Measuring health system responsiveness in a national community health worker primary care programme in rural Liberia

Author:

Mendin Savior Flomo1,Krause Julie A1,Gweh Andrew2,Baysah Massaboi2,Nyumah Joseph1,Gaye Chris J1,Max Zorh T-1,Kraemer John D3ORCID,Subah Marion1,Hirschhorn Lisa R4ORCID

Affiliation:

1. Last Mile Health , Boston, MA, USA

2. Liberia Ministry of Health & Social Welfare , 77C6+984, Monrovia, Liberia

3. Department of Health Systems Administration, Georgetown University , 3700 O St NW, Washington, DC 20057, USA

4. Department of Medical Social Science, Northwestern University Feinberg School of Medicine , 625 N Michigan Ave 14-013, Chicago, IL 60611, USA

Abstract

Abstract As many low- and middle-income countries scale up community health worker (CHW) programmes to achieve universal health coverage, ensuring quality as well as access is critical. Health system responsiveness (HSR) is a core domain of quality patient-centred care but has not been widely measured in CHW-delivered care. We report results from a household survey measuring HSR and health systems’ quality of CHW-delivered care in two Liberian counties where the national CHW programme of Community Health Assistants (CHAs) for communities ≥5 km from a health centre has been implemented. We conducted a cross-sectional population-based household survey in 2019 in Rivercess (RC) and Grand Gedeh (GG) counties, using a two-stage cross-sectional cluster sampling approach. We included validated HSR questions on six responsiveness domains and patient-reported health system outcomes, such as satisfaction and trust in the CHA’s skills and abilities. The HSR questions were administered to women aged 18–49 years who reported seeking care from a CHA in the 3 months prior to the survey. A composite responsiveness score was calculated and divided into tertiles. Multivariable analysis using Poisson regression with log link and adjusting for respondent characteristics was used to determine the association between responsiveness and patient-reported health system outcomes. The proportion of individuals rating responsiveness as very good or excellent was similar across all domains within a district, with ratings being lower in RC (23–29%) than in GG (52–59%). High ratings in both counties were seen for high trust in the CHA’s skills and abilities (GG 84%, RC 75%) and high confidence in the CHA (GG 58%, RC 60%). Compared with women in the lowest responsiveness tertile (score ≤3), women in the highest tertile (score $ \ge $4.25) were significantly more likely to report high quality of CHA-delivered care (prevalence ratio, PR = 14.1), very good/excellent at meeting health needs (PR = 8.0), high confidence in the CHA to provide future care (PR = 2.4), and a high level of trust in CHA’s skills and abilities (PR = 1.4). Controlling for respondent characteristics, the composite responsiveness score was significantly associated with all patient-reported health system outcomes (P < 0.001). We found that HSR was associated with important patient-reported health system quality outcomes, including satisfaction, trust, and confidence in the CHA. Measuring patients’ experience and outcomes of care is important to complement more common measures of technical quality for CHW-delivered care to ensure that this domain of quality is central to the community health programme design and delivery.

Funder

Gavi, the Vaccine Alliance

Publisher

Oxford University Press (OUP)

Subject

Public Health, Environmental and Occupational Health,Health Policy,General Medicine

Reference22 articles.

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5. Towards patient-centred care in Ghana: health system responsiveness, self-rated health and experiential quality in a nationally representative survey;Ratcliffe;BMJ Open Quality,2020

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