Association between Sick Child Facility Readiness and Provision of Care at the Individual and Facility Level in Five Low- and Middle-Income Countries

Abstract

Abstract Background Raising the quality of health services is key to continued progress in improving child health, however, data on service quality are limited and difficult to interpret. The relationship between facility readiness and the provision of quality care is poorly characterized. Methods Using publicly available data sets from five low- and middle-income countries (LMICs), we assessed 1) how structural factors enable or restrict provision of care and 2) how closely provision of healthcare aligns with structural factors for managing sick children. We developed indices for readiness and provision of care accounting for available indicators, expert opinion, and alignment with IMCI guidelines. In each country, we assessed the association between readiness and provision of care, with and without adjusting for other factors. We considered associations overall, by domain, and by provider type, explored non-linear associations, and compared associations at the individual and facility-level. Results The analysis included data from 3,149 health facilities and 11,159 sick child observations. In four of the five countries included in the analysis, we observed a significant positive association between readiness and provision of care with a magnitude of approximately 0.1 after adjusting for facility type and managing authority. There was little evidence of a non-linear relationship or a threshold effect altering the relationship between readiness and provision of care. Beyond readiness, younger child age, higher cost of care, and having a respiratory, digestive, or febrile diagnosis were most often associated with a higher quality of care. Higher “human resources” readiness domain scores were most consistently associated with better provision of care, while the provision of care domain of “treatment” was the least influenced by readiness. Facility-level associations did not vary greatly from individual-level associations. Conclusions These analyses suggest facility readiness plays a significant but limited role in the quality of case management provided to children with common illnesses of early childhood. Data for assessing provision of health services are limited, presenting challenges for understanding health worker actions. We need better data to assess the quality of care being delivered in LMICs to understand what factors drive health worker decision-making, with the ultimate goal of improving the management of sick children.