TY - JOUR
T1 - Facility management associated with improved primary health care outcomes in Ghana
AU - Macarayan, Erlyn K.
AU - Ratcliffe, Hannah L.
AU - Otupiri, Easmon
AU - Hirschhorn, Lisa R.
AU - Miller, Kate
AU - Lipsitz, Stuart R.
AU - Gawande, Atul A.
AU - Bitton, Asaf
PY - 2019/7/1
Y1 - 2019/7/1
N2 - Background Strong primary health care (PHC) is essential for achieving universal health coverage, but in many low- and middle-income countries (LMICs) PHC services are of poor quality. Facility management is hypothesized to be critical for improving PHC performance, but evidence about management performance and its associations with PHC in LMICs remains limited. Methods We quantified management performance of PHC facilities in Ghana and assessed the experiences of women who sought care at sampled facilities. Using multi-level models, we examined associations of facility management with five process outcomes and eight experiential outcomes. Findings On a scale of 0 to 1, the average overall management score in Ghana was 076 (IQR = 068–085). Facility management was significantly associated with one process outcome and three experiential outcomes. Controlling for facility characteristics, facilities with management scores at the 90th percentile (management score = 090) had 22% more essential drugs compared to facilities with management scores at the 10th percentile (060) (p = 0002). Positive statistically non-significant associations were also seen with three additional process outcomes—integration of family planning services (p = 0054), family planning types provided (p = 0067), and essential equipment availability (p = 0104). Compared to women who sought care at facilities with management scores at the 10th percentile, women who sought care at facilities at the 90th percentile reported 8% higher ratings of trust in providers (p = 0028), 15% higher ratings of ease of following provider’s advice (p = 0030), and 16% higher quality rating (p = 0020). However, women who sought care in the 90th percentile facilities rated their waiting times as worse (22% lower, p = 0039). Interpretation Higher management scores were associated with higher scores for some process and experiential outcomes. Large variations in management performance indicate the need to strengthen management practices to help realize the full potential of PHC in improving health outcomes.
AB - Background Strong primary health care (PHC) is essential for achieving universal health coverage, but in many low- and middle-income countries (LMICs) PHC services are of poor quality. Facility management is hypothesized to be critical for improving PHC performance, but evidence about management performance and its associations with PHC in LMICs remains limited. Methods We quantified management performance of PHC facilities in Ghana and assessed the experiences of women who sought care at sampled facilities. Using multi-level models, we examined associations of facility management with five process outcomes and eight experiential outcomes. Findings On a scale of 0 to 1, the average overall management score in Ghana was 076 (IQR = 068–085). Facility management was significantly associated with one process outcome and three experiential outcomes. Controlling for facility characteristics, facilities with management scores at the 90th percentile (management score = 090) had 22% more essential drugs compared to facilities with management scores at the 10th percentile (060) (p = 0002). Positive statistically non-significant associations were also seen with three additional process outcomes—integration of family planning services (p = 0054), family planning types provided (p = 0067), and essential equipment availability (p = 0104). Compared to women who sought care at facilities with management scores at the 10th percentile, women who sought care at facilities at the 90th percentile reported 8% higher ratings of trust in providers (p = 0028), 15% higher ratings of ease of following provider’s advice (p = 0030), and 16% higher quality rating (p = 0020). However, women who sought care in the 90th percentile facilities rated their waiting times as worse (22% lower, p = 0039). Interpretation Higher management scores were associated with higher scores for some process and experiential outcomes. Large variations in management performance indicate the need to strengthen management practices to help realize the full potential of PHC in improving health outcomes.
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U2 - 10.1371/journal.pone.0218662
DO - 10.1371/journal.pone.0218662
M3 - Article
C2 - 31265454
AN - SCOPUS:85069268645
VL - 14
JO - PLoS One
JF - PLoS One
SN - 1932-6203
IS - 7
M1 - e0218662
ER -