Health Finance and Governance Activity Primary Healthcare Report Assessment of Supply and Demand Drivers

The report was prepared in collaboration with the Ministry of Health's Primary Healthcare Directorate and central and governorate staff, with technical input from Dr. Ayyoub Al Sayaydeh, the Assistant Secretary General for Primary Health Care at the Ministry of Health. Jordan's Health Sector Reform Action Plan 2018-2022 emphasizes the best utilization of primary healthcare services, with a focus on improving the quality and safety of healthcare services, controlling communicable diseases, reducing the prevalence of non-communicable diseases, and enhancing reproductive health and child services. The report highlights the need for cost-effective primary care to achieve these objectives. The report notes that Jordan faces familiar and systemic primary healthcare constraints, with only 18% of the total health expenditure allocated to primary healthcare, compared to 74% on curative care. Most Jordanian citizens prefer to bypass primary care in favor of ambulatory care at secondary/tertiary care facilities, which is driven by the growing non-communicable disease burden. The report provides a qualitative and quantitative perspective on primary healthcare in Jordan, evaluating factors such as utilization rates in primary healthcare centers, distribution of primary healthcare centers, and patient choice. A sample of primary healthcare centers was selected to demonstrate potential improvements in cost, utilization, distribution, and overall system design. The analysis reveals several key findings, including significant inefficiencies in managing resources and their relevant cost, with cost per visit varying considerably between facilities of the same type. Political and social factors are considered significant barriers to reforming primary healthcare, and the enabling environment that made the PHC revamping succeed in Turkey is not available in the Jordanian context. The report also highlights the need for a holistic strategy that looks at physical structures distribution, manpower productivity, traffic re-engineering, referral systems, compensation and incentive schemes, and proper budget allocations. Public perception of primary healthcare quality and services is a key sensitive area to work on, and measuring patient satisfaction and perceptions should be a continuous activity closely linked to primary healthcare improvements. The report concludes that the current MOH PHC centers opening criteria needs to be improved, updated, and implemented, with factors such as "Time of Travel" and "Population Density" considered in determining whether an area/district needs a PHC center or not. The Ministry of Health provides a wide range of preventive and curative care to the population in Jordan through a huge network of health centers, with 109 comprehensive health centers, 374 primary health centers, and 1861 branch health centers. These health centers are intended to provide primary health service to the population in Jordan, with each center serving an average of 17,000 people. The Ministry of Health has established a set of criteria to prioritize the need to establish or renew branch, primary, and comprehensive health centers, based on population density, distance from other centers, and the availability and easiness of transportation to the center. The criteria for establishing or renewing a branch health center include a building area of not less than 100 m2, a population density of not less than 500, and a distance from the closest PHC or CHC of more than 10 km. The prioritization to build a branch health center is based on the total points, with a total of 18 points. The criteria for establishing or renewing a primary health center include a building area of not less than 350 m2, a population density of 3000 and more, and a distance from the closest PHC or CHC of more than 10 km. The prioritization to build a primary health center is based on the total points, with a total of 24 points.