ArticleBulletin of the World Health Organization2017
Variation in quality of primary-care services in Kenya, Malawi, Namibia, Rwanda, Senegal, Uganda and the United Republic of Tanzania.
Article in Bulletin of the World Health Organization, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 69 papers, 3 of them syntheses that pooled it.
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Who cites it
69 citing papers in PubMed, 3 syntheses or guidelines pooled it, 116 citations in OpenAlex.
- Impacts of performance-based financing on health system performance: evidence from the Democratic Republic of Congo.BMC medicine · 2023Pooled it
- Pooled it
- Mortality due to low-quality health systems in the universal health coverage era: a systematic analysis of amenable deaths in 137 countries.Lancet (London, England) · 2018Pooled it
- Effectiveness of Smartphone-Based Community Case Management on the Urgent Referral, Reconsultation, and Hospitalization of Children Aged Under 5 Years in Malawi: Cluster-Randomized, Stepped-Wedge Trial.Journal of medical Internet research · 2021Trial
- Assessing quality of childbirth care provided by skilled health personnel in Exemplar countries.Nature medicine · 2026Article
- Specific service readiness for sick child health services and its relationship with quality of care and user experience in eight low-and middle-income countries.BMC health services research · 2026Article
- Enhancing health professional clinical performance through supervision strategies: from 5311 facilities across eight countries in sick child healthcare.Journal of global health · 2026Article
- Article
- Clinical process quality of antenatal care in low and middle-income countries: Cross-sectional evidence from 13 countries.PLOS global public health · 2026Article
- Do health care quality improvement policies work for all? Distributional effects by baseline quality in South Africa.Health economics · 2025Article
- Association between sick child facility readiness and quality of care at the individual and facility level in five low- and middle-income countries.BMC health services research · 2024Article
- Quality of antenatal care services received by women of reproductive age prior to delivery in selected public health facilities in the northern zone of Ghana.BMC health services research · 2024Article
- Association between achieving adequate antenatal care and health-seeking behaviors: A study of Demographic and Health Surveys in 47 low- and middle-income countries.PLoS medicine · 2024Article
- User-reported quality of care: findings from the first round of the People's Voice Survey in 14 countries.The Lancet. Global health · 2024Review
- Challenges and Strategies of Providing Effective Antenatal Education Services in Oman's Public Healthcare System: Perspectives of service providers and pregnant women.Sultan Qaboos University medical journal · 2023Article
- Continuing professional development training needs for primary care doctors in central Uganda.African journal of primary health care & family medicine · 2023Article
- Health service quality in 2929 facilities in six low-income and middle-income countries: a positive deviance analysis.The Lancet. Global health · 2023Article
- Spatial heterogeneity of low-birthweight deliveries on the Kenyan coast.BMC pregnancy and childbirth · 2023Article
- A descriptive analysis of the coverage of newborn care services among women who delivered in health facilities in 17 sub-Saharan African countries.BMC pregnancy and childbirth · 2023Article
- The costs and financing needs of delivering Kenya's primary health care service package.Frontiers in public health · 2023Article
9 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
4 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo analyse factors affecting variations in the observed quality of antenatal and sick-child care in primary-care facilities in seven African countries.
methodsWe pooled nationally representative data from service provision assessment surveys of health facilities in Kenya, Malawi, Namibia, Rwanda, Senegal, Uganda and the United Republic of Tanzania (survey year range: 2006-2014). Based on World Health Organization protocols, we created indices of process quality for antenatal care (first visits) and for sick-child visits. We assessed national, facility, provider and patient factors that might explain variations in quality of care, using separate multilevel regression models of quality for each service.
findingsData were available for 2594 and 11 402 observations of clinical consultations for antenatal care and sick children, respectively. Overall, health-care providers performed a mean of 62.2% (interquartile range, IQR: 50.0 to 75.0) of eight recommended antenatal care actions and 54.5% (IQR: 33.3 to 66.7) of nine sick-child care actions at observed visits. Quality of antenatal care was higher in better-staffed and -equipped facilities and lower for physicians and clinical officers than nurses. Experienced providers and those in better-managed facilities provided higher quality sick-child care, with no differences between physicians and nurses or between better- and less-equipped clinics. Private facilities outperformed public facilities. Country differences were more influential in explaining variance in quality than all other factors combined.
conclusionThe quality of two essential primary-care services for women and children was weak and varied across and within the countries. Analysis of reasons for variations in quality could identify strategies for improving care.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.