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Primary Health Care Reform in Albania: Findings from an Impact Assessment of a Pilot Project

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Primary Health Care Reform in Albania: Findings from an Impact Assessment of a Pilot Project Partners for Health Reformplus Primary Health Care Reform in Albania: Findings from an Impact Assessment of a Pilot Project June 2005 Prepared by: David Hotchkiss, PhD Tulane University Linda Piccinino, MPS Abt Associates Inc. Altin Malaj, MPH, MD Abt Associates Inc. Andrés Berruti, MA This document was produced by PHRplus with funding from the US Agency for Tulane University International Development (USAID) under Project No. 936-5974.13, Contract No. HRN-C-00-00-00019-00 and is in the public domain. The ideas and opinions in this document are the authors’ and do not necessarily reflect those of USAID or its Sujata Bose, MS employees. Interested parties may use the report in part or whole, providing they Abt Associates Inc. maintain the integrity of the report and do not misrepresent its findings or present the work as their own. This and other HFS, PHR, and PHRplus documents can be viewed and downloaded on the project website, www.PHRplus.org. Abt Associates Inc. 4800 Montgomery Lane, Suite 600 Bethesda, Maryland 20814 Tel: 301/913-0500 Fax: 301/652-3916 In collaboration with: Development Associates, Inc. Emory University Rollins School of Public Health Philoxenia International Travel, Inc. Program for Appropriate Technology in Health Social Sectors Development Strategies, Inc. Training Resources Group Tulane University School of Public Health and Tropical Medicine University Research Co., LLC. Order No TE 066 Mission Partners for Health Reformplus is USAID’s flagship project for health policy and health system strengthening in developing and transitional countries. The five-year project (2000-2005) builds on the predecessor Partnerships for Health Reform Project, continuing PHR’s focus on health policy, financing, and organization, with new emphasis on community participation, infectious disease surveillance, and information systems that support the management and delivery of appropriate health services. PHRplus will focus on the following results: Implementation of appropriate health system reform. Generation of new financing for health care, as well as more effective use of existing funds. Design and implementation of health information systems for disease surveillance. Delivery of quality services by health workers. Availability and appropriate use of health commodities. June 2005 Recommended Citation Hotchkiss, David, Linda Piccinino, Altin Malaj, Andrés Berruti, and Sujata Bose. June 2005. Primary Health Care Reform in Albania: Findings from an Impact Assessment of a Pilot Project. Bethesda, MD: The Partners for Health Reformplus Project, Abt Associates Inc.. For additional copies of this report, contact the PHRplus Resource Center at [email protected] or visit our website at www.PHRplus.org. Contract/Project No.: HRN-C-00-00-00019-00 Submitted to: USAID/Tirana and: Karen Cavanaugh, CTO Health Systems Division Office of Health, Infectious Disease and Nutrition Center for Population, Health and Nutrition Bureau for Global Programs, Field Support and Research United States Agency for International Development Abstract This report describes results from the monitoring and evaluation of a primary health care (PHC) pilot in Albania. Recent health sector reform efforts in Albania have focused on strengthening the primary health care system. The Partners for Health Reformplus (PHRplus) Project provided technical assistance to Albanian counterparts for the implementation and assessment of a pilot PHC intervention in two Albanian districts with the hope that results from the pilot would inform the design of a national PHC model. Components planned under the PHC pilot intervention were: purchasing new equipment for pilot facilities; training providers in the implementation of clinical practice guidelines; revising the medical chart system; building management capacity; improving community outreach; and implementing health financing reform. The purpose of assessment was to evaluate whether the intervention was carried out as planned and to measure its impact on availability, utilization, and quality of PHC services, emphasizing reproductive and curative care. Baseline and follow-up surveys were conducted of health facilities, individual providers, and households in four intervention areas (in Berat and Kuçova districts) and two control areas (in Fier district) between 2002 and 2004. The assessment showed that PHRplus was able to implement all of the planned intervention components, with the exception of health financing reform. Key results in intervention areas include: a sharp increase in modern contraceptive use; a significant decrease in “bypassing” of PHC facilities; an overall increase in the percentage of clients using PHC facilities; and evidence of increased use of data for clinical and managerial decision-making. This case study suggests that making changes in the PHC system using a pilot approach is not only feasible, but that pilot activities themselves have the potential to improve utilization and quality of care at PHC facilities. Table of Contents Acronyms ..............................................................................................................................................ix Acknowledgments.................................................................................................................................xi Executive Summary ............................................................................................................................xiii 1. Introduction ....................................................................................................................................1 1.1 Background on PHRplus .......................................................................................................1 1.2 Overview of Evaluation Study ..............................................................................................2 2. Description of Pilot Intervention ....................................................................................................3 2.1 Situational Analysis of Primary Health Care System............................................................3 2.2 Description of PHRplus-supported Intervention ...................................................................4 3. Study Design and Methodology .....................................................................................................9 3.1 Household Survey ...............................................................................................................10 3.2 Facility Survey ....................................................................................................................11 3.3 Provider Survey...................................................................................................................12 4. Results ..........................................................................................................................................13 4.1 Was the Intervention Carried Out as Planned?....................................................................13 4.2 Did the Expected Changes Occur? ......................................................................................15 4.3 Are the Changes that Occurred Attributable to the Intervention? .......................................22 5. Conclusion....................................................................................................................................25 Annex A. Average Changes in Selected Population-based Indicators.................................................27 Annex B: Bibliography ........................................................................................................................31 List of Tables Table 3.1: Households in the Sampling Frame, by Study Group................................................................10 Table 3.2: Number of Households in the Sampling Frame and the Number Surveyed, by Sample Area .10 Table 3.3: Government Health Facilities by Type of Facility and by Study Group ...................................12 Table 3.4: Providers by Facility Type and Region .....................................................................................12 Table A-1: Average Changes in Selected Population-based Indicators between Baseline and Follow-up Surveys and between Intervention and Control Areas.........................................................................29 Table of Contents vii List of Figures Figure 2.1: Albania Health Care System Situation Analysis ........................................................................4 Figure 2.2: PHRplus Albania Primary Health Care Strategy........................................................................5 Figure 4.1: Percentage of Acute Care Clients of Primary Health Centers Who Report that the Quality of Care Received in the Past Month is Excellent or Good, by Urban/Rural Status .................................17 Figure 4.2: Percentage of Women of Reproductive Age Who Report Currently Using a Modern Contraceptive Method .........................................................................................................................18 Figure 4.3: Percentage of Women of Reproductive Age Who Report Receiving Reproductive Health Advice in the Past Year from a Health Care Provider.........................................................................19 Figure 4.4: Percent of Contraception Users Who Received Advice on Family Planning in the Intervention Group, by Type of Person Who Provided Advice
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