Abstract
ObjectiveTo develop a composite measure of primary care quality and apply it to Haiti’s primary care system.MethodsUsing the Primary Health Care Performance Initiative’s framework, we defined four domains of primary care service delivery: (i) accessible care; (ii) effective service delivery; (iii) management and organization; and (iv) primary care functions. We gave each primary care facility in Haiti a quality score for each domain and overall, with poor, fair and good quality indicated by scores of 0.00–0.49, 0.50–0.74 and 0.75–1.00, respectively. We quantified access and effective access to primary care as the proportions of the population within 5 km of any primary care facility and a good facility, respectively.FindingsOf the 786 primary care facilities in Haiti in 2013, only 332 (43%) facilities were classified as good for accessible care. Fewer facilities were classified as good in the domains of effective service delivery (30; 4%), management and organization (91; 12%) and primary care functions (43; 5%). Although about 91% of the population lived within 5 km of a primary care facility, only an estimated 23% of the entire population – including just 5% of the rural population – had access to primary care of good quality.ConclusionDespite an extensive network of health facilities, a minority of Haitians had access to a primary care facility of good quality. Such facilities were especially scarce in rural areas. Similar systematic analyses of the quality of primary care could inform national efforts to strengthen health systems.
Highlights
Thirty years after the Declaration of Alma-Ata, the 2008 World Health Report declared that primary health care was a global priority “ more than ever”.1 Primary care forms the cornerstone of a functional health system
To highlight the challenges and opportunities of measurement in this understudied area, we focused on the service delivery component of the Primary Health Care Performance Initiative’s framework
We developed metrics of service delivery quality following the Primary Health Care Performance Initiative’s framework
Summary
Thirty years after the Declaration of Alma-Ata, the 2008 World Health Report declared that primary health care was a global priority “ more than ever”.1 Primary care forms the cornerstone of a functional health system. Research on the quality of primary care includes investigations of provider behaviour and knowledge,[5] programme evaluations[9] and small-scale case studies.[10] Broader assessments of primary care systems, in the wake of conflict[11] or natural disaster,[12] have included the development of balanced scorecards. These scorecards have focused on infrastructure inputs and community perspectives and given relatively little attention to the processes of care. One limitation of the research in this field is the lack of a comprehensive definition of primary care quality that is applicable across contexts and countries
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