An Analysis of Clinical Knowledge, Absenteeism, and Availability of Resources for Maternal andChild Health : A Cross-Sectional Quality of Care Study in 10 African Countries

This paper assesses the quality of health care across African countries based on healthproviders' clinical knowledge, their clinic attendance, and drug availability, with a focus on seven conditionsaccounting for a large share of child and maternal mortality: malaria, tuberculosis, diarrhea, pneumonia,diabetes, neonatal asphyxia, and postpartum hemorrhage. With nationally representative, cross-sectional data from 10countries in Sub-Saharan Africa, collected using clinical vignettes, unannounced visits, and visual inspections offacilities, this study assesses whether health providers are available and have sufficient knowledge and means todiagnose and treat patients suffering from common conditions amenable to primary health care. The study draws on datafrom 8,061 primary and secondary care facilities in Kenya, Madagascar, Mozambique, Nigeria, Niger, Senegal, SierraLeone, Tanzania, Togo, and Uganda, and 22,746 health workers. These data were gathered under the Service DeliveryIndicators program. Across all conditions and countries, health care providers were able to correctly diagnose 64percent of the clinical vignette cases, and in 45 percent of the cases, the treatment plan was aligned with the correctdiagnosis. For diarrhea and pneumonia, two common causes of under-five deaths, 27 percent of the providers correctlydiagnosed and prescribed the appropriate treatment for both conditions. On average, 70 percent of health workers werepresent in the facilities to provide care during facility hours when those workers were scheduled to be on duty. Takentogether, the estimated likelihood that a facility has at least one staff present with competency and the key inputsrequired to provide child, neonatal, and maternity care that meets minimum quality standards is 14 percent. Poor clinicalknowledge is a greater constraint in care readiness than drug availability or health workers' absenteeism in the10 countries. However, the paper documents substantial heterogeneity across countries.