PERFORMANCE OF HEALTH FACILITIES IN NHIS ACCREDITATION:
AN ANALYSIS OF NHIS ACCREDITATION DATA
JULY 2009-DECEMBER 2012
Preliminary Findings
PREAMBLE• Presentation is part of a study into the performance of
health facilities in the NHIS accreditation aimed at supporting weaker facilities and accreditation in Ghana
• Commissioned by IFC and supported by IFC, NHIA, GHS and SPMDP
• Key investigator Dr Nicholas A. Tweneboa supported by:o GHS: Mrs Susana Larbi Wumbee and Mrs Christiana Akufoo SPMDP: Dr Kwasi Odoi-Agyarkoo NHIA: Mrs Vivian Addo-Cobbiah and Mrs Constance Addo
Quaye• Analysis of NHIS accreditation data and field work• Data analysis by consultant and Mrs Addo-Cobbiah still in
progress. Following are preliminary findings.
PRESENTATION OUTLINEINTRODUCTION
ANALYSIS 1
• Nationwide performance of all facilities• Performance by region
ANALYSIS 2
• Performance by facility type
ANALYSIS 3
• Performance by ownership (1° hospitals, clinics /health centres, maternity homes)
Note: Further analysis in progress
INTRODUCTION – ACCREDITATION PROCESS• Facility applies• Application vetted• Facility inspected by trained accreditation
surveyors• Data analysed• Accreditation decision made• Communication of inspection result and
accreditation decision• Accreditation certificates issued (not done in
most cases)• Post accreditation monitoring (not systematic)
Introduction 2 – GRADING
• Grade A+ 90-100% overall score and pass in critical areas
• Grade A: 80-89%• Grade B: 70-79%• Grade C: 60-69%• Grade D: 50-59%• Grade E (Fail): Less than 50%• Provisional: fail but provisional to create access
SET 1
ACCREDITATION DATA ANALYSIS – 1PERFORMANCE NATIONWIDE
AND BY REGION
NATIONWIDE PERFORMANCE OF ALL FACILITIES BY GRADE
GRADE NUMBER PERCENTAGE
GRADE A+ 7 0.2%
GRADE A 94 2.5%
GRADE B 734 19.8%
GRADE C 1562 42.2%
GRADE D 1145 30.9%
PROVISIONAL 45 1.2%
FAIL 114 3.1%
TOTAL 3701 100.0%
NATIONWIDE PERFORMANCE OF ALL FACILITIES BY GRADE
PERFORMANCE NATIONWIDE
• 3,701 facilities were inspected between July 2009 and December 2012
• The 3,701 includes 11 secondary hospitals of which 2 had A, 8 had B and 1 had C.
• Most of the facilities inspected (over 95%) passed and were accredited; 4.3% failed
• Majority of the facilities (73%) obtained Grade C or D
• 101 facilities (2.7%) obtained A+ or A
Performance nationwide – 2
• 835 facilities (22.5%) obtained top three grades (A+, A, B) and 2,866 (77.4%) obtained lowest three grades (C, D, E or fail)
• Conclusiono The nationwide pass rate of facilities in the NHIS
accreditation was high but the quality of the passes was not impressive
PERFORMANCE BY REGION (NUMBER, %)
REGIONGRADE A+
(No., %)
GRADE A
(No., %)
GRADE B
(No., %)
GRADE C
(No., %)
GRADE D
(No., %)
FAILED
(No., %)
NUMBER
INSPECTED
ASHANTI 0 0.0 10 1.6 81 13.1 212 34.4 284 46.0 30 4.9 617
BR. AHAFO 0 0.0 2 0.5 47 12.7 140 37.7 153 41.2 29 7.9 371
CENTRAL 0 0.0 13 4.0 107 32.6 132 40.2 61 18.6 15 4.6 328
EASTERN 0 0.0 11 2.4 80 17.5 245 53.7 114 25.0 6 1.4 456
GR. ACCRA 1 0.2 13 3.0 118 27.0 179 41.0 103 23.6 23 5.2 437
