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HEALTH SYSTEMS: Essential factors for improving primary care quality outlined

May 25, 2023
HEALTH SYSTEMS: Essential factors for improving primary care quality outlined
A snip from the The Lancet Global Health journal with an inset of Ifakara Health Institute scientist, Dr. Mwifadhi Mrisho, who contributed to the study and publication. GRAPHIC | IFAKARA/KMC.

In a new study, scientists have identified good management and leadership as essential factors for health facilities to perform at their best. The two factors among others were analyzed as part of a survey to investigate health facility performances in six low-income and middle-income countries.

Ifakara Health Institute scientist, Dr. Mwifadhi Mrisho, contributed to the study along with other colleagues from partner institutions. The lead authors of the study are Todd Lewis and Margaret Kruk from Harvard TH Chan School of Public Health. Other contributors include Margaret McConnell, Amit Aryal from the University of Basel, Grace Irimu from the University of Nairobi, and Suresh Mehata from the Ministry of Health, Nepal.

Public, private facilities involved
A total of 2929 public and private health facilities were part of the survey whose findings were published on The Lancet Global Health journal. Scientists used routinely collected health system data from Service Provision Assessments (SPA) of six countries – the Democratic Republic of the Congo, Haiti, Malawi, Nepal, Senegal, and Tanzania.

Data were collected from June 2013 to February 2020 to identify the best-and worst-performing health facilities and facility-level factors that explain the performance gap.

The study primarily used a framework based on previously identified foundations of high-quality health systems involving four domains – population, governance, workforce, and tools. The results showed that best-performing hospitals outperformed worst-performing hospitals on the population, governance, and workforce dimensions.

Best, worst-performing clinics
The largest difference between the best-and worst-performing clinics was on the governance dimension while the tools dimension was largely associated with the best-performing hospitals and clinics despite the similar availability of tools between best and worst performers in “unadjusted analyses”.

In their discussion about the association of tools in health facilities and performance, the scientists say, “Although supplies are essential to care provision, they are no guarantee of high-quality care. It might be that facilities with strong management and leadership are better able to ensure adequate infrastructure in the facility, rather than infrastructure leading to strong medical practice.”

Governance is key differentiator
On governance, the scientists said “In our models, we found that governance was a key differentiator between hospitals and clinics in bivariable analyses... Important factors included high-quality management meetings, strong external supervision, quality assurance mechanisms, clinical guidelines, and obtaining multiple sources of funding.”

“These factors reflect the important role of leaders who engage their staff, act on the basis of feedback, and make transparent decisions. These leaders also ensure the availability of essential resources for top performance, including up-to-date clinical information and reliable sources of revenue.”

Performance gaps
Overall, the study showed performance gaps between facilities across the six countries despite operating in similar contexts. This suggests that good medical practice is possible in limited resource settings when facilities have the right tools and support such as strong management, a supported workforce, supplies and equipment, and close linkages with the community.

“Our findings suggest that best-performing health facilities are characterized by good management and leaders who can engage staff and community members. Governments should look to best performers to identify scalable practices and conditions for success that can improve primary care quality overall and decrease quality gaps between health facilities.”

>> Read full article: https://pubmed.ncbi.nlm.nih.gov/37202022/