Measuring Ghana’s primary health care system readiness towards attaining universal health coverage using a composite index

Background: This paper develops a robust and scientifically appealing composite index for measuring Ghana’s primary health care (PHC) system readiness towards attaining universal health coverage (UHC) and uses this index to measure the readiness at all levels of health care within PHC system. Methods: Health facility data from the national program for strengthening the implementation of Community-based Health Planning and Services (CHPS) initiative program was used. Indicators were selected and categorized as availability of trained staff, functional equipment, essential medicines, essential supplies and infrastructure; type of service delivery; monitoring of quality health care; and facility working with community agents. Principal component analysis was carried out to generate the components of the composite index after which a single score was generated to measure system readiness at each level of the PHC system. System readiness scores were then ranked on a scale of 5, ranging from least ready to most ready towards attaining UHC. Results: The composite index for measuring readiness of the PHC system towards attaining UHC comprised of 5 components which explained 45% of the common variance of 70 selected indicators. These components were related to the categories of monitoring of quality care, availability of functional equipment, availability of essential medicines and the type of service delivery. Health facilities at the lower level of the PHC system such as CHPS zones and health centres which were mostly government owned were least ready to attain UHC. Maternity homes and clinics which were mostly private for profit were most ready to attain UHC. Conclusion: A composite index for measuring Ghana’s PHC system readiness towards attaining UHC was developed using a robust a mathematical approach which allowed for system readiness to be measured at the various level of the PHC system.