Primary Health Care Performance Research Articles

Is it better to bring digital health tools together? Where Burkina Faso is going with a minimal digital ecosystem (MDE)

Abstract Digital health technologies are proliferating in low-income countries. However, they are not always optimally integrated and focused on health system priorities. To improve the performance of primary health care and accelerate progress toward universal health coverage, Burkina Faso aims to bring together eight digital health tools in two health districts as a pilot project, an initiative known as the ‘Minimal Digital Ecosystem’. A co-creation approach is used to develop and implement these tools, involving the Ministry of Health, international non-governmental organizations that promote the tools, donors, and researchers. Despite the many challenges in developing and deploying it, the Minimal Digital Ecosystem (MDE) is a promising experiment that deserves special attention to reap its full benefits.

Abstract P153: Disruptions to Diabetes and Hypertension Care During the COVID-19 Pandemic and Recovery Approaches in the Latin America and Caribbean Region

Background: The COVID-19 pandemic disrupted healthcare services in Latin America and the Caribbean (LAC). However, few studies provided comprehensive and quantitative data on the magnitude of this disruption. Objectives: To synthesize evidence on the extent of disruptions to diabetes and hypertension care in LAC during the COVID-19 pandemic and interventions to recover. Methods: We conducted a scoping review of published papers in English, Spanish, and Portuguese. We adopted the Primary Health Care Performance Initiative (PHCPI) Framework to identify healthcare services susceptible to disruptions during the COVID-19 pandemic, specific to diabetes and hypertension, including recovery approaches. We synthesized study findings narratively to represent the diversity of findings geographically and health system. Results: Our search yielded 33,510 abstracts after de-duplication; following title/abstract screening and full-text review, 330 articles (218 on disruptions; 112 on interventions) were included in the synthesis. Although there was high heterogeneity, similarities in landscape of disruptions to primary care services across LAC exist. Of the PHCPI Framework domains, disruptions to workforce, medications and supplies, and patient-related outcomes were most recurrent. Intervention studies focused telehealth using digital strategies for diverse care areas and counseling support for health behaviors and mental health. There were data gaps within LAC regarding health system readiness and digital health effectiveness, adoption, efficiency, reach, and sustainability ( Figure ). Conclusions: This scoping review identified priorities for action within LAC: 1) establish and fund high-quality research and surveillance systems for hypertension and diabetes; 2) Optimally integrate digital health into hypertension and diabetes care; 3) implement mental health promotion strategies among healthcare workers; 4) establish optimal governance, leadership, and financing of healthcare systems.

Primary care providers’ preferences for pay-for-performance programs: a discrete choice experiment study in Shandong China

BackgroundPay-for-performance (P4P) schemes are commonly used to incentivize primary healthcare (PHC) providers to improve the quality of care they deliver. However, the effectiveness of P4P schemes can vary depending on their design. In this study, we aimed to investigate the preferences of PHC providers for participating in P4P programs in a city in Shandong province, China.MethodWe conducted a discrete choice experiment (DCE) with 882 PHC providers, using six attributes: type of incentive, whom to incentivize, frequency of incentive, size of incentive, the domain of performance measurement, and release of performance results. Mixed logit models and latent class models were used for the statistical analyses.ResultsOur results showed that PHC providers had a strong negative preference for fines compared to bonuses (− 1.91; 95%CI − 2.13 to − 1.69) and for annual incentive payments compared to monthly (− 1.37; 95%CI − 1.59 to − 1.14). Providers also showed negative preferences for incentive size of 60% of monthly income, group incentives, and non-release of performance results. On the other hand, an incentive size of 20% of monthly income and including quality of care in performance measures were preferred. We identified four distinct classes of providers with different preferences for P4P schemes. Class 2 and Class 3 valued most of the attributes differently, while Class 1 and Class 4 had a relatively small influence from most attributes.ConclusionP4P schemes that offer bonuses rather than fines, monthly rather than annual payments, incentive size of 20% of monthly income, paid to individuals, including quality of care in performance measures, and release of performance results are likely to be more effective in improving PHC performance. Our findings also highlight the importance of considering preference heterogeneity when designing P4P schemes.

Strengthening primary health care in low- and middle-income countries: furthering structural changes in the post-pandemic era.

