Rethinking assumptions about delivery of healthcare: implications for universal health coverage

Abstract

Simply providing more resources for universal coverage is not enough to improve health, argue Jishnu Das and colleagues. We also need to ensure good quality of care

Fig 1

Total time spent by healthcare providers with patients over a day. The sample from Madhya Pradesh, includes 199 private providers (mostly untrained) and 119 providers in public clinics. The sample from Birbhum, is 256 providers in rural locations, most of whom are not formally trained. The survey from Vietnam is based on a representative sample of 214 commune health facilities (similar to primary health centres) and 171 district hospitals

Fig 2

Variations in medical knowledge of medical officers (fully trained doctors) and nurses assessed by World Bank’s Service Delivery Indicators Survey. The boxes show 25th percentile, median, and 75th percentile adherence to condition specific checklist items for the common illnesses, with the whiskers giving the 10th and 90th percentiles

Fig 3

Relation between medical qualification and knowledge among doctors in Vietnam, as assessed by medical vignettes. The circles show the number of providers in each bin of 0.1 standard deviation across the entire distribution. The corresponding density plots (relative scale) are calculated from the underlying unbinned distributions

Fig 4

Differences between how providers said they would manage diarrhoea and turberculosis in clinical vignettes and what they actually did with standardised patients presenting with the symptoms in the vignettes (ORS=oral replacement solution, AFB=acid fast bacilli test, CXR=chest radiography)