{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T21:03:37Z","timestamp":1792616617957,"version":"4.5.0"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2024,6,7]],"date-time":"2024-06-07T00:00:00Z","timestamp":1717718400000},"content-version":"vor","delay-in-days":8,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,5,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Despite a consensus that quality of care is critically deficient in low-income countries, few nationally representative studies provide comparable measures of quality of care across countries. To address this gap, we used nationally representative data from in-person administrations of clinical vignettes to measure the competence of 16 127 health care providers across 11 sub-Saharan African countries. Rather than large variations across countries, we found that 81% of the variation in competence is within countries and the characteristics of health care providers do not explain most of this variation. Professional qualifications\u2014including cadre and education\u2014are only weakly associated with competence: across our sample, one-third of nurses are more competent than the average doctor in the same country and one-quarter of doctors are less competent than the average nurse. Finally, while younger cohorts do tend to be more competent, perhaps reflecting improvements in medical education, it would take 25 decades of turnover to improve care by 10 percentage points, on average, if we were to rely on such improvements alone. These patterns necessitate a fundamentally different approach to health care human resource management, calling into question typical staffing policies based on qualifications and seniority rather than directly measured quality.<\/jats:p>","DOI":"10.1093\/haschl\/qxae066","type":"journal-article","created":{"date-parts":[[2024,6,5]],"date-time":"2024-06-05T15:09:52Z","timestamp":1717600192000},"source":"Crossref","is-referenced-by-count":7,"title":["The medical competence of health care providers in sub-Saharan Africa: Evidence from 16 127 providers across 11 countries"],"prefix":"10.1093","volume":"2","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9652-6653","authenticated-orcid":false,"given":"Benjamin","family":"Daniels","sequence":"first","affiliation":[{"name":"McCourt School of Public Policy, Georgetown University , Washington, DC 20057 , United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0435-9072","authenticated-orcid":false,"given":"Andres","family":"Yi Chang","sequence":"additional","affiliation":[{"name":"Office of the Chief Economist for Human Development, The World Bank, Washington, DC 20433, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberta","family":"Gatti","sequence":"additional","affiliation":[{"name":"Office of the Chief Economist for Middle East and North Africa , The World Bank, Washington, DC 20433 , United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jishnu","family":"Das","sequence":"additional","affiliation":[{"name":"McCourt School of Public Policy and the Walsh School of Foreign Service, Georgetown University , Washington, DC 20057 , United States"},{"name":"Centre for Policy Research , New Delhi 110021 , India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,6,7]]},"reference":[{"issue":"12","key":"2024060708141926800_qxae066-B1","doi-asserted-by":"crossref","first-page":"1835","DOI":"10.1038\/s41591-020-1059-1","article-title":"Global maps of travel time to healthcare facilities","volume":"26","author":"Weiss","year":"2020","journal-title":"Nat Med."},{"issue":"1","key":"2024060708141926800_qxae066-B2","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1146\/annurev-economics-080213-041350","article-title":"Quality of primary care in low-income countries: Facts and economics","volume":"6","author":"Das","year":"2014","journal-title":"Annu Rev Econom."},{"issue":"9","key":"2024060708141926800_qxae066-B3","doi-asserted-by":"crossref","first-page":"e003393","DOI":"10.1136\/bmjgh-2020-003393","article-title":"Antibiotic overuse in the primary health care setting: A secondary data analysis of standardised patient studies from India, China and Kenya","volume":"5","author":"Sulis","year":"2020","journal-title":"BMJ Global Health"},{"issue":"2","key":"2024060708141926800_qxae066-B4","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1257\/jep.37.2.123","article-title":"The prices in the crises: What we are learning from 20 years of health insurance in low-and middle-income countries","volume":"37","author":"Das","year":"2023","journal-title":"J Econ Perspect"},{"issue":"11","key":"2024060708141926800_qxae066-B5","doi-asserted-by":"crossref","first-page":"e1196","DOI":"10.1016\/S2214-109X(18)30386-3","article-title":"High-quality health systems in the sustainable development goals era: Time for a revolution","volume":"6","author":"Kruk","year":"2018","journal-title":"Lancet Glob Health."},{"key":"2024060708141926800_qxae066-B6","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1016\/B978-0-444-53592-4.00006-2","article-title":"Who ordered that? The economics of treatment choices in medical care","volume":"2","author":"Chandra","year":"2011","journal-title":"Handb Health Econ"},{"issue":"12","key":"2024060708141926800_qxae066-B7","doi-asserted-by":"crossref","first-page":"e003377","DOI":"10.1136\/bmjgh-2020-003377","article-title":"Analysis of clinical knowledge, absenteeism and availability of resources for maternal and child health: A cross-sectional quality of care study in 10 African countries","volume":"5","author":"Di Giorgio","year":"2020","journal-title":"BMJ Global Health"},{"issue":"13","key":"2024060708141926800_qxae066-B8","doi-asserted-by":"crossref","first-page":"1715","DOI":"10.1001\/jama.283.13.1715","article-title":"Comparison of vignettes, standardized patients, and chart abstraction: A prospective validation study of 3 methods for measuring quality","volume":"283","author":"Peabody","year":"2000","journal-title":"JAMA"},{"issue":"2","key":"2024060708141926800_qxae066-B9","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1016\/j.jdeveco.2004.11.004","article-title":"Which doctor? 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