In March 2023, two workshops were conducted: the first workshop, held in Kenya from 13th to 17th March 2023, focused on anglophone AFR countries, while the second workshop, held in Cote d'Ivoire from 20th to 24th March 2023, targeted francophone and lusophone AFR countries. The workshops brought together key country stakeholders from all Member States in the WHO African region to review country practices and priorities for strengthening integrated health services performance assessment within the context of strengthening PHC-oriented health systems.
The three key areas of focus were to enhance the country's conceptualization of PHC monitoring and its practical application, incorporate a PHC lens into the overall health sector monitoring, and introduce innovative measurement tools. The workshops aimed to equip participants with the tools and knowledge needed to assess and improve the performance of integrated health services, while considering the essential principles and practices of PHC.
In advance of the workshops, country teams were invited to prepare brief PHC situation analyses, consolidate data on rapid assessments, and share best practices for integrated health services performance assessment in the context of strengthening PHC-oriented health systems monitoring and evaluation.
The PHC measurement framework and a corresponding menu of indicators were presented to explain how they can be used by countries to track, monitor, and improve PHC capacities and performance toward the achievement of universal health care (UHC) and Sustainable Development Goals (SDGs). Discussions highlighted how the framework and indicators can be applied to fill critical gaps that inform PHC-oriented actions and reforms and monitor progress, quality, equity, and resilience.
The highest priority PHC measurement indicators reported by over 90% of countries included the existence of policy, strategy, or plan for improvement of quality and safety; national health policy oriented to PHC/UHC; and health emergency and disaster risk management strategies.
Member states depicted varying levels of data availability and use at national, sub-national, and provider levels related to governance mechanisms, policies, and models of care. Country teams discussed best practices for ensuring the use of data to improve performance including the use of PHC dashboards to provide a snapshot of key performance indicators. There is a need to establish and strengthen sustainable country health information systems to improve efficient and effective monitoring.
Much like PHC is conceptualized differently in different country settings, PHC measurement also needs to be interpreted and applied differently in each country. The PHC measurement framework and indicators can serve as a “menu” for countries, to select and integrate as applicable at national and sub-national levels accordingly. Moving forward, countries would benefit from a comprehensive regional monitoring and evaluation framework that brings together the various tools into a single guide in the context of health sector monitoring and evaluation using the PHC approach. The meeting also echoed the necessity to emphasize information for sub-national units, as critical first-level management units, typically nearest to the implementation level.
Member states agreed to consolidate data mapping exercises into preliminary country profiles to visualize data and generate automated dashboards. Each country identified key actions to measure progress in thematic areas related to implementing a PHC approach, including defining the essential health package, determining modalities for service delivery, ensuring PHC principles are applied during system development, and enhancing system readiness to provide essential interventions in the short, medium, and long terms.
These workshops were highly anticipated by countries and proved to be successful, with discussions focusing on the operationalization of a holistic PHC approach and its impact on monitoring and evaluation. Member states gained practical experience with the measurement framework and regional initiatives, which will inform the creation of country profiles, roadmaps, and regional standards for PHC measurement in the WHO AFRO region.