Evaluation of Primary Health Care Physicians’ and Nurses’ performance for WHO PEN protocol for cardiovascular diseases applied in Salfit district, Palestine

Background: Palestinian ministry of health is planning to adopt PEN protocol (package of essential non communicable disease (NCD) intervention) which aims to help low resources countries to address NCD prevention and control strategies within primary health care clinics; the first step was to apply the protocol as pilot in Salfit district. Objective: This study aims to evaluate WHO PEN protocol implementation in Salfit district by assessing knowledge, attitude and performance of physician and nurses who received training on protocol, assessing the completeness and documentation of new patient file records, in addition to assessing the barriers for implementation of the protocol from two points of view (participant and program holder). Methodology: The multistage evaluation included a well developed questionnaire to assess knowledge and attitudes in physician and nurses, direct observation of health workers’ performance, reviewing the completeness of patient records and three in depth focus group discussions to assess barriers for implementation. Result: Majority of the participants expressed good level of knowledge regarding the protocol principles, most of them believed the protocol is important and beneficial but they mainly suggested increasing the number of staff working in PHC clinics. Their performance is considered being acceptable in general. The reviewed patient files showed good documentation of file components. The main barriers identified were workload, lack of clear responsibilities and shortage of medications from participants’ view, while lack of interest and motivation among HCWs and long time period between training and implementation were identified as the main barriers from program holder’s point of view. Conclusion: Although the training course helps in improving participants knowledge there is a need to increase the practical elements within the training course to improve protocol implementation.