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Table 3 Selected definitions of quality in WHO HSS building blocks and Individual PHIT Partnerships

From: Approaches to ensuring and improving quality in the context of health system strengthening: a cross-site analysis of the five African Health Initiative Partnership programs

  Service delivery Health Workforce Information Medical Products, Vaccines, & Technologies Financing Leadership and governance
WHO [1] Coverage, comprehensive accessibility continuity, person-centeredness coordination, accountability and efficiency
General and specific service readiness score 1
Health worker distribution* Performance of specific surveys and other health measurements
Facility reporting
Data quality (through Data quality audits: DQA)
Availability of tracer drugs* National expenditure of health
Out of pocket expenditures
Insurance coverage
Presence of relevant strategies and guidelines
Ghana [12] Quality of care delivered by CHWs
Patient satisfaction
Community satisfaction (care (availability, perception of quality)
Full complement of staff per facility
Supervision of CHWs by DHMTs
Effective use of data to drive appropriate allocation and care delivery
Data quality (concordance)
Availability of tracer drugs and other commodities Allocation of project funds reflective of identified needs Leadership capacity
Data-driven allocation of funds
Mozambique [16] Timeliness of primary health care service provision
Patient satisfaction
Population coverage
Service integration
Efficiency in the allocation of trained health workers
Availability of trained health workers.
Frequency of supervision visits (facility and district).
Data quality (through DQA) Availability of tracer drugs and other commodities Equity of funding distribution across districts
Public sector capacity for management of project funds
Financial management capacity
Availability of trained district and facility management personnel
Frequency of management meetings (district and facility)
Rwanda [10] Quality of care delivered
Service volume
Population coverage (equity; effective coverage)
Facility staffing
Staff training
HCW retention and satisfaction
Receipt of supervision
Data quality (focus on health facility and CHW registries)
Internet/network downtime
Utilization of facility data for management decisions
Appropriate equipment levels
Availability of tracer drugs and other commodities
Strength of district supply chain management
Availability of selected lab capacity
Insurance coverage
Costing of services delivered
Public sector management of project funds
Utilization of data to drive improvement
Tanzania2[11] Availability of selected services,
Outreach performed for care
Quality of care
Staff training
Facility staff levels
Receipt of supervision
Performance of QA activities
Required routine data reports submitted Availability of tracer drugs and other commodities
Availability of selected lab capacity
  Meetings at Health Facility to discuss management and governance
Zambia [8] Quality of care delivered
Service readiness
Guideline availability at site
Community reported utilization of selected health services
Density, motivation and training of health workers Data quality and record keeping Availability of selected tracer drugs and other commodities Financial planning capacity and activities
Public sector management of project funds
Geographic equity of funding allocation
Facility governance (self-rated)
Community participation in health service delivery and perceived appropriate governance
Funding allocation and activities reflecting identified gaps
  1. WHO: World Health Organization; CHW: community health workers; DHMT: District Health Management team; QA: Quality Assurance
  2. *chosen as core measures across all PHIT projects
  3. 1 Includes drugs and commodities infrastructure, (basic amenities), basic equipment, laboratory, infection control and specialized services
  4. 2 Also used principal component analysis to convert data from MACRO Service Provision assessment tool (SPA) into composite indices of health system strength (e.g. readiness to provide curative care, readiness to provide preventive care, readiness to provide advanced clinical care)