Ehiri J E, Oyo-Ita A E, Anyanwu E C, Meremikwu M M, Ikpeme M B
Department of Maternal & Child Health, School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
Child Care Health Dev. 2005 Mar;31(2):181-91. doi: 10.1111/j.1365-2214.2004.00493.x.
To assess the quality of child health services in primary health care (PHC) facilities in Calabar, south-east Nigeria.
Cross-sectional, descriptive design.
Key informant interviews, structured observation, self-administered questionnaire and focus group discussion.
Calabar, south-east Nigeria. Participants All 10 PHC facilities in Calabar, 252 PHC workers serving in the facilities, and 76 mothers whose children received care in the facilities.
Adequacy of structure (equipment and personnel); process (diagnosis, training and knowledge, use of national case-management algorithm, and supervision), and output (clients' satisfaction).
PHC facilities were adequately equipped to the extent of providing immunization services and management of diarrhoea but not for other aspects of care expected of a PHC centre, including management of acute respiratory infections (ARI), a common problem in children in the region. Supply of essential drugs was inadequate in all centres and facilities for emergency care were lacking. Many of the health care workers (68.3%) had adequate training in immunization, and their knowledge scores on immunization issues (62%) was higher than in other aspect of PHC. Use of the national case management algorithm was low among PHC workers. Results of the focus group discussions with mothers showed that a few perceived quality of care to be poor. The main concerns were long waiting time, lack of essential drugs, and attitude of the health workers.
Inadequacy in the quality of child health services in PHC facilities is a product of failures in a range of quality measures -- structural (lack of equipment and essential drugs), process failings (non-use of the national case management algorithm and lack of a protocol of systematic supervision of health workers). Efforts to improve the quality of child health services provided by PHC workers in the study setting and similar locales in less developed countries should focus not only on resource-intensive structural improvements, but also on cheap, cost-effective measures that address actual delivery of services (process), especially the proper use of national guidelines for case management, and meaningful supervision.
评估尼日利亚东南部卡拉巴尔初级卫生保健（PHC）机构中儿童保健服务的质量。
横断面描述性设计。
关键 informant 访谈、结构化观察、自填问卷和焦点小组讨论。
尼日利亚东南部卡拉巴尔。参与者 卡拉巴尔的所有 10 个初级卫生保健机构、在这些机构工作的 252 名初级卫生保健工作者以及其孩子在这些机构接受护理的 76 位母亲。
结构（设备和人员）的充足性；过程（诊断、培训和知识、国家病例管理算法的使用以及监督）和产出（客户满意度）。
初级卫生保健机构在提供免疫服务和腹泻管理方面有足够的设备，但在初级卫生保健中心预期的其他护理方面不足，包括急性呼吸道感染（ARI）的管理，这是该地区儿童的常见问题。所有中心基本药物供应不足，且缺乏急诊护理设施。许多医护人员（68.3%）在免疫方面接受了充分培训，他们在免疫问题上的知识得分（62%）高于初级卫生保健的其他方面。初级卫生保健工作者中使用国家病例管理算法的比例较低。与母亲们的焦点小组讨论结果表明，一些人认为护理质量较差。主要问题是等待时间长、缺乏基本药物以及医护人员的态度。
初级卫生保健机构中儿童保健服务质量不足是一系列质量措施失败的结果——结构方面（缺乏设备和基本药物）、过程方面的失败（未使用国家病例管理算法以及缺乏对医护人员的系统监督协议）。在研究环境及欠发达国家类似地区，提高初级卫生保健工作者提供的儿童保健服务质量的努力不仅应侧重于资源密集型的结构改进，还应侧重于解决实际服务提供（过程）的廉价、具有成本效益的措施，特别是正确使用国家病例管理指南以及进行有意义的监督。
