Performance of Selected COVID-19 Centers in the Primary Health Care System during COVID-19 Pandemics in Iran

Background. In order to respond the people in the COVID-19 crisis, a number of comprehensive urban health centers in the primary health care system converted to the selected COVID-19 centers in 2020. Considering the importance of evaluating the performance of the mentioned centers and ensuring the continuity of the services provided in accordance with the rules and instructions, the performance evaluation of the mentioned units began from July 2020 to march 2021 in three levels: self-evaluation (first level evaluation), university evaluation (second level evaluation) and the evaluation of the experts of the Ministry of Health and Medical Education (third level evaluation). Material. A cross-sectional descriptive-analytical study was conducted in all selected COVID-19 centers including 978 in all 63 universities / medical schools across the country in 2020. The sample was selected by census sampling method and includes a total of 978 centers. In this study, 28 main criteria in the fields of education and information, staff and client safety by observing social distance and using personal protective equipment, supplying manpower, equipment, disinfection and work processes and 91 sub-criteria were determined by using Delphi Technique. Results. With the criteria and sub-criteria defined in the areas of "education and information of the people", staff training, observance of social distance, facilities, waste management, manpower supply, supply of medical equipments and work processes , it was identified that in the self-evaluation ( first level evaluation), the criterion with the lowest score was "staff training". The lowest score in the evaluation of the level of universities / medical schools (second level evaluation) was related to the observance of social distance in the centers and the highest score in both evaluation levels was related to the criterion of "providing necessary education to patients regarding prevention and control of COVID-19". Conclusion. Establishment and setting up of selected COVID-19 centers has been one of the effective measures in controlling and managing COVID-19, which was created as a result of changing the structure of the primary health care system. Continuity of service quality of selected centers requires continuous monitoring and evaluation of their performance. Extended Abstract Background Performance evaluation is one of the best ways to obtain information for decision making and management in organizations. In order to respond quickly to the people in the COVID-19 pandemic, a number of comprehensive rural and urban health centers in the PHC converted to the selected Covid-19 centers (16 hours and 24 hours) at the end of the first week of March 2017. Based on the five main functions defined (initial triage of patients, diagnosis and primary care, physician visit, treatment based on the national protocol of outpatient treatment and conducting diagnostic tests of Covid-19).Considering the importance of monitoring and evaluation the performance evaluation of the mentioned units began from July 1399 in three levels: self-evaluation (first level evaluation), university evaluation (second level evaluation) and the evaluation of the experts of the Ministry of Health (third level evaluation). Material A cross-sectional descriptive-analytical study was conducted from July 2016 to March 2017 for 9 months. The study population in this study included 978 selected COVID-19 centers in all 63 universities / medical schools across the country. This study was conducted by three levels of service delivery including first line providers, the university and the Ministry of Health under the leadership of the Network Management Center of the Deputy Minister of Health. To evaluate, the researcher-made checklists in two input sections (including requirements, devices and equipments, supply manpower, public training and information and staff, facilities and physical space and personal protective equipment) and care processes section (referral, diagnosis and Treatment, medication delivery, data recording and laboratory services) were used.In this study, 28 main criteria in the fields of education and information, staff and client safety by observing social distance and using personal protective equipment, supplying manpower, equipment, disinfection and work processes and 91 sub-criteria were determined. All criteria and sub-criteria were finalized using Delphi technique. For this purpose, the Delphi questionnaire containing criteria and sub-criteria was prepared and sent to 30 experts in the Ministry of Health and medical universities across the country to receive their comments and sugestions.To confirm the validity and reliability of this study, after forming focused discussion groups including (managers and experts of the Ministry of health and executive managers and experts in the universities / medical schools) and the completion of relevant checklists by group members, the results sent to the members and they confirmed the accuracy of the results.The data is collected at all three levels in the network management center portal to the following address: http://www.health.gov.ir/hnd/Lists/191/AllItems.aspx, and analyzed using SPSS software. A two-days training course was held for evaluators to conduct a national level evaluation. Results According to the study results, the field of education and information of the people (subject of criteria 1, 2 and 17) at the level of self-evaluation has varied between 85 to 98% and at the level of university evaluation between 60 to 99%. The area of staff training (subject of criterion 10) in self-evaluation of administrative and service staff training is 99% and in university level evaluation is 97%. The training of laboratory staff in self-evaluation was 77% and in university evaluation was 76%.The self-evaluation performed in the field of observing social distance in selected centers was 73% and in the second level evaluation was 65%.In terms of facilities, in both evaluations, about 95% of the centers had good ventilation, about 91% had toilet facilities and about 86% of the centers had adequate personal protection.In the field of waste management, disinfectants were present in 94% of the centers in both evaluations, and about 98% of the centers managed infectious wastes in accordance with the existing instructions.In the field of manpower supply, in both evaluations, 88% of the centers stated that they had provided manpower according to the operating instructions of the selected COVID-19 centers.In terms of medical equipment and supplies, in the first level evaluation (self- evaluation), 89% of the centers stated that the equipment and supplies were provided according to the declared standards, in the second level evaluation (university level) this amount decreased to 71% (The reason is that during the evaluation of the second level, a number of equipments were added to the list of standards, which could not be provided in universities due to lack of credit).In evaluating the scope of care processes, such as registering information in level one digital systems (98%), providing pharmaceutical services (93%), coordination with the emergency unit (82 to 90%), eliminating shortcomings based on the previous evaluation report (87% based on the second level evaluation), secure packaging of the laboratory samples (77%) was examined.As can be seen, the care processes are rated between 77% (secure sample packing and transfer) to 98% (information registration in the digital system). Conclusion The establishment and operation of selected COVID-19 centers has been one of the effective measures in controlling and managing the disease, which resulted from the restructuring of the primary health care system. Continuity of service quality of selected centers requires continuous evaluation and monitoring of their performance. Practical Implications of Research In general, according to the results of this study, it can be said that the assessment of selected centers of COVID-19 led to the improvement of the quality of delivered services in the selected centers. One of the important issues of implementing this step is reducing the unnecessary visits to hospitals and to prevent overcrowding in hospitals and disrupting the service to the people. Ethical Considerations In this study, the portal data of the networked management center was used and no intervention was made. Conflict of Interest The authors hereby declare that this study is the result of an independent study and has no conflict of interest with other organizations and individuals. Aknowledgment We would like to thank the esteemed officials of the Network Management Center of the Ministry of Health and all the colleagues who accompanied us in this research.