The medical competence of health care providers in sub-Saharan Africa: Evidence from 16 127 providers across 11 countries.

Health affairs scholar Pub Date : 2024-06-07 eCollection Date: 2024-06-01 DOI:10.1093/haschl/qxae066
Benjamin Daniels, Andres Yi Chang, Roberta Gatti, Jishnu Das
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Abstract

Despite a consensus that quality of care is critically deficient in low-income countries, few nationally representative studies provide comparable measures of quality of care across countries. To address this gap, we used nationally representative data from in-person administrations of clinical vignettes to measure the competence of 16 127 health care providers across 11 sub-Saharan African countries. Rather than large variations across countries, we found that 81% of the variation in competence is within countries and the characteristics of health care providers do not explain most of this variation. Professional qualifications-including cadre and education-are only weakly associated with competence: across our sample, one-third of nurses are more competent than the average doctor in the same country and one-quarter of doctors are less competent than the average nurse. Finally, while younger cohorts do tend to be more competent, perhaps reflecting improvements in medical education, it would take 25 decades of turnover to improve care by 10 percentage points, on average, if we were to rely on such improvements alone. These patterns necessitate a fundamentally different approach to health care human resource management, calling into question typical staffing policies based on qualifications and seniority rather than directly measured quality.

撒哈拉以南非洲医疗服务提供者的医疗能力:来自 11 个国家 16 127 名医疗服务提供者的证据。
尽管人们一致认为低收入国家的医疗质量严重不足,但很少有具有全国代表性的研究能对不同国家的医疗质量进行可比较的测量。为了弥补这一不足,我们使用了具有全国代表性的数据,这些数据来自于临床小节的现场管理,用于测量 11 个撒哈拉以南非洲国家的 16 127 名医疗服务提供者的能力。我们发现,81% 的能力差异发生在国家内部,而不是国家之间的巨大差异,医疗服务提供者的特征并不能解释其中的大部分差异。职业资格(包括干部和教育程度)与能力只有微弱的联系:在我们的样本中,三分之一的护士比同一国家的普通医生能力更强,四分之一的医生比普通护士能力更弱。最后,虽然年轻一代的能力确实更强,这或许反映了医学教育的进步,但如果我们仅仅依靠这种进步,平均需要 25 年的人员流动才能将医疗水平提高 10 个百分点。根据这些模式,我们有必要从根本上改变医疗保健人力资源管理的方法,对基于资历和年资而非直接衡量质量的典型人员配备政策提出质疑。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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