The Most Appropriate Indicator of Success in Primary Health Care
The correct answer is C: Health workers are able to provide care based on identified health needs of the people. This represents the fundamental principle of comprehensive, people-centered primary care that directly addresses population health needs and drives improved health outcomes.
Why Option C is the Best Indicator
The ability of health workers to provide care based on identified health needs reflects the core definition and function of successful primary health care. According to the World Health Organization's framework, primary care must ensure comprehensiveness—providing a diverse range of preventive, screening, diagnostic, treatment, rehabilitative, and palliative services based on actual population needs 1. This needs-based approach is what distinguishes effective primary care from other healthcare delivery models.
People-centeredness and responsiveness to identified needs are essential functions that enable primary care to optimize population health and reduce disparities 1. When health workers can identify and address the specific health needs of their communities, this leads to:
- Improved health outcomes including lower mortality and hospitalization rates 1
- Better chronic disease management 1
- More equitable distribution of health in populations 2
- Prevention of illness and death 2
Why the Other Options Are Inadequate Indicators
Option A: Free Services
While financial accessibility matters, providing free services alone does not indicate successful primary care implementation. Access to primary care involves multiple factors beyond cost, including health insurance adequacy, language barriers, health literacy, transportation, and workforce availability 1. Free services without comprehensive, needs-based care delivery would not achieve the core objectives of primary health care.
Option B: Local Officials as Decision Makers
Empowering local officials is not the defining feature of successful primary care. The evidence emphasizes patient autonomy and people-centeredness as core values 1. While community participation is important 3, the critical indicator is whether health workers can actually deliver appropriate care based on identified needs, not who makes administrative decisions.
Option D: Sustainability Based on Development Level
While sustainability is important, this option describes a constraint rather than an indicator of success. Successful primary care should aim to improve health outcomes regardless of development level, working within available resources while striving for comprehensive coverage 1. The ability to provide needs-based care (Option C) is what enables programs to be effective and sustainable.
The Evidence Framework
The American Heart Association's 2024 scientific statement defines high-quality primary care as "the provision of whole-person, integrated, accessible, and equitable health care that addresses health and wellness needs" 1. This directly supports Option C as the key indicator—health workers must be able to identify and address actual health needs to achieve these goals.
Primary care's five core functions all depend on needs-based service delivery 1:
- First contact accessibility
- Continuity of care relationships
- Comprehensiveness of services provided
- Coordination across the health system
- People-centeredness with patient autonomy
The third function—comprehensiveness—is measured by whether health workers can provide the range of services needed by the population they serve 1.
Common Pitfalls to Avoid
Don't confuse primary care with simply providing basic services or free care. The distinguishing feature of successful primary health care is its ability to comprehensively address identified population health needs through coordinated, continuous, people-centered services 1. Programs that focus only on access, cost, or administrative structure without ensuring needs-based care delivery will fail to achieve the morbidity, mortality, and quality of life improvements that define successful primary care 2, 4.