Focusing on primary care is the primary content of health care policies, however, there is a lack of effective measurement tools in practice.

To construct a index system for county health system development focusing on primary care, provide a reference for its monitoring approaches, and perform analysis and presentation with application cases.

In the study conducted from 2021 to 2022, the index system, weights and percentage conversion methods were constructed based on literature review and Delphi method, case application and analysis were conducted based on the data of questionnaire survey, institutional survey and medical insurance collected by baseline survey among residents, patients and medical workers, as well as data of key informant interview, in 2 experimental counties of county health system reform in Guangxi Zhuang Autonomous Region from 2020 to 2022.

The results of Delphi method showed that the authority coefficient of experts was 0.91, the coefficients of variation of two rounds of consultation were 0.14 and 0.13, respectively. The final constructed index system contains 3 domains, 15 dimensions, and 36 indicators, with a comprehensive index calculation method. The results showed that the overall scores for the two counties in Guangxi Zhuang Autonomous Region were 58.62 and 52.57, respectively, both of which were below the current national benchmark (60.00 points) .

Based on the data availability, the index system constructed in this study can be applied to monitor and evaluate county health system to achieve the goal of focusing on primary care, its application may improve visibility and priority of primary care development, facilitate the publish and implementation policies strengthening primary care.