Developing an Iranian Sub-national Primary Health Care Measurement and Improvement Framework

Abstract

Abstract Introduction: Desired health outcomes are more achievable through strong Primary Health Care (PHC). Decision-makers are guided to formulate better PHC reforms and policies through using comprehensive and scientific tools. Objective: This study introduces a sub-national framework based on the World Health Organization (WHO) proposed frameworks for the PHC performance measurement. Material and Methods: By a mixed-method and qualitative approach, the Iranian sub-national PHC Measurement and Improvement framework (PHCMI) was developed through a review of the WHO’s PHC measurement conceptual framework (for selecting Key Performance Indicators (KPIs)), literature review (academic database), PHC-related national documents, consultations with an advisory committee of national experts (6-meetings). Also, the progression model (33 measures) was revised and finalized to adapt to the needs and capacities of the sub-national level. Finally, quantitative and qualitative measures were assessed based on the scientific tools. Finally, based on Delphi technique the framework was finalized. Results: A total of 104 key performance indicators (KPIs) were selected to measure the sub-national primary health care. There was no data to measure 7 KPIs. The results of the gap analysis showed that the status of the KPIs in the East azerbaijan was favorable compared to the national average. Based on the results of measures assessment (33 measures), 69 percent of the measures (23 measures) scored the highest level (level four). After analyzing the results of the previous steps, four KPIs out of 104 KPIs were excluded by the experts panel, and finally, the sub-national primary health care performance assessment framework with 100 KPIs in three components, including the requirements of health systems, service delivery and primary health care system goals were finalized. Based on the scope of the chain of results, most of the KPIs were related to output (25 KPIs) and the least related to the process (8 KPIs). Conclusion: Regarding the comprehensiveness of the developed measurement framework due to its focus on all PHC operational levers and key aspects of PHC systems’ performance, it can be used as a practical tool for assessing and improving the Iranian sub-national PHC system.