Background
Methods
Structure of the PRIME-Tool
Fielding the PRIME-Tool in Ghana
Statistical analysis
Interpretation of EFA factors
Results
Characteristic | 2016 N = 142 | 2017 N = 148 |
---|---|---|
Region, N (%) | ||
Ashanti | 25 (17.6) | 24 (16.2) |
Brong-Ahafo | 13 (9.2) | 14 (9.5) |
Central | 18 (12.7) | 17 (11.5) |
Eastern | 19 (13.4) | 19 (12.8) |
Greater Accra | 12 (8.5) | 17 (11.5) |
Northern | 12 (8.5) | 12 (8.1) |
Upper East | 6 (4.2) | 10 (6.8) |
Upper West | 8 (5.6) | 7 (4.7) |
Volta | 10 (7.0) | 10 (6.8) |
Western | 19 (13.4) | 18 (12.2) |
Facility type, N (%) | ||
Hospitals/polyclinics | 71 (50.0) | 76 (51.4) |
Health centers and clinics | 48 (33.8) | 46 (31.1) |
CHPS* | 23 (16.2) | 26 (17.6) |
Managing authority, N (%) | ||
Public | 119 (83.8) | 129 (87.2) |
Private | 23 (16.2) | 19 (12.8) |
Number of beds, mean (SD) | 51 (62.6) | 60 (77.8) |
Participation in the National Health Insurance System, N (%) | 137 (97.2) | 145 (98.0) |
Item # | Items listed by original hypothesized domain | Variable type1 | 2016 N = 142 | 2017 N = 148 | Difference in means between years | |||||
---|---|---|---|---|---|---|---|---|---|---|
Mean2 (Scale: 0 to 1) | % at Floor3 | % at ceiling3 | Mean2 (Scale: 0 to 1) | % at floor3 | % at ceiling3 | Absolute (Scale: 0 to 1) | Percentage points (%) | |||
Target setting | ||||||||||
1 | Measures coverage of key population indicators | Y/N | 0.92 | 8.50 | 91.50 | 0.84 | 15.54 | 84.46 | −0.08 | −8.70 |
2 | Has one comprehensive annual budget for running costs | Y/N | 0.71 | 28.87 | 71.13 | 0.76 | 23.60 | 76.40 | + 0.05 | 7.04 |
3 | Reports accountability for health outcomes of a group of people | Y/N | 0.59 | 40.80 | 59.20 | 0.52 | 47.97 | 52.03 | −0.07 | −11.86 |
4 | Has formal goals and priorities for service delivery | Y/N | 4 items not included in 2016 | 0.95 | 4.73 | 95.27 | – | – | ||
5 | Has formal improvement targets to achieve service delivery goals | Y/N | 0.45 | 54.73 | 45.27 | – | – | |||
6 | Formal improvement targets for service delivery shared with staff | Y/N | 0.89 | 11.49 | 88.51 | – | – | |||
7 | Burden of target achievement evenly distributed to facility staff (SD) | Ord. | 0.78 (0.19) | 0.00 | 29.73 | – | – | |||
Operations | ||||||||||
8 | Hand washing area with soap and water available (SD) | Ord. | 0.95 (0.22) | 4.90 | 93.66 | 0.96 (0.17) | 2.70 | 93.92 | + 0.01 | 1.05 |
9 | Health worker present or on call in the facility 24 h a day | Y/N | 0.92 | 8.45 | 91.55 | 0.89 | 10.81 | 89.19 | −0.03 | −3.26 |
10 | Open every day | Y/N | 0.85 | 14.79 | 85.21 | 0.90 | 10.14 | 89.86 | + 0.05 | 5.88 |
11 | Facility head has received any formal management training | Y/N | 0.76 | 23.94 | 76.06 | 0.85 | 14.86 | 85.14 | + 0.09 | 11.84 |
12 | User fees displayed (SD) | Ord. | 0.45 (0.50) | 54.93 | 18.31 | 0.24 (0.38) | 66.89 | 15.54 | −0.21 | −46.67 |
13 | Proportion of time facility head spent on managerial activities the previous day (SD) | Cont. | 0.43 (0.24) | 9.90 | 1.40 | 0.39 (0.26) | 12.16 | 3.38 | −0.04 | −9.30 |
Human resources | ||||||||||
14 | Staff are offered training to improve their skills | Y/N | 0.99 | 1.41 | 98.59 | 0.99 | 0.68 | 99.32 | 0.00 | 0.00 |
15 | Supervisors have held individual meetings to review staff performance | Y/N | 0.95 | 4.93 | 95.07 | 0.95 | 4.73 | 95.27 | 0.00 | 0.00 |
