2017年-世界发展银行全球_Niger_Service_Delivery_Indicators___Health_2015_77页_2mb

Summary of Niger Service Delivery Indicators (Health, 2015)

Core Content

The report presents the findings from the first round of Service Delivery Indicators (SDI) surveys in the health sector of Niger, conducted between October and November 2015. It evaluates the performance of health service delivery in terms of provider effort, knowledge, inputs, and management, with a focus on quality and accessibility of care.

Main Findings

1. Provider Effort

• Absence Rate: On average, 33% of health workers are absent per day, with 82% of absences being approved. Public facilities report higher absence rates than private ones. Health centers have 1.8 times higher absence rates than health posts.
• Caseload: Adjusting for absence, health providers in Niger see an average of 9.8 outpatients per provider-day. Public facilities have a higher caseload than private ones (10.1 vs. 4.6). Hospitals have significantly lower caseloads (1.0) than health posts (6.1) or clinics (17.2).

2. Provider Knowledge and Ability

• Diagnostic Accuracy: Providers successfully diagnosed 31.5% of the five tracer conditions (malaria with anemia, acute diarrhea with severe dehydration, pneumonia, pulmonary tuberculosis, and diabetes mellitus). Private providers outperformed public ones in diagnosing diabetes (46.2% vs. 20.7%), while public providers failed to diagnose acute diarrhea with severe dehydration (3%).
• Adherence to Clinical Guidelines: Providers adhered to guidelines for 17.5% of the cases. Essential questions related to danger signs were often not asked. Public providers had better adherence to maternal and neonatal complication management than private ones.
• First Ante-natal Care Visit: Only 0.8% of providers correctly identified both pregnancy and anemia, while 91.7% diagnosed only pregnancy. Public providers performed better in identifying danger signs and key questions, but were more likely to miss anemia. Providers in Tahoua were less likely to identify anemia compared to those in Niamey.
• Severe Pre-eclampsia: 10.9% of providers correctly diagnosed severe pre-eclampsia, while 50.2% diagnosed pre-eclampsia in general. Public providers had better diagnostic performance than private ones. The recognition of pre-eclampsia without severity assessment was still significantly lower in Maradi, Tahoua, and Zinder compared to Niamey.

3. Inputs Available to Providers

• Drug Availability: On average, 50.4% of tracer drugs were available. Urban public facilities had better availability (60.5%) than rural ones (49.5%). Tracer drugs for children were more available than those for mothers.
• Equipment Availability: 35.9% of facilities had basic equipment available. Urban public facilities had significantly higher availability (77.2%) than rural ones (33.2%). Health posts had the lowest availability.
• Infrastructure Availability: 13.3% of facilities had safe drinking water, functional sanitation, and power available. Urban public facilities were 6.5 times more likely to have all three than rural public ones. Private facilities had better infrastructure than public ones.

4. Management, Supervision, and Community Engagement

• Leadership and Incentives: Facility heads rarely use incentives (positive: 33.5%, negative: 17.9%). Private facility heads are more than twice as likely to use positive incentives and 3.8 times more likely to use negative incentives.
• Supervision: Providers received visits on average once per quarter. Supervision worksheets were more commonly used in private and urban public facilities. Quality of care was more emphasized in private facilities (87.4%) than public ones (38%).
• Community Engagement: Only 6.8% of private facilities had functioning Health Facility Management Committees (HFMCs), compared to 96.5% of public ones. However, meeting minutes were missing in 40% of public facilities, with rural ones more likely to lack them.

Key Issues and Proposed Actions

Key Data Highlights

• Caseload per provider per day:

  • Niger: 9.8
  • Public: 9.9
  • Private: 5.7
  • Rural public: 10.1
  • Urban public: 8.2

• Absence rate:

  • Niger: 33.1%
  • Public: 33.3%
  • Private: 30.7%
  • Rural public: 31.1%
  • Urban public: 33.8%

• Diagnostic accuracy:

  • Niger: 31.5%
  • Public: 31.1%
  • Private: 38.7%
  • Rural public: 27.5%
  • Urban public: 38.8%

• Adherence to clinical guidelines:

  • Niger: 17.5%
  • Public: 17.5%
  • Private: 18.3%
  • Rural public: 17.3%
  • Urban public: 17.9%

• Management of maternal and neonatal complications:

  • Niger: 12.0%
  • Public: 12.1%
  • Private: 9.9%
  • Rural public: 12.1%
  • Urban public: 12.1%

• Drug availability:

  • Niger: 50.4%
  • Public: 50.4%
  • Private: 50.6%
  • Rural public: 49.5%
  • Urban public: 60.5%

• Equipment availability:

  • Niger: 35.9%
  • Public: 35.9%
  • Private: 34.3%
  • Rural public: 33.2%
  • Urban public: 77.2%

• Infrastructure availability:

  • Niger: 13.3%
  • Public: 10.7%
  • Private: 65.8%
  • Rural public: 7.9%
  • Urban public: 51.9%

Conclusion

The SDI findings highlight significant gaps in health service delivery in Niger, particularly in diagnostic accuracy, adherence to clinical guidelines, and management of maternal and neonatal complications. The report emphasizes the need for improved supervision, training, and incentives, as well as the strengthening of community engagement mechanisms and the development of standardized guidelines. The data also underscores the disparities between urban and rural, and public and private facilities, suggesting a need for targeted interventions to address these inequalities and improve service quality.