Inputs to quality: supervision, management, and community involvement in health facilities in Egypt in 2004

Abstract

BackgroundAs low- and middle-income countries experience economic development, ensuring quality of health care delivery is a central component of health reform. Nevertheless, health reforms in low- and middle-income countries have focused more on access to services rather than the quality of these services, and reporting on quality has been limited. In the present study, we sought to examine the prevalence and regional variation in key management practices in Egyptian health facilities within three domains: supervision of the facility from the Ministry of Health and Population (MOHP), managerial processes, and patient and community involvement in care.MethodsWe conducted a cross-sectional analysis of data from 559 facilities surveyed with the Egyptian Service Provision Assessment (ESPA) survey in 2004, the most recent such survey in Egypt. We registered on the Measure Demographic and Health Survey (DHS) website http://legacy.measuredhs.com/login.cfm to gain access to the survey data. From the ESPA sampled 559 MOHP facilities, we excluded a total of 79 facilities because they did not offer facility-based 24-hour care or have at least one physician working in the facility, resulting in a final sample of 480 facilities. The final sample included 76 general service hospitals, 307 rural health units, and 97 maternal and child health and urban health units (MCH/urban units). We used standard frequency analyses to describe facility characteristics and tested the statistical significance of regional differences using chi-square statistics.ResultsNearly all facilities reported having external supervision within the 6 months preceding the interview. In contrast, key facility-level managerial processes, such as having routine and documented management meetings and applying quality assurance approaches, were uncommon. Involvement of communities and patients was also reported in a minority of facilities. Hospitals and health units located in Urban Egypt compared with more rural parts of Egypt were significantly more likely to have management committees that met at least monthly, to keep official records of the meetings, and to have an approach for reviewing quality assurance activities.ConclusionsAlthough the data precede the recent reform efforts of the MOHP, they provide a baseline against which future progress can be measured. Targeted efforts to improve facility-level management are critical to supporting quality improvement initiatives directed at improving the quality of health care throughout the country.

Monitoring the ability to deliver care in low- and middle-income countries: a systematic review of health facility assessment tools

“…Only four studies located in the medical literature databases reported using a standardized assessment tool thereby meeting the inclusion criteria. Of these, three reported using the Service Provision Assessment ( Hong et al 2006 ; Agha and Do 2009 ; Cherlin et al 2011 ) and one reported using the Health Facility Census ( Gabrysch et al 2011 ); both of these tools were also located in the IHFAN database. None of the four studies included copies of the tools ( Figure 2 ).…”

Learning about Barriers to Care for People Living with HIV in Egypt

“…Some health facilities have already received international accreditation certificates, but the vast majority of the health facilities still require targeted efforts to improve the quality of care. 21 –25…”

“…Some health facilities have already received international accreditation certificates, but the vast majority of the health facilities still require targeted efforts to improve the quality of care. [21][22][23][24][25] A sustainable country-wide system for infection control trainings should be institutionalized, and specific HIV-related exercises could be integrated into it, such as risk assessment exercises or case studies in PLWHA. This would help health care workers make the missing link between standard infection control measures and HIV as well as help mitigate the fear of infection.…”

Health management committee strengthening and community mobilisation through women’s groups to improve trained health worker attendance at birth in rural Nepal: a cluster randomised controlled trial

“…Most HMCs were unable to hold regular meetings and we found it difficult to support them in a systematic way. It has been noted that the VDC secretary has many duties and low priority is often given to HMC issues [12], and regular HMC meetings and follow-up support are important for the success of locally managed interventions [12,29,30].…”