Primary Health Care Improvement: From Measurement to Improvement Professor Michael Kidd President World Organization of Family Doctors (WONCA)

“We need to turn our focus onto how we use the information from primary care to improve population health.” Professor Barbara Starfield, 2011

Indicators for health

“What gets measured, gets done.” Dr Margaret Chan

The Primary Health Care Performance Initiative seeking to help low- and middle-income countries build high-performing primary health care systems through better performance measurement and knowledge-sharing.

My concern? “If we really want to see improvement in primary health care, we need to focus on what should be measured, rather than on what can be measured.”

"Hear arguments about vertical and horizontal health care. The horizontal piece is the most important piece.” Bill Gates, at launch of PHCPI,

Some examples of measures of person- centredness in primary health care Where are clinics based? Are they accessible to those in greatest need? How do we measure patient satisfaction? – Scheduling of appointments – Access to care after hours – Access to interpreters and physical access – Outreach and home-based care How do we measure successful continuity of care? How do we measure integration of mental health services into primary care? And inclusion of preventive care and health promotion services into primary care services to improve chronic disease prevention, early detection and management? How do we measure quality and safety? (e.g. infection control, vaccine cold chain compliance and preparedness for epidemics of infectious diseases)

International Classification of Primary Care (ICPC) Allow us to measure what is happening daily in primary care locally, nationally, globally

Education and Training of our primary care workforce Do we send our most experienced doctors and nurses to work in the most challenging health care settings, in remote rural locations and with disadvantaged communities?

Is The Health Minister’s Salary Index the most important measure? Compare the salary of doctors and nurses working in remote rural areas with the salary of the nation’s Minister of Health. If a nation is paying its health care professionals working in the most challenging situations more than the nation pays its politicians, then things are probably on the right track.