Abstract
BackgroundImproving 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/designThis 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.DiscussionWe 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?
Highlights
Improving the quality of care at hospitals is a key step in rebuilding Liberia’s health system
We are 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?
Much of the physical infrastructure and equipment that were crucial to the health sector were destroyed during the war—many hospitals and clinics were burned to the ground; very few county hospitals had fully functional laboratories; most county hospitals and health centers were without running water, electricity, or functioning basic sanitary systems; and many health professionals, especially physicians, left the country
Summary
Improving the quality of care at hospitals is a key step in rebuilding Liberia’s health system. Much of the physical infrastructure and equipment that were crucial to the health sector were destroyed during the war—many hospitals and clinics were burned to the ground; very few county hospitals had fully functional laboratories; most county hospitals and health centers were without running water, electricity, or functioning basic sanitary systems; and many health professionals, especially physicians, left the country. The latter resulted in a severe shortage of human resources.
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