Abstract
BackgroundProviding comprehensive and high-quality services is one of the most important goals of the health systems and a basic principle for Universal Health Coverage (UHC). Fulfilling this important task would be feasible through continuous evaluation and improvement of the health services quality. The aim of this study was to develop a framework for quality assessment of Primary Health Care (PHC) in Iran’s health system.MethodsThis study is a literature review which continued by a qualitative research. The extracted quality dimensions and indicators for initial screening were reviewed and discussed in two panel meetings attended by the experts with regard to the current package of health system in Iran. Using Delphi method, the dimensions and Quality Indicators(QIs) were evaluated and approved by 39 national health professionals in two rounds. Finally, after 4 panel sessions at ministerial level, the selected QIs were categorized in form of the final dimensions of the quality of care.ResultsThe literature review emerged 13 Primary Health Care Quality Assessment Frameworks (PHCQAF) including 20 and 698 QIs. Delphi study resulted in developing Iranian PHCQAF comprising 7 dimensions and 40 QIs. Among these, 8 QIs of the dimension of access and equity, 5 QIs of safety dimension, 2 QIs of efficiency dimension, 13 QIs of effectiveness dimension, 2 QIs of patient-centeredness dimension, 3 QIs of governance dimension and 7 QIs of appropriateness dimension were presented.ConclusionsThe presented PHCQAF can be used as a comprehensive and practical tool for continuous improvement of the quality of PHC services at local, national and regional levels. Moreover, it can give some useful information to the health managers and policy makers on how the services are provided.
Highlights
Providing comprehensive and high-quality services is one of the most important goals of the health systems and a basic principle for Universal Health Coverage (UHC)
In the past decades, quality improvement has been considered by governments as a way to improve the effectiveness of Primary Health Care (PHC) systems, especially in Low and Middle Income Countries (LMICs), and extensive activities have been undertaken to improve the quality of these services [1]
Literature review Literature review led to the identification of 13 Primary Health Care Quality Assessment Frameworks (PHCQAF) in the world
Summary
Providing comprehensive and high-quality services is one of the most important goals of the health systems and a basic principle for Universal Health Coverage (UHC). Improving the effectiveness of services through providing high-quality services is one of the key factors for achieving Universal Health Coverage (UHC) [2]. The existing differences in Primary Health Care Quality Assessment Frameworks (PHCQAFs) pinpoint the necessity for considering the needs, plans, goals and context of each country in the development of these QAFs. In addition, considering that the structure and services package of PHC in each country is different and they mainly depend on such factors as the community needs, economic power and the state of health system infrastructure [23, 24]
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