New tool to assess primary health care services delivery piloted in Kazakhstan

WHO/Erica Barbazza

A pilot of a new tool, the Primary Health Care Tool for Monitoring Impact, Performance and Capacity (PHC-IMPACT) was conducted in May 2018, in Astana, Kazakhstan.

Measuring integrated health services delivery is a challenge. Health services delivery is inherently multidimensional, found at the crossroads between system structures and services delivery processes. Monitoring the impact of health services delivery ultimately requires observing the linkages between services delivery capacity and performance in terms of overall health status and well-being. Its measurement also requires information from the perspective of patients, providers, services and the system.

The tool addresses these challenges by drawing from a range of qualitative and quantitative data sources, which include international and national databases, survey data, key informants and, where other data sources are not available, expert consensus. By bringing these sources together in a common approach, PHC-IMPACT captures a multiperspective, 360° snapshot of primary health care. The tool has been adapted to the European Region context by the use of tracer conditions, such as hypertension, diabetes, depression, influenza and postnatal care. The range and number of tracers have been selected following an extensive review of regional strategies and action plans, prioritization of ambulatory care sensitive conditions and coverage of conditions across the lifespan and genders.

The initiative conducted in Astana in May 2018 piloted two instruments: a key informant electronic questionnaire to gather input from a multiprofile group of national informants, and a data extraction tool to gather input from national databases. The instruments proved comprehensive and a number of national data sources were identified.

Feedback on the indicators, definitions and Russian-language translation will inform the next iteration of the instruments. The findings of the pilot will be used to improve the overall tool, expected to be further piloted in the third quarter of 2018 for wider rollout in 2019.


In 2016, Member States endorsed the WHO European Framework for Action on Integrated Health Services Delivery and its implementation. With its endorsement came a call for intensifying monitoring and regular reporting on services delivery performance. Monitoring health services delivery is also crucial for tracking progress on the coverage, quality and equity of essential health services for Sustainable Development Goal target 3.8 on universal health coverage.

In order to fulfil this mandate, the WHO European Centre for Primary Health Care in Almaty has worked to develop a tool for monitoring primary health care as the cornerstone of services delivery and foundation for the integration of services. The data generated through this work is being fully embedded into the Region’s existing information infrastructure, the European Health Information Gateway. Since late 2017, the Ministry of Health, the Republican Centre for Healthcare Development and the Republican E-Health Centre have worked intensively with the WHO European Centre for Primary Health Care to pilot the instruments. This work has been developed in collaboration with the WHO European Office for the Prevention and Control of Noncommunicable Diseases and with the methodological support of the WHO Collaborating Centre for Quality and Equity in Primary Health Care Systems, Academic Medical Centre, University of Amsterdam.

This work has been made possible by the generous support of the Government of Kazakhstan.

For more information on PHC-IMPACT contact the WHO European Centre for Primary Health Care at