title: Assessing the quality of primary care in Haiti.
abstract: OBJECTIVE
  To develop a composite measure of primary care quality and apply it to Haiti's primary care system.
  
  
  METHODS
  Using the Primary Health Care Performance Initiative's framework, we defined four domains of primary care service delivery: (i) accessible care; (ii) effective service delivery; (iii) management and organization; and (iv) primary care functions. We gave each primary care facility in Haiti a quality score for each domain and overall, with poor, fair and good quality indicated by scores of 0.00-0.49, 0.50-0.74 and 0.75-1.00, respectively. We quantified access and effective access to primary care as the proportions of the population within 5 km of any primary care facility and a good facility, respectively.
  
  
  RESULTS
  Of the 786 primary care facilities in Haiti in 2013, only 332 (43%) facilities were classified as good for accessible care. Fewer facilities were classified as good in the domains of effective service delivery (30; 4%), management and organization (91; 12%) and primary care functions (43; 5%). Although about 91% of the population lived within 5 km of a primary care facility, only an estimated 23% of the entire population - including just 5% of the rural population - had access to primary care of good quality.
  
  
  CONCLUSIONS
  Despite an extensive network of health facilities, a minority of Haitians had access to a primary care facility of good quality. Such facilities were especially scarce in rural areas. Similar systematic analyses of the quality of primary care could inform national efforts to strengthen health systems.
authors.affiliation: Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA 02115, United States of America (USA).
authors.forename: Anna D
authors.initials: AD
authors.lastname: Gage
authors.affiliation: Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA 02115, United States of America (USA).
authors.forename: Hannah H
authors.initials: HH
authors.lastname: Leslie
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, USA .
authors.forename: Asaf
authors.initials: A
authors.lastname: Bitton
authors.affiliation: Zanmi LaSante, Cange, Haiti .
authors.forename: J Gregory
authors.initials: JG
authors.lastname: Jerome
authors.affiliation: Ministry of Health, Port-au-Prince, Haiti .
authors.forename: Roody
authors.initials: R
authors.lastname: Thermidor
authors.affiliation: Zanmi LaSante, Cange, Haiti .
authors.forename: Jean Paul
authors.initials: JP
authors.lastname: Joseph
authors.affiliation: Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA 02115, United States of America (USA).
authors.forename: Margaret E
authors.initials: ME
authors.lastname: Kruk
mesh_terms: D002983:Clinical Competence; D003266:Continuity of Patient Care; D014943:Global Health; D006205:Haiti; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data*