title: Assessing the quality of care in a new nation: South Sudan's first national health facility assessment.
abstract: OBJECTIVE
  We adapted a rapid quality of care monitoring method to a fragile state with two aims: to assess the delivery of child health services in South Sudan at the time of independence and to strengthen local capacity to perform regular rapid health facility assessments.
  
  
  METHODS
  Using a two-stage lot quality assurance sampling (LQAS) design, we conducted a national cross-sectional survey among 156 randomly selected health facilities in 10 states. In each of these facilities, we obtained information on a range of access, input, process and performance indicators during structured interviews and observations.
  
  
  RESULTS
  Quality of care was poor with all states failing to achieve the 80% target for 14 of 19 indicators. For example, only 12% of facilities were classified as acceptable for their adequate utilisation by the population for sick-child consultations, 16% for staffing, 3% for having infection control supplies available and 0% for having all child care guidelines. Health worker performance was categorised as acceptable in only 6% of cases related to sick-child assessments, 38% related to medical treatment for the given diagnosis and 33% related to patient counselling on how to administer the prescribed drugs. Best performance was recorded for availability of in-service training and supervision, for seven and ten states, respectively.
  
  
  CONCLUSIONS
  Despite ongoing instability, the Ministry of Health developed capacity to use LQAS for measuring quality of care nationally and state-by-state, which will support efficient and equitable resource allocation. Overall, our data revealed a desperate need for improving the quality of care in all states.
authors.affiliation: Liverpool School of Tropical Medicine, International Public Health Department, Liverpool, UK.
authors.forename: Sima
authors.initials: S
authors.lastname: Berendes
authors.forename: Richard L
authors.initials: RL
authors.lastname: Lako
authors.forename: Donald
authors.initials: D
authors.lastname: Whitson
authors.forename: Simon
authors.initials: S
authors.lastname: Gould
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Valadez
mesh_terms: D002648:Child; D002662:Child Health Services / Q000592:standards; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000592:standards*; D019538:Health Care Surveys; D006268:Health Facilities / Q000592:standards*; D006301:Health Services Needs and Demand; D006801:Humans; D017053:Infection Control; D055810:Lot Quality Assurance Sampling; D011785:Quality Assurance, Health Care / Q000379:methods; D013397:Sudan
keywords: Africa; Afrique; South Sudan; Sud-Soudan; Sudán del Sur; calidad de cuidados; capacity building; encuesta nacional; estado frágil; formación; fragile state; lot quality assurance sampling; monitoring and evaluation; monitorización y evaluación; muestreo de aceptación de lotes (LQAS); national survey; quality of care; qualité des soins; renforcement des capacités; surveillance et évaluation; surveillance nationale; África; échantillonnage par assurance de la qualité du lot; état fragile