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PERFORMANCE OF HEALTH FACILITIES IN NHIS ACCREDITATION: AN ANALYSIS OF NHIS ACCREDITATION DATA JULY 2009-DECEMBER 2012 Preliminary Findings. PREAMBLE.
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PERFORMANCE OF HEALTH FACILITIES IN NHIS ACCREDITATION:AN ANALYSIS OF NHIS ACCREDITATION DATAJULY 2009-DECEMBER 2012Preliminary Findings
PREAMBLE • Presentation is part of a study into the performance of health facilities in the NHIS accreditation aimed at supporting weaker facilities and accreditation in Ghana • Commissioned by IFC and supported by IFC, NHIA, GHS and SPMDP • Key investigator Dr Nicholas A. Tweneboa supported by: • GHS: Mrs Susana Larbi Wumbee and Mrs Christiana Akufo • SPMDP: Dr Kwasi Odoi-Agyarko • NHIA: Mrs Vivian Addo-Cobbiah and Mrs Constance Addo Quaye • Analysis of NHIS accreditation data and field work • Data analysis by consultant and Mrs Addo-Cobbiah still in progress. Following are preliminary findings.
PRESENTATION OUTLINE INTRODUCTION ANALYSIS 1 • Nationwide performance of all facilities • Performance by region ANALYSIS 2 • Performance by facility type ANALYSIS 3 • Performance by ownership (1° hospitals, clinics /health centres, maternity homes) Note: Further analysis in progress
INTRODUCTION – ACCREDITATION PROCESS • Facility applies • Application vetted • Facility inspected by trained accreditation surveyors • Data analysed • Accreditation decision made • Communication of inspection result and accreditation decision • Accreditation certificates issued (not done in most cases) • Post accreditation monitoring (not systematic)
Introduction 2 – GRADING • Grade A+ 90-100% overall score and pass in critical areas • Grade A: 80-89% • Grade B: 70-79% • Grade C: 60-69% • Grade D: 50-59% • Grade E (Fail): Less than 50% • Provisional: fail but provisional to create access
ACCREDITATION DATA ANALYSIS – 1PERFORMANCE NATIONWIDE AND BY REGION
PERFORMANCE NATIONWIDE • 3,701 facilities were inspected between July 2009 and December 2012 • The 3,701 includes 11 secondary hospitals of which 2 had A, 8 had B and 1 had C. • Most of the facilities inspected (over 95%) passed and were accredited; 4.3% failed • Majority of the facilities (73%) obtained Grade C or D • 101 facilities (2.7%) obtained A+ or A
Performance nationwide – 2 • 835 facilities (22.5%) obtained top three grades (A+, A, B) and 2,866 (77.4%) obtained lowest three grades (C, D, E or fail) • Conclusion • The nationwide pass rate of facilities in the NHIS accreditation was high but the quality of the passes was not impressive
PERFORMANCE BY REGION • The region with the largest number of inspected facilities is Ashanti (617 or 16.7% of facilities inspected nationwide), followed by Eastern Region (456 or 12.3%) and Western Region (453 or 12.2%) • By pass rate or failure rate alone, the best performing regions are Eastern (failure rate of 1.4%), Upper West (2.2%) and Upper East (2.8%) • By pass rate or failure rate alone, the least performing regions are Brong Ahafo (7.9% failure rate) followed by Volta (6.2%) and Greater Accra (5.2%)
Performance by region – 2 • Based on the quality of the passes, best performing regions are Central (36.6% of inspected facilities obtained A+, A or B), Upper East (34%) and Upper West (32.6%). • Hence Upper East and Upper West performed well on both pass rate and quality of passes • However, on quality of passes, Eastern dropped from 1st to a distant 5th (20.0%, falling below the national average of 22.6% inspected facilities obtaining A+, A or B)
Performance by region – 3 • The three least performing regions were Volta (12% inspected facilities fell in the A+, A, B bracket), Brong Ahafo (13.2%) and Ashanti (14.7%) • Conclusion: • The best performing regions were not ‘better endowed’ ones but ‘less endowed’ regions
PERFORMANCE BY FACILITY TYPE • Largest number inspected was CHPS (1,077 of 3,701 or 29.1% inspected); least number was diagnostic (213 or 5.8% of inspected facilities) • By pass rate alone, the best performing facility type was CHPS (with pass rate of 98.7%), followed by primary hospitals (pass rate of 97.6%), health centres and maternity homes a joint third (96.5%) • By pass rate alone, the least performing facility types were clinics (with failure rate of 11.8%, chemical sellers (10.6%) and pharmacy (6.6%)
Performance by facility type - 2 • Adjusted for quality of passes, CHPS and primary hospital still lead (29.8% and 28.1% respectively inspected had Grade A+, A or B) • However, diagnostic moves up from 5th place to 3rd (27.7%) and pharmacy (22.4%) moves up from 6th to 4th • Maternity home (20.4%) and health centre (15.9%) move down from joint 3rd to 5th and 6th respectively • Clinic (15.9% obtaining A+, A or B) and chemical seller (11.0%) remain poorly performing
Performance by facility type – 3 • Conclusions • Primary hospitals and CHPS performed well in accreditation • Clinics and health centres which are midway between CHPS and primary hospitals in the referral chain performed poorly • Chemical sellers as a group was the least performing facility type
