Determinants of primary care service quality in Afghanistan

Peter Meredith Hansen, David Peters, Anbrasi Magdalene Edward, Shivam Gupta, Aneesa Arur, Haseebullah Niayesh, Gilbert M Burnham

Research output: Contribution to journalArticle

Abstract

Objective: To identify factors associated with service quality provided by agencies implementing a basic package of health services in Afghanistan. Design: Cross-sectional survey of outpatient health facilities, health workers, patients and caretakers. Setting: Primary health care facilities in every province of Afghanistan. Main outcome measures: Composite scale measuring the quality of clinical processes in four areas: patient histories, physical examinations, communication and time spent with patient. Results: No difference in service quality was observed between male and female providers or between male and female patients, but when both the provider and patient were female quality was much higher. Overall, the quality of care at non-governmental organization and government-managed health facilities did not differ, but the poor received higher quality care at non-governmental facilities than at government facilities. Doctors provided higher quality care than lower level providers. Provision of six or more supervisory visits in the last 6 months was associated with higher service quality. Training doctors in integrated management of childhood illness was not associated with quality, but when lower level health workers received such training the quality of patient-provider communication was higher. Other recurrent inputs and geographic remoteness are not associated with the quality of care provided. Conclusions: The government's strategy to form partnerships with non-governmental organizations has led to higher quality of care provided to the poor. This represents a promising start in the reconstruction of Afghanistan's health system and provides useful evidence to other countries striving to increase access to quality care for the poor.

Original languageEnglish (US)
Pages (from-to)375-383
Number of pages9
JournalInternational Journal for Quality in Health Care
Volume20
Issue number6
DOIs
StatePublished - 2008

Fingerprint

Afghanistan
Quality of Health Care
Primary Health Care
Health Facilities
Communication
Organizations
Health
Health Status
Physical Examination
Health Services
Outpatients
Cross-Sectional Studies
Outcome Assessment (Health Care)

Keywords

  • Afghanistan
  • Equity
  • Integrated management of childhood illness
  • Non-governmental organizations
  • Quality of care
  • Supervision

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health

Cite this

Determinants of primary care service quality in Afghanistan. / Hansen, Peter Meredith; Peters, David; Edward, Anbrasi Magdalene; Gupta, Shivam; Arur, Aneesa; Niayesh, Haseebullah; Burnham, Gilbert M.

In: International Journal for Quality in Health Care, Vol. 20, No. 6, 2008, p. 375-383.

Research output: Contribution to journalArticle

@article{863e17c3d16840698a15b2575f208afc,
title = "Determinants of primary care service quality in Afghanistan",
abstract = "Objective: To identify factors associated with service quality provided by agencies implementing a basic package of health services in Afghanistan. Design: Cross-sectional survey of outpatient health facilities, health workers, patients and caretakers. Setting: Primary health care facilities in every province of Afghanistan. Main outcome measures: Composite scale measuring the quality of clinical processes in four areas: patient histories, physical examinations, communication and time spent with patient. Results: No difference in service quality was observed between male and female providers or between male and female patients, but when both the provider and patient were female quality was much higher. Overall, the quality of care at non-governmental organization and government-managed health facilities did not differ, but the poor received higher quality care at non-governmental facilities than at government facilities. Doctors provided higher quality care than lower level providers. Provision of six or more supervisory visits in the last 6 months was associated with higher service quality. Training doctors in integrated management of childhood illness was not associated with quality, but when lower level health workers received such training the quality of patient-provider communication was higher. Other recurrent inputs and geographic remoteness are not associated with the quality of care provided. Conclusions: The government's strategy to form partnerships with non-governmental organizations has led to higher quality of care provided to the poor. This represents a promising start in the reconstruction of Afghanistan's health system and provides useful evidence to other countries striving to increase access to quality care for the poor.",
keywords = "Afghanistan, Equity, Integrated management of childhood illness, Non-governmental organizations, Quality of care, Supervision",
author = "Hansen, {Peter Meredith} and David Peters and Edward, {Anbrasi Magdalene} and Shivam Gupta and Aneesa Arur and Haseebullah Niayesh and Burnham, {Gilbert M}",
year = "2008",
doi = "10.1093/intqhc/mzn039",
language = "English (US)",
volume = "20",
pages = "375--383",
journal = "International Journal for Quality in Health Care",
issn = "1353-4505",
publisher = "Oxford University Press",
number = "6",

