Table 2 PCN outcome measures and the data sources
Outcome measure | Indicator | Definition | Type | Data source |
|---|---|---|---|---|
Objective 1: Assessing the impact of PCNs on PHC functioning and health service delivery | ||||
Health facility readiness and service availability | Availability of essential medicines | Percentage of health facilities with available non-expired essential medicines among the assessed HFs | Quantitative | Health facility assessment (HFA) survey |
Stockouts of essential commodities | Percentage of facilities with stockouts in the past 3 months among the assessed HFs | Quantitative | HFA survey | |
Availability of basic equipment | Percentage of health facilities with available basic equipment among the assessed HFs | Quantitative | HFA survey | |
Availability of tracer diagnostics | Percentage of health facilities with diagnostic services among the assessed HFs | Quantitative | HFA survey | |
Availability of basic amenities | Percentage of health facilities with basic amenities among the assessed HFs | Quantitative | HFA survey | |
Improved medical records | Percentage of health facilities using electronic health records among the assessed HFs | Quantitative | HFA survey | |
Availability of referral guidelines | Percentage of health facilities with adopted referral guidelines among the assessed HFs | Quantitative | HFA survey | |
Provider caseload | Case load per provider per day | Quantitative | HFA survey | |
Health information system | Percentage of health facilities capturing data in any HMIS among the assessed HFs | Quantitative | HFA survey | |
Human resources for health (HRH) | Availability of health workers | Percentage of available health workers by cadre as per the norms and standards | Quantitative | HFA survey |
Absence rate | Percentage of health workers absent from the facility on the day of the survey | Quantitative | HFA survey | |
Access to health services | Utilization of health services | Number of OPD visits | Quantitative | Kenya Health Information System (KHIS) |
Maternal deliveries | Number of maternal deliveries | Quantitative | KHIS | |
ANC visits | Number of ANC visits | Quantitative | KHIS | |
DPT3 vaccination | Number of children that received DPT3 vaccine (under 1) | Quantitative | KHIS | |
Full immunization | Number of infants that are fully immunized | Quantitative | KHIS | |
BCG vaccination | Number of children that received BCG vaccine (under 1) | Quantitative | KHIS | |
Clients who received the required services | Percentage of clients who received the required services | Quantitative | Client exit survey | |
Transportation | Means of transport | Quantitative | Client exit survey | |
Time taken to reach health facility | Time in minutes to reach the health facility from home | Quantitative | Client exit survey | |
Expenditure on health care | Amount of out-of-pocket expenditure | Quantitative | Client exit survey | |
Gatekeeping | Clients whose first contact with the health system was at level 1, 2 or 3 | Percentage of clients whose first point of contact with the health system was level 1, 2 or 3 | Q uantitative | Client exit survey |
Referral | Referral patterns | Percentage of clients who were referred | Quantitative | Client exit survey |
Number of patients referred to other facilities | Quantitative | KHIS | ||
Number of patients referred from other facilities | Quantitative | KHIS | ||
Decongestion | Patient waiting time at level 4 facilities | The average waiting time | Quantitative | Client exit survey |
Client perception of waiting time | Percentage of clients who perceived the waiting time to be alright | Quantitative | Client exit survey | |
Quality of care | Client-reported experiences with care | Percentage of clients satisfied with the available PHC services | Quantitative | Client exit survey |
Client satisfaction with quality of care | Percentage of clients satisfied with the quality of available PHC services | Quantitative | Client exit survey | |
Timely access to care | Percentage of clients reporting that they receive the care they needed in a timely manner | Quantitative | Client exit survey | |
Health facility-community linkage | CHU linkage to HF | Number of functional CHUs linked to HF | Quantitative | KHIS/HFA survey |
Number of clients referred from the community | Quantitative | Client exit survey | ||
Number of clients that have been referred to the facility by community health volunteers/promoters | Quantitative | KHIS | ||
Objective 2: Assessing the implementation experience of PCNs | ||||
Process evaluation | Finances | Proportion of county budgetary allocation to PCNs, funding flows and spending | Quantitative | County budget reports |
Availability of implementation plans | Number of costed PCN work plan per sub-county | Quantitative | Sub-County Medical Officer of Health (SCMOH) reports | |
Leadership, governance and coordination | PCN Advisory Council meetings | County PCN Advisory Council meetings | Quantitative | County director of health (CDH) reports |
Inter-sectoral and partnership forum meetings | County PCN inter-sectoral and partnership forum meetings | Quantitative | CDH reports | |
Inter-sectoral representatives’ forum meeting | Sub-county PCN inter-sectoral representatives’ forum meetings | Quantitative | SCMOH/MDT – lead reports | |
PHC TWG meetings | Number of quarterly meetings held by the PHC TWG | Quantitative | SCMOH | |
Coordination | A description of coordination mechanisms | Qualitative | In-depth interviews | |
Presence of a coordinated referral system with back-and-forth documentation | Qualitative | In-depth interviews | ||
HRH | PCN sensitization | Number of CHMT members sensitized on PCNs | Quantitative | County PCN report |
Number of health facility managers sensitized on PCNs | Quantitative | County PCN report | ||
Creation of MDTs | MDT lead and team members identified | Quantitative | County PCN report | |
PCN training | Annual report on training conducted for the Community Unit Workforce | Quantitative | County PCN report | |
Multidisciplinary team-based service delivery | Services provided by the MDTs | Quantitative | HFA survey | |
Functional community health units (CHUs) | The number of CHUs meeting the criteria for a functional CHU defined in the guidelines and linked to a health facility | Quantitative | KHIS/HFA survey | |
Functional PCNs | The number of PCNs meeting the criteria for a functional PCN | Quantitative | County PCN reports | |
Functional MDTs | The number of functional MDTs | Quantitative | County PCN reports | |
PCN training | The proportion of trained health workers by cadre | Quantitative | HFA survey | |
Implementation experience | A description of the implementation experience and understanding of PCNs by stakeholders | Qualitative | In-depth interviews | |
A description of the effect of PCNs on workload, quality of care, efficiency, relationships between cadres/leadership and autonomy of HFs | Qualitative | In-depth interviews | ||
Community engagement | A description of community engagement in service planning and organization | Qualitative | County PCN reports | |
Objective 2: Assessing the political economy of PCN reforms | ||||
Stakeholders and their interests | A list of all the actors, including the government and implementing partners and their roles, actions, interests, influence and power relations | Qualitative | Document reviews/in-depth interviews | |
Power analysis | A description of actor interests, roles, level of power, influences and power relations | Qualitative | Document reviews/in-depth interviews | |
Objective 4: Assessing the gendered implications of PCNs | ||||
Leadership by gender and the implications | A description of top and facility leadership by gender and how it affects implementation of PHC | Qualitative | In-depth interviews | |
Service utilization by gender | Sub-analysis of outpatient visits by gender | Quantitative | KHIS | |
MDT members by gender | The composition of MDT by gender and how it affects service delivery | Quantitative and qualitative | HFA and in-depth interviews | |
Access by gender | Sub-analysis of clients who received the required services by gender | Quantitative | Client exit survey | |