Browsing by Author "Rinke De Wit, T.F."
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Item Comparison of perceived and technical healthcare quality in primary health facilities: Implications for a sustainable National Health Insurance Scheme in Ghana(Public Library of Science, 2015) Alhassan, R.K.; Duku, S.O.; Janssens, W.; Nketiah-Amponsah, E.; Spieker, N.; Van Ostenberg, P.; Arhinful, D.K.; Pradhan, M.; Rinke De Wit, T.F.Background: Quality care in health facilities is critical for a sustainable health insurance system because of its influence on clients' decisions to participate in health insurance and utilize health services. Exploration of the different dimensions of healthcare quality and their associations will help determine more effective quality improvement interventions and health insurancesustainability strategies, especially in resource constrained countries in Africa where universal access to good quality care remains a challenge. Purpose: To examine the differences in perceptions of clients and health staff on quality healthcareand determine if these perceptions are associated with technical quality proxies in health facilities. Implications of the findings for a sustainable National Health Insurance Scheme (NHIS) in Ghana are also discussed. Methods: This is a cross-sectional study in two southern regions in Ghana involving 64 primary health facilities: 1,903 households and 324 health staff. Data collection lasted from March to June, 2012. AWilcoxon-Mann-Whitney test was performed to determine differences in client and health staff perceptions of quality healthcare. Spearman's rank correlation test was used toascertain associations between perceived and technical quality care proxies in health facilities, and ordered logistic regression employed to predict the determinants of client and staff-perceived quality healthcare. Results: Negative association was found between technical quality and client-perceived quality care (coef. = -0.0991, p<0.0001). Significant staff-client perception differences were found in all healthcare quality proxies, suggesting some level of unbalanced commitment to qualityimprovement and potential information asymmetry between clients and service providers. Overall, the findings suggest that increased efforts towards technical quality care alone willnot necessarily translate into better client-perceived quality care and willingness to utilize health services in NHIS-accredited health facilities. Conclusion: There is the need to intensify client education and balanced commitment to technical andperceived quality improvement efforts. This will help enhance client confidence in Ghana's healthcare system, stimulate active participation in the national health insurance, increasehealthcare utilization and ultimately improve public health outcomes.Item Effect of community engagement interventions on patient safety and risk reduction efforts in primary health facilities: Evidence from Ghana(Public Library of Science, 2015) Alhassan, R.K.; Nketiah-Amponsah, E.; Spieker, N.; Arhinful, D.K.; Ogink, A.; Van Ostenberg, P.; Rinke De Wit, T.F.Background Patient safety and quality care remain major challenges to Ghana's healthcare system. Like many health systems in Africa, this is largely because demand for healthcare is outstripping available human and material resource capacity of healthcare facilities and new investment is insufficient. In the light of these demand and supply constraints, systematic community engagement (SCE) in healthcare quality assessment can be a feasible and cost effective option to augment existing quality improvement interventions. SCE entails structured use of existing community groups to assess healthcare quality in health facilities. Identified quality gaps are discussed with healthcare providers, improvements identified and rewards provided if the quality gaps are closed. Purpose This paper evaluates whether or not SCE, through the assessment of health service quality, improves patient safety and risk reduction efforts by staff in healthcare facilities. Methods A randomized control trail was conducted in 64 primary healthcare facilities in the Greater Accra and Western regions of Ghana. Patient risk assessments were conducted in 32 randomly assigned intervention and control facilities. Multivariate multiple regression test was used to determine effect of the SCE interventions on staff efforts towards reducing patient risk. Spearman correlation test was used to ascertain associations between types of community groups engaged and risk assessment scores of healthcare facilities. Findings Clinic staff efforts towards increasing patient safety and reducing risk improved significantly in intervention facilities especially in the areas of leadership/accountability (Coef. = 10.4, p<0.05) and staff competencies (Coef. = 7.1, p<0.05). Improvement in service utilization and health resources could not be attributed to the interventions because these were outside the control of the study and might have been influenced by institutional or national level developments between the baseline and follow-up period. Community groups that were gender balanced, religious/faith-based, and had structured leadership appeared to be better options for effective SCE in healthcare quality assessment. Conclusion Community engagement in healthcare quality assessment is a feasible client-centered quality improvement option that should be discussed for possible scale-up in Ghana and other resource poor countries in Africa. © 2015 Alhassan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.