Abstract
Assessment of structural quality of care is the beginning of the cycle for assessment of total quality care. OBJECTIVE: The objective of the study was to measure the structural quality (SQ) that supports diabetes services in health centers with comparison to specialized diabetes centers in Khartoum State, 2013. METHODOLOGY: A cross section study was carried at 40 health centres (HCs) and three specialized diabetic centres (SDCs). A check list of 16 items was used for measuring the potential resources of diabetes services in the study centres. The main variables in the check list were availability of; management protocols, trained staff, laboratory investigations, clinical assessment tools, anti-diabetes and anti-hypertensive drugs and the tools for diabetes education and wound management. The knowledge and training of 91 medical doctors were assessed by self-administered questionnaire. The median was used to differentiate the adequate structures of the study centers. ANOVA tested the significance of the mean difference of the SQ scores. Comprehensiveness scores were compared between the HCs and SDCs. Chi square tested the association of study centers with the knowledge of medical doctors about the timing of feet exam and requesting HBA1c. Approval was obtained from Khartoum State Ministry of Health. RESULTS: Adequate SQ was shown in 57.5% of HCs compared to 100% SDCs. The mean SQ score in HCs was significantly low compared to SDCs, 8.33 + 2.8 and 13.0 + 2 respectively, P=0.007. The comprehensiveness score in HCs was 52% compared to 81.3% in SDCs. The proportion of medical doctors in HCs who knew the timing of requesting HBA1c was significantly low compared to SDCs, 41.0% versus 100% respectively, P=0.01. CONCLUSION: Structural quality of diabetes services in health centers is inadequate. Policy makers in Khartoum State Ministry of Health should address this gap.