Abstract
Introduction
The Level 2 Quality of Care Assessment (L2QCA) is a tool that is used to measure the process of delivering health care services in the health system in Cambodia. L2QCA was conducted in 2015 among 52 referral hospitals (RHs) and 543 health centers (HCs) across 15 provinces and the Phnom Penh led by the Ministry of Health (MOH). This 2015 assessment collected data on the quality of care (QoC), mainly the process of care, which is routinely offered at public health facilities. The results have been used extensively to improve healthcare services and tools to be more responsive to health facilities and to better reflect updated guidelines and standard operation procedures. Additionally, it serves as a baseline for the H-EQIP, which was implemented throughout Cambodia between 2016 and 2020. This 2017 assessment aimed to reassess the QoC via L2QCA tools for comparison with the baseline results to monitor whether there were improvements in program indicators supported by GIZ-supported provinces, such as Kampong Thom, Kampot and Kep provincial RHs.
Methods
This descriptive cross-sectional, referral hospital-based study was conducted at provincial and RHs in Kampong Thom, Kampot and Kep Provinces. In total, 9 health facilities (6 RHs and 3 provincial RHs), were assessed in August 2017. The data collection methods included document review, direct observation, and clinical vignettes. Twenty-five service modules of L2QCA out of 31 modules were used for this assessment. Medical doctors, midwives, registered nurses, and laboratory technicians were interviewed and observed for their clinical practices, while patients were also interviewed in some areas for client perception in some modules. The collected data were checked manually for completeness and inconsistencies and double-entried into a database using CSPro V7 software. Descriptive analysis was performed in Stata 14.2.
Results
An improvement was observed across modules. Among the 14 health service modules assessed, the quality scores were above average, ranging from 52.8% (Module 5: OPD for pediatric, and Module 17: Lab oratory) to 80.6% (Module 8: Supplement record from obstetric surgery, Module 11: Delivery). The comparison between the assessments in 2015 and 2017 indicates that most of the healthcare services in the three provinces have some improvements and varied across healthcare services. For example, the overall quality scores increased from 58.8% (2015) to 66.4% (2017), whereas clinical vignette knowledge increased from 42.7% to 64.0%.
Conclusion
Overall, there were some improvements in most healthcare services in the three provinces, although they varied across healthcare services. Therefore, health providers should focus on obtaining better scores in the next assessment of laboratory services and OPDs for pediatric services by improving their internal and external quality of care and improving their health. Other service module indicators should better provide consultations and enough feedback on patients’ diagnoses and proper information on family planning methods.