|Assessing the quality of primary care in Haiti|
||Anna D Gage, Hannah H Leslie, Asaf Bitton, J Gregory Jerome, Roody Thermidor, Jean Paul Joseph, and Margaret E Kruk
||Bulletin of the World Health Organization, 95(3):182-190. doi: 10.2471/BLT.16.179846
Health care utilization
||Objective To develop a composite measure of primary care quality and apply it to Haiti’s primary care system.
Methods Using the Primary Health Care Performance Initiative’s framework, we defined four domains of primary care service delivery:
(i) accessible care; (ii) effective service delivery; (iii) management and organization; and (iv) primary care functions. We gave each primary
care facility in Haiti a quality score for each domain and overall, with poor, fair and good quality indicated by scores of 0.00–0.49, 0.50–0.74
and 0.75–1.00, respectively. We quantified access and effective access to primary care as the proportions of the population within 5 km of
any primary care facility and a good facility, respectively.
Findings Of the 786 primary care facilities in Haiti in 2013, only 332 (43%) facilities were classified as good for accessible care. Fewer facilities
were classified as good in the domains of effective service delivery (30; 4%), management and organization (91; 12%) and primary care
functions (43; 5%). Although about 91% of the population lived within 5 km of a primary care facility, only an estimated 23% of the entire
population – including just 5% of the rural population – had access to primary care of good quality.
Conclusion Despite an extensive network of health facilities, a minority of Haitians had access to a primary care facility of good quality.
Such facilities were especially scarce in rural areas. Similar systematic analyses of the quality of primary care could inform national efforts
to strengthen health systems.