Two new NICHE publications: one on primary health care in Turkey

01 MAY 2011

This month two more NICHE articles were accepted for publication. The first describes the primary care health system in Turkey. The second is a commentary on the EVIDEM framework and its usefulness for priority setting across a wide range of interventions. 

Dionne S Kringos, Wienke GW Boerma, Ernst Spaan and Martina Pellny Title : A snapshot of the organization and provision of primary care in Turkey. BMC Health Services Research.

This WHO study aimed to support the primary care (PC) reforms in Turkey by implementing the WHO Primary Care Evaluation Tool (PCET). This article provides an overview of the organization and provision of primary care in Turkey. Methods. The WHO Primary Care Evaluation Tool was implemented in two provinces (Bolu and Eskisehir) in Turkey in 2007/08. The Tool consists of three parts: a questionnaire for the organisation and financing of primary care in the country; a questionnaire for primary care physicians; and another for patients. Results. In Turkey, only recently primary care has become an official priority and the geographical distribution of services is still uneven. Although family doctors (FDs) were increasingly available, nationwide shortages of primary care staff exist. Coordination of care could be improved and quality control mechanisms were lacking. However, patients were very satisfied with the treatment by GPs. Conclusions. The study was able to provide an overview of the current state of PC in Turkey for those provinces with newly introduced family medicine by using a structured approach to evaluate the essential functions of PC, including governance, financing, resource generation, as well as the characteristics of a “good”service delivery system (as being accessible, comprehensive, coordinated and continuous).


Sitaporn Youngkong, Noor Tromp and Dereck Chitama. The EVIDEM framework and its usefulness for priority setting across a broad range of health interventions. Cost Effectiveness and Resource Allocation 2011, 9:8

This commentary responds to the article by Goetghebeur et al., which applies the EVIDEM (Evidence and Value: Impact on DEcision-Making) framework to evaluate growth hormone therapy for Turner syndrome patients. While we value the qualities of the EVIDEM because of its scope and breadth, we have doubts on the results consistency of the EVIDEM to compare competing interventions, particularly when setting priorities across broad healthcare service areas (e.g. in designing the national health benefit package) for two main reasons. First, the EVIDEM framework ignores the contextual nature of priority setting process by assuming a set of universal priority setting criteria. Secondly, the EVIDEM is vulnerable to interventions ranking inconsistency where performance evaluation of a broad range of competing interventions is mandated. To address its limitations, we propose a stepwise process to identify criteria and their weights, and rank ordered interventions.

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