scholarly journals Effective Coverage for Nutrition: Operationalizing Effective Coverage Cascades for Nutrition Interventions Delivered to Pregnant Women and Children

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 853-853
Author(s):  
Shannon King ◽  
Rebecca Heidkamp ◽  
Ashley Sheffel ◽  
Yvonne Yiru Xu ◽  
Melinda Munos
Keyword(s):  
Antenatal Care ◽  
Health System ◽  
Sick Child ◽  
Household Survey ◽  
Data Availability ◽  
Nutrition Interventions ◽  
Effective Coverage ◽  
Provision Of Care ◽  
Facility Readiness

Abstract Objectives Many low and middle income country (LMIC) decision makers rely on data from multi-topic household surveys to identify the proportion of the population that has been reached with nutrition services, but these surveys do not always account for the quality of the services. Effective coverage cascades, commonly used in health systems research, capture measures of both coverage and quality to generate actionable information to improve nutrition programs, interventions, and policies. This study aims to describe the operationalization of effective coverage cascades for maternal and child nutrition interventions delivered through the health system using extant data in LMICs. Methods By linking household survey and health facility assessment data from seven LMICs, effective coverage cascades were developed for nutrition interventions delivered through antenatal care visits and sick-child visits. Facility readiness and provision of care index scores were defined for each intervention from clinical guidelines and an expert survey, then refined based on data availability. The facility readiness and provision of care scores were linked to individual care-seeking episodes from household survey data based on geographic domain and facility type. Finally, steps of the coverage cascade for each service in each country were estimated. Results National estimates of the effective coverage cascade for each set of nutrition interventions will be presented. Analysis is ongoing, however preliminary findings show gaps in service readiness such as lack of provider training and gaps in provision of care such as limited nutrition counseling. A substantial drop is seen from service contact to input-adjusted coverage to quality-adjusted coverage for both antenatal care and sick child care. Conclusions The cascade approach yielded summary measures that were useful for identifying high-level barriers to effective coverage; however, detailed measures within the cascade may be more useful for evidence-based decision making. Data availability on quality of care for nutrition interventions is scant, highlighting an opportunity to expand facility-based surveys to include nutrition interventions delivered through the health system. Funding Sources Bill & Melinda Gates Foundation through the DataDENT initiative and the Improving Measurement and Program Design grant.

scholarly journals Development of summary indices of antenatal care service quality in Haiti, Malawi and Tanzania

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e032558
Author(s):  
Ashley Sheffel ◽  
Scott Zeger ◽  
Rebecca Heidkamp ◽  
Melinda Kay Munos
Keyword(s):  
Quality Of Care ◽  
Service Quality ◽  
Antenatal Care ◽  
Low Income ◽  
Care Service ◽  
Weighted Average ◽  
The Other ◽  
Provision Of Care ◽  
Facility Readiness

IntroductionMeasuring quality of care in low-income and middle-income countries is complicated by the lack of a standard, universally accepted definition for ‘quality’ for any particular service, as well as limited guidance on which indicators to include in measures of quality of care, and how to incorporate those indicators into summary indices. The aim of this paper is to develop, characterise and compare a set of antenatal care (ANC) indices for facility readiness and provision of care.MethodsWe created nine indices for facility readiness using three methods for selecting items and three methods for combining items. In addition, we created three indices for provision of care using one method for selecting items and three methods for combining items. For each index, we calculated descriptive statistics, categorised the continuous index scores using tercile cut points to assess comparability of facility classification, and examined the variability and distribution of scores.ResultsOur results showed that, within a country, the indices were quite similar in terms of mean index score, facility classification, coefficient of variation, floor and ceiling effects, and the inclusion of items in an index with a range of variability. Notably, the indices created using principal components analysis to combine the items were the most different from the other indices. In addition, the index created by taking a weighted average of a core set of items had lower agreement with the other indices when looking at facility classification.ConclusionsAs improving quality of care becomes integral to global efforts to produce better health outcomes, demand for guidance on creating standardised measures of service quality will grow. This study provides health systems researchers with a comparison of methodologies commonly used to create summary indices of ANC service quality and it highlights the similarities and differences between methods.

scholarly journals Assessing health system performance: effective coverage at the Mexican Institute of Social Security

