Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.
University of Basel, Basel, Switzerland.
Front Public Health. 2021 Dec 22;9:747689. doi: 10.3389/fpubh.2021.747689. eCollection 2021.
The quality of care (QoC) of primary health care (PHC) services in Albania faces challenges on multiple levels including governance, access, infrastructure and health care workers. In addition, there is a lack of trust in the latter. The Health for All Project (HAP) funded by the Swiss Agency for Development and Cooperation therefore aimed at enhancing the population's health by improving PHC services and implementing health promotion activities following a multi-strategic health system strengthening approach. The objective of this article is to compare QoC before and after the 4 years of project implementation. A cross-sectional study was implemented at 38 PHC facilities in urban and rural locations in the Diber and Fier regions of Albania in 2015 and in 2018. A survey measured the infrastructure of the different facilities, provider-patient interactions through clinical observation and patient satisfaction. During clinical observations, special attention was given to diabetes and hypertensive patients. Infrastructure scores improved from base- to endline with significant changes seen on national level and for rural facilities ( < 0.01). Facility infrastructure and overall cleanliness, hygiene and basic/essential medical equipment and supplies improved at endline, while for public accountability/transparency and guidelines and materials no significant change was observed. The overall clinical observation score increased at endline overall, in both areas and in rural and urban setting. However, infection prevention and control procedures and diabetes treatment still experienced relatively low levels of performance at endline. Patient satisfaction on PHC services is generally high and higher yet at endline. The changes observed in the 38 PHC facilities in two regions in Albania between 2015 and 2018 were overall positive with improvements seen at all three levels assessed, e.g., infrastructure, service provision and patient satisfaction. However, to gain overall improvements in the QoC and move toward a more efficient and sustainable health system requires continuous investments in infrastructure alongside interventions at the provider and user level.
阿尔巴尼亚基层医疗保健（PHC）服务的医疗质量（QoC）在多个层面上都面临挑战，包括治理、可及性、基础设施和医疗保健工作者。此外，后者缺乏信任。因此，由瑞士发展与合作署资助的全民健康项目（HAP）旨在通过改善 PHC 服务和实施健康促进活动，以多策略加强卫生系统的方法，来提高人民的健康水平。本文的目的是比较项目实施 4 年后 QoC 的前后变化。2015 年和 2018 年，在阿尔巴尼亚的迪比尔和菲尔地区的城乡 38 个 PHC 设施中进行了一项横断面研究。一项调查衡量了不同设施的基础设施、通过临床观察和患者满意度来衡量医患互动。在临床观察过程中，特别关注了糖尿病和高血压患者。基础设施评分从基线到终线都有所提高，在国家层面和农村设施方面有显著变化（<0.01）。终线时，设施基础设施和整体清洁度、卫生和基本/必要医疗设备和用品有所改善，而在公共问责制/透明度以及准则和材料方面没有观察到显著变化。总体临床观察评分在终线时整体上有所增加，在两个地区以及农村和城市环境中都有所增加。然而，感染预防和控制程序以及糖尿病治疗在终线时的表现仍然相对较低。患者对 PHC 服务的满意度总体较高，在终线时更高。在 2015 年至 2018 年期间，阿尔巴尼亚两个地区的 38 个 PHC 设施的变化总体上是积极的，在评估的所有三个层面上都有所改善，例如基础设施、服务提供和患者满意度。然而，要全面提高 QoC 并朝着更高效和可持续的卫生系统迈进，需要持续投资基础设施，同时在提供者和使用者层面进行干预。
