Health service delivery in nine African countries
8 | Further details on the calculation of each indicator are available in appendix A, table A.3. 9 | The category “other health workers” includes a variety of positions, depending on the country. It may include health assistants, community health workers, and midwives. In some contexts, it can include technicians, pharmacists, nutritionists, or orderlies, if they are involved with patient diagnosis and treatment. 10 | Diarrhea at 7.6 percent of disability-adjusted life years, malaria at 7.9 percent, diabetes at 1.3 percent, lower respiratory infections at 8.7 percent, tuberculosis at 3.3 percent, and anemia at 1.4 percent, based on IHME (2020). 11 | Correct treatment is not made conditional on correct diagnosis, so providers can occasionally prescribe the correct treatment without the correct diagnosis. Further information on the clinical vignettes is provided in Andrews et al. (2021). 12 | This section includes results from multivariate regressions presented in Andrews et al. (2021). Multivariate regressions for diagnostic and treatment accuracy include facility- and provider-level controls. The facility-level controls are ownership (public, private), location (urban, rural), facility level (hospital, health clinic, health post), and country. The provider-level controls are type, education, age (in 10-year groupings), and gender. 13 | In the diarrhea with dehydration vignette, the child presents as a case of diarrhea but displays multiple warning signs for severe dehydration. According to IMCI guidelines, severe dehydration necessitates rehydration with an intravenous line or nasogastric tube. However, 86 percent of providers simply prescribe oral rehydration salts (ORS), and 45 percent prescribe ORS plus zinc. ORS plus zinc is scored as appropriate treatment, because the child is able to drink in most vignettes. Similarly, for malaria with anemia, most providers identify malaria as the primary condition (diagnosed by 81 percent) but do not identify the warning signs for anemia (diagnosed by 21 percent) and therefore do not prescribe iron supplements. 14 | A facility is considered to have “improved toilets” if the enumerators confirms it has one or more functioning flush toilets or ventilated improved pit latrines, or covered pit latrine (with slab). A facility is considered as having an “improved water source” if it reports that its main source of water is piped into the facility, piped onto facility grounds, or comes from a public tap/standpipe, tube well/ borehole, a protected dug well, a protected spring, bottled water, or a tanker truck. This definition is based on the WHO/UNICEF Joint Monitoring Program for Water Supply, Sanitation, and Hygiene. See also appendix A, table A.3.
References Adair-Rohani, H., K. Zukor, S. Bonjour, S. Wilburn, A. C. Kuesel, R. Hebert, and E. R. Fletcher. 2013. “Limited Electricity Access in Health Facilities of Sub-Saharan Africa: A Systematic Review of Data on Electricity Access, Sources, and Reliability.” Global Health: Science and Practice 1 (2): 249–61. https://doi.org/10.9745/GHSP-D-13-00037. Andrews, K., R. Conner, R. Gatti, and J. Sharma. 2021. “The Realities of Primary Care: Variation in Quality of Care across Nine Countries in Sub-Saharan Africa.” Policy Research Working Paper 9607, World Bank, Washington, DC. Bamgboye, E. A., and A. I. Adeleye. 1992. “Sickness Absenteeism in a Nigerian Teaching Hospital.” East African Medical Journal 69 (8): 450–55.
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