Trop Med Int Health. 2021 Dec 5. doi: 10.1111/tmi.13701. Online ahead of print.
ABSTRACT
OBJECTIVE: High-quality healthcare is essential to ensuring maternal and newborn survival. Efficient measurement requires knowing how long measures of quality provide consistent insight for intended uses.
METHODS: We used a repeated health facility assessment in Senegal to calculate structural and process quality of antenatal care (ANC), delivery, and child health services in facilities assessed 2 years apart. We tested agreement of quality measures within facilities and regions. We estimated how much input-adjusted and process quality-adjusted coverage measures changed for each service when calculated using quality measurements from the same facilities measured 2 years apart.
RESULTS: Over 6 waves of continuous surveys, 628 paired assessments were completed. Changes at the facility level were substantial and often positive, but inconsistent. Structural quality measures were moderately correlated (0.40 – 0.69) within facilities over time, more so in hospitals; correlation was <0.20 for process measures based on direct observation of ANC and child visits. Most measures were more strongly correlated once averaged to regions; process quality of child services was not (-0.32). Median relative difference in national adjusted coverage estimates was 6.0%; differences in subnational estimates were largest for process quality of child services (19.6%).
CONCLUSION: Continuous measures of structural quality demonstrated consistency at regional levels and in higher-level facilities over 2 years; results for process measures were mixed. Direct observation of child visits provided inconsistent measures over time. For other measures, linking population data with health facility assessments from up to 2 years prior is likely to introduce modest measurement error in adjusted coverage estimates.
PMID:34865274 | DOI:10.1111/tmi.13701
