Best and worst performing health facilities
A positive deviance analysis of perceived drivers of primary care performance in Nepal
Bibliographic Data
| ID | 4603092 |
|---|---|
| Authors | Todd P Lewis (0000-0002-0018-532X, Harvard Global Health Institute, corresponding author), Amit Aryal (0000-0001-9899-5226), Suresh Mehata (0000-0003-3426-2108), Astha Thapa (0000-0002-4374-0338), Aisha K Yousafzai (0000-0002-1592-8923, Harvard Global Health Institute), Margaret E Kruk (0000-0002-9549-8432, Harvard Global Health Institute) |
| Year | 2022 |
| Volume | 309 |
| Pages | 115251 |
| Publication date | 2022-09-01 |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | Social Science & Medicine (JOURNAL) |
| Journal identifiers | ISSN: 0277-9536 • E-ISSN: 1873-5347 |
| Publisher | Elsevier BV (PUBLISHER) |
| DOI | 10.1016/j.socscimed.2022.115251 |
| PMID | 35961216 |
| OpenAlex | W4289338318 |
| Language | EN |
| Citations received | 3 |
| References cited | 38 |
Primary care services are on average of low quality in Nepal. However, there is marked variation in performance of basic clinical and managerial functions between primary health care centers. The determinants of variation in primary care performance in low- and middle-income countries have been understudied relative to the prominence of primary care in national health plans. We used the positive deviance approach to identify best and worst performing primary health care centers in Nepal and investigated perceived drivers of best performance. We selected eight primary health care centers in Province 1, Nepal, using an index of basic clinical and operational activities to identify four best and four worst performing primary health care centers. We conducted semi-structured, in-depth interviews with managers and clinical staff from each of the eight primary health care centers for a total of 32 interviews. We identified the following factors that distinguished best from worst performers: 1) Managing the facility effectively, 2) engaging local leadership, 3) building active community accountability, 4) assessing and responding to facility performance, 5) developing sources of funding, 6) compensating staff fairly, 7) managing clinical staff performance, and 8) promoting uninterrupted availability of supplies and equipment. These findings can be used to inform quality improvement efforts and health system reforms in Nepal and other similarly under-resourced health systems
Accountability · Best practice · Business · Economic growth · Environmental health · Family medicine · Health care · Health facility · Health services · Political science · Population · Positive deviance · Primary care · Global Maternal and Child Health · Healthcare Systems and Reforms · Medicine · Nursing · Patient Satisfaction in Healthcare
Revisiting Alma-Ata
The Lancet Global Health Commission on financing primary health care
Effectiveness of strategies to improve health-care provider practices in low-income and middle-income countries
Power to the People
High-quality health systems in the Sustainable Development Goals era
Contribution of Primary Care to Health Systems and Health
Hospital Board And Management Practices Are Strongly Related To Hospital Performance On Clinical Quality Metrics
Building Strong Primary Health Care to Tackle the Growing Burden of Non-Communicable Diseases in Nepal
Quality of Care for Maternal and Newborn Health in Health Facilities in Nepal
Systems on the edge
Anchoring contextual analysis in health policy and systems research
Health provider responsiveness to social accountability initiatives in low- and middle-income countries
A systematic review of the literature for evidence on health facility committees in low- and middle-income countries
Pathways to high and low performance
When information is not power
| Citations per year | 3 |
|---|---|
| Citation span | 2025 - 2025 (1) |
| Highly cited | No |