Strengthening primary health care (PHC) is the most cost-effective approach in low- and middle-income countries (LMICs) to achieve sustainable universal health coverage (UHC), protect against health shocks, and promote health and wellbeing for all people. It has been 45 years since PHC was put on the global agenda followed by multiple efforts to advocate for more funding and improved performance of PHC. Yet, investment in PHC is still insufficient and overall performance of PHC systems is weak in LMICs, resulting in increased vulnerability and poor health outcomes especially among marginalized populations. As countries recover from the COVID-19 pandemic, which exposed the fragility of PHC platforms, it is imperative to go beyond advocacy for PHC investments and make systemic changes to strengthen PHC as the foundation of resilient and equitable health systems. We propose five gamechangers to facilitate structural changes for strengthening PHC through a focused health systems approach: (i) integration of client-centered health services at PHC level; (ii) digitization of PHC services; (iii) efficiency gains invested in essential health services; (iv) strengthening management practices for PHC at district and facility levels; and (v) advancing community engagement for PHC. To be successful, the implementation of the gamechangers must be contextualized and focus on achieving sustainable health outcomes, and therefore use implementation approaches that link essential health services to health outcomes. Through this way countries will maximize the possibility of achieving UHC and attaining the ambitious health targets of the Sustainable Development Goals (SDGs) by 2030.

Family planning integration in Ethiopia’s primary health care system: a qualitative study on opportunities, challenges and best practices

BackgroundFamily planning (FP) service integration into primary health care (PHC) is an effective approach to realize reproductive autonomy, increase the use of contraceptives, and improve maternal and child health outcomes. The Ethiopian government promotes integration of FP services into primary health care (PHC). However, there is paucity of evidence on the status of FP service integration. The aim of this study is to explore the state of FP integration into PHC services and identify facilitators and barriers to integration.MethodsA qualitative study nested with a larger national study was conducted from July to October 2022. A total of 60 interviews were conducted with FP stakeholders including, government organizations, non-governmental organizations, donors, service providers, and clients. Interviews were audio recorded, transcribed, and coded using OpenCode 4.03. The coded data were analyzed using framework analysis approach, using the Primary Health Care Performance Initiative (PHCPI) framework. Direct quotes and results from the coding and categorization were used to develop the report.ResultsFamily planning is largely provided in designated units by dedicated staff within PHC facilities. The provision of integrated FP service within each service unit is in its early stage. Successful examples of integration include integration of FP with postnatal care, abortion care, and youth-friendly service centers. Facilitators of integration include commitment of the government and partners, the presence of policies and guidelines, and positive attitude of service providers and clients. However, integration of FP also faces challenges that are largely related to challenges of the FP program even before integration. These include resource shortage, health workers shortage, health workers’ capacity/skill gaps, misconceptions about FP, religious and socio-cultural norms, and lack of awareness.ConclusionsIntegration of FP with PHC services in the Ethiopian public health facilities is viable. Pre-existing challenges of the FP program continued to be barriers to integration. Expanding the experiences of good practices in the integration of FP with post abortion care, post-natal care, and youth-friendly service centers to other components of PHC warrants attention. Addressing both supply- and demand-side challenges of the FP program is needed to facilitate the integration of FP with other PHC services.

Pay for performance in Brazilian primary health care: quality of work processes, actions and services

PurposeIn 2011, Brazil introduced a national pay-for-performance (P4P) scheme called the National Program for Improving Primary Health Care Access and Quality (PMAQ), rolled out over three cycles and reaching more than 5,000 municipalities and 40,000 family health teams (FHTs). There is little evidence on how the PMAQ was implemented locally and whether this variation in implementation affects performance, particularly, in terms of work process indicators. This study compared different cases of municipal-level PMAQ implementation (bonuses paid or not to FHTs) over the last two program cycles to analyze the quality of the work processes, actions and services of FHTs.Design/methodology/approachThis was a cross-sectional analytical study using secondary data from an external evaluation of the Brazilian PMAQ. In total, 27,500 FHTs participated in the evaluation. They were divided into four clusters based on whether or not municipalities paid bonuses to workers during cycles 2 and 3 of the program (2013–2019). Variables regarding work processes, actions and services were classified as “Quality Assurance – QA” or “Continued Quality Improvement – CQI”, and an individual score was assigned based on the average score of each variable.FindingsThe four clusters displayed an increase in overall QA and CQI scores between the two program cycles; though this increase was small between the set of primary health care teams that received bonuses and those that did not.Originality/valueThis paper contributes to bridging the gap in the scientific literature for evaluative studies on the relationship between direct payment for performance to health professionals and better quality actions and services in low and middle-income countries.

