Wang, Wenjuan, Mai Do, John Hembling, and Paul Ametepi. 2014. Assessing the Quality of Care in Family Planning, Antenatal, and Sick Child Services at Health Facilities in Kenya, Namibia, and Senegal. DHS Analytical Studies No. 44. Rockville, Maryland, USA: ICF International.
This study assessed the quality of care at health facilities in providing family planning, antenatal care, and sick child care, using data from nationally representative Service Provision Assessment (SPA) surveys in Kenya, Namibia, and Senegal. Quality of care was measured in structure, process, and outcome of service provision. Associations between the outcome and structural and process attributes were analyzed using multiple regressions. Health facilities had inadequate infrastructure and supplies that are essential for providing good-quality services. Shortage of service-specific guidelines and infection prevention precautions was common across service areas and countries. Other structural inadequacies include the limited number of contraceptive methods provided by family planning facilities, little use of the Integrated Management of Childhood Illness (IMCI) guide in assessing and treating sick children, and poor availability of diagnosis tests to verify malaria for children under age 5. Although hospitals and health centers generally possessed better structural attributes than clinics and other lower-level health facilities, their performance in adhering to standards of care during service delivery was not necessarily superior, and sometimes was poorer than lower-level facilities. Long waiting time was a common problem across countries and services, and was more serious in hospitals and health centers than in clinics and other facilities. Long waiting time stands out for its consistent association with lower levels of client satisfaction. Our analysis also found evidence of more client satisfaction in the private sector than in the public sector.