Quality assessment of primary health care for infants and young children in Hunan Province of China

Abstract

Abstract Objective To comprehensively evaluate the service quality of primary health care (PHC) for children aged 0–3 years in healthcare facilities of China, and to identify strengths and existing gaps to provide evidence for optimizing regional child health service policies. Methods A multi-stage stratified random sampling method was used to select 35 healthcare facilities from 4 geographical regions in Hunan province of China. Data were collected using the WHO Western Pacific Regional Office Primary Health Care Quality Improvement Guide, which included facility assessments, medical record reviews, and caregiver interviews. All indicators were assessed against China national basic public health service standards and WHO PHC quality benchmarks. Chi-square test was used for comparative analysis between sick and healthy children. Results The overall PHC foundation was sound: 85.0% of service rooms had qualified handwashing facilities, 92.0% were equipped with alcohol rub, and over 97% of facilities had standardized protocols for breastfeeding screening and infection control. The key basic medicines and routine growth monitoring supplies achieved an availability rate above 91.4%. The under-6-month exclusive breastfeeding rate was 38.9%, and National Immunization Programme (NIP) vaccine coverage remained over 90% for most routine vaccines. However, significant gaps existed. Well children showed far higher health screening rates than sick children, with growth measurement completion rates of 93.9% vs. 72.2% for weight and 92.1% vs. 9.0% for height; respiratory rate screening remained extremely low at around 17% in both groups. Non-NIP vaccine coverage was only 28.5%–47.1%. The availability of therapeutic food, special vaccines and essential emergency medicines was below 30%, and only 45.8% of rooms were equipped with sharps containers and merely 28.6% of facilities had child abuse and neglect management protocols. Additionally, the staff IMCI training rate was only 54.2%, and patient–staff ratios ranged from 48.6% to 65.9% across clinics. Conclusion Child PHC services in Hunan Province perform well in basic infrastructure, routine health management and national immunization, but have prominent deficiencies in standardized clinical assessment for sick children, breastfeeding promotion, non-NIP vaccine accessibility, child protection system construction, essential drug supply, and human resource allocation. Targeted interventions on clinical standardization, material guarantee, professional training and child protection mechanism improvement are needed to further elevate the overall quality and equity of early childhood PHC services.