Quality of care provided to sick children in health facilities in Ethiopia: a systematic review

Abstract

Abstract Background Despite the increasing number of primary studies on the quality of health care for sick children in Ethiopia, the findings have not been systematically synthesized to inform quality improvement in policies or strategies. This systematic review synthesized published evidence on the quality of care provided to sick children in Ethiopia's health facilities and on related barriers and enablers. Methods We searched studies that measured the structure, process, and outcome measures of quality of care as proposed by Donabedian’s framework. We searched in PubMed/Medline, EMBASE, and Web of Science using the Population, Concept, and Context (PCC) framework. Grey literature was searched in Google Scholar and institutional websites. We appraised the studies’ quality using the Mixed Method Quality Appraisal Tool version 2018. Data were analysed using content thematic analysis and presented using a narrative approach. Results We included 36 of 701 studies. Thirty (83.3%) were nonexperimental including 21 (70%) cross-sectional studies and 5 (16.7%) qualitative studies. Of the 31 facility-based studies, 29 (93.5%) were conducted in public facilities. The structural, technical and interpersonal processes of care were low quality. While some studies reported the effectiveness of interventions in reducing child mortality, the uptake of services and providers’ and caretakers’ experiences were suboptimal. The major structural barriers to providing quality care included inadequacy of essential drugs, supplies and equipment, training, clinical guidelines, and ambulance services. Caretakers’ non-compliance to referral advice was a common demand-side barrier. The enabling factors were implementing various health system strengthening interventions including quality improvement strategies such as user-centered service delivery and optimizing engagement of community-level structures such as health promotors and religious leaders to create demand. Conclusion The quality of care provided to sick children in health facilities is generally low in Ethiopia. Structural barriers were common constraints to quality care provision. Health systems strengthening and quality improvement interventions were identified as enablers. More research is needed on the quality of care provided in private facilities.