An 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

Di Giorgio, Laura ; Evans, David K. ; Lindelow, Magnus ; Nguyen, Son Nam ; Svensson, Jakob ; Wane, Waly ; Tarneberg, Anna Welander

World Bank, Washington, DC

关键词: MATERNAL HEALTH;    CHILD HEALTH;    HEALTH SERVICE DELIVERY;    QUALITY OF HEALTH CARE;    CHILDHOOD ILLNESS;   

DOI  :  10.1596/1813-9450-9440
RP-ID  :  WPS9440

学科分类：社会科学、人文和艺术（综合）

来源: World Bank Open Knowledge Repository

【 摘 要 】

This paper assesses the quality ofhealth care across African countries based on healthproviders' clinical knowledge, their clinic attendance,and drug availability, with a focus on seven conditionsaccounting for a large share of child and maternalmortality: malaria, tuberculosis, diarrhea, pneumonia,diabetes, neonatal asphyxia, and postpartum hemorrhage. Withnationally representative, cross-sectional data from 10countries in Sub-Saharan Africa, collected using clinicalvignettes, unannounced visits, and visual inspections offacilities, this study assesses whether health providers areavailable and have sufficient knowledge and means todiagnose and treat patients suffering from common conditionsamenable to primary health care. The study draws on datafrom 8,061 primary and secondary care facilities in Kenya,Madagascar, Mozambique, Nigeria, Niger, Senegal, SierraLeone, Tanzania, Togo, and Uganda, and 22,746 healthworkers. These data were gathered under the Service DeliveryIndicators program. Across all conditions and countries,health care providers were able to correctly diagnose 64percent of the clinical vignette cases, and in 45 percent ofthe cases, the treatment plan was aligned with the correctdiagnosis. For diarrhea and pneumonia, two common causes ofunder-five deaths, 27 percent of the providers correctlydiagnosed and prescribed the appropriate treatment for bothconditions. On average, 70 percent of health workers werepresent in the facilities to provide care during facilityhours when those workers were scheduled to be on duty. Takentogether, the estimated likelihood that a facility has atleast one staff present with competency and the key inputsrequired to provide child, neonatal, and maternity care thatmeets minimum quality standards is 14 percent. Poor clinicalknowledge is a greater constraint in care readiness thandrug availability or health workers' absenteeism in the10 countries. However, the paper documents substantialheterogeneity across countries.