Diagnostic quality in rural health centres in Burkina Faso

Krause, Gérard; Schleiermacher, Dietlind; Borchert, Matthias; Benzler, Justus; Heinmüller, Rolf; Ouattara, K.; Coulibaly, Seydou; Diasso, I.; Ilboudo, Abdoul Kader; Diesfeld, Hans Jochen

doi:10.1046/j.1365-3156.1998.00200.x

Cited by 31 publications

(28 citation statements)

References 12 publications

(11 reference statements)

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“…A study from Burkina Faso assessed the quality of diagnostic practice of nurses working in rural health centres. There was immense variation among nurses' skills of history taking and clinical examination and no correlation could be found with regard to their basic training (Krause et al, 1998b). This by no means suggests that training of health providers, especially as part of continuing education, is not essential.…”

Section: Discussionmentioning

confidence: 94%

Prescription practices of public and private health care providers in Attock District of Pakistan

Siddiqi¹,

Hamid

Rafique

et al. 2002

Health Planning & Management

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The irrational use of drugs is a major problem of present day medical practice and its consequences include the development of resistance to antibiotics, ineffective treatment, adverse effects and an economic burden on the patient and society. A study from Attock District of Pakistan assessed this problem in the formal allopathic health sector and compared prescribing practices of health care providers in the public and private sector. WHO recommended drug use indicators were used to study prescription practices. Prescriptions were collected from 60 public and 48 private health facilities. The mean (+/- SE) number of drugs per prescription was 4.1 +/- 0.06 for private and 2.7 +/- 0.04 for public providers (p < 0.0001). General practitioners (GPs) who represent the private sector prescribed at least one antibiotic in 62% of prescriptions compared with 54% for public sector providers. Over 48% of GP prescriptions had at least one injectable drug compared with 22.0% by public providers (p < 0.0001). Thirteen percent of GP prescriptions had two or more injections. More than 11% of GP prescriptions had an intravenous infusion compared with 1% for public providers (p < 0.001). GPs prescribed three or more oral drugs in 70% of prescriptions compared with 44% for public providers (p < 0.0001). Prescription practices were analysed for four health problems, acute respiratory infection (ARI), childhood diarrhoea (CD), fever in children and fever in adults. For these disorders, both groups prescribed antibiotics generously, however, GPs prescribed them more frequently in ARI, CD and fever in children (p < 0.01). GPs prescribed steroids more frequently, however, it was significantly higher in ARI cases (p < 0.001). For all the four health problems studied, GPs prescribed injections more frequently than public providers (p < 0.001). In CD cases GPs prescribed oral rehydration salt (ORS) less frequently (33.3%) than public providers (57.7%). GPs prescribed intravenous infusion in 12.3% cases of fever in adults compared with none by public providers (p < 0.001). A combination of non-regulatory and regulatory interventions, directed at providers as well as consumers, would need to be implemented to improve prescription practices of health care providers. Regulation alone would be ineffective unless it is supported by a well-established institutional mechanism which ensures effective implementation. The Federal Ministry of Health and the Provincial Departments of Health have to play a critical role in this respect, while the role of the Pakistan Medical Association in self-regulation of prescription practices can not be overemphasized. Improper prescription practices will not improve without consumer targeted interventions that educate and empower communities regarding the hazards of inappropriate drug use.

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Section: Discussionmentioning

confidence: 94%

Prescription practices of public and private health care providers in Attock District of Pakistan

Siddiqi¹,

Hamid

Rafique

et al. 2002

Health Planning & Management

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“…Possible reasons for low utilisation might be existing patients' dissatisfaction with the quality of health services [30,[34][35][36] leading to a preference towards traditional healers or self-treatment. Baltussen et al [37] found that the quality of care perceived at Nouna hospital was even worse than that of rural health centres.…”

Section: Discussionmentioning

confidence: 99%

Costing of Malaria treatment in a rural district hospital

Koné¹,

Marschall²,

Fleßa³

2010

Health

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Objective: It is the aim of this paper to estimate the provider's cost of treating paediatric cases of Malaria in a rural African hospital. Furthermore, we intend to give some insights into the possibilities of improving the efficiency of treating children with this disease in order to support policy makers in the resource allocation process. Methods: The cost analysis was done in the district hospital of Nouna, Burkina Faso. Based on a comprehensive cost-of-illness information system, the cost of treating paediatric Malaria in the district hospital in the year 2005 were estimated using a combination of topdown and activity-based costing. It divides the entire treatment process into a set of activities along the clinical pathway and allocates monetary values for the resource consumption to each activity. Results: The average actual provider's cost were 6.74 US$ for a paediatric outpatient with Malaria, 61.08 US$ for a paediatric Malaria inpatient with anaemia and, respectively 74.29 US$ for a case of paediatric Malaria with neurological affection. 54% of the cost was due to laboratory work. This high unit cost was mainly due to a severe underutilisation of the hospital capacity. The current cost recovery rate per case was between 18% and 43%. It would be between 32% and 73% if the occupancy increased to 80%. Conclusion: The paper demonstrates that detailed costing is possible in a district hospital in rural Africa. The unit cost seems to be extra-ordinary high and the share of laboratory cost is tremendous. However, this is mainly due to a very strong underutilisation of the existing capacities. This fact calls for intensive efforts of the management of the institution to attract more patients by improving the quality of services and in particular the satisfaction of the patients.

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“…The most frequent explanations are financial barriers and low quality of services [7]. Some elements of health care reforms in Burkina Faso address these issues, for instance by introducing quality management [8] and by implementing new financing mechanisms (e.g. community-based health insurances) [9,10].…”

Section: Introductionmentioning

confidence: 99%

Expanding access to primary care without additional budgets? A case study from Burkina Faso

Marschall

Fleßa

2008

Eur J Health Econ

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The aim of this study is to demonstrate the impact of increased access to primary care on provider costs in the rural health district of Nouna, Burkina Faso. This study question is crucial for health care planning in this district, as other research work shows that the population has a higher need for health care services. From a public health perspective, an increase of utilisation of first-line health facilities would be necessary. However, the governmental budget that is needed to finance improved access was not known. The study is based on data of 2004 of a comprehensive provider cost information system. This database provides us with the actual costs of each primary health care facility (Centre de Santé et de Promotion Sociale, CSPS) in the health district. We determine the fixed and variable costs of each institution and calculate the average cost per service unit rendered in 2004. Based on the cost structure of each CSPS, we calculate the total costs if the demand for health care services increased. We conclude that the total provider costs of primary care (and therefore the governmental budget) would hardly rise if the coverage of the population were increased. This is mainly due to the fact that the highest variable costs are drugs, which are fully paid for by the customers (Bamako Initiative). The majority of other costs are fixed. Consequently, health care reforms that improve access to health care institutions must not fear dramatically increasing the costs of health care services.

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Diagnostic quality in rural health centres in Burkina Faso

Cited by 31 publications

References 12 publications

Prescription practices of public and private health care providers in Attock District of Pakistan

Prescription practices of public and private health care providers in Attock District of Pakistan

Costing of Malaria treatment in a rural district hospital

Expanding access to primary care without additional budgets? A case study from Burkina Faso

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