The association of health workforce capacity and quality of pediatric care in Afghanistan.
OBJECTIVE
To examine the relationship between workforce capacity and quality of pediatric care in outpatient clinics in Afghanistan.


METHODS
Annual national performance assessments were conducted between 2005 and 2008 to determine quality of care through patient observations in >600 health facilities, selected by stratified random sampling each year. Other variables measured were health provider capacity, competency and adequacy of support systems.


METHODS
Primary care facilities in 29 provinces in Afghanistan.


METHODS
Pediatric patients and their caretakers greater than 2400 were selected at random each year.


METHODS
Index of observed quality of care for patient assessment and counseling based on WHO's Integrated Management of Childhood Illness (IMCI) clinical guidelines.


RESULTS
Quality of care improved for all IMCI indices between 2005 and 2008 (IMCI index increased from 43.1 to 56.1; P < 0.001) and was significantly associated with the availability of doctors, IMCI training and knowledge and factors such as provider job satisfaction, availability of clinical guidelines, frequency of supervision and the presence of community councils. There was also a progressive increase in the index summarizing staffing capacity during the study period. Basic health centers increased from 75.6 to 85.5% (P < 0.001), comprehensive health centers increased from 27.9 to 37.9% (P < 0.03) and district hospitals increased from 34.1 to 37.2% (P > 0.05).


CONCLUSIONS
Enhancing workforce capacity and competency and ensuring appropriate supervision and systems support mechanisms can contribute to improved quality of care. Although the results indicate sustained improvements over the study period, further research on the mixture of provider skills, competency and factors influencing provider motivation are essential to determine the optimal workforce capacity in Afghanistan.
Department of International Health, Johns Hopkins Bloomberg School of Public Health, 21205 Baltimore, MD, USA. aedward@jhsph.edu
Anbrasi
A
Edward
Binay
B
Kumar
Haseebullah
H
Niayesh
Ahmad Jan
AJ
Naeem
Gilbert
G
Burnham
David H
DH
Peters
D000346:Afghanistan; D000367:Age Factors; D017028:Caregivers; D002675:Child, Preschool; D002983:Clinical Competence; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006280:Health Workforce / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007588:Job Satisfaction; D008297:Male; D010372:Pediatrics / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D012737:Sex Factors