Health service delivery in nine African countries
each condition, and correct diagnosis and treatment refer to having at least one health care provider in the facility who is able to give correct answers on the related vignette. Each bar is conditional on the availability of inputs in the prior step, with the final bar representing the overall likelihood of a patient receiving all of the necessary steps in the care process for that specific ailment. For example, to treat a case of malaria, the required tools for diagnosis are a thermometer and a malaria rapid diagnostic test, the facility needs to have at least one provider who can accurately diagnose and treat malaria in the clinical vignette, and the required medicine for treatment is artemisinin combination therapy. Although most facilities have some of these individual components, only a little over half of facilities have all of the necessary components in combination and can therefore be considered prepared to treat a case of malaria. Readiness to provide care differs across conditions, with a high of 57.6 percent of facilities prepared to provide care for a malaria patient and a low of 10.8 percent of facilities prepared to provide care for a diabetes patient. For diabetes and tuberculosis, a limiting factor is the lack of necessary tools and medicines. Lack of timely screening and diagnosis has been identified as a pressing issue for both of these diseases, and the results of this analysis suggest that primary care facilities still do not have the tools to address this problem or to provide appropriate medicines (Manne-Goehler et al. 2019; Raviglione et al. 2012). For the other conditions, no single factor emerges as dominant; rather, a combination of deficiencies results in facilities often being unprepared to offer full care.
Conclusions: What will it take to improve service delivery in health? The SDI health surveys give insight into ordinary people’s experience of PHC in nine Sub-Saharan African countries. SDI data shed light on the obstacles people encounter in seeking quality care for common medical conditions within these health systems and identify entry points for policy to improve PHC delivery and results. Despite decades of global efforts to promote robust PHC, SDI evidence suggests that the quality of PHC delivery in these nine countries remains suboptimal. Upon arriving at a typical health facility, patients in these countries are likely to find a substantial number of clinical personnel absent. Despite the absences, many providers’ outpatient caseloads are not especially elevated. This raises questions about how health systems organize and distribute their human resources. When health care providers are available, patients have a high likelihood of receiving an incorrect diagnosis and insufficient treatment. These risks
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