Comparison of provider quality of care and caretaker's recall of care received for children under-five in Afghanistan

Reconstruction efforts to strengthen the capacity of the health system include the implementation of a basic package of health services to ensure optimal service delivery in Afghanistan. The performance of health services have been assessed through the national health services performance assessment conducted annually by the Ministry of Public Health. In 2006, 630 health facilities were selected through a stratified sampling methodology and assessments on quality of care were made on a random sample of 2912 sick children under-five years. Results: The primary complaint was fever, followed by diarrhea and cough or difficulty in breathing. A majority of the caretakers were mothers (67%) and only 6% of the caretakers were literate. Only 43% of the providers counseled the caretakers on signs for immediate return to the clinic, and 47% informed the caretakers the date of the follow-up visit. More than 50% of the caretakers reported receiving information on the disease and appropriate home care. Although more than 90% of the caretakers knew the dosage and time to administer the drugs, only 42% knew the duration and frequency. Less than 30% of the caretakers were aware that fever, inability to drink or breastfeed, change in consciousness, blood in stool and rapid or difficult breathing are signs for immediate return. Long waiting times were reported by 51% of the caretakers and 68% reported payment for registration and consultation. However more than 90% of caretakers reported satisfaction with the care received. Although the quality of counseling has significantly improved since 2004 (counseling index: 40.4 in 2004 vs 51.5 in 2006, p<0.001), it still remains sub-optimal and increased efforts need to be made to improve provider adherence to counseling standards to ensure appropriate disease management by caretakers.