Service readiness of health facilities in Bangladesh, Haiti, Kenya, Malawi, Namibia, Nepal, Rwanda, Senegal, Uganda and the United Republic of Tanzania

Leslie, Hannah H; Spiegelman, Donna; Zhou, Xin; Kruk, Margaret E

doi:10.2471/blt.17.191916

Cited by 116 publications

(90 citation statements)

References 36 publications

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“…Compared to the HPs/PHCCs, the district hospital had better service readiness, especially in terms of medicines and supplies, basic infrastructure and human resources. Similar findings of better service readiness in hospitals compared to primary care facilities is evident in other settings as well [33,45]. Studies have shown that healthcare utilization patterns, retention in care and people's decision to bypass facilities is due to the patient's perception of quality [46,47].…”

Section: Discussionmentioning

confidence: 53%

“…), resulting in inability to take preventive measures or receive treatment in a timely manner. An assessment of service readiness of health facilities in ten countries, including Nepal, found that only 2% of facilities surveyed between 2007 and 2015 had eight diagnostic tests defined as essential for basic service readiness by the WHO, including those necessary for antenatal care, such as urine dipsticks for protein and glucose, syphilis rapid diagnostic tests, and HIV diagnostic capacity [33]. In many LMICs, the lack of laboratory facilities and diagnostic equipment remains a barrier to effective patient assessment and diagnosis.…”

Section: Discussionmentioning

confidence: 99%

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Assessment of facility and health worker readiness to provide quality antenatal, intrapartum and postpartum care in rural Southern Nepal

Lama

Munos

Katz

et al. 2020

BMC Health Serv Res

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Background: Increased coverage of antenatal care and facility births might not improve maternal and newborn health outcomes if quality of care is sub-optimal. Our study aimed to assess the facility readiness and health worker knowledge required to provide quality maternal and newborn care. Methods: Using an audit tool and interviews, respectively, facility readiness and health providers' knowledge of maternal and immediate newborn care were assessed at all 23 birthing centers (BCs) and the District hospital in the rural southern Nepal district of Sarlahi. Facility readiness to perform specific functions was assessed through descriptive analysis and comparisons by facility type (health post (HP), primary health care center (PHCC), private and District hospital). Knowledge was compared by facility type and by additional skilled birth attendant (SBA) training. Results: Infection prevention items were lacking in more than one quarter of facilities, and widespread shortages of iron/folic acid tablets, injectable ampicillin/gentamicin, and magnesium sulfate were a major barrier to facility readiness. While parenteral oxytocin was commonly provided, only the District hospital was prepared to perform all seven basic emergency obstetric and newborn care signal functions. The required number of medical doctors, nurses and midwives were present in only 1 of 5 PHCCs. Private sector SBAs had significantly lower knowledge of active management of third stage of labor and correct diagnosis of severe pre-eclampsia. While half of the health workers had received the mandated additional two-month SBA training, comparison with the non-trained group showed no significant difference in knowledge indicators. Conclusions: Facility readiness to provide quality maternal and newborn care is low in this rural area of Nepal. Addressing the gaps by facility type through regular monitoring, improving staffing and supply chains, supervision and refresher trainings is important to improve quality.

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Section: Discussionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Assessment of facility and health worker readiness to provide quality antenatal, intrapartum and postpartum care in rural Southern Nepal

Lama

Munos

Katz

et al. 2020

BMC Health Serv Res

View full text Add to dashboard Cite

show abstract

“…We recognize that this is not a comprehensive quality metric. However, research has found facility inputs and human resources to be necessary, but not sufficient for quality services, so we feel this was a reasonable proxy [44,45].…”

Section: Discussionmentioning

confidence: 94%

Understanding client and provider perspectives of antenatal care service quality: a qualitative multi-method study from Tanzania

