Frameworks of Performance Measurement in Public Health and Primary Care System: A Scoping Review and Meta‑Synthesis

Somayeh Noorihekma, Hamed Rahimi, Mohammad H. Mehrolhassani, Mohamadreza Chashmyazdan, Ali Akbar Haghdoost, Seyed Vahid Ahmadi Tabatabaei, Reza Dehnavieh


Background: This study was conducted to synthesize the evidence on the dimensions of performance appraisal of the public health and primary care system through a scoping review and meta‑synthesis.

Methods: The review conducted systematically in 2018 with a scoping review approach. To identify pertinent studies, the following electronic databases were systematically searched until December 20, 2017: Cochrane, ISI Web of Science, PubMed, Scopus, Science Direct, and Embase. Reviewing the studies found on the search bases was carried out in three stages by two persons individually. According to refined studies, the data were extracted to meet the objectives and respond to the research questions. The thematic analysis was used to identify and categorize the dimensions of performance measurement.

Results: Using this process, 20 studies were eligible for our research. The critical points in measuring the performance of the public health field were classified into eight main domains including leadership and stewardship, funding, resource generation, service delivery, quality, accessibility, efficiency/productivity, and community health status. The differences in measurement frameworks are inevitable. One reason for the differences in the health system performance measurement framework is the differences in the data or data collection, analysis, and reporting. Performance measurement in the field of health, especially primary care, was a multidimensional issue.

Conclusions: Each of the main dimensions had several sub‑criteria, indicating the broadness and complexity of the performance of first‑level care providers. Single‑dimensional performance measurement could underpin incorrect policies and decisions.


Efficiency; performanc; primary health care; public health; quality of care; review

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