Facility infrastructure does not indicate healthcare quality in low/middle-income countries

While a strong infrastructure is important for healthcare, measures of health facility infrastructure are poorly correlated with health system quality, according to a new study published this week in PLOS Medicine by Hannah Leslie from the Harvard T.H. Chan School of Public Health, USA, and colleagues.

Improved quality of care is increasingly recognized as a necessary step toward better health outcomes in low- and middle-income countries. Current measurements of quality of care often center on structural inputs to care, including amenities and equipment. In the new study, researchers used health surveys conducted in eight countries between 2007 and 2015: Haiti, Kenya, Malawi, Namibia, Rwanda, Senegal, Tanzania and Uganda. From the data, which included 35,531 observations of care in 4,354 facilities, they constructed indices of structural inputs and clinical quality related to family planning, antenatal care, sick-child care, and labor and delivery.

Overall, facilities had moderate levels of infrastructure ratings and low adherence to evidence-based guidelines. However, correlation between infrastructure and evidence-based care was low. Facilities with similar infrastructure ratings delivered widely varying quality of care. There was no minimum level of that was reliably associated with higher quality of care in any area.

"As the quality of care assumes a more prominent role in national and global efforts to improve population health outcomes, accurate measurement is vital," the authors say. "Health care providers and physical inputs, such as building, medicines, and equipment are an essential foundation for delivering healthcare. However, we found that these structural measures provide little insight on the quality of services delivered to patients."

In an accompanying Perspective, Lars Persson of the London School of Hygiene & Tropical Medicine, UK, discusses the need for new measurements of quality of care in order to reach current goals in maternal, newborn, and child health. "So far the existing tools and information systems are not adequate for measuring of care," he writes. "Accurate measurements are needed that reflect the context, the processes of giving and receiving care, and the effects on the status of patients and populations."


Explore further

Alternative payment model boosts quality of care for low-income patients

More information: Leslie HH, Sun Z, Kruk ME (2017) Association between infrastructure and observed quality of care in 4 healthcare services: A cross-sectional study of 4,300 facilities in 8 countries. PLoS Med 14(12): e1002464. doi.org/10.1371/journal.pmed.1002464
Provided by Public Library of Science
Citation: Facility infrastructure does not indicate healthcare quality in low/middle-income countries (2017, December 12) retrieved 22 February 2019 from https://medicalxpress.com/news/2017-12-facility-infrastructure-healthcare-quality-lowmiddle-income.html
This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only.
0 shares

Feedback to editors

User comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more