2019 ◽  
Vol 34 (Supplement_2) ◽  
pp. ii67-ii76 ◽  
Author(s):  
Hannah H Leslie ◽  
Svetlana V Doubova ◽  
Ricardo Pérez-Cuevas
Keyword(s):  
Quality Of Care ◽  
Social Security ◽  
Health System ◽  
Newborn Care ◽  
Public Healthcare ◽  
Potential Health ◽  
Effective Coverage ◽  
Childhood Diarrhoea ◽  
Life Years

Abstract Universal health coverage is a national priority in Mexico, with active efforts to expand public healthcare system access, increase financial protection and improve quality of care. We estimated effective coverage of multiple conditions within the Mexican Institute of Social Security (IMSS), which covers 62 million individuals. We identified routinely collected performance indicators at IMSS from 2016 related to use and quality of care for conditions avertable with high-quality healthcare; where candidate indicators were available, we quantified need for service from a population-representative survey and calculated effective coverage as proportion of individuals in need who experience potential health gains. We assessed subnational inequality across 32 states, and we weighted conditions by relative contribution to national disease burden to estimate composite effective coverage. Conditions accounting for 51% of healthcare-avertable disability-adjusted life years lost in Mexico could be assessed: antenatal care, delivery care, newborn care, childhood diarrhoea, cardiovascular disease and diabetes. Estimated effective coverage ranged from a low of 27% for childhood diarrhoea to a high of 74% for newborn care. Substantial inequality in effective coverage existed between states, particularly for maternal and child conditions. Overall effective coverage of these six conditions in IMSS was 49% in 2016. Gaps in use and quality of care must be addressed to ensure good health for all in Mexico. Despite extensive monitoring of health status and services in Mexico, currently available data are inadequate to the task of fully and routinely assessing health system effective coverage. Leaders at IMSS and similar healthcare institutions must be more purposeful in planning the assessment of population need, utilization of care and quality impacts of care to enable linkage of these data and disaggregation by location or population sub-group. Only then can complex health systems be fairly and fully evaluated.

scholarly journals Effect of Health Systems Strengthening in Influencing Maternal and Neonatal Health Outcomes in Bungoma County, Kenya

2020 ◽  
Author(s):  
Beverly Ochieng ◽  
Giorgia Lattanzi ◽  
Milka Choge ◽  
Amarddep Thind
Keyword(s):  
Health System ◽  
Quality Care ◽  
Real Life ◽  
Health Indicators ◽  
Health Facilities ◽  
Health Systems Strengthening ◽  
Data Availability ◽  
Health System Strengthening ◽  
The Impact

Abstract Kenya is estimated to have a population of 47.6 million people. Its maternal and neo natal health indicators have steadily improved over the years. Despite the progress, many significant challenges remain, including persistent inequities between population subgroups, and a health care system that provides variable quality and inconsistent access to care, especially for women and new-borns. Purpose of this paper was to assess the impact of the maternal and new-born improvement intervention in Bungoma County, with a focus on access and quality of maternal and neonatal care services.Methodology: The study design was quasi-experimental, using household surveys to assess outcomes.Findings: Provision of transport vouchers decreased barriers to accessing care, resulting to an increased number of deliveries in health facilities. The health system strengthening intervention possibly had a role in improving potential and actual access to antenatal care and health facility delivery services for mothers as well as positively impacting quality of care provision in the intervention sub-counties. However, actual access for babies (measured by provision of PNC care within 48 hours of delivery) seemed to worsen in the intervention sub-counties.Conclusion: Our analysis suggests that it is possible to conduct an evaluation of the impact of interventions in messy real-life contexts where data availability is challenging. Key elements of health system strengthening include reducing cost barriers and enhancing the capacity of the health facilities to deliver the high quality care. These can fruitfully be implemented in other regions.

scholarly journals Health system interventions for adults with type 2 diabetes in low- and middle-income countries: A systematic review and meta-analysis

PLoS Medicine ◽  
2020 ◽  
Vol 17 (11) ◽  
pp. e1003434
Author(s):  
David Flood ◽  
Jessica Hane ◽  
Matthew Dunn ◽  
Sarah Jane Brown ◽  
Bradley H. Wagenaar ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Glycemic Control ◽  
Health System ◽  
Meta Analysis ◽  
Data Availability ◽  
Middle Income ◽  
Middle Income Countries ◽  
Glycemic Outcomes

