Associations of workforce characteristics, calendar time, and assessment modality with quality performance in family planning and post-abortion care services in Sierra Leone, 2019–2022

BACKGROUND: Quality assessment in family planning (FP) and post-abortion care (PAC) programmes is shaped by workforce capability, programme context, and assessment modality. Longitudinal evaluations may misattribute quality-score differences if repeated measurements and temporal patterning are ignored. OBJECTIVE: To examine associations of workforce characteristics, calendar period, service-delivery channel, and assessment modality with Quality Technical Assessment (QTA) performance in Sierra Leone, 2019-2022. METHODS: We analysed 108 QTA records from 23 service delivery points using Gaussian generalised estimating equations with facility-level clustering and robust standard errors. Models included year, modality, channel, active staff count, and core-service competency coverage; full-time staffing and assessor identity were examined in sensitivity analyses. In 2021, all facilities received planned in-person and then remote assessments in a fixed programme-wide sequence. RESULTS: Mean QTA scores increased descriptively from 89.8% (SD 7.4) in 2019 to 94.2% (SD 4.7) in 2022. In the primary model, 2020 scores were lower than 2019 (B = -5.15; 95% CI -9.99 to -0.32). Active staff count was inversely associated with QTA scores (B = -2.86; 95% CI -4.47 to -1.26). Remote assessment was associated with higher adjusted scores, but this cannot be interpreted causally because modality was confounded with year and assessment order. CONCLUSIONS: QTA performance varied across calendar periods and workforce structure. Longitudinal evaluations should account for within-facility correlation and modality timing before attributing quality differences to the workforce or assessment approach.