
Environmental factors, access to clinical supplies and facilities are important determinants of health worker motivation. Additionally, medication and supply quality is essential for patient safety.
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PHC Workforce
An adequately sized workforce with equitable distribution is essential for ensuring availability. National workforce strategies should establish eviddence-based competencies for all PHC workforce occupations; set education standards baesd on these competencies; ensure that the PHC workforce has all the required competencies; ensure that all actively-practicing PHC workforce are qualified; and ensure that quality standards are met in practice. Additionally, provider caseload is significant determinant of motivation and satisfaction. National workforce strategies should ensure an appropriate number and distribution of workforce to avoid overwork. Additionally, national workforce strategies can provide clear career pathways and opportunities for continuing education which may improve motivation.
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Physical Infrastructure
Facilities should have adequate infrastructure (sterilzation, waste and sharps disposal, and safety guidelines) to promote service availability, readiness, and patient safety. The design and layout of the facility also plays a role in safety, for example in fall prevention. Additionally, environmental factors, access to clinical supplies, and facilities are important determinants of health worker motivation.
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Policy and Leadership
PHC policies should define the scope of services provided by PHC and varying PHC facility types to guide measurement of readiness and service availability.
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Management of Services
Performance measurement and management is essential to ensuring that both inputs and PHC workforce is ready and available. This includes appropriate delegation of tasks between team members to ensure that each provider is delivering care consistent with their training and within the scope of practice. Facility leaders should also track provider availability, work to correct performance issues and absenteeism, and enact measures to promote efficiency (task shifting, facility flow, etc) to ensure adequate time for patient interactions. There should be systems in place to identify safety incidents, respond appropriately, and institute measures to prevent these incidents from reoccurring. Finally, managers have the responsibility to make sure that inputs are maintained and available over the course of service delivery and operating hours.
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Safety
Low safety for providers often results in low provider availability and motivation out of fear of working conditions.
Service Availability & Readiness
COMPLEMENTARY SUBDOMAINS
Information & Technology
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Timely remuneration can deter absenteeism and enhance workforce retention while also promoting motivation.
Multi-Sectoral Approach
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Social accountability measures (e.g. transparency, feedback mechanisms) facilitates strong patient provider respect and trust.
Purchasing & Payment Systems
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Adequate purchasing and payment systems help to ensure availability and readiness of services across PHC facilities by providing the adequate avenues to procure necessary medicines and supplies while also attracting and retaining PHC workforce.
Continuity
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Informational continuity is important for ensuring safe care and avoiding issues such as harmful medication interactions, while continuity over time supports improved and deepened provider-patient relationships and can contribute to building respect and trust.
Coordination
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Ensuring strong communication and appropriate transfer of knowledge during any kind of transition in ambulatory care can help to reduce errors and improve safety.
Organization of Services
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Improved assignment and distribution of the roles and responsibilities of various health care professionals allows for a broader workforce base that could interact with patients. Appropriate delegation between team members can ensure that each provider is delivering care consistent with their training and within their scope of practice.
People-Centeredness
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Organizing care around patient needs and engaging patients as partners in their care supports mutual respect and trust.
Population Health Management
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Appropriately sizing patient panels can help avoid overburdening providers and ensure providers have adequate time to devote to patient interactions. Community interactions between patients and providers may encourage stronger relationships and contribute to intrinsic motivation of providers while contributing to mutual respect and trust. This also strengthens the incorporation of local contextual factors into the provision of services. Empanelment establishes a usual source of care for patients, which supports relational continuity and improved respect and trust over time.
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.
Service Availability & Readiness explainer graphic
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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Walking the Talk: Reimagining Primary Health Care After COVID-19
Goal 1B: Support countries to introduce and scale up coverage of vaccines for prevention of endemic and epidemic diseases
Goal 1C: Enhance outbreak response through availability and strategic allocation of vaccine stockpiles
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 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"
Goal 4C: Scale up innovative immunisation-related products
"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 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
