Primary Impact Measurement for Action Indicators

The framework consists of 18 indicators, grouped into four categories: Structures & Systems, Inputs, Processes, Outputs, and Outcomes. The Structures & Systems category includes indicators that assess the existence and strength of policies, frameworks, and systems that support PHC. These indicators include the existence of evidence-based national PHC policies, a social accountability system for PHC planning and governance, and a national M&E framework that includes PHC indicators and structure for data use for improvement. The Inputs category focuses on the availability and distribution of resources that support PHC, including facilities, health workers, medicines, and equipment. Indicators in this category assess the availability of essential medicines, the existence of a national regulatory mechanism for medicines, and the availability of funds allocated for PHC. The Processes category evaluates the delivery of PHC services, including the existence of multidisciplinary team-based service delivery, proactive population outreach, and community engagement in PHC service planning and organization. Indicators in this category also assess the extent to which subnational units and facilities ensure social accountability of PHC to the community served. The Outputs category measures the availability and accessibility of PHC services, including geographic access to PHC services, patient-reported experience of acceptability, and the overall service utilization rate. Indicators in this category also assess the availability of services according to national defined service packages and the readiness of facilities to deliver tracer services. The Outcomes category evaluates the impact of PHC services on health outcomes, including patient-reported experience of first-contact accessibility, average service gaps between ANC1 and ANC4, and DPT1 and DPT3, and patient-reported experience of service continuity. Indicators in this category also assess the existence of referral completion tracking systems and patient-reported experience of comprehensiveness. The Primary Impact Measurement Framework is designed to provide a comprehensive and systematic approach to measuring the effectiveness of PHC systems, enabling policymakers and program managers to identify areas for improvement and track progress over time.