Objective To analyse factors affecting variations in the observed quality of antenatal and sick-child care in primary-care facilities in seven
African countries.
Methods We pooled nationally representative data from service provision assessment surveys of health facilities in Kenya, Malawi, Namibia,
Rwanda, Senegal, Uganda and the United Republic of Tanzania (survey year range: 2006–2014). Based on World Health Organization
protocols, we created indices of process quality for antenatal care (first visits) and for sick-child visits. We assessed national, facility, provider
and patient factors that might explain variations in quality of care, using separate multilevel regression models of quality for each service.
Findings Data were available for 2594 and 11 402 observations of clinical consultations for antenatal care and sick children, respectively.
Overall, health-care providers performed a mean of 62.2% (interquartile range, IQR: 50.0 to 75.0) of eight recommended antenatal care
actions and 54.5% (IQR: 33.3 to 66.7) of nine sick-child care actions at observed visits. Quality of antenatal care was higher in better-staffed
and -equipped facilities and lower for physicians and clinical officers than nurses. Experienced providers and those in better-managed
facilities provided higher quality sick-child care, with no differences between physicians and nurses or between better- and less-equipped
clinics. Private facilities outperformed public facilities. Country differences were more influential in explaining variance in quality than all
other factors combined.
Conclusion The quality of two essential primary-care services for women and children was weak and varied across and within the countries.