SDI health surveys: A finger on the pulse of primary health care

COVID-19 (coronavirus) has tested health systems in numerous ways, confirming what many in the health community have long known—strong PHC systems are the foundation of population health during and beyond health crises (WHO 2020). PHC systems are vital to control local outbreaks by preventing transmission, detecting cases, and ensuring quick clinical response. In addition, PHC systems need to ensure the continued delivery of nonpandemic essential health services to communities (PHCPI and World Bank 2020).

COVID-19 has also revealed weaknesses in many countries’ PHC systems and aggravated existing inequities. For instance, preliminary evidence from 29 countries suggests that access to sexual and reproductive health services has decreased and violations of related rights have increased as an indirect result of COVID-19 (Endler et al. 2021). As in previous epidemics, substantial mortality may be attributable to the disruption of routine PHC services (Parpia et al. 2016 and Roberton et al. 2020). The strains on health systems have exacerbated underlying flaws, exposing weaknesses in supply chains and highlighting ongoing inequities in access to care. If the COVID-19 virus has created deep clefts in health care systems, it has often done so by widening and deepening the cracks and deficiencies already there.

As countries recover from the COVID shock and plan how to improve health system responses in the future, they will have a unique opportunity to strengthen and reform PHC, increasing investment while making it more fit for purpose. These reforms can be far-reaching and offer a chance to reimagine the health sector, strengthen links within it, and address neglected challenges. Measuring and ensuring quality remain vital for improving health systems, as estimates indicate that more deaths globally are due to low quality of health care (5.0 million deaths annually) than to lack of access to care (3.6 million deaths annually) (Kruk, Gage, Johnson et al. 2018). To achieve the greatest gains in population health, new resources will need to be invested wisely in health system reforms focused on increasing the quality and coverage of PHC. The Service Delivery Indicators (SDI) surveys offer insights for advancing health system reforms, with actionable indicators and a road map for improvement.

The SDI health surveys offer a set of indicators for benchmarking PHC performance. These indicators focus on potential determinants of the quality of PHC services: medical providers’ level of knowledge; their efforts to provide patient care; and the availability of necessary equipment, supplies, and medicines. The distinctive strength of the SDI surveys comes from providing a “patient’s eye view” of what does and does not work in the health system. To measure the various aspects of health system functioning, one can imagine a typical patient