Background Effective health system interventions may help address the disproportionate burden of diabetes in low- and middle-income countries (LMICs). We assessed the impact of health system interventions to improve outcomes for adults with type 2 diabetes in LMICs. Methods and findings We searched Ovid MEDLINE, Cochrane Library, EMBASE, African Index Medicus, LILACS, and Global Index Medicus from inception of each database through February 24, 2020. We included randomized controlled trials (RCTs) of health system interventions targeting adults with type 2 diabetes in LMICs. Eligible studies reported at least 1 of the following outcomes: glycemic change, mortality, quality of life, or cost-effectiveness. We conducted a meta-analysis for the glycemic outcome of hemoglobin A1c (HbA1c). GRADE and Cochrane Effective Practice and Organisation of Care methods were used to assess risk of bias for the glycemic outcome and to prepare a summary of findings table. Of the 12,921 references identified in searches, we included 39 studies in the narrative review of which 19 were cluster RCTs and 20 were individual RCTs. The greatest number of studies were conducted in the East Asia and Pacific region (n = 20) followed by South Asia (n = 7). There were 21,080 total participants enrolled across included studies and 10,060 total participants in the meta-analysis of HbA1c when accounting for the design effect of cluster RCTs. Non-glycemic outcomes of mortality, health-related quality of life, and cost-effectiveness had sparse data availability that precluded quantitative pooling. In the meta-analysis of HbA1c from 35 of the included studies, the mean difference was −0.46% (95% CI −0.60% to −0.31%, I2 87.8%, p < 0.001) overall, −0.37% (95% CI −0.64% to −0.10%, I2 60.0%, n = 7, p = 0.020) in multicomponent clinic-based interventions, −0.87% (−1.20% to −0.53%, I2 91.0%, n = 13, p < 0.001) in pharmacist task-sharing studies, and −0.27% (−0.50% to −0.04%, I2 64.1%, n = 7, p = 0.010) in trials of diabetes education or support alone. Other types of interventions had few included studies. Eight studies were at low risk of bias for the summary assessment of glycemic control, 15 studies were at unclear risk, and 16 studies were at high risk. The certainty of evidence for glycemic control by subgroup was moderate for multicomponent clinic-based interventions but was low or very low for other intervention types. Limitations include the lack of consensus definitions for health system interventions, differences in the quality of underlying studies, and sparse data availability for non-glycemic outcomes. Conclusions In this meta-analysis, we found that health system interventions for type 2 diabetes may be effective in improving glycemic control in LMICs, but few studies are available from rural areas or low- or lower-middle-income countries. Multicomponent clinic-based interventions had the strongest evidence for glycemic benefit among intervention types. Further research is needed to assess non-glycemic outcomes and to study implementation in rural and low-income settings.

Managing the effectiveness of the regional health system

2020 ◽  
Vol 26 (3) ◽  
pp. 698-720
Author(s):  
E.V. Lobkova ◽  
A.S. Petrichenko
Keyword(s):  
Public Health ◽  
Health System ◽  
System Analysis ◽  
Health Indicators ◽  
Krasnoyarsk Krai ◽  
Regional Health ◽  
Luenberger Observer ◽  
Efficiency Assessment ◽  
Public Health Indicators

Subject. This article studies the mechanism of State health regulation and methods of management of efficiency of regional healthcare institutions. Objectives. The article aims to analyze the territorial health system in the context of the urgent need to optimize budget expenditures and address public health problems, as well as develop directions to improve the effectiveness of the regional health system of the Krasnoyarsk Krai. Methods. For the study, we used the method of index numbers and calculation of dynamics indicators using official statistics data. Results. We have developed and now present a system of indicators of regional health efficiency assessment, focused mainly on public health indicators and quality of medical services. We also offer our own version of the Luenberger observer modification adapted to the objectives of the regional health system analysis. Conclusions and Relevance. The article concludes that it is necessary to optimize the regional health system using the parameters of medical and social efficiency of the system. The proposed approach to assessing the effectiveness of regional health system can be used as a mechanism to develop recommendations for the management of the network of medical and prophylactic institutions of the region.

