Zeitz P S, Salami C G, Burnham G, Goings S A, Tijani K, Morrow R H
Department of International Health, Johns Hopkins University School of Hygiene and Public Health, Baltimore, MD 21205.
Int J Health Plann Manage. 1993 Jul-Sep;8(3):235-44. doi: 10.1002/hpm.4740080307.
Introduction. Management of primary health care (PHC) systems in less developed countries is often impeded by factors such as poorly trained personnel, limited financial resources, and poor worker morale. This study explored the ability of local-level PHC supervisors in rural Nigeria to use quality assurance (QA) management methods to improve the quality of the PHC system. Methods. PHC supervisors from Bama Local Government Area were trained for 3 days in the use of QA methods and tools. The supervisors targeted the supervisory system and the health information system (HIS) for improvement. Health worker performance in diarrhoea case management was assessed, using a simulated case, to measure the impact of supervision. A HIS audit assessed data collection forms used by 17 PHC facilities. Gaps in quality were monitored over a 2-month study period and flaws in work processes were modified. Results. PHC supervisors introduced a checklist during monthly visits to facilities to monitor how workers managed cases of diarrhoea. Performance in history-taking, physical examination, disease classification, treatment and counselling improved over the evaluation period. The HIS audit found that a variety of reporting forms were used at PHC facilities. After HIS reporting was standardized, the number of health facilities using a daily disease registry significantly improved during the study period. Conclusions. QA management methods were used by PHC supervisors in Nigeria to improve supervision and the HIS. QA management methods are appropriate for improving the quality of the PHC in Nigeria and in other less developed countries where at least a minimal PHC infrastructure exists.
引言。欠发达国家初级卫生保健（PHC）系统的管理常常受到一些因素的阻碍，如人员培训不足、财政资源有限以及工作人员士气低落。本研究探讨了尼日利亚农村地区基层初级卫生保健监督员运用质量保证（QA）管理方法来提高初级卫生保健系统质量的能力。方法。来自巴马地方政府辖区的初级卫生保健监督员接受了为期3天的质量保证方法和工具使用培训。监督员将监督系统和卫生信息系统（HIS）作为改进目标。通过模拟病例评估卫生工作者在腹泻病例管理方面的表现，以衡量监督的影响。对17个初级卫生保健机构使用的数据收集表进行了卫生信息系统审计。在为期2个月的研究期间监测质量差距，并对工作流程中的缺陷进行修正。结果。初级卫生保健监督员在每月对各机构的走访中引入了一份检查表，以监测工作人员对腹泻病例的管理情况。在评估期间，病史采集、体格检查、疾病分类、治疗和咨询方面的表现有所改善。卫生信息系统审计发现，初级卫生保健机构使用了多种报告表格。在卫生信息系统报告标准化后，在研究期间使用每日疾病登记册的卫生机构数量显著增加。结论。尼日利亚的初级卫生保健监督员运用质量保证管理方法来改善监督和卫生信息系统。质量保证管理方法适用于提高尼日利亚以及其他至少具备最低限度初级卫生保健基础设施的欠发达国家的初级卫生保健质量。
