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 .
Purposes of evaluation:
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.
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 6 -12 months after project completion.
B . According to function :
1 – Formative evaluation :
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Focus on identifying the strengths and weakness of the program
2- Progress evaluation :
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Occur during the achievement or program intervention to
monitor and improve it
3 – Impact evaluation :
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Focus on the overall effectiveness or impact of program or
intervention
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Areas of evaluation process:
1-Evaluating the program objectives.
2-Evaluating the program operation.
3-Evaluating the program achievements.
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
Statistical Indices used in Evaluation :
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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
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.
DIMENSIONS OF QUALITY IN HEALTH CARE
SERVICES
1.
2.
3.
4.
5.
6.
Effectiveness
Efficiency
Technical competence
Interpersonal relations
Safety
Amenities
Effectiveness:
Means the extent to which
pre-established program
objectives are attained as
a result of program activity
=(Achieved/goals)×100
Factors affecting Effectiveness :
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A ) Efficiency Of the service
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B )Utilization of health services
Efficiency of the service
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Efficiency Of the service :
Describe the extent to which time , effort and cost is well used to the intended
task or purpose
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Efficiency of the service depends on :
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a) Availability.
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b) Accessibility :
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 Geography
 Social, cultural
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Organizational
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c) System of work.
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- Flow of work. - Work hours

Referral system
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d) Personnel
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e) Safety
COST AND POOR QUALITY OF EFFICIENCY OF
HEALTH SERVICES
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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
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
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
{
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.