Determinants of primary care service quality in Afghanistan.
OBJECTIVE
To identify factors associated with service quality provided by agencies implementing a basic package of health services in Afghanistan.


METHODS
Cross-sectional survey of outpatient health facilities, health workers, patients and caretakers.


METHODS
Primary health care facilities in every province of Afghanistan.


METHODS
Composite scale measuring the quality of clinical processes in four areas: patient histories, physical examinations, communication and time spent with patient.


RESULTS
No difference in service quality was observed between male and female providers or between male and female patients, but when both the provider and patient were female quality was much higher. Overall, the quality of care at non-governmental organization and government-managed health facilities did not differ, but the poor received higher quality care at non-governmental facilities than at government facilities. Doctors provided higher quality care than lower level providers. Provision of six or more supervisory visits in the last 6 months was associated with higher service quality. Training doctors in integrated management of childhood illness was not associated with quality, but when lower level health workers received such training the quality of patient-provider communication was higher. Other recurrent inputs and geographic remoteness are not associated with the quality of care provided.


CONCLUSIONS
The government's strategy to form partnerships with non-governmental organizations has led to higher quality of care provided to the poor. This represents a promising start in the reconstruction of Afghanistan's health system and provides useful evidence to other countries striving to increase access to quality care for the poor.
Hansen
Peter Meredith
PM
Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Room E8132, 615 N. Wolfe Street, Baltimore, MD 22105, USA. phansen@jhsph.edu
Peters
David H
DH
Edward
Anbrasi
A
Gupta
Shivam
S
Arur
Aneesa
A
Niayesh
Haseebullah
H
Burnham
Gilbert
G
D000293:Adolescent; D000328:Adult; D000346:Afghanistan; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D016014:Linear Models; D008297:Male; D011320:Primary Health Care / Q000191:economics / Q000379:methods / Q000592:standards*; D011787:Quality of Health Care; D012737:Sex Factors; D012959:Socioeconomic Factors; D055815:Young Adult