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

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Extended Abstract
Background
Performance evaluation is one of the best ways to obtain information for organizational decision-making and management. In order to respond quickly to the people in the COVID-19 pandemic, several comprehensive rural and urban health centers linked to the primary healthcare system were designated as the selected COVID-19 centers (16 or 24 hours/day) at the end of the first week of March 2020 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).Monitoring and evaluating the performance of the mentioned units began in July 2020 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).
Methods
This cross-sectional descriptive-analytical study was conducted for nine months, from July 2020 to March 2021. The study population included 978 COVID-19 centers in 63 universities / medical schools across the country. This study was conducted in 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, equipment, manpower supply, public and staff training, 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, the 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 the Delphi technique. For this purpose, the Delphi questionnaire containing criteria and sub-criteria was developed and distributed to 30 experts from the Ministry of Health and medical universities across the country for their feedback and suggestions.A focus group discussion comprised of managers and experts from the Ministry of Health, executive managers, and universities/medical schools confirmed the validity and reliability of this study by completing appropriate checklists and confirming the accuracy of the results.The data were collected at all three levels in the network management center portal at http://www.health.gov.ir/hnd/Lists/191/AllItems.aspx and analyzed using Statistical Package for the Social Sciences (SPSS) software. A two-day training course was held for evaluators to conduct a national-level evaluation.
Results
According to the study results, the community education and information (subject of criteria 1, 2, and 17) at the level of self-evaluation ranged between 85 and 98% and at the level of university evaluation between 60 and 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 laboratory staff training in self-evaluation was 77%, and in university-evaluation was 76%.The self-evaluation performed in observing social distance in selected centers was 73% and in the second-level evaluation was 65%.In terms of facilities, in both evaluations, 95% of the centers had good ventilation, 91% had toilet facilities, and 86% of the centers had adequate personal protection.In the field of waste management, disinfectants were used in 94% of the centers in both evaluations, and 98% of the centers managed infectious wastes following 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, whereas 71% this in the second-level evaluation (university level) (the reason is that during the second-level evaluation, some equipment were added to the list of standards, which could not be provided in universities due to the 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 as a result of the primary healthcare system reorganization. Maintaining a high standard of service at selected centers requires constant evaluation and monitoring of personnel performance.
Practical Implications of Research
The results of this study revealed that the assessment of selected centers of COVID-19 enhanced the quality of service delivery in the selected centers. The most significant aspects of implementing this program are eliminating unnecessary hospital visits, preventing hospital overcrowding, and providing continuous service to the public.
Ethical Considerations
In this study, data from the network management center's portal were utilized without any intervention.
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.
Acknowledgment
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.