Table 5.
Differences in average quality dimension (QD) and thematic category scores, expressed as percentages of maximum achievable scores, according to year, while the variable council was set as a random effect
| Performance by quality dimension (QD) | ||||||||
| Overall | QD 1 | QD 2 | QD 3 | QD 4 | QD 5 | QD 6 | ||
| 2012 | 3.0** | −2.9* | 1.3 | − 1.2 | 5.9*** | 10.6*** | 1.9 | |
| 2013 | 6.2*** | − 0.9 | 5.4* | 2.4 | 6.7*** | 15.8*** | 5.2*** | |
| 2014 | 8.0*** | 3.9** | 3.7(58)° | 6.2*** | 9.9*** | 14.6*** | 7.3*** | |
| Constant | 61.6*** | 72.5*** | 52.4*** | 72.3*** | 66.3*** | 31.5*** | 77.4*** | |
| QD1: Physical environment and equipment by thematic category and responsible health system level | ||||||||
| QD 1.1, (l) | QD 1.1, (l/c) | QD 1.1, (c) | QD 1.2, (l/c/n) | |||||
| 2012 | −7.9** | −5.7* | −2.2 | − 0.2 | ||||
| 2013 | 0.7 | − 0.2 | − 1.3 | − 2.1 | ||||
| 2014 | 6.0** | 5.7* | 4.4 | 1.9 | ||||
| Constant | 67.4*** | 70.0*** | 50.3*** | 79.3*** | ||||
| QD 2: Job expectations by thematic category and responsible health system level | ||||||||
| QD2.1, (l) | QD 2.2, (l/c) | QD2.3, (c) | ||||||
| 2012 | −2.3 | 0.2 | 15.7*** | |||||
| 2013 | 1.1 | 5.4* | 7.1 | |||||
| 2014 | 0.4 | 4.9* | −11.3** | |||||
| Constant | 97.8*** | 49.1*** | 54.6***#i | |||||
| QD 3: Professional knowledge, skills and ethics by thematic category and responsible health system level | ||||||||
| QD 3.1, (l) | QD 3.2, (l) | QD 3.3, (l) | QD 3.4, (l) | QD 3.5, (l) | ||||
| 2012 | −7.0*** | −4.3 | 4.3* | −4.8 | 15.6*** | |||
| 2013 | −3.5* | 4.4 | 2.2 | 2.4 | 16.0*** | |||
| 2014 | 4.4** | 7.3** | 4.1* | 2.2 | 20.1*** | |||
| Constant | 78.2*** | 67.0*** | 81.7*** | 66.2***#ii | 76.3*** | |||
| QD 4: Management and administration by thematic category and responsible health system level | ||||||||
| QD 4.1, (l) | QD 4.2, (l/c) | QD 4.3, (c) | QD 4.4, (c/n) | QD 4.5, (l/c/n) | ||||
| 2012 | −0.6 | 14.1*** | −9.4* | −1.6 | 8.2*** | |||
| 2013 | 3.5 | 15.1*** | 2.8 | −3.6 | 7.1*** | |||
| 2014 | 11.6*** | 16.9*** | 5.5 | 6.1 | 8.1*** | |||
| Constant | 53.8***#iii | 55.2*** | 84.7*** | 27.9***#iv | 75.7*** | |||
| QD 5: Staff motivation by thematic category and responsible health system level | ||||||||
| QD 5.1, (l) | QD 5.2, (l/c) | QD 5.3, (c) | QD 5.4, (c/n) | QD 5.5, (c/n) | QD 5.6, (n) | |||
| 2012 | 7.2 | 2.4 | 8.7** | 13.1*** | 10.0*** | 12.3*** | ||
| 2013 | 10.9** | 4.2#v | 18.6*** | 12.6*** | 16.9*** | 14.4*** | ||
| 2014 | 15.7*** | 7.5** | 18.9*** | 9.2** | 15.1*** | 21.1*** | ||
| Constant | 59.8*** | 7.4**#vi | 38.2*** | 35.3***#vii | 23.5*** | 67.1*** | ||
Asterisks refer to p-values indicating the significance of a coefficient *p < 0.05, **p < 0.01, ***p < 0.001 °Coefficient that would have been significant in a model including additional categorical variables (health facility level and health facility owner) but was not in the model presented here [60]. #Coefficients with a p-value below 0.05 in the random or fixed effect model and which differed by more than 10% of their means: (i) random: 54.6*** (p = 0.000), fixed: 36.0 (p = 0.000); (ii) random: 66.2*** (p = 0.000), fixed: 73.3*** (p = 0.000); (iii) random: 53.8*** (p = 0.000), fixed: 45.1*** (p = 0.000); (iv) random: 27.9*** (p = 0.000), fixed: 23.8*** (p = 0.000); (v) random: 4.2 (p = 0.102), fixed: 4.8* (p = 0.038)); (vi) random: 7.4*** (p = 0.006), fixed: 2.2 (p = 0.399); (vii) random: 35.3*** (p = 0.000), fixed: 31.7*** (p = 0.000) There was a large fraction of unexplained variance attributed to the random effect for all models, meaning that scores were strongly correlated within councils (data not shown). Responsible health system levels are given in brackets for easier reference: l = local, c = council; n = national QD 1 = Physical environment and equipment: QD 1.1 = Physical environment, QD 1.2 = Equipment availability; QD 2 = Job expectations: QD 2.1 = Provider knowledge of services to be provided, QD 2.2 = Guideline and algorithm availability, QD 2.3 = Availability of job description; QD 3 = Professional knowledge, skills and ethics: QD 3.1 = Ethics and Infection Prevention and Control (IPC), QD 3.2 = Integrated Management of Childhood Illnesses (IMCI), QD 3.3 = Maternal health, QD 3.4 = Fever, QD 3.5 = HIV/AIDS and TB; QD 4 = Management and administration: QD 4.1 = Display of public information, suggestion box, meeting conduction, duty roster, referral plans, QD 4.2 = Information, Education and Communication (IEC) material availability and Health Management Information System (HMIS) implementation, QD 4.3 = Routine CHMT supportive supervision visits, QD 4.4 = Staffing level, QD 4.5 = Medicines availability; QD 5 = Staff motivation: QD 5.1 = In-house education, QD 5.2 = Appointment as best worker, QD 5.3 = Letter of appreciation and training follow up, QD 5.4 = Reward payment, house allocation, promotion, QD 5.5 = Training, QD 5.6 = Salary and promotion payment; QD 6 = Client satisfaction