Beyond Facility Counts
Aligning Primary Care Resources with Real Service Workload in Jordan
Mohannad Mahmoud Alarqan, PhD
Interdisciplinary Center for Healthcare Economics, Policy and Innovation
Mohannad Mahmoud Alarqan, PhD
Interdisciplinary Center for Healthcare Economics, Policy and Innovation
The decision
Add a workload review to primary care allocation decisions before choosing whether
to expand premises, adjust staffing, or change service hours. Facility counts describe
the network, but cannot show how much care each site can deliver or where patients
experience difficulty obtaining care.
Executive message
Jordan needs a planning process that reads population need, recorded use, workload,
and service mix together. Governorate averages can identify where a closer assessment
should begin, but they cannot determine which center should gain or lose resources.
This brief proposes a four-lens planning approach and a practical sequence for testing it.
The immediate policy priority is to investigate the causes of variation while protecting
geographic access.
Difference between the highest and lowest governorate averages for annual GP treatments
per Ministry of Health center in 2024.
Recorded activity varies across governorates
In 2024, 625 Ministry of Health centers recorded 11.46 million GP treatments across
12 governorates. These are treatment encounters, not unique patients or all primary
care activity.
The highest average was 42,280 treatments per center in Zarqa, while the lowest was
4,971 in Ma’an. This represents a ratio of 8.5.
These totals are a screening measure of recorded activity, not clinical workload adjusted
for staffing, consultation complexity, opening hours, or service mix.
The economic question
Which feasible change would improve timely and appropriate care most for the resources
available? The answer requires local evidence about bottlenecks and access.
Higher treatment volume alone is not a measure of health benefit.
Use four lenses before allocating resources
The ICHEPI Four-Lens Primary Care Allocation Approach is a proposed planning aid.
It is not a validated index or a funding formula. The lenses should be used together
to explain a service problem before selecting an intervention.
1. Population need
Assess age, chronic illness, deprivation, settlement patterns, and travel time.
Recorded use cannot reveal everyone who needs care. Low activity may reflect barriers
to access rather than lower need.
2. Utilization
Review encounters by service, patient residence, and referral route. Examine repeat
visits and the availability of other providers. Separate appropriate follow-up from
avoidable repetition.
3. Facility workload
Relate activity to staffed clinical hours, team composition, opening hours,
waiting times, and workload. Governorate averages should lead to facility-level checks.
4. Service mix
Account for prevention, maternal and child health, chronic disease management,
urgent care, and outreach. Encounter counts do not capture the time or resources
required for each service.
Match the response to the constraint
| Finding after local review | Response to assess |
|---|---|
| Long waits and insufficient staffed hours | Compare staff deployment, appointment changes, and extended opening hours. |
| Long travel times despite low activity | Assess outreach and transport options while preserving essential local access. |
| Missing clinical functions or equipment | Assess targeted service additions, referral support, and equipment. |
| Persistent space constraints after service review | Appraise expansion against alternatives, including recurrent costs. |
Make workload review part of annual planning
Reconcile facility lists, service definitions, and reporting completeness.
Build a governorate dashboard with drill-down to facilities, adding staffed hours,
waiting times, service mix, and travel-time information where available.
Select contrasting catchments for a diagnostic pilot. Review patient flows and staff
deployment with local teams. Compare targeted options using incremental costs,
expected service effects, and implications for equitable access.
Evaluate selected changes before wider adoption. Track waiting times, continuity,
unmet need, staff workload, and spending against baseline.
Data and methods
This brief uses a descriptive 2024 cross-section. Center counts by governorate were
summed across three facility types in Table 1:4, while GP treatments were taken from
Table 1:8 of the Jordan Ministry of Health Annual Statistical Report 2024.
Annual activity per center was calculated by dividing GP treatments by the number of
centers. The largest value divided by the smallest gives 8.505, reported as 8.5.
No causal effects or efficiency scores were estimated.
Limitations
Limitations include aggregation, differences in facility size and functions, repeat
encounters, patient flows across boundaries, and the absence of staffing and need
adjustment.
Other providers and non-GP services are outside the activity measure. The brief does
not estimate unmet need, quality, savings, or an optimal distribution of resources.
Independent policy analysis issued by ICHEPI. The proposed actions and planning approach
are author recommendations, not Ministry of Health policy. This publication is a policy
brief and has not undergone external peer review.
Suggested citation:
Alarqan MM. Beyond Facility Counts: Aligning Primary Care Resources with Real Service
Workload in Jordan. ICHEPI Policy Brief PB-2026-01. November 2026.