NORTHERN 1 0.3 21 6.1 74 21.5 150 43.6 87 25.3 11 3.2 344
UPPER EAST 2 1.0 5 2.4 64 30.6 98 46.9 34 16.3 6 2.8 209
UPPER WEST 1 0.6 8 4.5 49 27.5 76 42.7 40 22.5 4 2.2 178
VOLTA 0 0.0 2 0.6 35 11.4 117 38.0 135 43.8 19 6.2 308
WESTERN 2 0.4 9 2.0 79 17.4 213 47.0 134 29.6 16 3.6 453
TOTAL 7 0.2 94 2.5 734 19.8 1562 42.2 1145 30.9 159 4.3 3701
PERFORMANCE BY REGION (%)
PERFORMANCE BY REGION (BASED ON QUALITY OF PASS)
GRADES A+, A & B (70% AND ABOVE)
GRADES C, D & FAIL (BELOW 70%)
REGION NUMBER PERCENTAGE NUMBER PERCENTAGE NUMBER INSPECTED
ASHANTI 91 14.7 526 85.3 617
BR. AHAFO 49 13.2 322 86.8 371CENTRAL 120 36.6 208 63.4 328EASTERN 91 20.0 365 80.0 456GR. ACCRA 132 30.2 305 69.8 437NORTHERN 96 27.9 248 72.1 344UPPER EAST 71 34.0 138 66.0 209UPPER WEST 58 32.6 120 67.4 178VOLTA 37 12.0 271 88.0 308WESTERN 90 19.9 363 80.2 453TOTAL 835 22.6 2866 77.4 3701
PERFORMANCE BY REGION(BASED ON QUALITY OF PASS)
PERFORMANCE BY REGION
• The region with the largest number of inspected facilities is Ashanti (617 or 16.7% of facilities inspected nationwide), followed by Eastern Region (456 or 12.3%) and Western Region (453 or 12.2%)
• By pass rate or failure rate alone, the best performing regions are Eastern (failure rate of 1.4%), Upper West (2.2%) and Upper East (2.8%)
• By pass rate or failure rate alone, the least performing regions are Brong Ahafo (7.9% failure rate) followed by Volta (6.2%) and Greater Accra (5.2%)
Performance by region – 2
• Based on the quality of the passes, best performing regions are Central (36.6% of inspected facilities obtained A+, A or B), Upper East (34%) and Upper West (32.6%).
• Hence Upper East and Upper West performed well on both pass rate and quality of passes
• However, on quality of passes, Eastern dropped from 1st to a distant 5th (20.0%, falling below the national average of 22.6% inspected facilities obtaining A+, A or B)
Performance by region – 3
• The three least performing regions were Volta (12% inspected facilities fell in the A+, A, B bracket), Brong Ahafo (13.2%) and Ashanti (14.7%)
• Conclusion: o The best performing regions were not ‘better
endowed’ ones but ‘less endowed’ regions
GRADES BY REGION (PERCENTAGES)
REGIONGRADE
A+GRADE
AGRADE
BGRADE
CGRADE
DPASSED
(ACCRED)FAILED
ASHANTI 0.0 1.6 13.1 34.4 46.0 95.1 4.9BRONG AHAFO 0.0 0.5 12.7 37.7 41.2 92.1 7.9CENTRAL 0.0 4.0 32.6 40.2 18.6 95.4 4.6EASTERN 0.0 2.4 17.5 53.7 25.0 98.6 1.4GREATER ACCRA 0.2 3.0 27.0 41.0 23.6 94.8 5.2NORTHERN 0.3 6.1 21.5 43.6 25.3 96.8 3.2UPPER EAST 1.0 2.4 30.6 46.9 16.3 97.2 2.8UPPER WEST 0.6 4.5 27.5 42.7 22.5 97.8 2.2VOLTA 0.0 0.6 11.4 38.0 43.8 93.8 6.2WESTERN 0.4 2.0 17.4 47.0 29.6 96.4 3.6NATIONWIDE 0.2 2.5 19.8 42.2 30.9 95.7 4.3
PERCENTAGE PASS (ACCREDITED) BY REGION
FAILED FACILITIES BY REGION
PASSED (ACCREDITED) AND FAILED BY REGION
GRADE A+ BY REGION
GRADE A BY REGION
GRADE B BY REGION
GRADE C BY REGION
GRADE D BY REGION
SET 2
ACCREDITATION DATA ANALYSIS – 2PERFORMANCE BY FACILITY TYPE
SUMMARY PERFORMANCE BY FACILITY TYPE
A+ A B C D FAIL INSP.No % No % No % No % No % No % No
