Primary health care performance measurement in World Bank health, nutrition, and population projects: An analysis of trends, gaps, and promising practices in evidence-based measurement of primary health care performance

Effective measurement of primary health care (PHC) performance is an essential pillar for learning, accountability, and informed decision making in investments dedicated to achieving universal health coverage (UHC). The World Bank Health, Nutrition, and Population (HNP) Global Practice has a critical role to play to support sustainable and robust PHC measurement in client countries through project investments and project monitoring and evaluation (M&E) practices. Previous evaluations of the HNP portfolio have singled out measurement as a salient gap that must be bridged in HNP projects to better understand and improve results. However, existing evaluations provide limited in-depth understanding of nuances in measurement gaps and specific opportunities for improvement as it pertains to measurement of PHC in HNP projects. The objective of this analysis is to bridge this gap through a focused review of PHC measurement in HNP projects over the past decade (fiscal years [FY] 2010–FY 2020). Indicators from HNP projects were extracted and mapped to corresponding essential pillars of PHC performance, including capacity, financing, access, quality, coverage, equity, and outcomes. The definition of these pillars, along with the additional classification of indicators to more specific components of PHC performance, was guided by the application of a conceptual framework developed by the Primary Health Care Performance Initiative (PHCPI). Overall trends in PHC performance measurement, including common indicators utilized across the portfolio, data-collection methods, and distribution of projects measuring PHC performance by region, income bracket, and fiscal year of approval, were also identified and used to understand relative strengths and areas for improvement in PHC measurement. This exercise revealed a strong focus on the measurement of PHC system inputs, particularly workforce capacity and PHC coverage of Reproductive, Maternal, Newborn, and Child Health (RMNCH) and infectious disease services in HNP projects. Measurement of other crucial dimensions of PHC performance, including PHC financing, local capacity for high-quality PHC, demand-side barriers to access, quality of services delivered, effective service coverage, and equity, were limited. Trends in datacollection methods used to collect indicators in World Bank projects and variations in measurement practices across regions, economic contexts, and time revealed opportunities for the Bank to enhance the sustainability of PHC measurement for improvement in client countries. Results from this analysis were ultimately used to devise a series of recommendations for the World Bank to support short-term and long-term improvements in PHC measurement over the coming decade.