by Hannah H. Leslie, Zeye Sun, Margaret E. Kruk
PLoS Med 14(12): e1002464, Published: December 12, 2017
It is increasingly apparent that access to healthcare without adequate quality of care is insufficient to improve population health outcomes. The authors assess whether the most commonly measured attribute of health facilities in low- and middle-income countries (LMICs) – the structural inputs to care – predicts the clinical quality of care provided to patients. They conclude that inputs to care are poorly correlated with provision of evidence-based care in these 4 clinical services. Healthcare workers in well-equipped facilities often provided poor care and vice versa. While it is important to have strong infrastructure, it should not be used as a measure of quality. Insight into health system quality requires measurement of processes and outcomes of care.