16 | Has established criteria to evaluate staff performance | Y/N | 0.82 | 17.61 | 82.39 | 0.96 | 4.05 | 95.95 | + 0.14 | 17.07 |
17 | Has formal, supportive, and continuous supervision system (SD) | Ord. | 0.79 (0.29) | 4.90 | 58.45 | 0.89 (0.22) | 1.40 | 77.03 | + 0.10 | 12.66 |
18 | Perceived ability of staff to carry out assignments of daily work (SD) | Ord. | 2 items not included in 2016 | 0.82 (0.21) | 2.70 | 41.90 | – | – | ||
19 | Staff encouraged to share new ideas to management (SD) | Ord. | 0.88 (0.14) | 0.00 | 54.10 | – | – | |||
Monitoring | ||||||||||
20 | Maintains books to track revenue and expenditure (SD) | Ord. | 0.97 (0.17) | 2.80 | 54.23 | 0.82 (0.26) | 2.03 | 66.90 | −0.15 | −15.46 |
21 | Conducts quality improvement activities | Y/N | 0.94 | 6.34 | 93.66 | 0.95 | 4.73 | 95.27 | + 0.01 | 1.06 |
22 | Held meetings to discuss routine service statistics with staff | Y/N | 0.94 | 5.63 | 94.37 | 0.95 | 5.41 | 94.59 | + 0.01 | 1.06 |
23 | Has mechanism to report new disease outbreaks | Y/N | 0.93 | 7.04 | 92.96 | 0.97 | 2.70 | 97.30 | + 0.04 | 4.30 |
24 | Extent to which data to monitor & improve service delivery is valued (SD) | Ord. | 0.88 (0.19) | 2.10 | 61.97 | 0.89 (0.14) | 0.00 | 59.46 | + 0.01 | 1.14 |
25 | Tracks common conditions | Y/N | 0.88 | 11.97 | 88.03 | 0.91 | 8.78 | 91.22 | + 0.03 | 3.41 |
26 | Reports client opinions using any available tool | Y/N | 0.54 | 45.77 | 54.23 | 0.54 | 46.00 | 54.00 | 0.00 | 0.00 |
27 | Regularly receives reports tracking common conditions with results shared with staff (SD) | Ord. | 0.41 (0.21) | 7.70 | 2.11 | 0.40 (0.16) | 2.70 | 1.40 | −0.01 | −2.44 |
28 | Conducts formal case reviews for quality (SD) | Ord. | Item not included in 2016 | 0.64 (0.35) | 18.24 | 26.40 | – | – | ||
Community engagement | ||||||||||
29 | Collects client opinions using any tool | Y/N | 0.95 | 4.93 | 95.07 | 0.98 | 2.03 | 97.97 | + 0.03 | 3.16 |
30 | Shared information on performance with the community in the past 12 months | Y/N | 0.78 | 21.83 | 78.17 | 0.84 | 16.22 | 83.78 | + 0.08 | 10.26 |
31 | Patients’ opinions drive change or improvement (SD) | Ord. | 0.67 (0.20) | 0.70 | 14.79 | 0.66 (0.20) | 0.68 | 12.80 | −0.01 | −1.49 |
32 | Made changes based on client opinion in the last 12 months | Y/N | 0.64 | 35.92 | 64.08 | 0.57 | 43.24 | 56.76 | −0.07 | −10.94 |
33 | Has a community advisory board that meets regularly, and facility follows up on board discussions (SD) | Ord. | 0.52 (0.49) | 45.07 | 49.30 | 0.65 (0.46) | 31.76 | 61.49 | + 0.13 | 25.00 |
34 | Has a community member regularly attending staff meetings | Y/N | 0.31 | 69.01 | 30.99 | 0.34 | 66.20 | 33.80 | + 0.03 | 9.68 |
EFA1 | EFA2 | EFA3 | ||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
2016 PRIME version 2016 data, N = 142 facilities | 2016 PRIME version 2017 data, N = 148 facilities | 2017 PRIME version 2017 data, N = 148 facilities | ||||||||||||||||
Factors | Factors | Factors | ||||||||||||||||
1 | 2 | 3 | 4 | 5 | 1 | 2 | 3 | 4 | 5 | 1 | 2 | 3 | 4 | 5 | 6 | |||
Item # | Original domain | Eigenvalue | 2.7 | 2.7 | 2.6 | 2.0 | 1.9 | 2.6 | 2.3 | 2.2 | 2.1 | 1.5 | 2.6 | 2.3 | 2.2 | 2.0 | 1.7 | 1.6 |
% Variance accounted for | 15% | 15% | 14% | 11% | 10% | 16% | 15% | 14% | 13% | 9% | 12% | 11% | 10% | 9% | 8% | 7% | ||
