Abstract
Objective: To assess the quality and performance of public hospitals in Erbil Governorate, Iraq.
Methodology: This cross-sectional, multicenter mixed-methods study was conducted in all 13 public hospitals under the Directorate General of Health in Erbil Governorate, Kurdistan Region of Iraq, between the 1st of October 2023 and the 1st of October 2025. Hospital quality was evaluated using a psychometrically validated Iraqi-adapted Kayakalp checklist covering 6 domains, 53 criteria, and 300 compliances. Items were scored as 0 (non-compliant), 1 (partially compliant), or 2 (fully compliant), and converted to percentage scores.
Results: Overall hospital performance ranged from 309/600 to 387/600, corresponding to 51.5–64.5%. The highest-performing hospitals were Rapareen (64.5%), Hawler (62.0%), Hareer (61.8%), and Maternity (61.5%), whereas Eye (51.5%), Perman (52.5%), Zeravani (52.8%), and Rizgary (53.2%) had the lowest scores. Domain performance varied markedly: hospital upkeep ranged from 46.9% to 77.7%, sanitation and hygiene from 47.3% to 72.0%, support services from 30.0% to 82.5%, waste management from 36.0% to 83.0%, infection control from 37.0% to 73.0%, and hygiene promotion from 8.7% to 26.2%. None of the hospitals achieved the 70% Kayakalp recognition threshold overall.
Conclusion: Public hospitals in Erbil Governorate showed moderate overall quality performance with substantial inter-hospital variation. Infection control and hygiene promotion were consistently the weakest domain, indicating a priority area for improvement.

Key words: Environmental hygiene, healthcare quality, hospital assessment, hospital-acquired infections, Kayakalp.