Indicator of Success in Primary Health Care Approach
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 comprehensiveness and people-centeredness that defines successful primary health care implementation.
Core Rationale
The ability of health workers to provide care based on identified health needs reflects the essential comprehensiveness principle of primary health care, which ensures that a diverse range of preventive, screening, diagnostic, treatment, rehabilitative, and palliative services are provided based on actual population needs 1. This is fundamentally different from providing predetermined services or following external mandates.
According to the World Health Organization's definition, primary care must support "first-contact, accessible, continuous, comprehensive and coordinated person-focused care" that aims to optimize population health 1. The people-centeredness function specifically supports the belief that patients should have autonomy over their health decisions, and care should be tailored to their identified needs 1.
Why Other Options Fall Short
Option A (Free Services)
While financial accessibility is important, providing free services alone does not indicate successful PHC implementation 1. Access barriers extend beyond cost to include insurance coverage, transportation, language barriers, and health literacy 1. Free services without addressing identified health needs or ensuring quality care delivery represents an incomplete approach.
Option B (Local Officials as Decision Makers)
Empowering local officials as major decision makers does not align with the core PHC principle of people-centeredness, which emphasizes that patients themselves should have autonomy over health decisions 1. While community participation is valuable 2, concentrating decision-making power in local officials rather than ensuring health workers respond to community health needs misses the mark.
Option D (Sustainability Based on Development Level)
While sustainability is important, tying health programs strictly to development levels can perpetuate health inequities 1. Successful PHC should work to reduce disparities across populations and promote equal access to services regardless of development status 1.
Evidence Supporting Needs-Based Care Delivery
Effective primary care is person-centered, team-based, community-aligned, and designed to provide affordable health care that has the potential to improve identification and treatment of health behaviors and risk factors when promoted and valued appropriately 1.
Studies from low- and middle-income countries demonstrate that when community health workers can deliver care based on identified needs—particularly for chronic disease management like hypertension—they achieve improved health outcomes and patient satisfaction 1. Randomized controlled trials from rural China showed that primary care led by village doctors or non-physician healthcare workers was effective in managing chronic diseases when focused on identified community needs 1.
Key Implementation Considerations
The success indicator of needs-based care delivery requires:
- Coordination function: Primary care must organize services across levels of the health system and over time based on identified needs 1
- Continuity: Development of long-term relationships between people and the health care team to understand evolving needs 1
- First contact accessibility: Creating entry points for care that allow identification of health needs 1
Common Pitfall to Avoid
The critical error is confusing inputs (free services, administrative structures, funding levels) with outcomes (care delivery based on identified needs). Successful PHC is measured by whether the system can identify and respond to actual health needs of the population, not by the presence of specific organizational features alone 3, 4.