Promoting the culture of key performance indicators (KPIs) among primary health care staff at health district level: An intervention study.

Recently, identifying performance indicators and developing measurement frameworks have become crucial concerns. Our study first sought to analyze service statistics of Primary Health Care (PHC) facilities for the years 2017 and 2018 to develop PHC key performance indicators (KPI).This was then followed by a thorough discussion of these KPIs with staff and service providers. Finally, re-rating these PHC (KPI) changes by analyzing service statistics infographs for 2017 and 2018 relative to 2019. El-Aiat Health District-Giza Governorate and its 15 PHC facilities served as the study's setting. A quasi-experimental intervention design was used based on operation research with quantitative and qualitative data analysis. The pre-test consisted of a mathematical analysis of service and vital statistics for 2017 and 2018 to calculate composite indices and create infographs (simple colored matrices) for these indices. The intervention included two discussion meetings (2 h each). It included reviewing the Performance Knowledge Matrices (infographs) with the service providers for subsequent problem specification, solving, and suggestion extraction to enhance performance. The SWOC (Strengths, Weaknesses, Opportunities, and Challenges) framework was used to analyze the qualitative data extracted from these conversations. Among the identified flaws were a deficiency in the number of physicians and nurses, inadequate training, insufficient work environments, and a lack of moral appreciation and recognition for the staff. The proposed solutions include providing health education services by nurses and follow-up services in certain units via home visits and mobile clinics. Post-test also entailed analyzing service and vital statistics for 2019 and redisplaying KPI infographics. Four of fifteen PHC facilities achieved a positive response based on the staff-suggested info-action-based intervention, according to our findings after comparing data for the pre-intervention and post-intervention periods of 2017-2018 and 2019. We concluded that reviewing the information derived from the "knowledge performance colored matrix" inspired district and PHC service providers to identify their weaknesses (avoided them as much as possible) and their strengths (practiced the solutions they suggested themselves) in the meetings which eventually improved their performance. Ultimately, the outcome scores and impact indicators of the provided PHC services were enhanced.

Adjustment of family planning service statistics reports to support decision-making at central and governorate level, Egypt.

BACKGROUND: The Ministry of Health and Population (MOHP)-Family Planning Sector (FPS) has a strong management information system (MIS) that allows the flow of data from MOHP-FP clinics, health districts, and governorates up to the central level. Yet, family planning (FP) quarterly reports issued at the central level are presented as database/spreadsheet software documents. These data are not used to provide indicators or information that aid in decision-making or the tracking of FP services over time. The objective of the study is to organize data in the database, develop key performance indicators, and design FP reports and policy briefs. METHODS: The study is operations research that is driven by published data derived from MOHP-FP sector-head, and 2014 service statistics quarterly hardcopy reports. The information was entered into an excel program, and 15 key performance indicators (KPIs) were calculated and used to rank Egypt's 27 governorates. We developed an annual FP report form, settled tables, and colored graphs that are liable to rank the governorates from best to least favorable. RESULTS: The quarterly data sheets issued by the MOHP-FP sector were organized for the quarters, and one annual sheet was developed with the organization of Egypt's Governorates into 4 specific regions, with each governorate having a fixed position in all reports. The key performance indicators were as follows: percent of clients aged 35 and up; percent of clients with fewer than three children; proportion of current FP users by method; percent of clients reported as first-time clients; percent of clients defined as new clients (non-FP users and FP discontinuers); and contraceptive coverage rate, i.e., percent coverage of married women of reproductive age with dispensed FP methods expressed as couple years. CONCLUSION: MOHP-FP sector service statistics data could be used for the development of fifteen key performance indicators. Having those indicators at governorate, district, and central levels in quarterly and annual reports and their communication with decision-makers at all levels and their tracking overtime will guide them to timely decision-making for improving performance in FP services at all levels.

Evaluation of health appraisal project of primary school children: a study in Egypt.