}

TY - JOUR

T1 - Determinants of primary care service quality in Afghanistan

AU - Hansen, Peter Meredith

AU - Peters, David

AU - Edward, Anbrasi Magdalene

AU - Gupta, Shivam

AU - Arur, Aneesa

AU - Niayesh, Haseebullah

AU - Burnham, Gilbert M

PY - 2008

Y1 - 2008

N2 - Objective: To identify factors associated with service quality provided by agencies implementing a basic package of health services in Afghanistan. Design: Cross-sectional survey of outpatient health facilities, health workers, patients and caretakers. Setting: Primary health care facilities in every province of Afghanistan. Main outcome measures: Composite scale measuring the quality of clinical processes in four areas: patient histories, physical examinations, communication and time spent with patient. Results: No difference in service quality was observed between male and female providers or between male and female patients, but when both the provider and patient were female quality was much higher. Overall, the quality of care at non-governmental organization and government-managed health facilities did not differ, but the poor received higher quality care at non-governmental facilities than at government facilities. Doctors provided higher quality care than lower level providers. Provision of six or more supervisory visits in the last 6 months was associated with higher service quality. Training doctors in integrated management of childhood illness was not associated with quality, but when lower level health workers received such training the quality of patient-provider communication was higher. Other recurrent inputs and geographic remoteness are not associated with the quality of care provided. Conclusions: The government's strategy to form partnerships with non-governmental organizations has led to higher quality of care provided to the poor. This represents a promising start in the reconstruction of Afghanistan's health system and provides useful evidence to other countries striving to increase access to quality care for the poor.

AB - Objective: To identify factors associated with service quality provided by agencies implementing a basic package of health services in Afghanistan. Design: Cross-sectional survey of outpatient health facilities, health workers, patients and caretakers. Setting: Primary health care facilities in every province of Afghanistan. Main outcome measures: Composite scale measuring the quality of clinical processes in four areas: patient histories, physical examinations, communication and time spent with patient. Results: No difference in service quality was observed between male and female providers or between male and female patients, but when both the provider and patient were female quality was much higher. Overall, the quality of care at non-governmental organization and government-managed health facilities did not differ, but the poor received higher quality care at non-governmental facilities than at government facilities. Doctors provided higher quality care than lower level providers. Provision of six or more supervisory visits in the last 6 months was associated with higher service quality. Training doctors in integrated management of childhood illness was not associated with quality, but when lower level health workers received such training the quality of patient-provider communication was higher. Other recurrent inputs and geographic remoteness are not associated with the quality of care provided. Conclusions: The government's strategy to form partnerships with non-governmental organizations has led to higher quality of care provided to the poor. This represents a promising start in the reconstruction of Afghanistan's health system and provides useful evidence to other countries striving to increase access to quality care for the poor.

KW - Afghanistan

KW - Equity

KW - Integrated management of childhood illness

KW - Non-governmental organizations

KW - Quality of care

KW - Supervision

UR - http://www.scopus.com/inward/record.url?scp=56749095549&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=56749095549&partnerID=8YFLogxK

U2 - 10.1093/intqhc/mzn039

DO - 10.1093/intqhc/mzn039

M3 - Article

C2 - 18799469

AN - SCOPUS:56749095549

VL - 20

SP - 375

EP - 383

JO - International Journal for Quality in Health Care

JF - International Journal for Quality in Health Care

SN - 1353-4505

IS - 6

ER -