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Do performance measurement models have any impact on primary health care? A systematic review

Brahim Zaadoud (Biotechnology and Quality, Ibn Tofail University, Kenitra, Morocco)
Youness Chbab (Biotechnology and Quality, Ibn Tofail University, Kenitra, Morocco)
Aziz Chaouch (Biotechnology and Quality, Ibn Tofail University, Kenitra, Morocco)

International Journal of Health Governance

ISSN: 2059-4631

Article publication date: 15 September 2020

Issue publication date: 5 December 2020



The purpose of this article is to analyze and compare between the frameworks of performance measurement in primary health care in the world. The subject of search is to compare if the frameworks of performance measurement in primary health care have an influence on performances of health centers.


We conducted a systematic review of the literature to (1) identify the conceptual framework for measuring quality management systems, (2) assess the effects of conceptual framework on quality improvement and quality of care outcomes. We opted for the frameworks that are more cited in the literature and we analyzed and compared between these frameworks.


Eight dimensions were identified for assessing performance in Primary Health Care Facilities “PHCF” in more than 50% frameworks: Effectiveness, Safety, Accessibility, Equity, Efficiency, Acceptability, Patient Centeredness and Timeliness.

Research limitations/implications

The limits of this study can be represented by the following elements: (1) lack of exhaustiveness with regard to the current Frameworks. (2) The evaluation of reliability and validity of the qualitative studies remains difficult to appreciate. (3) Most of the evaluation tools of the primary health care are not validated yet. (4) The difference in performance levels between countries, especially for the developed countries and the multitude of the frames of measure of performance, limits the comparability of the results.

Practical implications

This study provides a conceptual and descriptive literature on the different conceptual frameworks for performance measurement in primary health care, and a practical and useful tool for comparison between the different conceptual frameworks. Several organisations of accreditation or certification introduced, developed, incorporated and checked the indicators of clinical quality in the organizations of health care. Some studies revealed links with the governance, the access, the continuity, the coordination, the efficiency and the strength primary care (Dionne Kringos, 2018). Improvements in the quality of care have been observed in the results of accreditation and certification bodies regarding hospital infection control infrastructure, organization and performance.


Even if the links are not established within the framework of a scientific research, quality approaches are generally recognized as an essential tool to help establishments to improve the quality and the safety of the patients. Until now, it is not still common to make evaluation of the quality of care in the “PHCF” to obtain the relevant information. The necessity of having performance measurement tools, which puts in coherence the piloting of the operational level with the strategy, to integrate the organizational objectives into the measures of operational performances and make estimate its structures towards a real management by the quality.



Conflicts of Interest: There is no conflict of interest.Funding: There is any sources of funding.


Zaadoud, B., Chbab, Y. and Chaouch, A. (2020), "Do performance measurement models have any impact on primary health care? A systematic review", International Journal of Health Governance, Vol. 25 No. 4, pp. 319-334.



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