Instruments/Tools Used for Data Collection
| Facility Type | Aspect Measureda | Data Collection Instrument/Tool | Reliability/ Validity of Tool | Data Source | Data Collection Method | Nature of Variables |
|---|---|---|---|---|---|---|
| District hospital | Health system performance | Signal functions (percentage of essential functions and services available for each clinical domain)28–30 | Audit tool used by MRC team (adapted from WHO document, validated for South African context) | Staff, managers, and key documents | Interviews and review of documents | Continuous variables (percentage of total score for each clinical domain) |
| South African National Core Standards (Domain 2, which focuses on aspects of patient safety, clinical governance, and clinical care)31 | National tool, validated by Office of Health Standards Compliance | Continuous variables (percentage of total score for Domain 2) | ||||
| Quality of clinical care and health outcomes | Child PIP and Perinatal PIP32 | Validated tools (software based) used in South African health facilities | Child PIP and Perinatal PIP national databases | Assessment of data at facility level (admissions and deaths of children and perinatal losses) | Continuous variables (rates) | |
| Community health center | Health system performance | PCAT: 4-point Likert scale; domains of Primary Health Care33 | Pilot study and validation in Western Cape province | Patients, practitioners, and managers | Interviews, asking respondents to rate their agreement with each item on a 4-point Likert scale | Continuous variables (4-point Likert scale options were ordinal values, but variables were treated as continuous) |
| Quality of clinical care and health outcomes | Integrated CDM audit tool: percentage score34,35 | Valid tool (annual audit in Western Cape provincial facilities) | Observation and patient medical records | Assessment of facility’s structural components for CDM, as well as audit of 20 records for each of 5 chronic conditions (diabetes, hypertension, asthma, COPD, and epilepsy) | Continuous variables (percentage of total score for each chronic condition) |
CDM = chronic disease management; COPD = chronic obstructive pulmonary disease; MRC = Medical Research Council of South Africa; PCAT = Primary Care Assessment Tool; PIP = Problem Identification Program; WHO = World Health Organization.
↵a From the conceptual framework shown in Figure 1.