Measuring Quality of Care in South African Clinics and Hospitals

The move towards equity in South African health services is high on the national agenda. Given the emphasis on primary health care (PHC) in the reform of the health sector and mindful that equity underpins the PHC philosophy, it is only natural that an assessment is made of the degree of inequality that exists in health services in the country. It is even more important to determine whether there is a move away from inequality and, if so, to measure the extent of the movement towards greater equity. The measurement of equity is fraught with difficulty and economic measures such as Lorenz curves and Gini coefficients tell only part of the story.

Equity can be measured in a number of ways. While the use of the standard structure, process and output/outcome framework is valuable, the complexity of measures of equity warrants a considered approach to the development of measures or indicators of equity. Indicators of supply are often used to compare equity in communities, institutions and service provision but they fail to provide any information on the quality of care that patients receive. Despite their shortcomings, they do provide a discernible measure of equity. It would be of greater value if one could incorporate measures of structure (supply), process, output and outcome in a framework of quality of care that would bridge this gap.

In attempting to measure equity or inequity in the provision of clinics and hospitals in South Africa, a number of indicators are suggested. These include those that pinpoint geographic distribution across and within the nine provinces and within sub-regions or districts, as well as those highlighting urban/rural differences. They also include the provision of facilities, finances, staff, equipment, drugs and the infrastructure.