Assessing the quality of care in a new nation: South Sudan's first national health facility assessment

Abstract

Objectives: We adapted a rapid quality of care monitoring method to a fragile state with two aims: to assess the delivery of child health services in South Sudan at the time of independence and to strengthen local capacity to perform regular rapid health facility assessments.

Methods: Using a two-stage lot quality assurance sampling (LQAS) design, we conducted a national cross-sectional survey among 156 randomly selected health facilities in 10 states. In each of these facilities, we obtained information on a range of access, input, process and performance indicators during structured interviews and observations.

Results: Quality of care was poor with all states failing to achieve the 80% target for 14 of 19 indicators. For example, only 12% of facilities were classified as acceptable for their adequate utilisation by the population for sick-child consultations, 16% for staffing, 3% for having infection control supplies available and 0% for having all child care guidelines. Health worker performance was categorised as acceptable in only 6% of cases related to sick-child assessments, 38% related to medical treatment for the given diagnosis and 33% related to patient counselling on how to administer the prescribed drugs. Best performance was recorded for availability of in-service training and supervision, for seven and ten states, respectively.

Conclusions: Despite ongoing instability, the Ministry of Health developed capacity to use LQAS for measuring quality of care nationally and state-by-state, which will support efficient and equitable resource allocation. Overall, our data revealed a desperate need for improving the quality of care in all states.

Keywords: Africa; Afrique; South Sudan; Sud-Soudan; Sudán del Sur; calidad de cuidados; capacity building; encuesta nacional; estado frágil; formación; fragile state; lot quality assurance sampling; monitoring and evaluation; monitorización y evaluación; muestreo de aceptación de lotes (LQAS); national survey; quality of care; qualité des soins; renforcement des capacités; surveillance et évaluation; surveillance nationale; África; échantillonnage par assurance de la qualité du lot; état fragile.