The impact of a health system strengthening initiative on the quality of healthcare in a rural district of Madagascar
Abstract/Contents
- Abstract
- Assessing the effectiveness of a healthcare delivery program in a quantifiable and comprehensive manner is a challenge that most health system strengthening (HSS) organizations face continuously given the wide-range of contributors to effective care. While past studies predominantly focused on measures of access to care, the World Health Organization has urged in the last decade for an increased emphasis on measures of care quality, including its safety, timeliness, equity, and patient-centeredness. Here, we present one of the first studies to evaluate the impact of an HSS intervention on the content of healthcare, a proxy for quality, at the population-level; we deem care to be effective when it is appropriately delivered to all people in need of medical attention, not just those able to attend a health center. We conducted a longitudinal cohort study examining changes in the content of care (including medications prescribed, diagnostic tests performed, and patient counseling) provided to Malagasy pregnant women and ill children during the first two years of the joint Ministry of Health and non-profit PIVOT’s HSS intervention in Ifanadiana, a rural district of Madagascar. This work was based on responses from an independently-conducted, district-wide survey of 1600 randomly sampled households, with an intervention and control group, that was administered at baseline in 2014 and again in 2016. Our analysis revealed that as access to a public healthcare facility (PHF) increased by 10-20 percentage points over the study period in the intervention group, so too did the content of appropriate care increase by similar levels, while there were minimal changes for the control group. Notably, there was a significant increase in the percent of children ill with diarrhea who were given oral rehydration therapy at a PHF and in the percent of women whose babies were examined by a health professional soon after delivery. Conversely, we identified several indicators that remained low in the intervention group throughout the study period, particularly in the content of antenatal care for pregnant women. In addition to helping quantify the impact of the intervention in Ifanadiana and identifying aspects of care that need further improvement, this study establishes a new method of measuring the quality of health care in a population, although further validation of this method is needed. Thus, this work provides essential insights into the creation of an evidence-based healthcare delivery system, which could be applied to future HSS initiatives outside of Madagascar.
Description
| Type of resource | text |
|---|---|
| Date created | December 2017 |
Creators/Contributors
| Author | Ezran, Camille |
|---|---|
| Primary advisor | Maldonado, Yvonne |
| Advisor | Bonds, Matthew |
| Degree granting institution | Stanford University, Department of Health Research & Policy |
Subjects
| Subject | healthcare quality |
|---|---|
| Subject | Madagascar |
| Subject | health system strengthening |
| Subject | Stanford University Department of Health Research & Policy |
| Genre | Thesis |
Bibliographic information
Access conditions
- Use and reproduction
- User agrees that, where applicable, content will not be used to identify or to otherwise infringe the privacy or confidentiality rights of individuals. Content distributed via the Stanford Digital Repository may be subject to additional license and use restrictions applied by the depositor.
- License
- This work is licensed under a Creative Commons Attribution 3.0 Unported license (CC BY).
Preferred citation
- Preferred Citation
- Ezran, Camille. (2017). The impact of a health system strengthening initiative on the quality of healthcare in a rural district of Madagascar. Stanford Digital Repository. Available at: https://purl.stanford.edu/mn938rx7215
Collection
Epidemiology & Clinical Research Masters Theses
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- Contact
- camille_ezran@yahoo.com
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