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Measuring the quality of child health care at first-level facilities
Eleanor Gouws1, Jennifer Bryce, George Pariyo
1Department of Child and Adolescent Health and Development, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland. gouwse@unaids.org
Insights
Developing better quality of care measures for sick children in developing countries is crucial. This study revised indices using expert and statistical reviews, improving their validity for program decisions.
Area of Science:
- Public Health
- Health Services Research
- Measurement in Health
Background:
- Effective guidelines exist for managing sick children in developing countries, yet service quality and coverage remain low.
- Accurate measurement tools are essential for sound policy and program decisions in public health.
- Existing quality of care indices may not be sufficiently valid or reliable for program decision-making.
Purpose of the Study:
- To develop and evaluate summary indices for measuring the quality of care for sick children in first-level health facilities.
- To compare expert-driven index development with a statistically validated approach.
- To propose revised indices with improved validity and reliability for child health care programs.
Main Methods:
- Initial index development through expert consultation and policy-maker involvement to ensure face validity.
- Statistical evaluation of content and construct validity, and reliability using data from the multi-country evaluation of integrated management of childhood illness (MCE).
- Cross-disciplinary research involving public health experts and statisticians.
Main Results:
- Expert review alone led to conceptual errors and inappropriate indicators, resulting in indices difficult to interpret and limited in validity.
- Statistical evaluation identified significant issues with the initial expert-derived indices.
- A revised set of indices, supported by both expert and statistical reviews, demonstrated validity and yielded consistent programmatic insights across Brazil, Tanzania, and Uganda.
Conclusions:
- Expert review is insufficient for developing valid and reliable health program measures; statistical validation is critical.
- Revised summary indices improve the measurement of child health care quality in developing countries.
- Enhanced measurement tools can support policymakers and program planners to improve health facility care and child survival outcomes.
Abstract:
Sound policy and program decisions require timely information based on valid and relevant measures. Recent findings suggest that despite the availability of effective and affordable guidelines for the management of sick children in first-level health facilities in developing countries, the quality and coverage of these services remains low. We report on the development and evaluation of a set of summary indices reflecting the quality of care received by sick children in first-level facilities. The indices were first developed through a consultative process to achieve face validity by involving technical experts and policymakers. The definition of evaluation measures for many public health programs stops at this point. We added a second phase in which standard statistical techniques were used to evaluate the content and construct validity of the indices and their reliability, drawing on data sets from the multi-country evaluation of integrated management of childhood illness (MCE) in Brazil, Tanzania and Uganda. The statistical evaluation identified important conceptual errors in the indices arising from the theory-driven expert review. The experts had combined items into inappropriate indicators resulting in summary indices that were difficult to interpret and had limited validity for program decision making. We propose a revised set of summary indices for the measurement of child health care in developing countries that is supported by both expert and statistical reviews and that led to similar programmatic insights across the three countries. We advocate increased cross-disciplinary research within public health to improve measurement approaches. Child survival policymakers, program planners and implementers can use these tools to improve their monitoring and so increase the health impact of investments in health facility care.
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