How to measure the core functions of primary care in low-income and middle-income country settings

The core functions of primary care are first contact access, comprehensiveness, continuity, coordination and person-centredness. These five core functions are highlighted as essential aspects of quality by the new WHO’s measurement framework. In low-income and middle-income countries, the core functions are rarely measured and routinely collected data does not support their measurement. Existing international tools to measure the quality of primary care may evaluate some aspects of these core functions, but none of the reviewed tools focused on all of them. In sub-Saharan Africa, the Primary Care Assessment Tool has been developed over the last decade and a regional version of the tool has been validated to only measure the core functions as defined by the WHO. The tool uses exit interviews with users as recommended by the WHO. The tool has been piloted in South Africa, Uganda and Benin and will now be implemented in 11 African countries. The tool can enable low-income and middle-income countries to measure the core functions and plan interventions to improve the quality of primary care.

Summary box
- The WHO’s core functions of quality primary care are first contact access, comprehensiveness, continuity, coordination and person-centredness.
- Routinely collected data in low-income and middle-income countries are not able to measure these core functions.
- In sub-Saharan Africa, we have adapted the Primary Care Assessment Tool to measure the core functions in exit interviews with patients, as recommended by the WHO.
- Evaluations enable district management teams to improve primary care performance in collaboration with local communities.