Primary healthcare systems are central to achieving universal healthcare coverage. However, in many low- and middle-income country settings, primary care quality is challenged by inadequate facility infrastructure and equipment, limited human resources, and poor provider process. We study the effects of a recent large-scale quality improvement policy in South Africa, the Ideal Clinics Realization and Maintenance Program (ICRMP). The ICRMP introduced a set of standards for facilities and a quality improvement process involving manuals, district-based support, and external assessment. Exploiting differential prioritization of facilities for the ICRMP's quality improvement process, we apply differences-in-differences methods to identify the effects of the program's efforts on standards scores and primary care quality indicators over the first 12 months of implementation. We find large and statistically significant increases in standards scores, but mixed effects on care outcomes—a small magnitude improvement in early antenatal care usage, null effects on childhood immunization and cervical cancer screening, and small negative effect of human immunodeficiency virus (HIV) care. While the ICRMP process has led to significant improvements in facilities' satisfaction of the program's standards, we were unable to detect meaningful change in care quality indicators.

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设施标准和公共部门初级保健的质量：来自南非“理想诊所”计划的证据

初级医疗保健系统是实现全民医疗保健的核心。然而，在许多低收入和中等收入国家，初级保健质量受到设施基础设施和设备不足、人力资源有限以及提供者流程不完善的挑战。我们研究了南非最近一项大规模质量改进政策的效果，即理想诊所实现和维护计划 (ICRMP)。ICRMP 引入了一套设施标准和质量改进流程，包括手册、地区支持和外部评估。在 ICRMP 的质量改进过程中利用设施的不同优先级，我们应用差异中的差异方法来确定该计划的影响 在实施的前 12 个月内在标准分数和初级保健质量指标方面做出的努力。我们发现标准分数在统计上显着增加，但对护理结果的影响是混合的——早期产前护理使用量有小幅改善，对儿童免疫和宫颈癌筛查的影响为零，以及人类免疫缺陷病毒 (HIV) 护理的小负面影响. 虽然 ICRMP 流程显着提高了设施对计划标准的满意度，但我们无法检测到护理质量指标的有意义变化。对儿童免疫接种和宫颈癌筛查的无效影响，以及人类免疫缺陷病毒 (HIV) 护理的小负面影响。虽然 ICRMP 流程显着提高了设施对计划标准的满意度，但我们无法检测到护理质量指标的有意义变化。对儿童免疫接种和宫颈癌筛查的无效影响，以及人类免疫缺陷病毒 (HIV) 护理的小负面影响。虽然 ICRMP 流程显着提高了设施对计划标准的满意度，但我们无法检测到护理质量指标的有意义变化。