Evaluation of P.H.C. services by Prof.Dr. Sabry Ahmed Salem. Prof. of community, Environmental and occupational medicine

Definitions: Evaluation: is the process of determining the results obtained by some activities designed to accomplish a goal or objective. It is the process of collection and analysis of information to determine program performance and its progress by comparing with pre-determined standards.

1)To know how well the program had met the objectives. 2) Depend on the results of evaluation, decisions can be made: Continue or discontinue. 3)To improve practices, procedures. 4)To add or drop specific program techniques. 5)To improve the outcome of health services. 6) To increase consumer satisfaction. Purposes of evaluation:

Classification of evaluation A. according to its timing: 1) At the beginning “Ante evaluation”:  Carried out before a program is started.  Before a decision is made to under take the activity or approve funding for it. 2) On going evaluation:  Done during implementation phase of an activity.  Used to alert managers to problems so that corrective action can be taken. 3)Terminal evaluation: Done from months after project completion.

 B. According to function :  1 – Formative evaluation :  Focus on identifying the strengths and weakness of the program  2- Progress evaluation :  Occur during the achievement or program intervention to monitor and improve it  3 – Impact evaluation :  Focus on the overall effectiveness or impact of program or intervention

1-Evaluating the program objectives. 2-Evaluating the program operation. 3-Evaluating the program achievements. Areas of evaluation process:

1) Evaluating program objectives:  Are the objectives well defined.  Clear, realistic, acceptable.  Measurable.  In relation to time and components.

2) Evaluating the program operation: a) Resources:  Human resources: "man power" medical, paramedical staff  Non human resources: e.g. equipment, money, supplies b) Efforts : Measurements of the activities performed by the program and its staff. c) The performance: This measures the quality of the effort made e.g. how many cases were discovered by medical examination.

3) Evaluating the program achievements: It Judges on the results of the program.

Methods of evaluation: 1)Evaluation by statistical indices 2)Evaluation by experts. 3)Evaluation by recipients..

1 ) Evaluation by statistical indices :  More accurate.  Reliable method of evaluation. Characteristics of statistical indices used in :evaluation 1-Validity 2-reliability 3-completeness 4-coverage

 A ) Indices used in PHC centers :  ) Indicators of utilization e.g  % full immunized children  % home deliveries unattended  -)Morbidity and mortality indicators e.g  Infant mortality rate  Maternal mortality rate  B ) Indices used in hospitals :  Hospital Bed Utilization :  Bed occupancy rate  Bed Turn over rate  Average hospital stay Statistical Indices used in Evaluation :

2) Evaluation by experts: A group of experts, some from the program and others from out side. This helps in :  Clarification of misunderstanding.  Promotes benefiting from the evaluative results.

3)Evaluation by recipients: consumer opinion= patient satisfaction a) The reaction of those receiving the service. b) Collection information from people served by the program.

1. Effectiveness 2. Efficiency 3. Technical competence 4. Interpersonal relations 5. Safety 6. Amenities DIMENSIONS OF QUALITY IN HEALTH CARE SERVICES

Effectiveness: Means the extent to which pre-established program objectives are attained as a result of program activity =(Achieved/goals)×100

 A ) Efficiency Of the service  B )Utilization of health services Factors affecting Effectiveness :

 Efficiency Of the service :  Describe the extent to which time, effort and cost is well used to the intended task or purpose  Efficiency of the service depends on :  a) Availability.  b) Accessibility :  Geography  Geography  Social, cultural  Social, cultural  Organizational  c) System of work.  - Flow of work. - Work hours  Referral system  d) Personnel  e) Safety Efficiency of the service

 The adverse results ( problems ) include :  1-Visible problems:  Misdiagnosed patients  Incorrect use of drugs & antibiotics  Incorrect treatment  Prolonged illness  Death  2-Hidden problems :  Wasted time  Wasted materials & drugs  Prolonged infectiousness  Lost working days by absenteeism  Dissatisfied patients COST AND POOR QUALITY OF EFFICIENCY OF HEALTH SERVICES

2)Utilization of health services: Utilization denotes the manner in which a certain community makes use of its available medical resources.. Utilization depends on the consumers : a) Attitude: 1- Self reliance. 2- Active collaboration. 3-Passive resistance. 4- Extreme hostility. b) Social characteristics: e.g. culture, education religious.

Patient Satisfaction : Is defined as the extent to which patient s expectations or needs are adequately met by the services offered Is defined as the extent to which patient s expectations or needs are adequately met by the services offered Reasons to measure Patient Satisfaction : 1- It is an important tool to measure the performance of providers and health care system 2- Can be used for monitoring some aspects of quality of health care 3- The strength of the patient – physician relationship 4- Patient satisfaction is always required for health plans seeking accreditation

 Quality of the service from the consumer view  1- Easily accessible  2-Feeling of comfort  3- Politeness of health providers  4- Disappearance of: symptoms

 Causes Of Dissatisfaction Causes related to doctor s performance ِ  e.g  lack of detailed examination  lack of referral in official way  gap between prescribed medications and that the patient already have  deficiency in number of doctors  Causes related to nurses performance :  e.g. skills, behavior, language, attitude towards the patients

 Causes related to health facility environment  e.g : waiting places, lack of quietness & comfort, ticket price and ticket getting, waiting time  Administrative Problems e.g. waiting time, waiting places, visiting hours. Appointments  Other causes : e.g. cleanliness, communication, shared management

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Aim of the study:  To evaluate the Quality of primary health care services in Qassim province. Saudi Arabia from the view of the patients.  To determine the relationship between some socio demographic and medico-administrative factors and patient satisfaction.

:Results & conclusion of the study  The overall patient satisfaction to PHC services in Qassim province was relatively low.  The scores of satisfaction in urban health centers (76.9%) were significantly higher than that recorded in rural health centers (70.65%).

 Patients of university level of education had recorded the lowest score of satisfaction.  In both urban and rural health centers, with the increase of waiting time, satisfaction scores are decreased while with the increase of conclusion time satisfaction scores are increased.