Evaluating Primary Healthcare Effectiveness Under Funding Attrition: A Dual- Perspective Comparative Study in Conflict-Affected Coastal Yemen

Abstract This study aimed to evaluate the effectiveness of primary health care program implementation in urban health centers in the city of Hodeidah, Republic of Yemen, through a comparative monitoring of “structural and operational” inputs and processes between 2024 and 2025 from the perspective of health and administrative staff, surveying “outcomes and health impact” from the beneficiaries’ perspective, and analyzing statistical differences attributable to demographic, functional, and service-related variables. The study adopted a descriptive, analytical, and comparative design using two standardized questionnaires administered to two independent populations: a sample of health and administrative staff (N = 190) using a comprehensive survey and stratified sampling method, and a sample of beneficiaries (N = 197) using a convenience sampling method. The results showed a statistically significant decline (t = 16.58, p = 0.000) in the overall assessment of structure and process for the year 2024, with the overall mean dropping from 3.40 (high level) to 2.61 (moderate level). The “Partnership and External Support” dimension led the regression trend with the largest time-based difference (− 1.10) as a result of the decline in international humanitarian funding in 2025, while the “Effectiveness of Medical Operations and Protocols” dimension showed the highest resilience, with an average of 2.90 in 2025. Beneficiaries’ assessment of outcomes achieved an overall average score of 3.28, with the “Quality of Interaction” and “Perceived Health Impact” dimensions topping the rankings with an identical and high average of 3.52, while the “Quality of Infrastructure and Facilities” dimension ranked last with an average of 3.00, affected by power outages and the coastal climate. Statistically significant differences were also found in favor of permanent residents compared to displaced persons (p = 0.002), and in favor of recipients of immunization and antenatal care services compared to general screening clinics and medication dispensing (p = 0.009). The study presents an analytical model that explains the dynamics of the disconnect between the effectiveness of integrated preventive programs and the inadequacy of drug supply chains in health systems experiencing funding shocks.