Creating performance intelligence for primary health care strengthening in Europe.

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.

Глоссарий терминов: Инструмент мониторинга воздействия, показателей деятельности и потенциала первичной медико-санитарной помощи (PHC-IMPACT) в Европейском регионе ВОЗ

В настоящем глоссарии приведены определения терминов и понятий, имеющих отношение к Инструменту мониторинга воздействия, показателей деятельности и потенциала первичной медико-санитарной помощи (PHC-IMPACT) в Европейском регионе ВОЗ. PHC-IMPACT используется как вспомогательный инструмент в процессах мониторинга и улучшения качества первичной медико-санитарной помощи в Европейском регионе, а также для оценки работы по выполнению глобальных целей всеобщего охвата услугами здравоохранения в части предоставления услуг.Рамочная основа PHC-IMPACT разрабатывалась в соответствии с Европейской рамочной основой для действий по организации интегрированного предоставления услуг здравоохранения. Настоящий глоссарий подготовлен вместе с Паспортами индикаторов PHC-IMPACT, где приводится подробная информация, необходимая для использования полного комплекса индикаторов, из которых состоит инструмент. Определения в настоящем глоссарии разработаны на основе терминологии, используемой в международных системах классификации, включая Международную классификацию счетов здравоохранения, Международную стандартную классификацию занятий и Международную стандартную классификацию образования.

Glossary of terms: WHO European Primary Health Care Impact, Performance and Capacity Tool (PHC-IMPACT)

This glossary of terms aims to provide clarifying definitions related to the WHO European Primary Health Care Impact, Performance and Capacity Tool (PHC-IMPACT). PHC-IMPACT sets out to support the monitoring and improvement of primary health care in the European Region and the measurement of progress towards the services delivery component of global universal health coverage targets.The framework underpinning PHC-IMPACT has been guided by the WHO European Framework for Integrated Health Services Delivery. This glossary of terms accompanies PHC-IMPACT’s Indicator Passports – a resource providing detailed information for the use of the full suite of indicators that make up the tool. Importantly, the definitions included here have relied as far as possible on existing international classifications including the International Classification for Health Accounts, International Standard Classification of Occupations and International Standard Classification of Education.

Паспорта индикаторов: Инструмент мониторинга воздействия, показателей деятельности и потенциала первичной медико-санитарной помощи (PHC-IMPACT) в Европейском регионе ВОЗ: ред. 1

Настоящий документ разработан с целью подробного технического описания индикаторов, применяемых в Инструменте мониторинга воздействия, показателей деятельности и потенциала первичной медико-санитарной помощи (PHC-IMPACT) в Европейском регионе ВОЗ. PHC-IMPACT используется как вспомогательный инструмент в процессах мониторинга и повышения качества первичной медико-санитарной помощи в Европейском регионе, а также для оценки работы по выполнению глобальных целей всеобщего охвата услугами здравоохранения в части предоставления услуг.Рамочная основа PHC-IMPACT разрабатывалась в соответствии с Европейской рамочной основой для действий по организации интегрированного предоставления услуг здравоохранения. Для каждого паспорта индикатора, включенного в данный документ, приведены следующие сведения: отношение к рамочной основе (сфера, подсфера, характеристика), название индикатора/вопроса, определение индикатора/вопроса, числитель/знаменатель или выбор ответа, единица измерения, обоснование целесообразности, связанные определения, дезагрегация, известные ограничения и возможные источники сведений. Ключевые термины, выделенные в паспортах подчеркиванием, приведены в Глоссарии терминов, в котором дается разъяснение терминов в максимально возможном соответствии с существующими определениями и международными классификациями.

Indicator passports: WHO European Primary Health Care, Impact, Performance and Capacity Tool (PHC-IMPACT): version 1

This document of indicator passports aims to provide a detailed technical description of indicators for use in the WHO European Primary Health Care Impact, Performance and Capacity Tool (PHCIMPACT). PHC-IMPACT sets out to support the monitoring and improvement of primary health care in the European Region and measurement of progress towards the services delivery component of global universal health coverage targets.The framework underpinning PHC-IMPACT has been guided by the WHO European Framework for Integrated Health Services Delivery. For each indicator passport included here, the following details are specified: alignment to the framework (domain, subdomain, feature), indicator/question title, indicator/question definition, numerator/denominator or answer choices, unit of measurement, rationale, relevant definitions, disaggregation, known limitations and possible data sources. Key terms underlined in the passports are found an accompanied Glossary of terms – a resource providing clarifying definitions according to existing definitions and international classifications as far as possible.

Marginal benefit incidence of public health spending: evidence from Indonesian sub-national data.

We examine the marginal effects of decentralized public health spending by incorporating estimates of behavioural responses to changes in health spending in benefit incidence analysis. The analysis is based on a panel dataset of 207 Indonesian districts over the period from 2001 to 2004. We show that district public health spending is largely driven by central government transfers, with an elasticity of around 0.9. We find a positive effect of public health spending on utilization of outpatient care in the public sector for the poorest two quartiles. We find no evidence that public expenditures crowd out utilization of private services or household health spending. Our analysis suggests that increased public health spending improves targeting to the poor, as behavioural changes in public health care utilization are pro-poor. Nonetheless, most of the benefits of the additional spending accrued to existing users of services, as initial utilization shares outweigh the behavioural responses.