Performance assessment model; A suggestion for primary health care centers in Turkey

It is difficult to measure health-related outcomes and their effects on health system. Consequently, there is no simple answer to questions regarding performance of health systems. Assessment of health systems enables the appraisal of the currents situation and further assists with planning future services. There is no standard tool for evaluating the performance of primary health care services and assessment tools used in developed countries have not been successful in developing countries. This study aimed to propose a model for evaluating the performance of health centers, based on data routinely collected by the Ministry of Health in Turkey.

The study group included 117 health centers in a province of Turkey. This descriptive study didn’t include any primary data collection; instead, analyses were made using secondary data, collected via routine health recording system of the health centers, between 1999 through 2003. The model developed in this study implies that: 1) reliable and complete data from health centers should be grouped as “service” and “demographic”; 2) branch off each group as “incomes" and "outcomes"; 3) factor analysis is applied to each of the four groups separately (the smallest number of variables required for assessing the productivity are identified via factor analysis); 4) data envelope analysis is applied (data envelop analysis is carried out to distinguish the "productive" and "non-productive" health centers and to identify the reasons for nonproductiveness in order to guide health policy makers).

In this study, a model was developed to assess the performance of health centers, using the routinely collected data, and was tested. By means of the proposed model, the productivity of institutions suffering from missing/incomplete data can be assessed by limited data. Such a reduction in the amount of data needed for assessment would decrease the burden on service providers, while increasing the quality of data collected.