PRIM HOSP 0 0.0 8 2.4 86 25.7 140 41.9 92 27.5 8 2.4 334
CLINIC 1 0.3 2 0.6 52 15.0 122 35.2 129 37.2 41 11.8 347
H. CENTRE 2 0.2 19 2.2 119 13.5 390 44.2 321 36.4 31 3.5 882
MAT. HOME
0 0.0 6 2.7 40 17.7 76 33.6 96 42.5 8 3.5 226
CHPS 0 0.0 34 3.2 287 26.6 522 48.5 220 20.4 14 1.3 1077
DIAG. 3 1.4 12 5.6 44 20.7 81 38.0 63 9.6 10 4.7 213
PHARM 1 0.3 8 2.4 67 19.7 142 41.8 103 30.3 19 6.6 340
CHEM SELL. 0 0.0 3 1.3 25 9.8 79 31.1 120 47.2 27 10.6 254
TOTAL 7 0.2 94 2.5 734 19.8 1562 42.2 1145 30.9 159 4.3 3701
SUMMARY PERFORMANCE BY FACILITY TYPE
PERFORMANCE BY FACILITY TYPE (BASED ON QUALITY OF PASSES)
FACILITY TYPE A+, A, B (NUMBER, %)
C, D, FAIL (NUMBER, %)
NO. INSPECTED
PRIMARY HOSPITAL 94 28.1 240 71.9 334
CLINIC 55 15.9 292 84.1 347
HEALTH CENTRE 140 15.9 742 84.1 882
MATERNITY HOME 46 20.4 180 79.6 226
CHPS 321 29.8 756 70.2 1077
DIAGNOSTIC 59 27.7 154 72.3 213
PHARMACY 76 22.4 264 77.6 340
CHEMICAL SELLER 28 11.0 226 89.0 254
TOTAL 835 22.6 2866 77.4 3701
PERFORMANCE BY FACILITY TYPE(BASED ON QUALITY OF PASSES)
PERFORMANCE BY FACILITY TYPE
• Largest number inspected was CHPS (1,077 of 3,701 or 29.1% inspected); least number was diagnostic (213 or 5.8% of inspected facilities)
• By pass rate alone, the best performing facility type was CHPS (with pass rate of 98.7%), followed by primary hospitals (pass rate of 97.6%), health centres and maternity homes a joint third (96.5%)
• By pass rate alone, the least performing facility types were clinics (with failure rate of 11.8%, chemical sellers (10.6%) and pharmacy (6.6%)
Performance by facility type - 2
• Adjusted for quality of passes, CHPS and primary hospital still lead (29.8% and 28.1% respectively inspected had Grade A+, A or B)
• However, diagnostic moves up from 5th place to 3rd (27.7%) and pharmacy (22.4%) moves up from 6th to 4th
• Maternity home (20.4%) and health centre (15.9%) move down from joint 3rd to 5th and 6th respectively
• Clinic (15.9% obtaining A+, A or B) and chemical seller (11.0%) remain poorly performing
Performance by facility type – 3
• Conclusionso Primary hospitals and CHPS performed well in
accreditation
o Clinics and health centres which are midway between CHPS and primary hospitals in the referral chain performed poorly
o Chemical sellers as a group was the least performing facility type
GRADE A+ BY FACILITY TYPE
GRADE A BY FACILITY TYPE
GRADE B BY FACILITY TYPE
GRADE C BY FACILITY TYPE
GRADE D BY FACILITY TYPE
FAIL BY FACILITY TYPE
PRIMARY HOSPITALSGRADE NUMBER PERCENTAGE
GRADE A+ 0 0.0
GRADE A 8 2.4
GRADE B 86 25.7
GRADE C 140 41.9
GRADE D 92 27.5
FAIL 8 2.4
TOTAL 334 100.0
PRIMARY HOSPITALS
CLINICS
GRADE NUMBER PERCENTAGE
GRADE A+ 1 0.3
GRADE A 2 0.6
GRADE B 52 15.0
GRADE C 122 35.2
GRADE D 129 37.2
FAIL 41 11.8
TOTAL 347 100.0
CLINICS
HEALTH CENTRES
GRADE NUMBER PERCENTAGE
GRADE A+ 2 0.2
GRADE A 19 2.2
GRADE B 119 13.5
GRADE C 390 44.2
GRADE D 321 36.4
FAIL 31 3.5
TOTAL 882 100.0
HEALTH CENTRES
CHPS COMPOUNDS
GRADE NUMBER PERCENTAGE
GRADE A+ 0 0.0
GRADE A 34 3.2
GRADE B 287 26.6
