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Nigeria

Pitfalls of Patient Satisfaction Surveys and How to Avoid Them

David Evans's picture

A child has a fever. Her father rushes to his community’s clinic, his daughter in his arms. He waits. A nurse asks him questions and examines his child. She gives him advice and perhaps a prescription to get filled at a pharmacy. He leaves.

How do we measure the quality of care that this father and his daughter received? There are many ingredients: Was the clinic open? Was a nurse present? Was the patient attended to swiftly? Did the nurse know what she was talking about? Did she have access to needed equipment and supplies?

Both health systems and researchers have made efforts to measure the quality of each of these ingredients, with a range of tools. Interviewers pose hypothetical situations to doctors and nurses to test their knowledge. Inspectors examine the cleanliness and organization of the facility, or they make surprise visits to measure health worker attendance. Actors posing as patients test both the knowledge and the effort of health workers.

But – you might say – that all seems quite costly (it is) and complicated (it is). Why not just ask the patients about their experience? Enter the “patient satisfaction survey,” which goes back at least to the 1980s in a clearly recognizable form. (I’m sure someone has been asking about patient satisfaction in some form for as long as there have been medical providers.) Patient satisfaction surveys have pros and cons. On the pro side, health care is a service, and a better delivered service should result in higher patient satisfaction. If this is true, then patient satisfaction could be a useful summary measure, capturing an array of elements of the service – were you treated with respect? did you have to wait too long? On the con side, patients may not be able to gauge key elements of the service (is the health professional giving good advice?), or they may value services that are not medically recommended (just give me a shot, nurse!).

Two recently published studies in Nigeria provide evidence that both gives pause to our use of patient satisfaction surveys and points to better ways forward. Here is what we’ve learned:

Can modern technologies facilitate spatial and temporal price analysis?

Marko Rissanen's picture

The International Comparison Program (ICP) team in the World Bank Development Data Group commissioned a pilot data collection study utilizing modern information and communication technologies in 15 countries―Argentina, Bangladesh, Brazil, Cambodia, Colombia, Ghana, Indonesia, Kenya, Malawi, Nigeria, Peru, Philippines, South Africa, Venezuela and Vietnam―from December 2015 to August 2016.

The main aim of the pilot was to study the feasibility of a crowdsourced price data collection approach for a variety of spatial and temporal price studies and other applications. The anticipated benefits of the approach were the openness, accessibility, level of granularity, and timeliness of the collected data and related metadata; traits rarely true for datasets typically available to policymakers and researchers.

The data was collected through a privately-operated network of paid on-the-ground contributors that had access to a smartphone and a data collection application designed for the pilot. Price collection tasks and related guidance were pushed through the application to specific geographical locations. The contributors carried out the requested collection tasks and submitted price data and related metadata using the application. The contributors were subsequently compensated based on the task location and degree of difficulty.

The collected price data covers 162 tightly specified items for a variety of household goods and services, including food and non-alcoholic beverages; alcoholic beverages and tobacco; clothing and footwear; housing, water, electricity, gas and other fuels; furnishings, household equipment and routine household maintenance; health; transport; communication; recreation and culture; education; restaurants and hotels; and miscellaneous goods and services. The use of common item specifications aimed at ensuring the quality, as well as intra- and inter-country comparability, of the collected data.

In total, as many as 1,262,458 price observations―ranging from 196,188 observations for Brazil to 14,102 observations for Cambodia―were collected during the pilot. The figure below shows the cumulative number of collected price observations and outlets covered per each pilot country and month (mouse over the dashboard for additional details).

Figure 1: Cumulative number of price observations collected during the pilot

Investing in Africa’s talent

Esteve Sala's picture
Africa will have more people joining the labor force over the next 20 years than the rest of the world combined. Photo credit: World Bank

For every software developer in the United States, there are five open jobs. Africa, meanwhile, has the youngest, fastest-growing population on earth, with more people joining the labor force over the next 20 years than the rest of the world combined.

With this idea in mind, and the powerful belief that "brilliance is evenly distributed, but opportunity is not," Andela, founded four years ago, began recruiting recent graduates in Africa with the mission of connecting them to job opportunities in high-tech companies. Today, about 650 developers in Lagos, Nairobi, and Kampala work full-time for over 100 firms spread across 45 cities worldwide.

The 2018 Fragility Forum: Managing risks for peace and stability

Franck Bousquet's picture
© Caroline Gluck/Oxfam


In just under two weeks, about 1,000 people will gather in Washington D.C. for the 2018 Fragility Forum. Policy makers from developed and developing countries, practitioners from humanitarian agencies, development institutions and the peace and security communities, academics and representatives of the private sector will come together with the goal of increasing our collective impact in countries affected by fragility, conflict and violence (FCV).
 
