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BMC Health Serv Res. 2019 Dec 27;19(1):1006. doi: 10.1186/s12913-019-4853-z.

Creating performance intelligence for primary health care strengthening in Europe.

Author information

1
Amsterdam UMC, Department of Public Health, University of Amsterdam, Amsterdam Public Health research institute, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands. e.s.barbazza@amsterdamumc.nl.
2
WHO European Centre for Primary Health Care, Health Services Delivery Programme, Division of Health Systems and Public Health, Tole Bi 88, Almaty, Kazakhstan, 050000. e.s.barbazza@amsterdamumc.nl.
3
Amsterdam UMC, Department of Public Health, University of Amsterdam, Amsterdam Public Health research institute, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
4
WHO European Centre for Primary Health Care, Health Services Delivery Programme, Division of Health Systems and Public Health, Tole Bi 88, Almaty, Kazakhstan, 050000.
5
Integrated Prevention and Control of NCDs Programme, Division of NCDs and Promoting Health through the Life-Course, WHO Regional Office for Europe, Marmorvej 51, 2100, Copenhagen, Denmark.

Abstract

BACKGROUND:

Primary health care and its strengthening through performance measurement is essential for sustainably working towards universal health coverage. Existing performance frameworks and indicators to measure primary health care capture system functions like governance, financing and resourcing but to a lesser extent the function of services delivery and its heterogeneous nature. Moreover, most frameworks have weak links with routine information systems and national health priorities, especially in the context of high- and middle-income countries. This paper presents the development of a tool that responds to this context with the aim to create primary health care performance intelligence for the 53 countries of the WHO European Region.

METHODS:

The work builds-off of an existing systematic review on primary care and draws on priorities of current European health policies and available (inter)national information systems. Its development included: (i) reviewing and classifying features of primary care; (ii) constructing a set of tracer conditions; and (iii) mapping existing indicators in the framework resulting from (i). The analysis was validated through a series of reviews: in-person meetings with country-nominated focal points and primary care experts; at-distance expert reviews; and, preliminary testing with country informants.

RESULTS:

The resulting framework applies a performance continuum in the classical approach of structures-processes-outcomes spanning 6 domains - primary care structures, model of primary care, care contact, primary care outputs, health system outcomes, and health outcomes - that are further classified by 26 subdomains and 63 features of primary care. A care continuum was developed using a set of 12 tracer conditions. A total of 139 indicators were mapped to the classification, each with an identified data source to safeguard measurability. Individual indicator passports and a glossary of terms were developed to support the standardization of the findings.

CONCLUSION:

The resulting framework and suite of indicators, coined the Primary Health Care Impact, Performance and Capacity Tool (PHC-IMPACT), has the potential to be applied in Europe, closing the gap on existing data collection, analysis and use of performance intelligence for decision-making towards primary health care strengthening.

KEYWORDS:

Europe; Health systems; Measurement; Performance assessment; Primary care; Primary health care

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