GRADE C 522 48.5
GRADE D 220 20.4
FAIL 14 1.3
TOTAL 1077 100.0
CHPS COMPOUNDS
MATERNITY HOMES
GRADE NUMBER PERCENTAGE
GRADE A+ 0 0.0
GRADE A 6 2.7GRADE B 40 17.7
GRADE C 76 33.6
GRADE D 96 42.5
FAIL 8 3.5
TOTAL 226 100.0
MATERNITY HOMES
DIAGNOSTIC CENTRESGRADE NUMBER PERCENTAGE
GRADE A+ 3 1.4
GRADE A 12 5.6
GRADE B 44 20.7
GRADE C 81 38.0
GRADE D 63 29.6
FAIL 10 4.7
TOTAL 213 100.0
DIAGNOSTIC CENTRES
PHARMACIESGRADE NUMBER PERCENTAGE
GRADE A+ 1 0.3
GRADE A 8 2.4
GRADE B 67 19.7
GRADE C 142 41.8
GRADE D 103 30.3
FAIL 19 5.6
TOTAL 340 100.0
PHARMACIES
CHEMICAL SHOPS
GRADES TOTAL PERCENTAGE
GRADE A+ 0 0.0
GRADE A 3 1.2
GRADE B 25 9.8
GRADE C 79 31.1
GRADE D 120 47.2
FAIL 27 10.6
TOTAL 254 100.0
CHEMICAL SHOPS
FAILURE RATE BY FACILITY TYPE
FACILITY TYPE TOTAL INSPECTED FAILEDPERCENTAGE
FAILED
PRIMARY HOSPITALS 334 8 2.4
HEALTH CENTRES 882 31 3.5
CLINICS 347 41 11.8
MATERNITY HOMES 226 8 3.5
CHPS COMPOUNDS 1077 14 1.3
PHARMACIES 340 29 5.6
CHEMICAL SHOPS 254 27 10.6
DIAGNOSTIC CENTRES 213 10 4.7
SET 3
ACCREDITATION DATA ANALYSIS – 3 COMPARATIVE ANALYSIS OF
PERFORMANCE BY OWNERSHIP(primary hospitals, clinics/health
centres, maternity homes)
PERFORMANCE OF PRIMARY HOSPITALS BY OWNERSHIP
PUBLIC(NUMBER, %)
PRIVATE(NUMBER, %)
MISSION(NUMBER, %)
QUASI-GOVT(NUMBER, %)
GRADE A+ 0 0.0% 0 0.0% 0 0.0% 0 0.0%
GRADE A 0 0.0% 2 1.3% 3 5.3% 3 27.3%
GRADE B 31 28.7% 26 16.5% 24 42.1% 5 45.5%
GRADE C 52 48.1% 64 40.5% 21 36.8% 3 27.3%
GRADE D 25 23.1% 58 36.7% 9 15.8% 0 0.0%
FAIL 0 0.0% 8 5.1% 0 0.0% 0 0.0%
TOTAL 108 100.0% 158 100.0% 57 100.0% 11 100.0%
PRIMARY HOSPITALS
PERFORMANCE OF PRIM. HOSP. BY OWNERSHIP(BASED ON QUALITY OF PASSES)
PUBLIC(NUMBER, %)
PRIVATE (NUMBER, %)
MISSION(NUMBER, %)
QUASI-GOVT(NUMBER, %)
A+, A, B 31 28.7 28 17.7 27 47.4 8 72.7
C,D, FAIL 77 71.3 130 82.3 30 52.6 3 27.3
TOTAL 108 100.0 158 100.0 57 100.0 11 100.0
PERFORMANCE OF PRIM. HOSP. BY OWNERSHIP(BASED ON QUALITY OF PASSES)
PERFORMANCE OF PRIMARY HOSPITALS
• Largest number of primary hospitals inspected were privately owned (158 or 47.3% of all primary hospitals inspected)
• Other primary hospitals inspected:o Public (108 or 32.3%); oMission (57 or 17.1%); o Quasi-government (11 or 3.3%)
• All primary hospitals inspected passed and were accredited except for private primary hospitals of which 8 (5.1%) failed
Performance of primary hospitals by ownership - 2• By either pass rate or quality of the passes, private
primary hospitals performed least among the primary hospitals inspected, with pass rate of 94.9% compared to 100% for other ownerships
• By quality of passes private primary hospitals still performed least as 17.7% inspected obtained Grade A+, A or B as compared to mission (47.4%), public (28.7%) and quasi-govt. (72.7%, n=11)
Performance of primary hospitals by ownership - 3
• Conclusiono Private primary hospitals performed least among
the primary hospitals inspected, based on either pass or failure rate or the quality of the passes
PERFORMANCE OF CLINICS AND HEALTH CENTRES BY OWNERSHIP
PUBLIC(NUMBER, %)
PRIVATE(NUMBER, %)
