Does stewardship make a difference in the quality of care? Evidence from clinics and pharmacies in Kenya and Ghana.
OBJECTIVE
To measure level and variation of healthcare quality provided by different types of healthcare facilities in Ghana and Kenya and which factors (including levels of government engagement with small private providers) are associated with improved quality.


METHODS
Provider knowledge was assessed through responses to clinical vignettes. Associations between performance on vignettes and facility characteristics, provider characteristics and self-reported interaction with government were examined using descriptive statistics and multivariate regressions.


METHODS
Survey of 300 healthcare facilities each in Ghana and Kenya including hospitals, clinics, nursing homes, pharmacies and chemical shops. Private facilities were oversampled.


METHODS
Person who generally saw the most patients at each facility.


METHODS
Percent of items answered correctly, measured against clinical practice guidelines and World Health Organization's protocol.


RESULTS
Overall, average quality was low. Over 90% of facilities performed less than half of necessary items. Incorrect antibiotic use was frequent. Some evidence of positive association between government stewardship and quality among clinics, with the greatest effect (7% points increase, P = 0.03) for clinics reporting interactions with government across all six stewardship elements. No analogous association was found for pharmacies. No significant effect for any of the stewardship elements individually, nor according to type of engagement.


CONCLUSIONS
Government stewardship appears to have some cumulative association with quality for clinics, suggesting that comprehensive engagement with providers may influence quality. However, our research indicates that continued medical education (CME) by itself is not associated with improved care.
Connor P
CP
Spreng
Ifelayo P
IP
Ojo
Nicholas E
NE
Burger
Neeraj
N
Sood
John W
JW
Peabody
Lisa M
LM
Demaria
D000293:Adolescent; D000328:Adult; D000368:Aged; D002983:Clinical Competence; D005260:Female; D005869:Ghana; D006268:Health Facilities / Q000592:standards / Q000706:statistics & numerical data*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007630:Kenya; D008297:Male; D008875:Middle Aged; D010594:Pharmacies / Q000592:standards / Q000706:statistics & numerical data*; D017149:Private Sector / Q000706:statistics & numerical data*; D017150:Public Sector / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000592:standards / Q000706:statistics & numerical data*; D055815:Young Adult