Policy Bite: What gets measured gets managed?

September, 2015

Prof Amanda Howe is on holidays, so this month’s Policy Bite is written by guest author Dr Luisa Pettigrew. Luisa is a member of WONCA Executive and our liaison person with the WHO. Find out more about Luisa here.


The cliché is that “if it is not measured it is not managed” - or simply may not be done. Whilst there are numerous pitfalls associated with wanting to measure things that cannot or should not be measured, there is also some underlying truth in this saying. The biggest challenge is therefore measuring what matters, and coming up with feasible and appropriate ways of doing so.

The health and well-being of patients and populations are the most important end-point measures for any health system, but health outcomes are often long-term and based on numerous different factors. Structure and process measures, which measure how care is delivered, are also important as indicators of the quality of service and its consistency with evidence. These are particularly relevant to primary care, where evidence suggests that if condition-specific outcome targets are used to direct health services this can be to the detriment of other conditions, holistic care and to health system strengthening. This is particular relevant when resources are limited and the appeal of vertical programmes for funders is strong.

In August the WONCA executive therefore published a letter in The Lancet underlining the need for global primary care development indicators. The letter stressed that there is a need to try to measure the distinctive dimensions that evidence suggests make primary care effective. These include coordination, comprehensiveness and continuity of care, as well as measures of quality of care and integration into the health system. It is also important to be able to measure government expenditure on primary care, financial accessibility to primary care and workforce development.

We acknowledge that many of these dimensions are currently very challenging to measure in a large part of the world as the resources and mechanisms to collect the data are not yet there. However examples exist of how it can be done, and although these are principally from higher income country settings they provides a basis from which to start (1,2).

The United Nations have set 17 ambitious Sustainable Development Goals to be achieved by 2030. Good quality comprehensive primary care is essential to meet not only the main health related goal, but it can also make a significant contribution across the other goals.

We therefore need to be ambitious about measuring what matters, and primary care matters.

1. Johns Hopkins Primary Care Policy Centre. Primary care assessment tools.www.jhsph.edu/research/centers-and-institutes/johns-hopkins-primary-care-policy-center/pca_tools.html.
2. Dionne S. Kringos, Wienke G.W. Boerma, Allen Hutchinson, Richard B. Saltman. Building primary care in a changing Europe. European Observatory on Health Systems and Policies & NIVEL. www.euro.who.int/en/about-us/partners/observatory/publications/studies/building-primary-care-in-a-changing-europe