For the last three measures we created indices composed of multiple items; details are available from the corresponding author. We calculated the natural log of the number of services offered by the facility and staff per bed for easier interpretation of the results. Finally, as this was a pooled analysis of all seven countries, we used an indicator variable for country as a proxy for national factors that may influence quality. Statistical analysisTo compare quality across countries, we calculated mean and interquartile range (IQR) for antenatal care and sick-child care quality. For each process quality score and explanatory covariate, we estimated the mean and standard deviation (SD), weighted based on client sampling weights. Bivariate analyses were then performed for quality on each covariate. Variables were included in the final model if they were statistically significant at the P < 0. 10 level for at least one type of visit (antenatal care or sick-child visits) or were conceptually important.
How clinical quality would change if all providers performed at their highest observed level and at the level of the highest quartile of facilities in Kenya, Malawi, Namibia, Rwanda, Senegal, Uganda and the United Republic of Tanzania, 2006–2014Notes: Data were obtained from service provision assessment surveys of health facilities in each country (survey year range: 2006–2014). The three bars represent: (i) the level of quality of care measured in this study; (ii) the predicted quality if all consultations were at the provider’s highest quality visit; and (iii) the predicted quality if all consultations were done to the same standard as the top 25% of primary-care facilities in the country.
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ووفقًا لبروتوكولات منظمة الصحة العالمية، أنشأنا مؤشرات لجودة تدابير الرعاية المقدمة في مرحلة ما قبل الولادة (الزيارات الأولى) والزيارات الخاصة بالمرضى من الأطفال. وقيَّمنا العوامل الوطنية والعوامل المرتبطة بالمنشأة والمرضى والجهات الموفرة للخدمة والتي قد تفسر التباين في مستوى جودة الرعاية المقدمة، حيث استخدمنا نماذج تحوّف منفصلة متعددة المستويات فيما يتعلق بمستوى الجودة لكل نوع من أنواع الخدمات. النتائج كانت البيانات متاحةً بشأن 2594 و11402 من عمليات ملاحظة الاستشارات العلاجية فيما يتعلق بالرعاية المقدمة في مرحلة ما قبل الولادة والمقدمة للمرضى من الأطفال، على التوالي. وإجمالاً، بلغ متوسط تنفيذ جهات توفير الرعاية الصحية للإجراءات الموصى بها 62. 2% (المدى الربيعي: من 50.
36, 37Performance differed substantially across countries, not only due to differences in national wealth or health-worker supply. For example, Kenya’s average antenatal care quality was comparable to Namibia’s despite having half the per capita number of physicians and one-quarter the national income. Uganda, with one-tenth the national income and one-third the physicians of Namibia, performed nearly as well in sick-child care.
Les prestataires expérimentés ainsi que ceux qui exerçaient dans des établissements mieux gérés ont fourni des soins de meilleure qualité aux enfants malades, aucune différence n'ayant été observée entre les médecins ou les infirmiers ou entre les centres de consultation mieux équipés et ceux moins bien équipés. Les établissements privés ont obtenu de meilleurs résultats que les établissements publics. Les différences entre les pays ont davantage permis d'expliquer les variations de qualité que tous les autres facteurs combinés. ConclusionDeux services de soins primaires essentiels pour les femmes et les enfants se sont révélés de qualité médiocre, celle-ci variant selon les pays et au sein des pays. Une analyse des raisons des variations qualitatives permettrait de définir des stratégies afin d'améliorer les soins.
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DiscussionIn this analysis of nearly 14 000 clinical consultations in seven countries, we found relatively weak quality of care for pregnant women and sick children: providers performed half to two thirds of a minimal set of recommended clinical actions. Providers for antenatal care were primarily nurses, whereas sick children were seen by both nurses and clinical officers. Nursing assistants conducted one in five visits for both services. Other studies in similar settings, often done in the context of quality improvement, have found that the care of sick children was weak.
27 (3. 10)11 81412. 46 (3. 40)Staff per bed, d mean (SD) no. 2 5353. 57 (4. 13)11 3283. 49 (4. 88)Infrastructure index, e mean (SD)2 6380. 56 (0. 16)11 8140. 16)Equipment index, f mean (SD)2 6380. 73 (0. 19)11 7910. 78 (0. 26)Management index, g mean (SD)2 6380. 65 (0. 18)11 8140. 63 (0. 19)Country, no. (%)2 6382 638 (100)11 81411 814 (100) Kenya–344 (13. 0)–1 516 (12. 8)Malawi–513 (19. 5)–2 136 (18. 1)Namibia–363 (13.
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