Table 1

PHC Progression Model assessment strategies used across countries

ArgentinaGhanaRwandaSenegalTanzania
External (PHCPI) team
 Lead organisationWorld Bank GroupResults for DevelopmentBill & Melinda Gates FoundationWorld Bank GroupWorld Bank Group
 Context of relationships in countryEngaged via a US$300 million investment focused on supporting effective Universal Health Coverage.Results for Development has a series of long-standing partnerships with governmental agencies in Ghana, primarily focused on health financing and health systems strengthening.Technical partnership on projects related to telehealth and drone-delivered commodities.Engagement with government through development of Global Financing Facility Investment Case and new World Bank Investment Project financing focused on improving maternal, child, and adolescent health.Engaged via a US$200 million Program-for-Results focused on strengthening PHC system performance.
In-country team
 Ministerial engagementMinisterial approval to initiate engagement.
Active ministerial involvement and engagement throughout data collection and internal scoring exercise.
Ministerial engagement to review results and approve release.
Ministerial approval to initiate engagement.
Steering Committee made up of leaders from the MOH, Ghana Health Service, National Health Insurance Authority, and local representatives from the World Bank and WHO approved methods and findings.
Ministerial engagement to review results and approve release.
Ministerial approval to initiate engagement.
Minister of State engaged at assessment outset to approve process and give green light to conduct data collection.
Active ministerial involvement and engagement throughout data collection and internal scoring exercise.
Ministerial engagement to review results and approve release.
Ministerial approval to initiate engagement.
Ministerial engagement to review results and approve release.
Ministerial approval to initiate engagement.
Permanent Secretary engaged at assessment outset to approve process and give green light to conduct data collection.
Ministerial engagement to review results and approve release.
 Senior official engagementPosition: Under Secretary of Public Health Care Coverage, National Direction of Quality in Health Services and Health Regulations, and Office of the General Coordination Unit of the National MOH
Role: Set direction of assessment, oversaw the composition of technical team, engaged as key informants, and provided political support throughout the process.
Position: Director of Policy, Planning, Monitoring and Evaluation within Ghana Health Service
Role: Set direction of assessment, oversaw composition of technical team, engaged as key informant, and provided political support throughout the process.
Position: Director General of Planning, Health Financing and Information Systems and Director General of Rwanda Biomedical Center
Role: Actively involved throughout data collection, engaged as key informants, provided political support, and participated in internal scoring exercise.
Position: Director of Planning, Research and Statistics
Role: Set direction of assessment, oversaw composition of technical team, engaged as key informant, and provided political support throughout the process.
Position: Director of Department of Quality Assurance
Role: Set direction of assessment, oversaw composition of technical team, engaged as key informant, and provided political support throughout the process.
 Technical teamExternal, in-country consultant team made up of four researchers from the Institute of Clinical Effectiveness and Health Policy.
TWG made up of the three MOH focal points, external consultants, and additional MOH staff and directors (four or more, depending on the topic under discussion), with support from in-country World Bank staff.
 Two external, in-country doctoral-level quantitative and qualitative consultants
 Project coordinator.
 TWG led by Deputy Director of Policy, Planning, Monitoring and Evaluation of the Ghana Health Service and comprised representatives from:
  •  MOH

  •  University of Ghana

  •  Ghana Health Service

  •  Ghana Statistical Service

  •  National Health Insurance Authority

  •  UNICEF Ghana

 Two external, in-country consultants, one PhD and one masters-level researcher.
 Working group led by Director of Monitoring and Evaluation and Rwanda Biomedical Center and the
 Health Information Systems and Report Lead Specialist at the MOH and comprised representatives from:
  •  MOH

  •  Rwanda Biomedical Center

  •  Rwanda Nursing Council

  •  District hospitals

  •  WHO Rwanda Office

  •  Management Sciences for Health and other development partners

 Two external, in-country doctoral-level consultants
 Core working group led by General Director for Health Services, comprised representatives from:
  •  WHO Senegal Country Office

  •  World Bank Group Senegal

  •  National Statistics and Demography Agency

  •  Private Sector Alliance

  •  University and Research Institute

 External, in-country doctoral-level consultant
 Working Group comprised:
  •  Representative from the MOH, Community Development, Gender, Elderly and Children

  •  National Professional Officer for Family and Reproductive Health of WHO Tanzania Country Office

  •  Senior Economist of the World Bank Group, Tanzania

Assessment process
 PreparationPHCPI oriented consultants and provided overview of process.TWG and Steering Committee formed.
PHCPI oriented TWG and provided overview of process.
PHCPI oriented consultants and senior officials and provided overview of process.PHCPI oriented consultants and senior officials and provided overview of process.PHCPI oriented and provided overview of PHC Progression Model assessment process to consultants and working group.
 Identification of data sourcesResponsible person(s): Consultant team.
MOH focal points reviewed and approved.
Responsible person(s): TWG.Responsible person(s): Technical team.
Working group reviewed and approved.
Responsible person(s): Core working group, senior MOH official and consultants.Responsible person(s): Consultant and working group.
 Data collectionResponsible person(s): Consultants
17 interviews completed.
22 documents reviewed.
Regional/local perspective not available due to regulatory compliance and concurrent political events, so relevant parts of the assessment (PHFM) not completed at this time.
Responsible person(s): Qualitative consultant and TWG
Approximately 70 interviews completed in total by the TWG and consultant.
Approximately 40 documents reviewed.
Regional/local perspective ensured by sampling a representative set of five regions and two districts (one urban and one rural) per region and conducting interviews with relevant regional and district staff.
Quantitative data used came from reports and documents—no de novo analysis conducted.
Responsible person(s): Consultants
25 interviews completed.
105 documents reviewed and 10 main data websites consulted.
TWG attended by 25 people including the MOH, the Director General of Rwanda Biomedical Center, the Director General in charge of planning, different Ministry’s department representatives, district hospitals directors, representatives of development partners, and local civil society organisations.
Quantitative data used came from reports and documents—no de novo analysis conducted.
Responsible person(s): Consultants
22 interviews completed.
28 documents reviewed.
Regional/local perspective ensured through attendance by TWG at scoring exercise.
Responsible person(s): Consultant
12 interviews completed by consultant.
25 documents reviewed by consultant.
8 datasets mined for quantitative data, including the STAR rating system, an accreditation system that collects data on an annual basis from all facilities.
Regional/local perspective ensured by engagement with the President’s Office for Regional and Local Governance.
 Data synthesisResponsible person(s): ConsultantsResponsible person(s): Qualitative consultant and programme coordinator. Support provided by Results for Development staff.Responsible person(s): ConsultantsResponsible person(s): ConsultantsResponsible person(s): Consultant
 Internal scoringConsultants with input by MOH’s focal points.TWG and consultants completed internal scoring.Working Group and consultants convened to complete internal scoring.Large TWG made up of 15 experts from across Senegal convened to offer evidence and perspectives through the internal scoring exercise.Working Group and consultant convened to complete internal scoring.
Workshop with broad representation from relevant MOH departments and partner organisations, including all who served as key informants, held to review internal scoring and provide additional input.
  • MOH, Ministry of Health; PHC, primary healthcare; PHCPI, Primary Health Care Performance Initiative; PHFM, Population Health and Facility Management; TWG, Technical Working Group.