Ayanore Martin, Asampong Robert, Akazili James, Awoonor-Williams John Koku, Akweongo Patricia
School of Public Health, University of Health and Allied Sciences, Ho, Ghana.
School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
PLoS One. 2022 Jun 3;17(6):e0269546. doi: 10.1371/journal.pone.0269546. eCollection 2022.
Service availability and readiness are critical for the delivery of quality and essential health care services. In Ghana, there is paucity of literature that describes general service readiness (GSR) of primary health care (PHC) facilities within the national context. This study therefore assessed the GSR of PHC facilities in Ghana to provide evidence to inform heath policy and drive action towards reducing health inequities.
We analysed data from 140 Service Delivery Points (SDPs) that were part of the Performance Monitoring and Accountability 2020 survey (PMA2020). GSR was computed using the Service Availability and Readiness Assessment (SARA) manual based on four out of five components. Descriptive statistics were computed for both continuous and categorical variables. A multivariable binary logistic regression model was fitted to assess predictors of scoring above the mean GSR. Analyses were performed using Stata version 16.0. Significance level was set at p<0.05.
The average GSR index of SDPs in this study was 83.4%. Specifically, the mean GSR of hospitals was 92.8%, whereas health centres/clinics and CHPS compounds scored 78.0% and 64.3% respectively. The least average scores were observed in the essential medicines and standard precautions for infection prevention categories. We found significant sub-national, urban-rural and facility-related disparities in GSR. Compared to the Greater Accra Region, SDPs in the Eastern, Western, Upper East and Upper West Regions had significantly reduced odds of scoring above the overall GSR. Majority of SDPs with GSR below the average were from rural areas.
Overall, GSR among SDPs is appreciable as compared to other settings. The study highlights the existence of regional, urban-rural and facility-related differences in GSR of SDPs. The reality of health inequities has crucial policy implications which need to be addressed urgently to fast-track progress towards the achievement of the SDGs and UHC targets by 2030.
服务的可及性和准备情况对于提供高质量的基本医疗服务至关重要。在加纳，缺乏在国家背景下描述初级卫生保健（PHC）机构总体服务准备情况（GSR）的文献。因此，本研究评估了加纳初级卫生保健机构的服务准备情况，以提供证据为卫生政策提供参考，并推动采取行动减少健康不平等。
我们分析了来自140个服务提供点（SDP）的数据，这些服务提供点是2020年绩效监测与问责制调查（PMA2020）的一部分。基于五个组成部分中的四个，使用服务可及性和准备情况评估（SARA）手册计算GSR。对连续变量和分类变量都进行了描述性统计。拟合了一个多变量二元逻辑回归模型，以评估得分高于平均GSR的预测因素。使用Stata 16.0版本进行分析。显著性水平设定为p<0.05。
本研究中服务提供点的平均GSR指数为83.4%。具体而言，医院的平均GSR为92.8%，而卫生中心/诊所和社区卫生规划服务点（CHPS）的得分分别为78.0%和64.3%。在基本药物和感染预防标准预防措施类别中观察到的平均得分最低。我们发现GSR在国家以下、城乡和机构相关方面存在显著差异。与大阿克拉地区相比，东部、西部、上东部和上西部地区的服务提供点得分高于总体GSR的几率显著降低。大多数GSR低于平均水平的服务提供点来自农村地区。
总体而言，与其他情况相比，服务提供点的GSR情况尚可。该研究突出了服务提供点在GSR方面存在区域、城乡和机构相关差异。健康不平等的现实具有关键的政策影响，需要紧急加以解决，以加快在2030年前实现可持续发展目标和全民健康覆盖目标的进展。
