Accreditation as a quality-improving policy tool: family planning, maternal health, and child health in Egypt
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ORIGINAL PAPER
Accreditation as a quality‑improving policy tool: family planning, maternal health, and child health in Egypt Amira El‑Shal1 · Patricia Cubi‑Molla2,3 · Mireia Jofre‑Bonet2,3 Received: 19 November 2019 / Accepted: 15 October 2020 © The Author(s) 2020
Abstract Accreditation of healthcare providers has been established in many high-income countries and some low- and middle-income countries as a tool to improve the quality of health care. However, the available evidence on the effectiveness of this approach is limited and of questionable quality, especially in low- and middle-income countries. We exploit the interventions introduced under Egypt’s health sector reform program between 2000 and 2014 to estimate the effect of health facility accreditation on family planning, maternal health, and child health outcomes. We use difference-in-differences fixed-effects and propensity score matching difference-in-differences models. To do so, we spatially link women to their nearest mapped health facilities using their global positioning system coordinates. We find that accreditation had multiple positive effects, especially on delivery care and child morbidity prevalence. The effects appear to weaken over time though. Our findings suggest that facility accreditation can be effective in improving family planning, antenatal care, delivery care, and child health, but stress the need to study how the effects can be sustained. Keywords Primary health care · Policy evaluation · Morbidity · Outpatient · Public health · Middle-income · Accreditation · Maternal health · Child health JEL Classification I11 · I12 · I18
Introduction In 1997, Egypt launched a comprehensive Health Sector Reform Program (HSRP) to address fundamental challenges in the healthcare system. The HSRP introduced an integrated package of service delivery and financing interventions to address the means by which primary health care (PHC) is financed, delivered, organized, and managed [1, 2]. One of the cornerstones of the HSRP was the facility accreditation program, which was defined by the country’s Ministry of Health and Population (MOHP) as a process for evaluating PHC facilities according to a set of standards that define
* Amira El‑Shal [email protected] 1
Department of Economics, Faculty of Economics and Political Science, Cairo University, Giza, Egypt
2
Office of Health Economics, London, UK
3
Department of Economics, City, University of London, London, UK
activities and structures that directly contribute to improved patient outcomes. The main aim of the program was to provide the HSRP with a framework for continuous quality improvement [3, 4]. Accreditation of healthcare providers has been established in many high-income countries and some low- and middle-income countries (LMICs) as an approach to improve the quality of care that combines the two elements of quality assurance and quality improvement [5, 6]. There is consistent evidence that accreditation programs improve the process of care in all settings, espe
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