Performing up to Nordic principles? Geographic and socioeconomic equity in ambulatory care sensitive conditions among older adults in capital areas of Denmark, Finland and Sweden in 2000–2015

BackgroundDenmark, Finland and Sweden pursue equity in health for their citizens through universal health care. However, it is unclear if these services reach the older adult population equally across different socioeconomic positions or living areas. Thus, we assessed geographic and socioeconomic equity in primary health care (PHC) performance among the older adults in the capital areas of Denmark (Copenhagen), Finland (Helsinki) and Sweden (Stockholm) in 2000–2015. Hospitalisations for ambulatory care sensitive conditions (ACSC) were applied as a proxy for PHC performance.MethodsWe acquired individual level ACSCs for those aged ≥ 45 in 2000–2015 from national hospitalisation registers. To identify whether the disparities varied by age, we applied three age groups (those aged 45–64, 65–75 and ≥ 75). Socioeconomic disparities in ACSCs were described with incidence rate ratios (IRR) and annual rates by education, income and living-alone; and then analysed with biennial concentration indices by income. Geographic disparities were described with biennial ACSC rates by small areas and analysed with two-level Poisson multilevel models. These models provided small area estimates of IRRs of ACSCs in 2000 and their slopes for development over time, between which Pearson correlations were calculated within each capital area. Finally, these models were adjusted for income to distinguish between geographic and socioeconomic disparities.ResultsCopenhagen had the highest IRR of ACSCs among those aged 45–64, and Helsinki among those aged ≥ 75. Over time IRRs decreased among those aged ≥ 45, but only in Helsinki among those aged ≥ 75. All concentration indices slightly favoured the affluent population but in Stockholm were mainly non-significant. Among those aged ≥ 75, Pearson correlations were low in Copenhagen (-0.14; p = 0.424) but high in both Helsinki (-0.74; < 0.001) and Stockholm (-0.62; < 0.001) – with only little change when adjusted for income. Among those aged ≥ 45 the respective correlations were rather similar, except for a strong correlation in Copenhagen (-0.51, 0.001) after income adjustment.ConclusionsWhile socioeconomic disparities in PHC performance persisted among older adults in the three Nordic capital areas, geographic disparities narrowed in both Helsinki and Stockholm but persisted in Copenhagen. Our findings suggest that the Danish PHC incorporated the negative effects of socio-economic segregation to a lesser degree.

Primary health care capacity assessment in Qatar: the primary health care progression model as an assessment method

Background: The Primary Health Care Performance Initiative (PHCPI) was developed as a measurement of Primary Health Care (PHC) to evaluate the PHC systems, improve services, and maximize health outcomes. With the limitation of data sources and metrics of PHC capacity, PHCPI designed the PHC Progression Model, as a rubric-based mixed-methods assessment tool for capacity measurement through a participatory process. This paper uses the PHC progression model to assess the system capacity of primary health care in Qatar. Methods: The PHC Progression Model consists of a set of 33 quantitative and qualitative measures, each of which is assessed using a rubric that classifies the level of performance into 4 levels, ranging from Level 1 (low capacity) to Level 4 (high capacity). The assessment measured both quantitative and qualitative information. Results: The assessment showed that PHC in Qatar has a strong capacity with an overall score of the key measures of capacity governance (3.6), inputs (4.0), and population health management (4.0). Conclusion: The main strength of the system was in the key inputs such as facility, workforce, fund, information system, and drugs and supply. Also, the assessment showed strong population health and facility management including standardized team organization, measuring performance, community engagement, and use of the information system data. Keywords: Primary health care, progression model, health system evaluation, health care capacity, Qatar

Developing Iranian sub-national primary health care measurement framework: a mixed-method study

BackgroundDesired health outcomes are more achievable through strong Primary Health Care (PHC). Using comprehensive and scientific tools, decision-makers are guided to formulate better PHC reforms and policies. This study introduces a sub-national framework based on the World Health Organization (WHO) proposed frameworks for the PHC performance measurement.MethodBy a mixed-method and qualitative approach, the Iranian sub-national PHC Measurement Framework (PHCMF) 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), and the Delphi technique for finalizing the framework.ResultsThe Iranian sub-national PHCMF was finalized with 100 KPIs in three components including Health systems determinants, Service Delivery, and Health system objectives. Based on the result chain domain, most KPIs were related to the output (24 KPIs) and the least were related to the input and the process (9 KPIs).ConclusionRegarding 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.

