INTRODUCTION
The purpose of metrics is to focus attention on what is important that may be overlooked amidst
pressing day-to-day concerns. In translating knowledge into action, metrics offer guidance and
direction. Metrics can prompt us to contemplate the meaning and impact of activities too easily
routinized (30). They allow us to consider what is being done well (111), what might be better
left undone (48), what needs to be changed (121) and what is essential and therefore needs to be
remain unchanged (139).
Metrics in primary health care serve three uses: to assess performance (processes and outcomes),
to inform reflection on purpose, and to foster aspirational conversations that lead to ongoing
development. Linking performance metrics to payment may increase the quality of narrowly
defined care in the short term (19) but risks unintended consequences in the longer term (9, 19,
87). In environments that support reflection, development, and collaborative action, metrics can
enable primary health care to heal and develop itself (79) so that it can deliver on its promise to heal
and develop the health of individuals, families, and communities (141). Below we describe what is
important about primary health care, relevant metrics and their effective use, and environments
needed to help metrics do more good than harm.