Section of Health Policy and Administration, School of Public Health, New Haven, CT, USA.
BMC Health Serv Res. 2011 Oct 20;11:282. doi: 10.1186/1472-6963-11-282.
As low- and middle-income countries experience economic development, ensuring quality of health care delivery is a central component of health reform. Nevertheless, health reforms in low- and middle-income countries have focused more on access to services rather than the quality of these services, and reporting on quality has been limited. In the present study, we sought to examine the prevalence and regional variation in key management practices in Egyptian health facilities within three domains: supervision of the facility from the Ministry of Health and Population (MOHP), managerial processes, and patient and community involvement in care.
We conducted a cross-sectional analysis of data from 559 facilities surveyed with the Egyptian Service Provision Assessment (ESPA) survey in 2004, the most recent such survey in Egypt. We registered on the Measure Demographic and Health Survey (DHS) website http://legacy.measuredhs.com/login.cfm to gain access to the survey data. From the ESPA sampled 559 MOHP facilities, we excluded a total of 79 facilities because they did not offer facility-based 24-hour care or have at least one physician working in the facility, resulting in a final sample of 480 facilities. The final sample included 76 general service hospitals, 307 rural health units, and 97 maternal and child health and urban health units (MCH/urban units). We used standard frequency analyses to describe facility characteristics and tested the statistical significance of regional differences using chi-square statistics.
Nearly all facilities reported having external supervision within the 6 months preceding the interview. In contrast, key facility-level managerial processes, such as having routine and documented management meetings and applying quality assurance approaches, were uncommon. Involvement of communities and patients was also reported in a minority of facilities. Hospitals and health units located in Urban Egypt compared with more rural parts of Egypt were significantly more likely to have management committees that met at least monthly, to keep official records of the meetings, and to have an approach for reviewing quality assurance activities.
Although the data precede the recent reform efforts of the MOHP, they provide a baseline against which future progress can be measured. Targeted efforts to improve facility-level management are critical to supporting quality improvement initiatives directed at improving the quality of health care throughout the country.
随着中低收入国家经济的发展，确保医疗保健服务质量是卫生改革的核心组成部分。然而，中低收入国家的卫生改革更多地关注服务的可及性，而不是这些服务的质量，而且质量报告也很有限。在本研究中，我们试图在三个领域内检查埃及卫生机构中关键管理实践的流行率和区域差异：卫生部对机构的监督、管理流程以及患者和社区对护理的参与。
我们对 2004 年埃及最近一次的埃及服务提供评估（ESPA）调查中对 559 个机构进行的横断面分析。我们在 Measure Demographic and Health Survey（DHS）网站（http://legacy.measuredhs.com/login.cfm）上注册，以获取调查数据。从 ESPA 抽样的 559 个卫生部设施中，我们总共排除了 79 个设施，因为它们不提供基于设施的 24 小时护理，或者至少有一名医生在该设施工作，因此最终样本为 480 个设施。最终样本包括 76 个综合服务医院、307 个农村卫生单位、97 个母婴保健和城市卫生单位（MCH/城市单位）。我们使用标准频率分析来描述设施特征，并使用卡方检验来检验区域差异的统计学显著性。
几乎所有设施都报告在访谈前 6 个月内有外部监督。相比之下，关键的设施级管理流程，如定期和记录管理会议以及应用质量保证方法，并不常见。社区和患者的参与也只在少数设施中报告。与更农村的埃及地区相比，位于埃及城市的医院和卫生单位更有可能至少每月召开管理委员会会议，保存会议的正式记录，并采取审查质量保证活动的方法。
尽管这些数据早于卫生部最近的改革努力，但它们提供了一个可以衡量未来进展的基准。有针对性地努力改善设施级管理对于支持旨在提高全国医疗保健质量的质量改进举措至关重要。
