PHC Progression Model: a novel mixed-methods tool for measuring primary health care system capacity

Abstract

High-performing primary health care (PHC) is essential for achieving universal health coverage. However, in many countries, PHC is weak and unable to deliver on its potential. Improvement is often limited by a lack of actionable data to inform policies and set priorities. To address this gap, the Primary Health Care Performance Initiative (PHCPI) was formed to strengthen measurement of PHC in low-income and middle-income countries in order to accelerate improvement. PHCPI’s Vital Signs Profile was designed to provide a comprehensive snapshot of the performance of a country’s PHC system, yet quantitative information about PHC systems’ capacity to deliver high-quality, effective care was limited by the scarcity of existing data sources and metrics. To systematically measure the capacity of PHC systems, PHCPI developed the PHC Progression Model, a rubric-based mixed-methods assessment tool. The PHC Progression Model is completed through a participatory process by in-country teams and subsequently reviewed by PHCPI to validate results and ensure consistency across countries. In 2018, PHCPI partnered with five countries to pilot the tool and found that it was feasible to implement with fidelity, produced valid results, and was highly acceptable and useful to stakeholders. Pilot results showed that both the participatory assessment process and resulting findings yielded novel and actionable insights into PHC strengths and weaknesses. Based on these positive early results, PHCPI will support expansion of the PHC Progression Model to additional countries to systematically and comprehensively measure PHC system capacity in order to identify and prioritise targeted improvement efforts.

Stakeholders’ perspectives on facilitative supervision implementation in north-western Ghana: an exploration of adherence and quality of primary healthcare

“…In this regard, long travel distances from Wechau 4 to subdistrict health centres and CHPS increase the costs of conducting FS, and thus limits the number of supervision sessions that are fiscally affordable. This finding is consistent with previous research findings where constraints in the conduct of PHC provision's supervision were attributed to limited availability inputs (Aikins et al, 2013, Kweku et al, 2020, Ratcliffe et al, 2019. A related finding that is of interest to this research is the revelation that the variation in the regularity of supervision in the districts did not create discrepancies in supervisees' level of adherence to the guidelines of FS.…”

“…Although this finding was reported earlier by Aikins et al (2013) in their study of FS in PHC service delivery in Northern Ghana, it is important to discuss it within the framework of McGregor's (1960) X and Y theory. Whereas the finding contradicts the X side of the theory as well as the lineal input-output relationship of the Primary Health Care Performance Initiative (PHCPI) framework for implementing FS (PHCPI, 2018a, Ratcliffe et al, 2019), on the contrary, the finding can be associated with the Y side of McGregor's theory, which espouses that employees characteristically love to work and that they have inner satisfaction in accomplishing tasks, which their view, contributes to career progression (McGregor, 1960). Evidence of adherence to the guidelines despite limited supervision demonstrates a high sense of commitment on the part of the supervisees in the Wa West district to provide quality health care to the population.…”

“…Having rationalised the need to carry out FS, we adopt the Primary Health Care Performance Initiative (PHCPI) tool for measuring countries' performance in PHC provision as the conceptual framework of the study. This framework is designed to support countries to identify priority PHC areas for improvement, track progress over time, and promote accountability for results (Ratcliffe et al, 2019, PHCPI, 2018a. For an FS programme to achieve its goal and objectives, it is important to examine the governance system under which it operates (Kweku et al, 2020, PHCPI, 2018a.…”

“…These resources would include human resources for health, health infrastructure (supervisors and supervisees), equipment, supplies and logistics, and funds. The availability of these inputs in their right quantities and quality sets the stage for the commencement of FS in the form of participatory monitoring and evaluation (PM&E), training and building capacity, and mentoring staff of health facilities (Kweku et al, 2020, PHCPI, 2018a, Ratcliffe et al, 2019. These activities will yield some immediate results in the form of output, including improvement in skills and capacities of health staff, improvement in the quality of PHC communication, discussion of feedback on staff, and improvement in communication.…”

“…It is expected that the successful implementation of FS will result in improved health of the population. In this regard, users' satisfaction with the quality of health care services will increase and lead to increased uptake of PHC services (Kweku et al, 2020, PHCPI, 2018a, Ratcliffe et al, 2019. In a nutshell, this framework observes that since health service providers operate in a system, the proper functioning of all the FS programme characteristics will lead to the achievements of the goals and objectives of the FS.…”