Abstract
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.
| Original language | English (US) |
|---|---|
| Article number | e0218662 |
| Journal | PloS one |
| Volume | 14 |
| Issue number | 7 |
| DOIs | |
| State | Published - Jul 1 2019 |
Funding
Funding was provided by the Bill & Melinda Gates Foundation. The funders played no role in study design; collection, analysis, and interpretation of data; writing of the paper; or decision to submit for publication. We acknowledge the enumerators in Ghana who patiently collected data for this study and the survey respondents who dedicated their time to this study. We also gratefully acknowledge collaborators at Johns Hopkins University, including Hannah Olson, Blake Zachary, Linnea Zimmerman, Shulin Jiang, and Scott Radloff, for their support in fielding the surveys and collecting and cleaning data, and Brandon Neal of Ariadne Labs for his assistance with data analysis. The Lancet High-Quality Health Systems Secretariat also provided useful methodological feedback. Dr. Koku Awoonor-Williams provided essential input to the design of the survey, and Dr. Awoonor-Williams and Vicky Okine provided invaluable feedback to help clarify and contextualize our results. Funding for this work was provided by the Bill & Melinda Gates Foundation.
ASJC Scopus subject areas
- General
