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Performance rating of Primary Health Centres, Andhra Pradesh
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Subject Area="Health information systems." Objective="Performance monitoring to improve services."
Details for Reform Option "Performance rating of Primary Health Centres, Andhra Pradesh"

Background: The existing Health Management Information System (HMIS) was failing to provide an adequate communication link between Primary Health Centres (PHCs) and state government, resulting in ineffective monitoring and evaluation of public sector health programmes in the community. Action: In order to improve the primary health care services, the Government of Andhra Pradesh’s Department of Health and Family Welfare introduced a Performance Rating System (PRS) first at Community Health Centres (CHCs) and later at PHCs. The PRS used measurable outcomes of a PHC as indicators: (i) total number of out-patients treated, (ii) number of women given ante-natal care, examined and counselled for HIV/ Prevention of Mother to Child Transmission (PMTCT), (iii) number of institutional deliveries at the PHC, (iv) number of children immunised, (v) number of at-risk pregnant women referred, (vi) number of maternal and infant deaths audited. Various expected levels of achievement as a percentage of the population covered are determined as benchmark measures and performances are measured against them. Different weightings are given to each indicator. They are aggregated and graded as A, B, C and D.

Cost This addition to the existing HMIS does not require additional cost except for the additional stationery and time required to calculate performance rates.
Place Andhra Pradesh. 1998 – 2002.
Time Frame Three to 6 months.

Incentives: (Non-monetary) to PHC staff who want to achieve a high grade for their centre. Even stronger if the results are made known to the community. Service: Encourages a higher rate of institutional deliveries. Simplicity: It uses primary health care indicators and is easy to calculate.


Misleading statistics: The performance ratings cannot be looked at in isolation. Other factors eg number of staff working at PHC/drug supply etc should be taken into account to assess the real situation.


-- Government support. -- Development of performance rating tool. -- Statistical personnel services at various levels. -- Supply of reporting formats. -- Time schedule for submission of reports. -- Provision of computers.

Who needs to be consulted

State government. Officers looking-after the MIS including the PHC Medical Officer (MO), Chief Medical Health Officer (CMHO) at the district level.



Is cost effective, easy to implement and provides an incentive to each PHC.

Chances of Replication

Each state can devise its own performance rating tool to suit its requirements.


The PRS was developed as part of the multi-sectoral Andhra Pradesh Economic Restructuring Project, in cooperation with the World Bank.


Submitted By

Sara Joseph, Researcher, ECTA, New Delhi. September 2004.

Status Active
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