Monitoring Quality of Care in the WHO Africa Region-A study design for measurement and tracking, towards UHC attainment

Figures & data

Table 1. Description of identified sub-domains for defining quality of care

Sub-domain	Description
User Experiences	The perceptions of how well the care process adhered to their expectations; this is what drives utilization, though not always correlated with the actual quality of care provided, given the subjectivity of this measurement, and its associated biases
Patient Safety	How well clients can avoid harm during the process of receiving care
Effectiveness of Interventions	How appropriate the interventions provided are for the care needs

Table 2. Proposed proxy indicators for a quality of care index in the WHO Africa Region

	User Experience	Patient Safety	Effectiveness of Interventions
INPUT	Basic Amenities Availability Score
	Basic Equipment Availability Score
	Essential Medicines Availability Score
	Diagnostics Availability Score
PROCESS	Satisfaction with Basic Health Services	Standard Precautions for Infection Prevention and Control
OUTPUT		Still birth rate TB treatment success rate	Mortality from CVD cancer, diabetes or CRD between exact ages 30 and 70

Table 3. Standard data sources for indicators identified

Indicator	Source	Frequency	Level of collection
Basic Amenities Availability Score	Facility assessments	Periodic	Health Facility
Basic Equipment Availability Score	Facility assessments	Periodic	Health Facility
Essential Medicines Availability Score	Facility assessments	Periodic	Health Facility
Diagnostics Availability Score	Facility assessments	Periodic	Health Facility
General Service Readiness Score	Facility assessments	Periodic	Health Facility
Satisfaction with Basic Health Services	Facility assessments	Periodic	Health Facility
Standard Precautions for Infection Prevention and Control	Facility assessments	Periodic	Health Facility
Still birth rate	Population based surveys	Periodic	Population-based
TB treatment success rate	Population based surveys	Periodic	Population-based
Mortality from CVD cancer, diabetes or CRD between exact ages 30 and 70	Population based surveys	Periodic	Population-based

Table 4. Options for improving data availability and quality for strengthened monitoring of the quality of care in the Africa Region

Invest in actionable National Quality of Care M&E Frameworks
-	Galvanize political action and leadership to generate knowledge on the importance of increasing the scope of available measures for quality of care at country level
-	At national level, foster collaboration between health information directorates and quality of care directorates to scale up assessments of quality of care within the system
Embed patient assessments on User Experiences in household population-based surveys
-	To strengthen the availability of data on process, incorporate into population-based surveys, to reduce the introduction of courtesy bias that is often associated with exit interviews for user experience assessments
Scale up use of electronic health records which are vital opportunities for tracking quality of care process measures
-	Use of Electronic Health Records that can provide information on waiting times, and other patient-level indicators that can be used to assess quality
Strengthen and routinize health facility assessment processes
-	Conduct facility assessments on a frequent basis to provide timely and relevant information for quality measurement. These should be deployed from a system perspective, vs the programme-specific facility surveys that currently fragments efforts

Data availability statement

Data for execution of study design are publicly available through WHO Global Health Observatory. https://www.who.int/data/gho