EFFECTIVENESS OF USING MCH BOOKS AND MONSCA APPLICATIONS IN THE IMPLEMENTATION OF 14 T ANTENATAL SERVICE STANDARDS

2020 ◽  
Vol 12 (1) ◽  
pp. 68-73
Author(s):  
Rahmawati Rahmawati ◽  
Syarif Syafruddin ◽  
Nontji Wena
Keyword(s):  
Antenatal Care ◽  
Pregnant Women ◽  
Continuity Of Care ◽  
Control Design ◽  
Sampling Technique ◽  
Limited Time ◽  
Control Groups ◽  
Post Test ◽  
Service Standards

The component of antenatal care received by pregnant women is classified as incomplete because the implementation of standard pregnancy services is still using conventional methods. There are obstacles faced by midwives, such as the limited time in a recording, which has an impact on the declining quality of antenatal care standards. This research aims to compare the effectiveness of the use of KIA books and MONSCA applications in midwives in the application of the standard Antenatal service 14 T. This research was conducted in Puskesmas Tanete and Puskesmas Bontobangun Bulukumba District. The method used in the study is experimental quasi (pre-test post-test nonequivalent control design). Using a sample of midwives in this study, as many as 36 people were divided into two groups (18 intervention groups and 18 control groups). The sampling technique in this study used purposive sampling. Data were analyzed using the Mann-Whitney Test. The results showed that there was a difference in the effectiveness of using KIA books with MONSCA applications, MOSCA's applications were easier to use, faster, safer, and more accurate than KIA books. It can be concluded that the MONSCA application is more effective than KIA books. Key words: Effectiveness, Android-based Smart Continuity of Care application, KIA book, Antenatal service 14 T

Scoundrels or Stars? Theory and Evidence on the Quality of Workers in Online Labor Markets

2016 ◽  
Vol 92 (1) ◽  
pp. 93-114 ◽  
Author(s):  
Anne M. Farrell ◽  
Jonathan H. Grenier ◽  
Justin Leiby
Keyword(s):  
Labor Markets ◽  
Data Availability ◽  
Accounting Research ◽  
Research Participants ◽  
Large Numbers ◽  
Research Designs ◽  
Online Labor Markets ◽  
Online Labor ◽  
Low Pay

ABSTRACT Online labor markets allow rapid recruitment of large numbers of workers for very low pay. Although online workers are often used as research participants, there is little evidence that they are motivated to make costly choices to forgo wealth or leisure that are often central to addressing accounting research questions. Thus, we investigate the validity of using online workers as a proxy for non-experts when accounting research designs use more demanding tasks than these workers typically complete. Three experiments examine the costly choices of online workers relative to student research participants. We find that online workers are at least as willing as students to make costly choices, even at significantly lower wages. We also find that online workers are sensitive to performance-based wages, which are just as effective in inducing high effort as high fixed wages. We discuss implications of our results for conducting accounting research with online workers. Data Availability: Contact the authors.

scholarly journals Implementation of a performance-based financing scheme in Malawi and resulting externalities on the quality of care of non-incentivized services

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Stephan Brenner ◽  
Caterina Favaretti ◽  
Julia Lohmann ◽  
Jobiba Chinkhumba ◽  
Adamson S. Muula ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Health Services ◽  
Antenatal Care ◽  
Service Provision ◽  
Child Health Services ◽  
Negative Externalities ◽  
Positive Externalities ◽  
Performance Based Financing ◽  
A Performance

Abstract Background Countries in Africa progressively implement performance-based financing schemes to improve the quality of care provided by maternal, newborn and child health services. Beyond its direct effects on service provision, evidence suggests that performance-based financing can also generate positive externalities on service utilization, such as increased use of those services that reached higher quality standards after effective scheme implementation. Little, however, is known about externalities generated within non-incentivized health services, such as positive or negative effects on the quality of services within the continuum of maternal care. Methods We explored whether a performance-based financing scheme in Malawi designed to improve the quality of childbirth service provision resulted positive or negative externalities on the quality of non-targeted antenatal care provision. This non-randomized controlled pre-post-test study followed the phased enrolment of facilities into a performance-based financing scheme across four districts over a two-year period. Effects of the scheme were assessed by various composite scores measuring facilities’ readiness to provide quality antenatal care, as well as the quality of screening, prevention, and education processes offered during observed antenatal care consultations. Results Our study did not identify any statistically significant effects on the quality of ANC provision attributable to the implemented performance-based financing scheme. Our findings therefore suggest not only the absence of positive externalities, but also the absence of any negative externalities generated within antenatal care service provision as a result of the scheme implementation in Malawi. Conclusions Prior research has shown that the Malawian performance-based financing scheme was sufficiently effective to improve the quality of incentivized childbirth service provision. Our findings further indicate that scheme implementation did not affect the quality of non-incentivized but clinically related antenatal care services. While no positive externalities could be identified, we also did not observe any negative externalities attributable to the scheme’s implementation. While performance-based incentives might be successful in improving targeted health care processes, they have limited potential in producing externalities – neither positive nor negative – on the provision quality of related non-incentivized services.

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