Monitoring and evaluation framework for Primary Health Care programmes and systems: a scoping review

Abstract

Background: Primary health care (PHC) is a whole-of-society approach that strengthens the national health system and brings health services closer to communities. It encompasses health service provision, community engagement, and multisectoral action. The health system’s performance regarding PHC is expected to be evaluated based on these three perspectives. However, comprehensive evidence presenting the elements to be evaluated in each aspect of PHC was lacking. Therefore, we assessed essential elements to be considered in the PHC monitoring and evaluation processes. Methods: We searched articles from PubMed, EMBASE, Web of Science, CINAHL, and PsycInfo. A complementary search of grey literature was conducted from Google Scholar, WHO website, Primary Health Care Program Initiative interface, and Google. We synthesised findings by bringing similar concepts into a common dimension based on predetermined set of activities, including identifying review questions, selecting relevant frameworks, extracting data, identifying domains, and categorising in major themes, The main themes are structure, input, process, output, and outcome. Results: A total of 48 monitoring and evaluation frameworks were included. When evaluating PHC performance, it’s essential to consider population characteristics and contexts, including social, economic, cultural, and political factors. Existing population-based data sources should inform these assessments. Within the broader context, global and national health systems need to address effective system structures. Key components include governance, leadership, health financing, and alignment with population health needs. Inputs such as physical infrastructure, health workforce, medicines, health information, and digital technologies play a crucial role. Processes involve models of care, quality improvement systems, and resilient health facilities and services. Outputs in service delivery encompass access, availability, and quality of care. The goal of the PHC system is to improve health outcomes (reduced morbidity and mortality) and achieve health system objectives (equity, efficiency, resilience, and responsiveness). Conclusions: The review identified areas of overlap within the three aspects of PHC. Many monitoring and evaluation frameworks lack comprehensiveness and uniformity, show differences between data sources, and use inadequate indicators. This review may offer insights for policy measures, clinical service enhancements, and community engagement strategies. It helps identify essential indicators towards the overarching goal of achieving universal health coverage, health security, and health system outcomes.