Primary healthcare capacity in Northwest Ethiopia: Insights through the Primary health care progression model
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Background
Primary healthcare (PHC) systems are widely recognized as essential foundations for ensuring equitable access to quality medical care for all. Achieving the health-related Sustainable Development Goals (SDGs), including the sub-targets of universal health coverage by 2030 requires resilient PHC systems, supported by scientific evidences to inform better policy. However, there is a lack of evidence regarding the PHC system capacity at the operational level in Ethiopia. Therefore, we assessed the capacity of primary health care at the health facilities level in northwest Ethiopia.
Methods
We used a mixed-method assessment of the PHC capacity guided by the progression model, which includes governance, input, and population health and facility management domains with a total of 33 rubric-based (scaled from 1 to 4) measurement items. We included a total of three primary hospitals and five health centers from Northwest Ethiopia. Key informants interviews, facility observations including guideline and policy reviews and reports, discussion with key stakeholders, were our source of data. Data were independently collected by two groups of assessors (internal and external assessors) and a final score was determined by consensus through panel discussion. Finally, we summarized and synthesized the results over the three domains of PHC capacity assessment and the nine subdomains.
Results
All the three domains scores were found to be low. We found that the scores were 1.5, 2.2, and 1.3 out of four points for the governance, input, and population health and facility management domains, respectively. While we found a better achievement on health management information system and civil registration and vital statistics, the local priority setting, facility management capability, innovation and learning, community engagement and social accountability measures had lowest capacity score.
Conclusions
Our study highlighted that the governance and population health and facility management domains scored lower at the health facilities in central Gondar zone. Therefore, it is crucial to enhance these domains to strengthen PHC though a comprehensive approach, aiming to meet its targets and achieve UHC by 2030 or beyond.
