Measuring Quality of Care in Public Primary Facilities
There is growing recognition that the provision of physical access to healthcare is unlikely to improve health outcomes if the quality of the provided healthcare is inadequate (Das, Hammer and Leonard, 2008; Das and Hammer, 2014). In the context of various policy initiatives focused on improving the quality of public healthcare in South Africa such as the National Health Insurance proposal and process, the newly established Office of Health Standards Compliance, the Ideal Clinic Initiative and the Department of Health’s Norms and Standards, we have started to explore various methodologies available to measure the quality of healthcare at primary healthcare (PHC) facility level. Although user satisfaction surveys provide quick and easy snapshot views of individuals’ experiences of healthcare, this measurement approach has shortcomings. There are various other innovative measurement approaches available that potentially allow for more accurate and nuanced measurement of quality of healthcare. These include enhanced client exit surveys, observation of health staff, health staff knowledge vignettes, explicit consideration of population health, clinic benchmarking and peer review, and the standardised or mystery patient approach.
The health research team with ReSEP has actively been working on improving our understanding and use of alternative measurement approaches for the quality of healthcare. This includes the use of anchoring vignettes in user satisfaction surveys, the inclusion of more objective measures on the delivery of care in exit interviews and the standardized or mystery patient approach. We recently completed a small-scale pilot using the standardized patient approach in a number of public sector primary healthcare facilities in a province of South Africa. During 2016 this will be expanded to a second province of South Africa, allowing us to learn about the benefits and shortcomings of the approach.
Accurate, reliable real-time facility data on quality of healthcare services is required for learning and improvement within these facilities, but also at a higher level. Ultimately, this data should be used to not only encourage performance, but also identify pockets of under- and over-performance which will allow for the identification of the factors that facilitate this. Accurate data on quality and performance at PHC facility level has an essential role in encouraging transparency and public accountability. By moving this data to publically accessible platforms it can enable informed choices by clients and eventually allow for greater competition between facilities.