Assessment of Providers' Performance in Implementing Child Health Services in Primary Health Care Centers in Al-Ramadi City
Al- Anbar Medical Journal,
2015, Volume 12, Issue 1, Pages 67-78
AbstractBackground: The demand for high quality health care for children has been constantly increasing. Performance assessment of primary care providers in this context facilitates the control of whether objectives are being achieved by primary health care settings and gives information about which areas of their performance should be improved.
Objectives: The aim of the study was to assess primary health care providers' performance in the implementation of selected child health care Programmes: 1- Acute respiratory tract infection Programme , 2- Expanded Programme of immunization, and 3- Growth monitoring Programme.
Methodology: A cross sectional observational health center- based study was conducted during the period from October 2012 to February 2013 in ten PHC centers in Al-Ramadi City, 7main and 3 sub centers, chosen randomly and constituted 25% of all PHC centers in the area.The providers' performance was assessed and validated in case management for 638 children under 5 years of age, attending those centers with acute respiratory infection. Providers' Performance in implementing EPI and growth monitoring Programmes on 300 children was also evaluated through observation of process.
Results: Results showed that history taking and examination performed were less than adequate for the majority of cases in both main and sub centers. The sensitivity of doctors in charge to diagnose pneumonia and severe pneumonia was very low (23.2%) in main centers, and their specificity was 99.4%. While the sensitivity of medical assistants in sub centers was 0% and specificity of 100%.
Providers performance was very satisfactory in the technique of vaccine administration in both main and sub centers, and satisfactory in recording 66.3% of vaccination cards in main centers and only for 6.2% in sub centers. On the other hand, their performance in health education on vaccination was poor for 30% of vaccinated children in main centers, and for all (100%) of children attending sub centers.
Results also showed that Providers performance in weight and growth monitoring was satisfactory for nearly half of attending children in main centers, but poor in sub centers. Their performance in nutritional education was poor for 50% of children in main centers and in all (100% ) in sub centers.
Conclusion: Providers' performance in implementing child health care Programme was suboptimal in main primary health care centers and poor in sub centers.
The study highlights the need for Programme planners and health policy makers to undertake a major review of the quality of child health care delivery focusing more on issues relating to providers' performance, and with particular emphasis on health workers training and appropriate use of standard case management guidelines
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