Table 2

Instruments/Tools Used for Data Collection

Facility TypeAspect MeasuredaData Collection Instrument/ToolReliability/ Validity of ToolData SourceData Collection MethodNature of Variables
District hospitalHealth system performanceSignal functions (percentage of essential functions and services available for each clinical domain)2830Audit tool used by MRC team (adapted from WHO document, validated for South African context)Staff, managers, and key documentsInterviews and review of documentsContinuous 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)31National tool, validated by Office of Health Standards ComplianceContinuous variables (percentage of total score for Domain 2)
Quality of clinical care and health outcomesChild PIP and Perinatal PIP32Validated tools (software based) used in South African health facilitiesChild PIP and Perinatal PIP national databasesAssessment of data at facility level (admissions and deaths of children and perinatal losses)Continuous variables (rates)
Community health centerHealth system performancePCAT: 4-point Likert scale; domains of Primary Health Care33Pilot study and validation in Western Cape provincePatients, practitioners, and managersInterviews, asking respondents to rate their agreement with each item on a 4-point Likert scaleContinuous variables (4-point Likert scale options were ordinal values, but variables were treated as continuous)
Quality of clinical care and health outcomesIntegrated CDM audit tool: percentage score34,35Valid tool (annual audit in Western Cape provincial facilities)Observation and patient medical recordsAssessment 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.