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There is growing recognition that access to healthcare facilities is unlikely to improve health outcomes if the quality of the care provided at these facilities is inadequate. The emerging consensus on the importance of quality of health care is reflected in proposed policy reforms in South Africa, as well as in increased measurement of quality at primary health care facilities.

Through focus on clinical quality and client satisfaction, we provide a critique of current approaches used to measure quality. We argue that the measurement of quality will be strengthened by complementing current approaches with alternatives such as standardised clients and vignettes. Other alternative approaches that are also considered include health worker knowledge tests, direct observation and asking clients about the clinical dimensions of client-provider interaction. The presented alternative measures can help to overcome biases inherent in current approaches and assist in establishing a better understanding of the state of clinical quality in primary health care facilities.

More public debate is needed on meaningful, affordable and robust approaches to quality measurement. We recommend that such debates should consider and discuss the affordability, feasibility, reliability, credibility and relevance of current and alternative approaches.


Burger, R., Ranchod, S., Rossouw, L., & Smith, A. 2016. Strengthening the measurement of quality of public health care. 2016. In Padarath, A., King, J., Mackie, E.L and Casciola, J (eds.). South African Health Review 2016 (accredited journal). Durban: Health Systems Trust.