Strong healthcare infrastructure not linked with better quality in low- and middle-income countries

In countries such as Haiti, Malawi, and Rwanda, having well-equipped health facilities doesn’t necessarily mean that the health care they provide will be high quality.

In a study published December 12, 2017 in PLOS Medicine, Harvard T.H. Chan School of Public Health postdoctoral fellow Hannah Leslie and colleagues found that while a strong infrastructure is important for healthcare, measures of health facility infrastructure are actually poorly correlated with health system quality.

The researchers used health surveys conducted from 2007-2015 in eight countries, including Haiti, Kenya, Malawi, Namibia, Rwanda, Senegal, Tanzania, and Uganda. They analyzed health facilities’ infrastructure—things like buildings, medicines, and equipment—and also looked at clinical quality related to family planning, antenatal care, sick-child care, and labor and delivery.

The study found low correlation between infrastructure and quality care. Facilities with similar infrastructure ratings delivered widely varying quality of care. In addition, there was no minimum level of infrastructure that was reliably associated with higher quality of care in any area.

Given the study findings, the authors said that healthcare infrastructure should not be used to measure healthcare quality; instead, it should be measured by direct observations of clinical care and consideration of patient health outcomes and satisfaction.

Other Harvard Chan authors of the study included master’s student Zeye Sun and Margaret Kruk, associate professor of global health.