CHAPTER 4
Decomposing the Constraints to Quality of Care Using Data on Antenatal Care Consultations from Five Sub-Saharan African Countries Introduction This chapter first provides the motivation for the use of antenatal care (ANC) consultations for assessment of the quality of care and explains the three-gap framework in detail. Then, the chapter presents the data and describes how the various components are used to assess the three gaps. Next, it discusses the findings on the three gaps. The chapter concludes with a discussion of the policy implications of the results and ties them to the rest of this report, in particular chapter 5. ANC consultations are used to examine the extent to which clinical quality is constrained by (1) the competency of health care providers, (2) the availability of equipment and consumables, and (3) the effort gap. That is, for different components of ANC, the chapter assesses the share of consultations in which the providers know they should perform an action, have the equipment and supplies needed, and yet do not perform the action. Then, the analysis explores the characteristics of facilities, providers, and patients that correlate with the different gaps in the provision of highquality care. This analysis is novel for several reasons. Many previous assessments of health facility quality used physical infrastructure and supplies (Gatti et al. 2021), which this report terms structural quality, or health 57
