Integrated solution to assess primary healthcare performance

The major problem is the lack of a comprehensive method that can assess the performance and improvement in primary healthcare services, especially in rural south Egypt. The affected population in the selected area are over 5 million inhabitants. however, overall Egypt is around 70 million inhabitants (in case of generalization of the model). The main factors are less awareness, unsuitability of service, unavailability, poor accessibility and absence of a quality monitoring system.   

The idea behind developing a multicomponent model is to provide an integrated package of solutions that takes into consideration all of the associated factors with the performance in an accurate, effective and comprehensive way. The literature is vast in presenting classic ways of assessing primary healthcare performance and improvement. However, our vision is that applying a classical data-based model will lead to a biased estimation of the provided services. For example, the number of service users overtime as well as the number of provided services, etc. including the well-known 38 indicators and their referred to domains will try to qualify and quantify the service, given that such services are available, accessible and qualified, and that the community is quite aware of all PHC services, its effectiveness and quality. Additionally, assuming that there are no barriers at al to seek such services. The proposed model works in an action-oriented mechanism that guarantees linking the community to the service while assessing the progress. We hypothesize that linking the community to the associated village health unit will create an unbiased platform for assessing the improvement in primary healthcare performance using the most appropriate key performance indicators that will be further categorized in three main domains that tackle the key factors of primary healthcare performance. The three domains will entitle: the service provider’s vision and strategy, the existence of a qualified monitoring system that registers service uptake, feedback mechanism, connectivity and response in addition to saturating the unmet need by the linked community. An overall score-based analysis will be calculated and tested statistically to compare findings with the baseline assessment and hence establish a novel monitoring technique through implementation of the proposed model. 

The proposed model is targeting the rural areas in Menia governorate which is a southern Egyptian governorate with a population of 5 million plus. The novelty of this model can be briefed in two main axes, one it multicomponent composition where each component is tackling one of the main factors, two the capacity of the model to assess the improvement of services in a non-biased way and compare the evaluation phase with the baseline. Meanwhile, the model relies on in-depth understanding of the community unmet needs, linking the community to the provider and then assessing the improvement using a scientific-based tailored tool that adopts the program logic model technique.  

My self as the PI, I am a professor of ocular epidemiology and medical biostatistics, founder and chairman of an NGO that conducts community based research and intervention programs, as well as being a lead consultant in health economics and other branches with over 120 international publications in the filed (please see PubMed for: Ahmed Mousa). The team has a number of M. Sc. Level of public health and health economics as well as fundamental education, gastrointestinal, gynae obstetric, maternal health and other subspecialities. On both individual and organizational levels, the team has a considerable expertise in designing and implementing similar studies and intervention programs.  

The main barriers are having a classic system in place that doesn't take the community unmet needs into consideration, the lack of knowledge and awareness of the community to the available services in addition to presence of a gap between the provider and the recipient. there is a need for an interactive and comprehensive solution to enable unbiased assessment of the available service and to monitor its improvement. 

This comprehensive and integrated proposed model is designed to overcome such gaps and the associated barriers in addition to establish an effective method for periodical evaluation and improvement. 

The proposed model is a multicomponent model that consists of a number of components where each component is targeting a main factor that guarantees achieving the ultimate goal. Previous expertise in applying monitoring systems were either built on periodical data collection and analysis or tackling one or two factors that enable estimation of the progress. These common classic models ignored two main issues, one, understanding the type, nature and unmet needs of the target community or imply a participatory development approach that includes the community leaders as well as the grass roots in such monitoring. The concurrent concepts of providing medical services takes the patient’s (recipient) opinion in parallel with the medical staff (provider) into consideration. In other words, the patient has the right to accept or reject the recommended treatment modality by the clinicians. Many practical examples provided evidence on success in curing patients when their opinion is well-considered in contrary with the old school in medicine. Within this context, it is clear that monitoring numbers and success rates solely is not the best practice in terms of monitoring healthcare services. 

The impact goal will be: 

achieving a  novel interactive model for monitoring, evaluation and learning of primary healthcare system is well-established and validated.

The implementation process will include applying of a multicomponent model that implies five main components, those are: 

Community assessment, PHC assessment, Identification of gaps, Working to solve barriers and Applying program logic model to conduct the evaluation

The program logic model will link each specific components to the associated activities and the anticipated outcomes, and outputs

there is a need for developing a comprehensive and flexible tool that can be easily modified to suit the need and saturate the differences across different communities. Program logic model has been widely used in different disciplines since it was first introduced. Although it started as an evaluation tool, it was then used in different purposes. We believe that it will be the most suitable tool that fit with the goals and objectives of our model. 

Therefore, a specifically designed program logic model is designed to be used as a tool for assessing the progress while applying the whole model. 

We hypothesize that there is a need to first understand the community in terms of nature, traditions, norms and perspectives. So, an in-depth understanding of the community will be conducted to identify two main factors, the unmet need, and barriers to service uptake. Another assessment will be done to evaluate the capacity and quality of the provided care. Then, the community will be linked to the provided care with full awareness of the availability and quality of services. Finally, a comparative analysis and evaluation of the improvement in the provided services will be established and set in place for periodical assessment. 

The proposed model is based on proven scientific methodology that was more or less adopted in different health and developmental aspects. We worked to tailor the model by adding/removing and modifying some of the components to suit the ultimate goal. Thus, the model uses quantitative - qualitative methods in addition to data analysis techniques that properly serve the ultimate goal and the associated primary objectives. Moreover, the model applies an up to date evaluation of evaluation methodology to test its capacity while assessing the change/improvement of the provided services. 

The data collection process will relay on mixed researchers and health workers teams after conduct of the necessary training and elaboration on how the model works. A team hierarchy will guarantee the quality of data through including team leaders from the village health units and supervisors from the research center.

Data will then be checked for quality, managed and analyzed using data analysis software.   

There is a sort of lack of service utilization by females in the target areas, therefore the model is taking gender-sensitive approach to increase the service uptake by females. This is not a pure gender bias, however, it is highly affected by other socioeconomic factors. The model is also adopting participatory developmental approach by engaging people from the rural areas that include the village health workers as well as the available volunteers. Teams will allow brain storming, and further discussions to achieve the best practice and sustainability goals.  

Delta Research Center is a private sector research company, the center provides consultations in developmental, economics, social and health related studies. The customers to such services are quite varied in a range from governmental, private sector, NGOs, and other incorporations that seeks support in terms of study design, implementation, data analysis and reporting. 

The center is not only working in high and sophisticated econometric-based studies and reports, but it also provides recommendations to the government at higher level (upon request) and helps NGOs to achieve better goals through well-designed strategies.

The usual outcome is always benefit of the community unless the consultation is provided to a highly specialize company or business such as market intelligence research, etc.   

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