Can social accountability mechanisms using community scorecards improve quality of pediatric care in rural Cambodia?. (27th June 2020)

• Record Type: Journal Article
• Authors: Edward, Anbrasi; Jung, Younghee; Chhorvann, Chea; Ghee, Annette E; Chege, Jane
• Is Part Of: International journal for quality in health care. Volume 32:Number 6(2020)
• Page Start: 364
• Page End: 372
• Publication Date: 2020-06-27
• Subjects: Cambodia -- Integrated Management of Childhood Illness -- community scorecards; Medical care -- Quality control -- Periodicals; 362.1068
• DOI: 10.1093/intqhc/mzaa052
• Languages: English
• ISSNs: 1353-4505

Abstract

Abstract: Objective: To determine the effect of social accountability strategies on pediatric quality of care. Design and Setting: A non-randomized quasi experimental study was conducted in four districts in Cambodia and all operational public health facilities were included. Participants: Five patients under 5 years and their caretakers were randomly selected in each facility. Interventions: To determine the effect of maternal and child health interventions integrating citizen voice and action using community scorecards on quality of pediatric care. Outcome Measures: Patient observations were conducted to determine quality of screening and counseling, followed by exit interviews with caretakers. Results: Results indicated significant differences between intervention and comparison facilities; screening by Integrated Management of Childhood Illness (IMCI) trained providers (100% vs 67%, P < 0.019), screening for danger signs; ability to drink/breastfeed (100% vs 86.7%, P < 0.041), lethargy (86.7% vs 40%, P < 0.004) and convulsions (83.3 vs 46.7%, P < 0.023). Screening was significantly higher for patients in the intervention facilities for edema (56.7% vs 6.7%, P < 0.000), immunization card (90% vs 40%, P < 0.002), child weight (100 vs 86.7, P < 0.041) and checking growth chart (96.7% vs 66.7%, P < 0.035). The IMCI index, constructed from key performance indicators, was significantly higher for patients in the intervention facilities than comparison facilities (screening index 8.8 vs 7.0, P < 0.018, counseling index 2.7 vs 1.5, P < 0.001). Predictors of screening quality were child age, screening by IMCI trained provider, wealthier quintiles and intervention facilities. Conclusion: The institution of social accountability mechanisms to engage communities and facility providers showed some improvements in quality of care for common pediatric conditions, but socioeconomic disparities were evident.