BACKGROUND: School Health insurance (SHI) is working in Egypt since 2003. However, there were no impact indicators that inform policy makers about health status of school children. Therefore, the school health project was conducted by Arab Medical Union (AMU) Medical Syndicate in cooperation with Ministry of Education (MOE), Ministry of Health and Population (MOHP) and Public Health Department, Cairo University to conduct comprehensive medical services to primary school children and to assess the impact of the SHI and the efficiency of AMU project to promote health of children. METHODS: In-depth interview with policy makers in MOHP, MOE, SHI and secondary analysis of AMU documents. A systematic random sample of 7000 students (7-10 years) was selected which formed 10% of the examined children in AMU project and proportionally distributed in 355 schools in seven Districts in Fayoum Governorate. RESULTS: SHI was ineffective in providing preventive services to school children. The AMU project was efficient in covering 82% of the targeted students with clinical, preventive and referral services with estimated cost per student were 54.8LE. Clinical findings showed anaemia the major problem (84%), dental (33%), hair/scalp (9%) and visual errors (6%). CONCLUSION: The current Primary Health Care facilities needs to improve the quality preventive and curative health services provided to school children. Also, providing health services through medical conveys was of high cost and unsustainable.

Effective supervision model for improved primary healthcare services: case of Egypt.

BACKGROUND: In Egypt, primary healthcare workers (PHCWs) often work in challenging situations and in relative isolation from the health system and specialists' experiences. Supervision is currently applied by PHCWs to present practice, control and upgrade knowledge and skills. OBJECTIVES: To assess the current supervision system in the Ministry of Health and Population (MOHP) at the central, governorate, district, and primary healthcare (PHC) facility levels. METHODS: The research setting is the MOHP-PHC head quarter (HQ) and five governorates. DESIGN: Cross-sectional analytical observational health system research qualitative and quantitative study of Egyptian health service and operations. SAMPLING: The multistage sampling technique was used to select districts (n = 25) units (n = 250), physicians (n = 250), and nurses (n = 250) from five randomly selected governorates that represent four Egypt regions. DATA COLLECTION: Focus group discussions (FGDs) and self-administered questionnaires. RESULTS: Response rate to questionnaires were in total 73% (67% for physicians and 80% for nurses). FGDs demonstrated that PHC has an effective supervision system at central, governorate, and district levels. The effective supervision allowed overcoming barriers related to the shortage in PHCWs needed to cover 5364 PHC units in addition to mobile clinics. Supervisors use a standardized consistent checklist covering all items of service delivery. More than 95% of physicians and nurses appreciated receiving on-the-job training from the district supervisory teams. CONCLUSION: Egypt MOHP-PHC has an effective supervision model in place at the central, governorate and district levels that supports continuous communication between PHC facilities' staff and the health system enabling continuous personal and professional upgrade and development and improved problem-solving skills at the facility level.

Capitalizing on specialists' services in rural family health unit: Interventional study.

For achieving universal health coverage in Egypt, Ministry of Health aims to improve the accessibility to quality specialized health care. OBJECTIVES: The objectives of the study were to explore legal and regulatory environment for the policy of specialists' visits to unit and assess the impact of gynecology specialist's visits on utilization pattern of gynecological services and clients' satisfaction. METHODS: Settings The study settings were Ministry of Health/Headquarters, Giza Health Directorate, El-Badrashin Health District and Hospital, and Met-Rahinah Unit. Study design The study includes qualitative research (in-depth interviews with policymakers at all Ministry of Health levels and focus group discussions with service providers) and quantitative research (interventional operation research using separate sample pretest (n = 210) and posttest (n = 209) and family-planning service statistics). RESULTS: Analysis of specialist outreach services indicated integration absence between preventive and curative sectors. Capitalizing on the policy of specialists' outreach visits to the unit could support clients' access quality services and reduce referral to get specialist services in hospitals. There is a 6-month intervention of scheduled visits of a female gynecologist to a rural health unit. The intervention led to 12% increase in efficiency and utilization of services compared with the previous 6 months. Clients' satisfaction increased from 27% to 73% after the intervention (.001, OR = 7.5, CI = 4.9-11.6). CONCLUSION: Scheduled specialists' visits increase services' efficiency and clients' satisfaction.