Primary health care performance measurement at the service delivery level in Indonesia: a scoping review.

Abstract

Background: Indonesia has endeavoured to strengthen primary health care (PHC), a task requiring comprehensive measurement of PHC performance which remains a challenge. This scoping review aims to describe PHC performance measurement pertaining to service delivery in Indonesia and identify what has not been measured.

Methods: We conducted a scoping review, following the Preferred Reporting Items for Systematic Reviews Extension for Scoping Reviews guideline. We mapped the measurement used in the included studies to the WHO/UNICEF PHC measurement framework at the service delivery level. Our analysis involved process (domains: models of care, systems for improving quality, resilient health facilities and services) and output (domains: access and availability, quality care) indicators, 38 in total. These indicators are broadly categorised in the WHO/UNICEF framework based on their feasibility and relevance for measuring PHC performance as either Tier 1 - measurable in most contexts, or Tier 1 global - important for global monitoring, or Tier 2 - difficult to measure or requiring further assessment.

Results: Of the 4,831 studies initially identified, 33 were included in this review. The domains of PHC performance assessed included access and availability, models of care, and quality care. No studies reported on the domains: systems for improving quality, or resilient health facilities and services. Overall, 18/38 of the WHO/UNICEF framework indicators were not measured: 1 of 3 Tier 1 global indicators (admissions for ambulatory care sensitive conditions (ACSC)), 4 of 11 Tier 1 indicators, and 13 of 24 Tier 2 indicators. Few studies utilised instruments that have been designed for national reporting, and time-trend analysis was limited.

Conclusions: This study identified measurement gaps in PHC service delivery performance in Indonesia. Addressing these gaps, by developing a more comprehensive monitoring framework that incorporates unmeasured domains and indicators, adapting relevant global measurement instruments to the Indonesian context, and conducting time trend analyses, may contribute to improve PHC performance monitoring and support Indonesia PHC transformation agenda. These potentially offer insights for other countries with similar setting.