Bawo Luke, Leonard Kenneth L, Mohammed Rianna
Ministry of Health and Social Welfare, Monrovia, Liberia.
Department of Agricultural and Resource Economics, University of Maryland, College Park, MD, 20740, USA.
Implement Sci. 2015 Jan 13;10:9. doi: 10.1186/s13012-014-0194-9.
Improving the quality of care at hospitals is a key next step in rebuilding Liberia's health system. In order to improve the efficiency, effectiveness, and quality of care at the secondary hospital level, the country is developing a system to upgrade health worker skills and competencies, and shifting towards improved provider accountability for results, including a Graduate Medical Residency Program (GMRP) and provider accountability for improvements in quality through performance-based financing (PBF) at the hospital level.
METHODS/DESIGN: This document outlines the protocol for the impact evaluation of the hospital improvement program. The evaluation will provide an estimate of the impact of the project and investigate the mechanism for success in a way that can provide general lessons about the quality of health care in low-income countries. The evaluation aims 1) to provide the best possible estimate of program impact and 2) to quantitatively describe the changes that took place within facilities as a result of the program. In particular, the impact evaluation focuses on the changes in human resources within the hospitals. As such, we use a three-period intensive evaluation of treated and matched comparison hospitals to see how services change in treated hospitals as well as a continuous data collection effort to track the activities of individual health workers within treated hospitals.
We are particularly interested in understanding how facilities met quality targets. Did they bring in new health workers with higher qualifications? Did they improve the knowledge or competence of their existing staff? Did they improve the availability of medicines and equipment so that the capacities of existing health workers were improved? Did they address the motivation of health workers so that individuals with the same competence and capacity were able to provide higher quality? And, if they did improve quality, did patients notice?
提高医院护理质量是重建利比里亚卫生系统的关键下一步。为了提高二级医院护理的效率、效果和质量，该国正在开发一个提升卫生工作者技能和能力的系统，并转向加强提供者对结果的问责制，包括研究生医学住院医师培训计划（GMRP）以及通过医院层面基于绩效的融资（PBF）来加强提供者对质量改进的问责。
方法/设计：本文概述了医院改进计划影响评估的方案。该评估将估计项目的影响，并以一种能够为低收入国家医疗保健质量提供普遍经验教训的方式调查成功机制。评估旨在：1）尽可能准确地估计项目影响；2）定量描述因该计划而在医疗机构内部发生的变化。特别是，影响评估侧重于医院内部人力资源的变化。因此，我们对接受治疗的医院和匹配的对照医院进行为期三个阶段的深入评估，以观察接受治疗的医院服务如何变化，同时持续进行数据收集工作，以跟踪接受治疗医院内个体卫生工作者的活动。
我们特别感兴趣的是了解医疗机构如何实现质量目标。他们是否引进了资质更高的新卫生工作者？他们是否提高了现有员工的知识或能力？他们是否改善了药品和设备的供应，从而提高了现有卫生工作者的能力？他们是否解决了卫生工作者的积极性问题，以便具有相同能力和资质的个人能够提供更高质量的服务？而且，如果他们确实提高了质量，患者是否注意到了？
