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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)