Training And Supervision Did Not Meaningfully Improve Quality Of Care For Pregnant Women Or Sick Children In Sub-Saharan Africa.
In-service training courses and supportive supervision of health workers are among the most common interventions to improve the quality of health care in low- and middle-income countries. Despite extensive investment from donors, evaluations of the long-term effect of these two interventions are scarce. We used nationally representative surveys of health systems in seven countries in sub-Saharan Africa to examine the association of in-service training and supervision with provider quality in antenatal and sick child care. The results of our analysis showed that observed quality of care was poor, with fewer than half of evidence-based actions completed by health workers, on average. In-service training and supervision were associated with quality of sick child care; they were associated with quality of antenatal care only when provided jointly. All associations were modest-at most, improvements related to interventions were equivalent to 2 additional provider actions out of the 18-40 actions expected per visit. In-service training and supportive supervision as delivered were not sufficient to meaningfully improve the quality of care in these countries. Greater attention to the quality of health professional education and national health system performance will be required to provide the standard of health care that patients deserve.
Hannah H. Leslie (hleslie@hsph.harvard.edu) is a postdoctoral fellow in the Department of Global Health and Population at the Harvard T. H. Chan School of Public Health, in Boston, Massachusetts.
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Anna Gage is a visiting scientist at the Harvard T. H. Chan School of Public Health.
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Humphreys Nsona is program manager of the Integrated Management of Childhood Illness Unit in the Ministry of Health, in Lilongwe, Malawi.
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Lisa R. Hirschhorn is director of the implementation and improvement sciences platform at Ariadne Labs and an associate professor of medicine in the Department of Global Health and Social Medicine at Harvard Medical School, both in Boston.
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Margaret E. Kruk is an associate professor of global health in the Department of Global Health and Population at the Harvard T. H. Chan School of Public Health.
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D000328:Adult; D017954:Africa South of the Sahara; D002648:Child; D000067576:Child Health; D002662:Child Health Services / Q000458:organization & administration; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000458:organization & administration; D003906:Developing Countries; D005260:Female; D006282:Health Personnel / Q000193:education*; D006801:Humans; D000068097:Maternal Health; D008875:Middle Aged; D009934:Organization and Administration; D018743:Perinatal Care / Q000458:organization & administration*; D011247:Pregnancy; D011320:Primary Health Care / Q000458:organization & administration; D011787:Quality of Health Care; D018570:Risk Assessment; D016896:Treatment Outcome; D055815:Young Adult
Developing World < International/global health studies; Maternal And Child Health; Primary Care; Quality Of Care