MISSION(NUMBER, %)
QUASI(NUMBER, %)
GRADE A+ 1 0.1% 1 0.3% 1 0.7% 0 0.0%
GRADE A 14 1.9% 2 0.6% 5 3.6% 0 0.0%
GRADE B 88 12.0% 49 14.6% 29 20.7% 5 31.3%
GRADE C 330 44.9% 117 34.9% 58 42.1% 6 37.5%
GRADE D 279 38.0% 126 37.6% 40 29.3% 4 25.0%
FAIL 24 3.3% 41 12.2% 6 4.3% 1 6.3%
TOTAL 735 100.0% 336100.0% 139 100.0% 16 100.0%
CLINICS AND HEALTH CENTRES
PERFORMANCE OF HEALTH CENTRES AND CLINICS BY OWNERSHIP
(BASED ON QUALITY OF PASSES)
PUBLIC(NUMBER, %)
PRIVATE (NUMBER, %)
MISSION(NUMBER, %)
QUASI-GOVT(NUMBER, %)
A+, A, B 103 14.0 52 15.5 35 25.2 5 31.2
C,D, FAIL 633 86.0 284 84.5 104 74.8 11 68.8
TOTAL 735 100.0 336 100.0 139 100.0 16 100.0
PERFORMANCE OF HEALTH CENTRES AND CLINICS BY OWNERSHIP
(BASED ON QUALITY OF PASSES)
PERFORMANCE OF CLINICS AND HEALTH CENTRES BY OWNERSHIP
• Private clinics had the highest failure rate of 12.2% (41 out of 336 clinics failed)
• 6 of 139 (4.3%) of mission health centres failed compared to 24 of 735 public health centres (3.3%)
• Only 16 quasi-government health centres and clinics were inspected and 1 failed
Performance of health centres and clinics by ownership
• In respect of quality of the passes, CHAG health centres performed best, with 25.2% of inspected obtaining A+, A or B
• Public health centres and private clinics had similar quality of passes (14.0% and 15.5% respectively had Grade A+, A or B)
• ConclusionoMission health centres performed better than
private clinics and public health centres
PERFORMANCE OF MATERNITY HOMES BY OWNERSHIP
PUBLIC
(NUMBER, %)PRIVATE
(NUMBER, %)MISSION
(NUMBER, %)
GRADE A+ 0 0.0% 0 0.0% 0 0.0%
GRADE A 0 0.0% 6 2.7% 0 0.0%
GRADE B 2 66.7% 37 16.8% 1 33.3%
GRADE C 1 33.3% 74 33.6% 1 33.3%
GRADE D 0 0.0% 95 43.2% 1 33.3%
FAIL 0 0.0% 8 3.6% 0 0.0%
TOTAL 3 100.0% 220 100.0% 3 100.0%
MATERNITY HOMES
PERFORMANCE OF MATERNITY HOMES(BASED ON QUALITY OF PASSES)
PUBLIC(NUMBER, %)
PRIVATE (NUMBER, %)
MISSION(NUMBER, %)
A+, A, B 2 66.7 43 19.5 1 33.3
C,D, FAIL 1 33.3 177 80.5 2 66.7
TOTAL 3 100.0 220 100.0 3 100.0
PERFORMANCE OF MATERNITY HOMES (BASED ON QUALITY OF PASSES)
PERFORMANCE OF MATERNITY HOMES BY OWNERSHIP
• 8 of 220 private maternity homes (equivalent to 3.6%) failed the accreditation ; 96.4% passed
• Just about one-fifth of private maternity homes had A+, A or B
• The number of public and mission maternity homes (3 each) is too small to make comparisons with private maternity homes
• Conclusiono Private maternity homes had a good pass rate but
the quality of the passes was weak
OVERALL CONCLUSIONS• Nationwide, the pass rate of inspected facilities was
high but the quality of the passes was generally not impressive
• Facilities in relatively less endowed regions rather than relatively well endowed regions performed best in the accreditation
• Clinics and health centres which constitute the link between CHPS (community) and primary hospitals performed poorly. Chemical sellers also did poorly.
• Private facilities generally performed poorly
Thank you for your kind attention
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