The Performance of Primary Healthcare in China: The Need for a Systematic Design for Improvement Comment on "Quality and Performance Measurement in Primary Diabetes Care: A Qualitative Study in Urban China".

In the paper "Quality and Performance Measurement in Primary Diabetes Care: A Qualitative Study in Urban China," Rasooly and colleagues provide an in-depth analysis of the ways in which Shanghai manages the quality and performance of the primary healthcare (PHC). The present commentary extends the analytical perspective offered in this paper from the city of Shanghai to the entire Chinese Mainland. In so doing, it points out certain systemic shortcomings in the capabilities of family doctors, the unreasonable competition between primary, secondary, and tertiary forms of healthcare, and the negative incentives in the salary system for PHC providers that must be overcome to improve performance. This commentary also proposes strategies and other recommendations for overcoming the bottlenecks identified in the paper as a means of systematically enhancing PHC performance across Mainland China.

The Perception of quality and the performance in primary health Care of central Alentejo – Portugal

Quality and performance are current issues and a strategic priority for the Portuguese National Health Service. Currently, there is a lack of studies in primary health care (PHC) that assess the relationship between the quality and the level of performance of the Primary Health Care Teams. In Portugal, those teams are monitored through the Global Performance Index (GPI), which demonstrates, through a score, the procedures and results obtained by electronic records and the metrics defined for each indicator. This paper aims to analyze the relationship between the perception of the quality of health professionals (service culture; leadership; service strategy; infrastructure and external resources; information and knowledge; processes; service management; human resource planning and skills development, commitment; conditions, satisfaction, performance, and recognition; and results) in the different Primary Health Care teams of the PHC of Central Alentejo—Portugal, and the level of performance of the given teams (care performance; professional training; organizational quality; and services). Self-Perception of Quality Questionnaire for Primary Health Care (SPQQ4PHC) was used as an assessment tool. The population comprises 324 health professionals (Family Doctors, Nurses, and Medical Secretaries) distributed over 34 Primary Health Care Teams. When analyzing the global correlation of the variables in the SPQQ4PHC questionnaire with the GPI, it´s possible to confirm that twenty-one out of twenty-five correlates with the GPI. Thus, this study allowed us to conclude that, as health professionals perceive the quality of the variables increases, the GPI also increases, demonstrating that the dimensions of quality and performance are closely related.

Refocusing primary health care performance measurement on governance and management: A multi-country, joint learning approach applied in the WHO European Region

Refocusing primary health care performance measurement on governance and management: A multi-country, joint learning approach applied in the WHO European Region

Using Ambulatory Care Sensitive Conditions to Assess Primary Health Care Performance during Disasters

Introduction:Ambulatory care sensitive conditions (ACSCs) are health conditions for which appropriate primary care intervention could prevent hospital admission. ACSC hospitalization rates are a well established parameter for assessing the performance of primary health care (PHC). Although this indicator has been extensively used to monitor the performance of PHC systems in peacetime, its consideration during disasters has been neglected. The World Health Organization (WHO) has acknowledged the importance of PHC in guaranteeing continuity of care during and after a disaster for avoiding negative health outcomes.Method:A systematic review was conducted to evaluate the extent and nature of research activity on the use of ACSCs during disasters, with an eye toward finding innovative ways to assess the level of PHC function at times of crisis. Online databases were searched to identify papers.Results:A final list of nine publications was retrieved. The analysis of the reviewed articles confirmed that ACSCs can serve as a useful indicator of PHC performance during disasters, with several caveats that must be considered.Conclusion:The reviewed articles cover several disaster scenarios and a wide variety of methodologies showing the connection between ACSCs and health system performance. The strengths and weaknesses of using different methodologies are explored and recommendations are given for using ACSCs to assess PHC performance during disasters.

Política de Saúde Bucal no Brasil: transformações e rupturas entre 2018-2021

Abstract This study analyzed the implementation of Brazil’s National Oral Health Policy during the period 2018-2021, covering institutional actions, implementation of public dental services, results achieved, and federal funding. We conducted a retrospective descriptive study using documentary analysis and secondary data obtained from institutional websites, government information systems, and reports published by dental organizations. The findings show a significant reduction in funding between 2020 and 2021 and declining performance against indicators since 2018, such as coverage of first dental appointments and group supervised tooth brushing, which stood at 1.8% and 0.02%, respectively, in 2021. Federal funding dropped in 2018 and 2019 (8.45%), followed by an increase in 2020 (59.53%) and decrease in 2021 (-5.18%). The study period was marked by economic and political crises aggravated by the COVID-19 pandemic. This context influenced the functioning of health services in Brazil. There was a sharp reduction in performance against oral health indicators, while performance in primary health care and specialized care services remained stable.

