Assessing the quality of healthcare services is
a priority in low-resource and high-resource
settings alike. It is, however, a complex
endeavour. Outcome measures are subject
to case-mix variation, often require lengthy
follow-up periods to manifest, and are generally costly to monitor. Therefore, structure
and process measures are routinely considered reliable alternatives under the assumption of a causal link between the provision of
care and improved health status.
In this edition of BMJ Global Health,
Giorgio et al used such structure and process
measures—that is, service delivery indicators (SDI)—to assess the quality of healthcare across 10 African countries.2
The SDI
programme was set up to conduct crosssectional nationally representative surveys
that examine service delivery performance
in education and health in Africa. The health
indicators assess health worker availability,
health worker knowledge on the management of common ailments, and availability
of selected essential equipment and treatments. These surveys are aimed at providing
high-level snapshots of the quality of health
services in target countries.
In this editorial, we discuss some of the
limits of using data from a platform such
as the SDI programme to make sense of
quality of care and highlight complementary
approaches that are aligned with emergent
thinking in the field.