Indicators to assess the functionality of clubfoot clinics in low-resource settings: a Delphi consensus approach and pilot study

Abstract

BackgroundThis study aims to determine the indicators for assessing the functionality of clubfoot clinics in a low-resource setting.MethodsThe Delphi method was employed with experienced clubfoot practitioners in Africa to rate the importance of indicators of a good clubfoot clinic. The consistency among the participants was determined with the intraclass correlation coefficient. Indicators that achieved strong agreement (mean≥9 [SD <1.5]) were included in the final consensus definition. Based on the final consensus definition, a set of questions was developed to form the Functionality Assessment Clubfoot Clinic Tool (FACT). The FACT was used between February and July 2017 to assess the functionality of clinics in the Zimbabwe clubfoot programme.ResultsA set of 10 indicators that includes components of five of the six building blocks of a health system—leadership, human resources, essential medical equipment, health information systems and service delivery—was produced. The most common needs identified in Zimbabwe clubfoot clinics were a standard treatment protocol, a process for surgical referrals and a process to monitor dropout of patients.ConclusionsPractitioners had good consistency in rating indicators. The consensus definition includes components of the World Health Organization building blocks of health systems. Useful information was obtained on how to improve the services in the Zimbabwe clubfoot programme.

The Health Determinants of Accessibility to Clubfoot Treatment in LMICs: A Global Exploration of Barriers and Solutions

“…A recent study highlighted the importance of succinct surgical referrals and a process to monitor dropout rates of patients as an important factor for improved clubfoot management. 34 Although it is impossible to conclude a direct link with lack of skills and lack of equipment from a snapshot study of institutions that responded to the WHO SAT questionnaire, our study does provide a strong correlation and proposed direction in managing the global burden of CTEV.…”

“…with the third eye we can detect mistakes and correct them…’’ Supportive supervision and the management of Clubfoot by Ponseti method: Qualitative experiences from Mwanza, Tanzania

“…[9] In East Africa, Surgical methods have been used for many years, and over the last decade, they have been replaced with the Ponseti method [2] In countries such as Malawi and Uganda, the Ponseti method has proven to be successful. [2,10]…”

“…[1] Supportive supervision is an on-site activity of leading, helping, coaching, mentoring, and motivating staff to improve their performance and bring about high-standard healthcare services by improving their technical skills. [1][2][3] Supportive supervision increases job satisfaction and health workers' motivation, thereby contributing to quality treatment outcomes. [4] Clubfoot programmes use supportive supervision to achieve their objectives.…”

“…A study done in Nigeria found out the clubfeet treatment of choice in most cases used to be early extensive surgeries which resulted to complications to the operated foot leading to the adoption of conservative methods in this case Ponseti method. [9] In East Africa, Surgical methods have been used for many years, and over the last decade, they have been replaced with the Ponseti method [2] In countries such as Malawi and Uganda, the Ponseti method has proven to be successful. [2,10] In Tanzania, Ponseti method replaced Kite method when it was first introduced in 2008.…”

“…[9] In East Africa, Surgical methods have been used for many years, and over the last decade, they have been replaced with the Ponseti method [2] In countries such as Malawi and Uganda, the Ponseti method has proven to be successful. [2,10] In Tanzania, Ponseti method replaced Kite method when it was first introduced in 2008. [11] Despite the treatment method selected, considering the time required for clubfoot treatment, supportive supervision of clinics has become an important component to ensure that healthcare workers maintain the standard throughout treatment.…”