Quality of care assessment of public and private outpatient clinics in Metro Cebu, the Philippines

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Despite large investments in primary health care in developing countries, evaluation of the quality of services has been neglected. Managers need information on service quality to identify specific ways to improve health‐care delivery, and to determine how health programs can achieve their desired effects. We tested several quality‐assessment methods in 48 public and private outpatient clinics in Metro Cebu, The Philippines. Structured observations of immunization sessions and clinic logistics highlighted functional problems at particular clinics that contributed to shortages of vaccines, sterilized needles and oral rehydration salts (ORS). Quality assessment of medical records for the treatment of diarrhea revealed a wide variation in the recorded quality of services. Clinical case histories were presented to public and private providers, who advised different approaches for case management, highlighting areas where improvement is needed. For example, public providers were more likely to use ORS to treat dehydration; private providers were more likely to enquire about symptoms of dysentery. Private providers were more likely to treat a mild respiratory infection with antibiotics, but few providers were likely to prescribe antibiotics for a child with signs suggestive of severe pneumonia. Advice to mothers was insufficient in most areas. These quality‐assessment methods can be used by managers to develop training curricula and solve problems in the delivery of primary health‐care services.

Original languageEnglish (US)
Pages (from-to)273-286
Number of pages14
JournalThe International Journal of Health Planning and Management
Issue number4
StatePublished - Jan 1 1991


  • Philippines
  • Primary health care
  • Quality assurance

ASJC Scopus subject areas

  • Health Policy


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