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Evaluating health worker performance in Benin using the simulated client method with real children.
Alexander K Rowe1, Faustin Onikpo, Marcel Lama
1Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Mailstop A06, 1600 Clifton Road NE, Atlanta, GA 30333, USA. axr9@cdc.gov
Implementation Science : IS
|October 10, 2012
Summary
Simulated client surveys using real children safely evaluate health worker performance, revealing conspicuous observation biases, especially after quality improvement interventions.
Area of Science:
- Health Services Research
- Global Health
- Quality Improvement
Background:
- The simulated client (SC) method offers more realistic health worker performance data than conspicuous observation (CO).
- Previous SC studies lacked real children, limiting pediatric performance evaluation.
- This study explored using real children as SCs for pediatric illness evaluations.
Purpose of the Study:
- To assess the feasibility and safety of using real children as simulated clients.
- To compare performance data from SC surveys versus CO surveys.
- To evaluate the validity of CO by comparing it with SC findings.
Main Methods:
- Conducted simultaneous SC and CO surveys in 55 health facilities.
- Utilized adult caretakers as surveyors with real children.
- Compared 27 performance indicators using logistic regression.
Main Results:
- No serious issues arose during the SC survey with real children.
- CO showed moderately higher performance levels (16.4 pp difference).
- Bias was significantly greater for IMCI-trained workers (29.7 pp difference) than non-IMCI workers (3.1 pp difference).
Conclusions:
- SC surveys with real children are feasible and safe with precautions.
- CO introduces significant positive performance bias.
- Quality improvement interventions may amplify CO biases.