Political economy analysis of subnational health management in Kenya, Malawi and Uganda.

The need to bolster primary health care (PHC) to achieve the Sustainable Development Goal (SDG) targets for health is well recognized. In Eastern and Southern Africa, where governments have progressively decentralized health decision-making, health management is critical to PHC performance. While investments in health management capacity are important, so is improving the environment in which managers operate. Governance arrangements, management systems and power dynamics of actors can have a significant influence on health managers' ability to improve PHC access and quality. We conducted a problem-driven political economy analysis (PEA) in Kenya, Malawi and Uganda to explore local decision-making environments and how they affect management and governance practices for health. This PEA used document review and key informant interviews (N = 112) with government actors, development partners and civil societies in three districts or counties in each country (N = 9). We found that while decentralization should improve PHC by supporting better decisions in line with local priorities from community input, it has been accompanied by thick bureaucracy, path-dependent and underfunded budgets that result in trade-offs and unfulfilled plans, management support systems that are less aligned to local priorities, weak accountability between local government and development partners, uneven community engagement and insufficient public administration capacity to negotiate these challenges. Emergent findings suggest that coronavirus disease 2019 (COVID-19) not only resulted in greater pressures on health teams and budgets but also improved relations with central government related to better communication and flexible funding, offering some lessons. Without addressing the disconnection between the vision for decentralization and the reality of health managers mired in unhelpful processes and politics, delivering on PHC and universal health coverage goals and the SDG agenda will remain out of reach.

Performance patterns of primary health care in the face of COVID-19 in Brazil: characteristics and contrasts.

The adequate fight against pandemics requires effective coordination between primary health care (PHC) and health surveillance, guaranteed attention to acute and chronic demands, and a bond with the community dimension in the scope of basic health units (UBS, acronym in Portuguese). This study aims to contrast two extreme standards of PHC performance in the fight against COVID-19 in Brazil, comparing them with the profiles of the corresponding municipalities and characteristics of the organization of services. Based on the results of a cross-sectional national survey with a representative sample of UBSs, we created a synthetic index to evaluate how PHC performs against COVID-19 called CPI, composed of axes of health surveillance and social support (collective dimension) and of COVID-19 care and continuity of care (individual dimension). Of the 907 surveyed UBSs, 120 were selected, half of which had the highest indexes (complete standard) and the other half, the lowest ones (restricted standard). The municipalities of the UBSs with a complete standard are predominantly rural, have low Municipal Health Development Index (MHDI), high Family Health Strategy (FHS) coverage, and stand out in the collective dimension, whereas the UBSs in urban municipalities with this same standard have high MHDI, low FHS coverage, and an emphasis on the individual dimension. In the restricted standard, we highlight community health workers' reduced work in the territory. In the Brazilian Northeast, UBSs with complete standard predominate, whereas, in its Southeast, UBSs with restricted standard predominate. The study poses questions that refer to the role and organization of PHC in the health care network under situations that require prompt response to health issues and indicates the greater potential capacity of the FHS program in such situations.

Capacity and quality of maternal and child health services delivery at the subnational primary healthcare level in relation to intermediate health outputs: a cross-sectional study of 12 low-income and middle-income countries

ObjectivesTo examine the capacity and quality of maternal and child health (MCH) services at the subnational primary healthcare (PHC) level in 12 low-income and middle-income countries (LMICs) and its association...

Barriers to Community-Based Primary Health Care Delivery in Urban China: A Systematic Mapping Review.

Providing access to a range of basic health services, community-based primary health care (CB-PHC) plays a vital role in achieving the goal of health for all. Driven by a strong political commitment, China’s CB-PHC progress in the past decade has been swift and impressive. However, a well-functioning delivery system for care has yet to be established. This systematic mapping review synthesizes selected evidence on barriers to CB-PHC delivery in urban China and draws lessons for policy development. We performed searches on five electronic databases: CINAHL, MEDLINE, Scopus, Web of Science, and China National Knowledge Infrastructure, and included studies published between 2012 and 2021. The Downs and Black and Critical Appraisal Skills Program checklists were used to assess the quality of eligible papers. We conducted our searches and syntheses following the framework set out in the Primary Health Care Performance Initiative (PHCPI). We synthesized the results of the included studies using a thematic narrative approach and reported according to PRISMA guidelines. Six salient barriers arose from our syntheses of 67 papers: lack of comprehensive health insurance schemes, lack of public awareness, superficial care relationships, gaps in communication, staff shortages and poor training, and second-rate equipment. These barriers are grouped into three subdomains following the PHCPI framework: access, people-centered care, and organization and management. A host of negative impacts of these barriers on community-based health care were also identified. It was not possible to determine clear causes of these barriers from the contributing evidence because of the lack of conceptual frameworks and research methods constraints. Non-eastern regions of China and access-related barriers require further exploration. It follows that, at the national level, the problems are likely more severe than the research suggests.

