PRIMASYS: a health policy and systems research approach for the assessment of country primary health care systems

For the renewed global impetus on primary health care (PHC) to translate into action at a country level, it will be important to strengthen existing ways of understanding and assessing country PHC systems. The architecture and performance of primary care systems are widely acknowledged to be crucial determinants of the health of populations in high-income countries as well as in low- and middle-income countries. There is no one-size-fits-all model of a country-level PHC system, and countries have implemented diverse models, adapted to and conditioned by their respective social, economic and political contexts. This paper applies advances in the field of health policy and systems research (HPSR) to propose an approach to the assessment of country PHC systems, using a compendium of 70 elements of enquiry requiring mixed quantitative and qualitative assessment. The approach and elements of enquiry were developed based on a review of policy and guidance documents and literature on PHC and HPSR and were finalized as part of a consultation of experts on PHC. Key features of the approach include sensitivity to context, flexibility in allowing for in-depth enquiry where necessary, systems thinking, a learning emphasis, and complementarity with existing frameworks and efforts. Implemented in 20 countries to date, the approach is anticipated to have further utility in a single country as well as in comparative assessments of PHC systems.