Publication date: 
January 28, 2015

Seattle, WA – Health facilities in sub-Saharan Africa report providing a range of health services, but deficits in stocking critical medical supplies and equipment may compromise their full capacity to deliver care. This is one of many findings from the Access, Bottlenecks, Costs, and Equity (ABCE) project, a multicountry study that aims to assess the drivers of health system performance and costs of care.

On January 28, a number of datasets from the ABCE project were made publicly available, providing a unique opportunity for researchers, policymakers, and development partners to use facility-level information to better understand health system needs. A series of reports using these data also delve into country-focused results for four sub-Saharan African countries, highlighting the types of progress and challenges that Ghana, Kenya, Uganda, and Zambia have each experienced in health service provision. 

“This launch of four ABCE datasets – it’s incredibly exciting for us at IHME and our country collaborators. These data are going to be enormously useful for a broad range of individuals, from local program administrators to global policymakers,” says Dr. Emmanuela Gakidou, IHME Director of Education and Training and a principal investigator for the ABCE project. “This is the kind of information that can really show what’s working well – and pinpoint what the barriers are to providing higher-quality, cost-effective health services.”

Specific findings varied by country, but several cross-cutting results emerged, including the following:

  • Health facilities generally reported a high availability of certain services, such as formal immunization programs, HIV/AIDS services, and antenatal care (ANC). However, substantial gaps emerged between facilities’ reported and functional capacity to provide these services, with many often lacking vital medical supplies or equipment.
  • At a time when many countries in sub-Saharan Africa are seeing rising rates of non-communicable diseases (NCDs), their health systems may not be adequately prepared to respond. Very few health facilities had the medical equipment for NCDs, and many lacked the medications needed for managing more chronic conditions like diabetes and hypertension.
  • Much progress was made in improving facility infrastructure, such that many more primary care facilities had functional electricity, running water, and improved sanitation than what past studies have shown. At the same time, significant gaps remained, with many of these facilities still lacking proper sanitation systems and emergency infrastructure.
  • Most facilities demonstrated potential for expanding services and supporting larger patient volumes, as assessed by new efficiency analyses conducted at IHME. Researchers identified this potential for service expansion by assessing how observed facility resources, such as medical staff and beds, aligned with facility production of services.
  • Costs of care varied substantially across level of care and patient visit type. On average, facility costs were lowest for outpatient visits and highest for births.
  • Interviewed patients gave high ratings of their facility experiences, especially for staff interactions. Patients generally gave much lower marks for facility characteristics, particularly concerning the wait times they experienced prior to receiving care.
  • There was a rapid shift away from d4T-based drug regimens for new patients in antiretroviral therapy (ART) programs, a major success for improving treatment for HIV-positive patients.
  • Between 2008 and 2012, HIV-positive patients generally started treatment at earlier stages of disease progression, a factor that often contributes to better patient outcomes. At the same time, a substantial portion of HIV-positive patients started ART when they were symptomatic, suggesting that more efforts are needed to get patients into treatment sooner.

The ABCE project began in 2011, with Ghana, Kenya, Uganda, and Zambia as four of the countries initially involved in the study. Coordinated by IHME, much of the primary data-collection effort was led by ABCE country collaborators: the Ghana Health Service (GHS) and UNICEF in Ghana, Action Africa Help-International (AAH-I) in Kenya, the Infectious Diseases Research Collaboration (IDRC) in Uganda, and the University of Zambia (UNZA) in Zambia.

To learn more about the ABCE project or ask specific ABCE-related data questions, please contact e[email protected].