Back to Search
Start Over
Analysis of clinical knowledge, absenteeism and availability of resources for maternal and child health: a cross-sectional quality of care study in 10 African countries
- Source :
- BMJ Global Health, BMJ Global Health, Vol 5, Iss 12 (2020)
- Publication Year :
- 2020
-
Abstract
- ObjectiveAssess the quality of healthcare across African countries based on health providers’ clinical knowledge, their clinic attendance and drug availability, with a focus on seven conditions accounting for a large share of child and maternal mortality in sub-Saharan Africa: malaria, tuberculosis, diarrhoea, pneumonia, diabetes, neonatal asphyxia and postpartum haemorrhage.MethodsWith nationally representative, cross-sectional data from ten countries in sub-Saharan Africa, collected using clinical vignettes (to assess provider knowledge), unannounced visits (to assess provider absenteeism) and visual inspections of facilities (to assess availability of drugs and equipment), we assess whether health providers are available and have sufficient knowledge and means to diagnose and treat patients suffering from common conditions amenable to primary healthcare. We draw on data from 8061 primary and secondary care facilities in Kenya, Madagascar, Mozambique, Nigeria, Niger, Senegal, Sierra Leone, Tanzania, Togo and Uganda, and 22 746 health workers including doctors, clinical officers, nurses and community health workers. Facilities were selected using a multistage cluster-sampling design to ensure data were representative of rural and urban areas, private and public facilities, and of different facility types. These data were gathered under the Service Delivery Indicators programme.ResultsAcross all conditions and countries, healthcare providers were able to correctly diagnose 64% (95% CI 62% to 65%) of the clinical vignette cases, and in 45% (95% CI 43% to 46%) of the cases, the treatment plan was aligned with the correct diagnosis. For diarrhoea and pneumonia, two common causes of under-5 deaths, 27% (95% CI 25% to 29%) of the providers correctly diagnosed and prescribed the appropriate treatment for both conditions. On average, 70% of health workers were present in the facilities to provide care during facility hours when those workers are scheduled to be on duty. Taken together, we estimate that the likelihood that a facility has at least one staff present with competency and key inputs required to provide child, neonatal and maternity care that meets minimum quality standards is 14%. On average, poor clinical knowledge is a greater constraint in care readiness than drug availability or health workers’ absenteeism in the 10 countries. However, we document substantial heterogeneity across countries in the extent to which drug availability and absenteeism matter quantitatively.ConclusionOur findings highlight the need to boost the knowledge of healthcare workers to achieve greater care readiness. Training programmes have shown mixed results, so systems may need to adopt a combination of competency-based preservice and in-service training for healthcare providers (with evaluation to ensure the effectiveness of the training), and hiring practices that ensure the most prepared workers enter the systems. We conclude that in settings where clinical knowledge is poor, improving drug availability or reducing health workers’ absenteeism would only modestly increase the average care readiness that meets minimum quality standards.
- Subjects :
- Service delivery framework
Child Health Services
01 natural sciences
maternal health
0302 clinical medicine
Pregnancy
Health care
Absenteeism
030212 general & internal medicine
Child
media_common
Original Research
lcsh:R5-920
biology
Health Policy
Attendance
Child Health
Senegal
health services research
Editorial
Female
lcsh:Medicine (General)
Coronavirus Infections
health systems
medicine.medical_specialty
media_common.quotation_subject
Pneumonia, Viral
Nigeria
lcsh:Infectious and parasitic diseases
Sierra leone
03 medical and health sciences
Betacoronavirus
medicine
Humans
lcsh:RC109-216
Quality (business)
Maternal Health Services
0101 mathematics
Constraint (mathematics)
Pandemics
Quality of Health Care
business.industry
SARS-CoV-2
010102 general mathematics
Public Health, Environmental and Occupational Health
Infant, Newborn
COVID-19
biology.organism_classification
Kenya
Tanzania
Cross-Sectional Studies
Family medicine
Africa
business
health systems evaluation
Subjects
Details
- ISSN :
- 20597908
- Volume :
- 5
- Issue :
- 12
- Database :
- OpenAIRE
- Journal :
- BMJ global health
- Accession number :
- edsair.doi.dedup.....774429195a7c1a9555addb2b9fd92380