EFFECTIVE COVERAGE: A FRAMEWORK LINKING COVERAGE AND QUALITY
Table 2.2
Advantages and disadvantages of the data sources for measuring effective coverage Household survey
Vignettes
Advantages
Representative sample of Capture provider the entire population knowledge Real-life treatment episodes
Disadvantages
Patient/caregiver recall
Standardized patients
Direct clinical observation
Capture effort
Real-life treatment episodes
Hypothetical Realistic but fictitious Hard to establish patient’s true treatment episodes treatment episodes condition; Hawthorne effects
Source: World Bank.
rely on the recall of disease and treatment episodes that occurred in the past. In addition, especially if the information is based on patient (or child caregiver) recall, the understanding of the medical conditions and procedures experienced might be imperfect. Facility-based assessments of quality have several attractions: with the information being collected at the time of the interaction, the assessments are not (or, at least, less) subject to patient or caregiver recall bias. The information comes from trained enumerators with a medical background and therefore may be more accurate than information provided by a patient or caregiver. In addition, the information collected may cover more angles than is feasible in questions posed to a caregiver sometime after the event (Fink, Kandpal, and Shapira 2022). Facility-based quality assessments have disadvantages, however. The patients are typically different from the interviewees in a household survey, which poses a challenge in terms of population representativeness: even if the data are linked only at the national level, it is not always straightforward (and sometimes impossible because facility assessments are limited to just a few facilities; see Kruk et al. 2017) to make the facility data representative of the (typically national) population in need. Even if the household survey data and facility data refer to the same individuals, the household survey will typically cover the full history of visits with respect to a health event, such as a pregnancy, while an exit interview or a direct observation will typically cover just one visit (Fink, Kandpal, and Shapira 2022). Facility-based quality assessments pose other challenges. Health care provider vignettes are designed to capture provider knowledge when presented with specific medical cases, but they are based on hypothetical treatment episodes and do not measure real-life effort. Standardized patients, that is, when a trained actor comes to health facility and pretends to suffer from a specific condition to observe the provider’s actions, capture not only knowledge, but also the provider’s effort and are based on a realistic, but still 31