Using Ambulatory Care Sensitive Conditions to Assess Primary Health Care Performance during Disasters: A Systematic Review.

Ambulatory care sensitive conditions (ACSCs) are health conditions for which appropriate primary care intervention could prevent hospital admission. ACSC hospitalization rates are a well-established parameter for assessing the performance of primary health care (PHC). Although this indicator has been extensively used to monitor the performance of PHC systems in peacetime, its consideration during disasters has been neglected. The World Health Organization (WHO) has acknowledged the importance of PHC in guaranteeing continuity of care during and after a disaster for avoiding negative health outcomes. We conducted a systematic review to evaluate the extent and nature of research activity on the use of ACSCs during disasters, with an eye toward finding innovative ways to assess the level of PHC function at times of crisis. Online databases were searched to identify papers. A final list of nine publications was retrieved. The analysis of the reviewed articles confirmed that ACSCs can serve as a useful indicator of PHC performance during disasters, with several caveats that must be considered. The reviewed articles cover several disaster scenarios and a wide variety of methodologies showing the connection between ACSCs and health system performance. The strengths and weaknesses of using different methodologies are explored and recommendations are given for using ACSCs to assess PHC performance during disasters.

Assessment of Primary Healthcare Facilities Coverage in Rural Population of Sharg-Elnil Locality - Khartoum State from 2018 to 2020.

Background: Sudan’s health system is based on the district health system approach, which emphasizes the principles of Primary HealthCare (PHC). Nevertheless, the decentralization of the public sector resulted in more deterioration of the PHC system particularly in rural and peripheral areas due to lack of financial resources and managerial capacities.&#x0D; Objectives: The study aimed to assess the primary Healthcare facilities coverage for rural population in Sharg Elnil locality from 2018 to 2020. The study was conducted in the rural areas of Sharg Elnil locality.&#x0D; Materials and methods: Analytical, prospective Facility based study. A number of (37) Health facility was selected for the study. The study was conducted by using questionnaires. Data was computed and analyzed using SPSS program version 25.0. Descriptive and inferential statistic was used.&#x0D; Results: The majority of health facilities were compliance with classification of ministry of health standards (94.6%). The number of villages that health facility covered in rural hospital was (10.3±1.4), (4.9±.5) health centers and (3.9±.6) in dispensaries. The vast majority of health facilities 83.8% have a mean of transportation to access health facility. Nearly half of the health facilities were distance less than 2 km of health area 48.6%. The vast majority of health facilities 83.8% have a mean of transportation to access health facility. The majority of health services available in health facilities were vaccination service (100%), nutrition services (94.6%), reproductive health services (70.3%), health education services (64.9% ), disease surveillance system (64.9%), Essential, Community mobilization service (51.4%) while the health services available by less than 50% were drugs list in the health facility (45.9%), Health insurance coverage (27%) Free drugs for children less than 5 yrs (16.2%), the lab services (21.6%), referred system 24.3%, ambulance services 24.3%, blood bank services (13.5%), dentist services 5.4%, x-rays services 8.1% and other services 2.7%. Only 10.8% of the existence equipment in health facilities was adequate. The most basic problems and challenges found in health facilities were unsuitability of work environment 51.4%, deficit in medical devices 35.1%, deployment of contractors and health promoters 32.4%, no ambulance during summer days where scorpion and snake bites is more 32.4%, no treatment available during rainy season days 29.7%, un-continuity of electricity and water 21.6%, no health insurance 16.2% and building maintenance 5.4%.&#x0D; Conclusion: The results show that, although the average PHC performance is almost appropriate and some of the surveyed health facilities have very high performances, some low-income and deprived areas experience substantial challenges. It is recommended that PHC plans should be formulated across the country and then implemented according to the local health needs and priorities.