The theme of the Forum, Managing Risks for Peace and Stability, reflects a strategic shift in how the global community addresses FCV – among other ways by putting prevention first. This renewed approach is laid out in an upcoming study done jointly by the World Bank and United Nations: Pathways for Peace: Inclusive Approaches to Preventing Violent Conflict. The study says the world must refocus its attention on prevention as a means to achieving peace. The key, according to the authors, is to identify risks early and to work closely with governments to improve response to these risks and reinforce inclusion.

Using adaptive social protection to cope with crisis and build resilience

Michal Rutkowski's picture
In a world increasingly filled with risk, social protection systems help individuals and families cope with civil war, natural disaster, displacement, and other shocks. ©
 Farhana Asnap/World Bank


Crisis is becoming a new normal in the world today. Over the past 30 years, the world has lost more than 2.5 million people and almost $4 trillion to natural disasters. In 2017 alone, adverse natural events resulted in global losses of about $330 billion, making last year the costliest ever in terms of global weather-related disasters. Climate change, demographic shifts, and other global trends may also create fragility risks. Currently, conflicts drive 80 percent of all humanitarian needs and the share of the extreme poor living in conflict-affected situations is expected to rise to more than 60 percent by 2030.

Why technology will disrupt and transform Africa’s agriculture sector—in a good way

Simeon Ehui's picture
© Dasan Bobo/World Bank
© Dasan Bobo/World Bank


Agriculture is critical to some of Africa’s biggest development goals. The sector is an engine of job creation: Farming alone currently accounts for about 60 percent of total employment in sub-Saharan Africa, while the share of jobs across the food system is potentially much larger. In Ethiopia, Malawi, Mozambique, Tanzania, Uganda, and Zambia, the food system is projected to add more jobs than the rest of the economy between 2010 and 2025. Agriculture is also a driver of inclusive and sustainable growth, and the foundation of a food system that provides nutritious, safe, and affordable food. 

Creating a flood resilient city: Moving from disaster response to disaster resilience in Ibadan

Salim Rouhana's picture

We’re pleased to announce that the 2015 edition of World Development Indicators (WDI)  has been released.  WDI is the most widely used dataset in our Open Data Catalog and it  provides high-quality cross-country comparable statistics about development and people’s lives around the globe. As usual you can download or query the database, read the publication and  access the online tables.

While the seasoned WDI user will know that the database is updated quarterly and historical versions are also available, for those new to the WDI, the annual release of a new edition is an opportunity to review the trends we’re seeing in global development and to take stock of what’s been achieved.

Depression and its links to conflict and welfare in Nigeria

Julie Perng's picture
Also available in: Español and Français
High-performing systems set rigorous standards for becoming a teacher in order to ensure that only the most qualified individuals enter classrooms

 
Ed's note: This guest blog is by Betsy Brown Ruzzi of the National Center on Education and the Economy (NCEE).

Developing teachers with a deep understanding of the content they teach underpins the success of primary schools in top-performing education systems.  This is one of the key findings in a new report recently released by the National Center on Education and the Economy’s Center on International Education Benchmarking, Not So Elementary: Primary School Teacher Quality in Top-Performing Systems.

Solar Mini Grids Put Nigeria on Path to Energy for All by 2030

Sunita Chikkatur Dubey's picture

I was glad to read the announcement made by World Bank President, Dr. Jim Kim, at the start of this year’s UN General Assembly meetings, about the Bank’s projected financing support through the end of 2015 to help developing countries reach the Millennium Development Goals (MDGs) for women and children’s health.  As we move toward the culmination of the MDGs in 2015 and beyond, preventing maternal and child deaths should be seen by all government delegations and their partners in the international development community as a clear yardstick to measure their commitment for creating more just and inclusive societies.

Transport is not gender-neutral

Karla Gonzalez Carvajal's picture

Transport is not gender-neutral. This was the key message that came out of a high-level gender discussion co-hosted by the World Bank and the World Resources Institute during the recent Transforming Transportation 2018 conference, which was held in Washington DC between January 11-12, 2018. This was the first time in the 15-year history of this annual event that a plenary session looked specifically at the gender dimensions of transport.
 
Women represent the largest share of public transport users around the world, yet they face many barriers that limit their mobility. The numbers speak for themselves. Some 80% of women are afraid of being harassed while using public transport. In developing countries, safety concerns and limited access to transport reducing the probability of women participating in the labor market by 16.5%, with serious consequences on the economy: the global GDP could grow by an additional $5.8 trillion if the gender gap in male and female labor force participation is decreased by 25% by 2025 (International Labour Organization). Women and men have different mobility needs and patterns, yet transport policies for most countries remain unrelentingly gender-blind.
 
Female participation in the transport sector—as operators, drivers, engineers, and leaders—remains low. According to Harvard Business Review, “women make up 20% of engineering graduates, but nearly 40% of them either quit or never enter the profession.” As a result, the transport industry remains heavily male-dominated, which only makes it harder for women service users to make themselves heard, and limits incentives for the sector to become more inclusive.
 
The gender plenary at Transforming Transportation brought together five women and two men on the panel to discuss these issues and highlight practical solutions used in their work to ensure inclusive transport.

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