Number of items in factor | 8 | 6 | 7 | 3 | 4 | 5 | 4 | 5 | 7 | 4 | 8 | 6 | 4 | 5 | 3 | 4 | ||
Item | Factor loadings | Factor loadings | Factor loadings | |||||||||||||||
24 | Monitoring | Extent to which data to monitor & improve service delivery is valued | 0.72 | 0.87 | 0.45 | 0.65 | ||||||||||||
31 | Community | Patients’ opinions drive change or improvement | 0.65 | 0.55 | −0.38 | 0.73 | ||||||||||||
17 | HR | Has formal, supportive, and continuous supervision system | 0.61 | −0.40 | 0.57 | 0.36 | 0.68 | 0.32 | ||||||||||
20 | Monitoring | Maintains books to track revenue and expenditure | 0.58 | 0.69 | 0.64 | |||||||||||||
13 | Operations | Proportion of time facility head spent on managerial activities the previous day | 0.57 | 0.43 | No loadings2 | |||||||||||||
16 | HR | Has established criteria to evaluate staff performance | 0.48 | 0.54 | Dropped 1 | Dropped 1 | ||||||||||||
2 | Target setting | Has one comprehensive annual budget for running costs | 0.48 | 0.42 | 0.34 | 0.36 | 0.64 | 0.33 | 0.52 | |||||||||
11 | Operations | Facility head has received any formal management training | 0.35 | 0.62 | 0.68 | 0.34 | 0.37 | |||||||||||
26 | Monitoring | Reports client opinions using any available tool | 0.30 | 0.67 | 0.87 | 0.91 | ||||||||||||
15 | HR | Supervisors have held individual meetings to review staff performance | 0.37 | 0.85 | Dropped 1 | Dropped 1 | ||||||||||||
21 | Monitoring | Conducts quality improvement activities | 0.55 | 0.57 | 0.87 | 0.43 | 0.83 | 0.39 | ||||||||||
22 | Monitoring | Held meetings to discuss routine service statistics with staff | 0.57 | 0.41 | 0.85 | 0.32 | 0.33 | 0.74 | 0.37 | |||||||||
27 | Monitoring | Regularly receives reports tracking common conditions with results shared with staff | 0.83 | 0.67 | 0.39 | 0.84 | ||||||||||||
23 | Monitoring | Has mechanism to report new disease outbreaks | 0.94 | 0.65 | 0.53 | 0.85 | ||||||||||||
32 | Community | Made changes based on client opinion in the last 12 months | 0.75 | 0.66 | −0.37 | −0.31 | 0.31 | 0.57 | ||||||||||
34 | Community | Has a community member regularly attending staff meetings | 0.85 | 0.37 | No loadings 2 | No loadings 2 | ||||||||||||
30 | Community | Shared information on performance with the community in the past 6 months | 0.70 | 0.74 | 0.40 | 0.31 | 0.64 | |||||||||||
33 | Community | Has a community advisory board that meets regularly and facility follows up on board discussions | 0.81 | 0.89 | No loadings 2 | |||||||||||||
14 | HR | Staff are offered training to improve their skills | Dropped 1 | |||||||||||||||
29 | Community | Collects client opinions using any tool | Dropped 1 | |||||||||||||||
4 | Target setting | Has formal goals and priorities for service delivery | 7 items not included in 2016 PRIME | Dropped 1 | ||||||||||||||
5 | Target setting | Has formal improvement targets to achieve goals | 0.88 | |||||||||||||||
6 | Target setting | Formal improvement targets shared with staff | 0.64 | 0.50 | ||||||||||||||
7 | Target setting | Burden of target achievement evenly distributed to staff | No loadings 2 | |||||||||||||||
18 | HR | Perceived ability of staff to carry out assignments | −0.34 | 0.68 | ||||||||||||||
19 | HR | Staff encouraged to share new ideas to management | 0.79 | |||||||||||||||
28 | Monitoring | Conducts formal case reviews for quality | 0.43 | 0.55 |