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Toolkits for Strengthening Primary Health Care

In Albania, the PHRplus project and Albania counterparts developed and tested a series of tools designed to introduce family medicine concepts and strengthen primary health care (PHC) services. Toolkits were developed and tested in four pilot PHC centers in one region. The Ministry of Health (MOH) is using the tools to scale up improved PHC in Albania, and the tools can be adapted for use elsewhere. PHC facility managers and projects supporting the strengthening of PHC services will find the toolkits useful reference materials as they develop their own strategies and tools to improve quality of care and monitor and evaluate PHC strengthening efforts. This series comprises three toolkits:

  • Improving PHC Service Delivery Toolkit
  • PHC Quality Improvement Toolkit
  • A facility-based PHC Health Information Systems (HIS) Toolkit
The series provides a comprehensive set of reference materials to help PHC providers, family medicine trainers, and health care managers and supervisors strengthen PHC service delivery. Individual toolkits and forms are hyper-linked to the table of contents to facilitate navigation through the document.

Application & Results
The tools were tested in four health centers in the Berat region of Albania and have been extended throughout the region. The MOH has officially endorsed the HIS for national scale-up. The HIS was streamlined to halve the cost of encounter forms, cut the time providers need to complete the forms, and reduce data entry time by 40 percent. Clinics have used the tools to rationalize use of antibiotics and injections, reduce patient waiting time, target community outreach efforts on high incidence health problems, and improve charting techniques by 32 percent.

While each tool or toolkit can be used separately, PHRplus experience in Albania has demonstrated that activities aimed at strengthening PHC are strongly inter-connected and ideally are implemented in a comprehensive and coordinated fashion. Implementation often requires shifts in cultural paradigms for providers, so results may be best achieved by implementing processes in a step-by-step manner, with one tool (e.g., clinical practice guidelines) leading to development of another (training curricula on content and use of guidelines).

PHRplus experience in Albania demonstrated that improvements in quality of care were possible despite lack of monetary incentives for the participating medical staff. However, central and regional health authorities should be encouraged to more actively monitor quality of care and implement management and finance reforms that provide incentives for providers to continuously improve quality so initial provider enthusiasm is not lost.

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