Sheffel¹,

Heidkamp²,

Mpembeni³

et al. 2019

Journal of Global Health

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Background Measures of quality of care in low-and middle-income countries (LMICs) rarely include experience of care. This gap in service quality metrics may be driven by a lack of understanding of client and provider perspectives. Understanding these perspectives is a critical first step in not only improving metrics, but also in improving service delivery. This study identifies the items antenatal care (ANC) clients and health care providers in Tanzania associate with a quality ANC service and explores the experience of care domain from both client and provider perspectives. Methods We conducted semi-structured interviews with15 providers and 35 clients in Tanzania that included a free-listing activity to elicit items clients and providers associate with quality ANC services. We analyzed the free-listing for rank order and frequency to identify the most salient items, which were included in the second phase of data collection. We then conducted semi-structured interviews with a pile sort activity with the same 15 providers and 32 new clients to understand the importance of the items identified in the free-listing. We used a thematic analysis driven by the framework approach to analyze interview data. Results Both clients and providers perceived quality of ANC as being comprised of items related to experience of care, provision of care, and cross-cutting essential physical and human resources. The free-listing findings illuminated that the experience of care was equally important to clients and providers as the availability of physical and human resources and the content of the care delivered. In addition, clients and providers perceived that a positive patient care experience-marked by good communication, active listening, keeping confidentiality, and being spoken to politely-increased utilization of health services and improved health outcomes. Conclusions The experience of care in LMICs is an overlooked, yet critically important topic. Understanding the experience of care from those who receive and deliver services is key to measuring and improving the quality of ANC. Our research highlights the importance of incorporating experience of care into future quality improvement activities and quality measures. By doing so, we identify barriers and facilitating factors of practical use to policy-makers and governments in LMICs. Reducing maternal mortality has been a long-standing global priority. Monitoring progress towards reductions in mortality has often focused on measuring service coverage defined as the proportion of the population at risk that receives an intervention [1]. Although coverage measures are widely used in

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“…Even simple tests are often unavailable: blood glucose meters and urine strips were available in only 18-61% of facilities across Mali, Mozambique, and Zambia [17]. Another study of 10 countries found that only 2% of healthcare facilities had the eight diagnostic tests (hemoglobin, blood glucose, malaria test, urine dipstick for protein and sugar, HIV and syphilis test, and pregnancy test) included in WHO basic service readiness index [18].…”

Section: Using Edl As a Tool For Estimating Access To Testingmentioning

confidence: 99%

Essential Diagnostics: A Key Element of Universal Health Coverage

Kohli¹

2019

DSAHMJ

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Good primary care is an essential precondition for a decent healthcare system. In fact, primary health care is at the heart of Universal Health Coverage (UHC). UHC, in turn, is critical to achieve the sustainable development goals. While access to essential medicines is explicit in UHC, access to essential diagnostics has received little attention. In May 2018, the World Health Organization (WHO) published the first Essential Diagnostics List (EDL), and declared its commitment to give equal importance to diagnostic tests and essential medicines. The EDL has been positively received by a variety of stakeholders, including industry. The EDL offers countries a benchmark that they can use to measure and improve diagnostic services, and preliminary data from India show limited access to essential tests at the primary care level. Some countries, notably India, have already begun developing National EDLs (NEDLs). Hopefully, such national efforts will enable the implementation of EDLs, and improve access to diagnostics. It is time for Low-and Middle-Income Countries (LMICs) to not only increase coverage of health care, but also improve quality of care. Access to essential tests is the first key step in improving quality of care.

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Service readiness of health facilities in Bangladesh, Haiti, Kenya, Malawi, Namibia, Nepal, Rwanda, Senegal, Uganda and the United Republic of Tanzania

Cited by 116 publications

References 36 publications

Assessment of facility and health worker readiness to provide quality antenatal, intrapartum and postpartum care in rural Southern Nepal

Assessment of facility and health worker readiness to provide quality antenatal, intrapartum and postpartum care in rural Southern Nepal

Understanding client and provider perspectives of antenatal care service quality: a qualitative multi-method study from Tanzania

Essential Diagnostics: A Key Element of Universal Health Coverage

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