Primary health care reviews : guidelines and methods

Abstract

A detailed guide to methods and procedures that can be used to assess the efficiency of a national programme for primary health care, identify problems, and plan for future improvements. Firmly rooted in practical experience, the manual aims to facilitate a well-planned review by helping readers think through the multiplicity of factors that influence the efficiency of primary health care and determine health status at the population level. Addressed to health administrators and policy-makers, the book features a methodology of data collection developed by WHO and widely tested over a number of years. The methodology, which utilizes both existing data and complementary new information collected in the field, is intended to facilitate a review procedure lasting from 36 months. To allow for adaptation to local circumstances, the book uses checklists, series of questions, and numerous model tables and charts to structure thinking and illustrate the questions and issues that need to be raised during the planning stage. Specific detailed questionnaires are proposed for certain areas where experience has shown that the formulation of appropriate questions is particularly difficult. The book also sets out 14 key indicators that can be used to assess primary health care at levels ranging from national health policy to households. The book features 24 chapters presented in seven parts. Chapters in the first part present and discuss the procedures involved in planning the review, collecting data, and synthesizing the findings. Details range from an example of a budget framework, through advice on how to design survey questionnaires, to a checklist of equipment and supplies for survey teams. Chapters in the second part describe methods that can be used to probe problems at the national level and elicit crucial information about health policy, policies in other sectors, the involvement of communities in policy formulation, budget and financing, training, and health facilities. The third part, devoted to the district level, offers advice on how to assess the effectiveness of the organization and management of primary health care at the district level. Chapters in part four provide examples of issues that the review team might consider when composing its own questionnaires to be used in structured, yet flexible, interviews at the health centre level. Other parts cover the assessment of community health workers and traditional birth attendants, and the interviewing of community leaders. The final part outlines a methodology for gathering information at the household level, noting that, in most cases, resources and manpower available for the review will need to be invested in assessment at this level. Further practical information is set out in a series of four annexes, which describe sampling procedures, present detailed model forms that can be used when interviewing traditional birth attendants and community leaders, and reproduce detailed sample questionnaires for household surveys and for assessing immunization coverage