Muinga Naomi, Ayieko Philip, Opondo Charles, Ntoburi Stephen, Todd Jim, Allen Elizabeth, English Mike
KEMRI/Wellcome Trust Research Programme, Nairobi, Kenya.
BMC Health Serv Res. 2014 Jun 28;14:282. doi: 10.1186/1472-6963-14-282.
The 'resource readiness' of health facilities to provide effective services is captured in the structure component of the classical Donabedian paradigm often used for assessment of the quality of care in the health sector. Periodic inventories are commonly used to confirm the presence (or absence) of equipment or drugs by physical observation or by asking those in charge to indicate whether an item is present or not. It is then assumed that this point observation is representative of the everyday status. However the availability of an item (consumables) may vary. Arguably therefore a more useful assessment for resources would be one that captures this fluctuation in time. Here we report an approach that may circumvent these difficulties.
We used self-administered questionnaires (SAQ) to seek health worker views of availability of key resources supporting paediatric care linked to a cluster randomized trial of a multifaceted intervention aimed at improving this care conducted in eight rural Kenyan district hospitals. Four hospitals received a full intervention and four a partial intervention. Data were collected pre-intervention and after 6 and 18 months from health workers in three clinical areas asked to score item availability using an 11-point scale. Mean scores for items common to all 3 areas and mean scores for items allocated to domains identified using exploratory factor analysis (EFA) were used to describe availability and explore changes over time.
SAQ were collected from 1,156 health workers. EFA identified 11 item domains across the three departments. Mean availability scores for these domains were often <5/10 at baseline reflecting lack of basic resources such as oxygen, nutrition and second line drugs. An improvement in mean scores occurred in 8 out of 11 domains in both control and intervention groups. A calculation of difference in difference of means for intervention vs. control suggested an intervention effect resulting in greater changes in 5 out of 11 domains.
Using SAQ data to assess resource availability experienced by health workers provides an alternative to direct observations that provide point prevalence estimates. Further the approach was able to demonstrate poor access to resources, change over time and variability across place.
卫生设施提供有效服务的“资源就绪情况”体现在经典的唐纳贝迪安范式的结构组成部分中，该范式常用于评估卫生部门的医疗质量。定期盘点通常用于通过实地观察或询问负责人物品是否存在来确认设备或药品的有无。然后假定这种点观察代表日常状态。然而，物品（消耗品）的可用性可能会有所不同。因此，可以说，对资源进行更有用的评估应该是能够捕捉这种随时间波动的评估。在此，我们报告一种可能规避这些困难的方法。
我们使用自填式问卷（SAQ）来征求卫生工作者对支持儿科护理的关键资源可用性的看法，该问卷与一项在肯尼亚八个农村地区医院进行的旨在改善此类护理的多方面干预措施的整群随机试验相关。四家医院接受了全面干预，四家接受了部分干预。在干预前以及干预6个月和18个月后，从三个临床领域的卫生工作者那里收集数据，要求他们使用11分制对物品可用性进行评分。使用所有三个领域共有的物品的平均得分以及使用探索性因素分析（EFA）确定的分配到各个领域的物品的平均得分来描述可用性并探索随时间的变化。
从1156名卫生工作者那里收集了SAQ。EFA在三个部门中确定了11个项目领域。这些领域的平均可用性得分在基线时通常<5/10，这反映出缺乏基本资源，如氧气、营养物质和二线药物。对照组和干预组的11个领域中有8个领域的平均得分有所提高。干预组与对照组的均值差异差异计算表明，干预产生了效果，导致11个领域中有5个领域发生了更大的变化。
使用SAQ数据评估卫生工作者所经历的资源可用性，为提供点患病率估计的直接观察提供了一种替代方法。此外，该方法能够证明资源获取情况不佳、随时间的变化以及不同地点之间的差异。
