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Measuring the quality of child health care at first-level facilities


  • Gouws, Eleanor
  • Bryce, Jennifer
  • Pariyo, George
  • Armstrong Schellenberg, Joanna
  • Amaral, João
  • Habicht, Jean-Pierre


Sound policy and program decisions require timely information based on valid and relevant measures. Recent findings suggest that despite the availability of effective and affordable guidelines for the management of sick children in first-level health facilities in developing countries, the quality and coverage of these services remains low. We report on the development and evaluation of a set of summary indices reflecting the quality of care received by sick children in first-level facilities. The indices were first developed through a consultative process to achieve face validity by involving technical experts and policymakers. The definition of evaluation measures for many public health programs stops at this point. We added a second phase in which standard statistical techniques were used to evaluate the content and construct validity of the indices and their reliability, drawing on data sets from the multi-country evaluation of integrated management of childhood illness (MCE) in Brazil, Tanzania and Uganda. The statistical evaluation identified important conceptual errors in the indices arising from the theory-driven expert review. The experts had combined items into inappropriate indicators resulting in summary indices that were difficult to interpret and had limited validity for program decision making. We propose a revised set of summary indices for the measurement of child health care in developing countries that is supported by both expert and statistical reviews and that led to similar programmatic insights across the three countries. We advocate increased cross-disciplinary research within public health to improve measurement approaches. Child survival policymakers, program planners and implementers can use these tools to improve their monitoring and so increase the health impact of investments in health facility care.

Suggested Citation

  • Gouws, Eleanor & Bryce, Jennifer & Pariyo, George & Armstrong Schellenberg, Joanna & Amaral, João & Habicht, Jean-Pierre, 2005. "Measuring the quality of child health care at first-level facilities," Social Science & Medicine, Elsevier, vol. 61(3), pages 613-625, August.
  • Handle: RePEc:eee:socmed:v:61:y:2005:i:3:p:613-625

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    References listed on IDEAS

    1. Glei, Dana A. & Goldman, Noreen & Rodríguez, Germán, 2003. "Utilization of care during pregnancy in rural Guatemala: does obstetrical need matter?," Social Science & Medicine, Elsevier, vol. 57(12), pages 2447-2463, December.
    2. repec:aph:ajpbhl:2001:91:10:1625-1635_2 is not listed on IDEAS
    3. Williams, Holly Ann & Jones, Caroline O. H., 2004. "A critical review of behavioral issues related to malaria control in sub-Saharan Africa:: what contributions have social scientists made?," Social Science & Medicine, Elsevier, vol. 59(3), pages 501-523, August.
    4. Radyowijati, Aryanti & Haak, Hilbrand, 2003. "Improving antibiotic use in low-income countries: an overview of evidence on determinants," Social Science & Medicine, Elsevier, vol. 57(4), pages 733-744, August.
    5. Howteerakul, Nopporn & Higginbotham, Nick & Freeman, Sonia & Dibley, Michael J., 2003. "ORS is never enough: physician rationales for altering standard treatment guidelines when managing childhood diarrhoea in Thailand," Social Science & Medicine, Elsevier, vol. 57(6), pages 1031-1044, September.
    6. Franco, Lynne Miller & Bennett, Sara & Kanfer, Ruth & Stubblebine, Patrick, 2004. "Determinants and consequences of health worker motivation in hospitals in Jordan and Georgia," Social Science & Medicine, Elsevier, vol. 58(2), pages 343-355, January.
    7. Criel, Bart & Waelkens, Maria Pia, 2003. "Declining subscriptions to the Maliando Mutual Health Organisation in Guinea-Conakry (West Africa): what is going wrong?," Social Science & Medicine, Elsevier, vol. 57(7), pages 1205-1219, October.
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    Cited by:

    1. Martine AUDIBERT, 2009. "Issues and Challenges of Measurement of Health:Implications for Economic Research," Working Papers 200922, CERDI.
    2. World Bank, 2011. "Tajikistan - Quality of Child Health Services," World Bank Other Operational Studies 2793, The World Bank.
    3. David Bishai & Gita Mirchandani & George Pariyo & Gilbert Burnham & Robert Black, 2008. "The cost of quality improvements due to integrated management of childhood illness (IMCI) in Uganda," Health Economics, John Wiley & Sons, Ltd., vol. 17(1), pages 5-19.
    4. Friend-du Preez, Natalie & Cameron, Noël & Griffiths, Paula, 2013. "“So they believe that if the baby is sick you must give drugs…” The importance of medicines in health-seeking behaviour for childhood illnesses in urban South Africa," Social Science & Medicine, Elsevier, vol. 92(C), pages 43-52.


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