scholarly journals Beyond Health System Contact: Measuring and Validating Quality of Childbirth Care Indicators in Primary Level Facilities of Northern Ethiopia

2020 ◽  
Author(s):  
Haftom Gebrehiwot Weldearegay ◽  
Araya Abrha Medhanyie ◽  
Hagos Godefay ◽  
Alemayehu Bayray Kahsay
Keyword(s):  
Health System ◽  
Population Level ◽  
Health Interventions ◽  
Receiver Operating Curve ◽  
Maternal And Newborn Health ◽  
Northern Ethiopia ◽  
Primary Level ◽  
Individual Level ◽  
Basic Care

Abstract Background: Measurement of quality of health care has been largely overlooked and continues to be a major health system bottleneck in monitoring performance and quality to evaluate progress against defined targets for better decision making. Hence, metrics of maternity care are needed to advance from health service contact alone to content of care. We assessed the accuracy of indicators that describe the quality of basic care for childbirth functions both at the individual level as well as at the population level in Northern Ethiopia. Methods: A validation study was conducted by comparing women’s self-reported coverage of maternal and newborn health interventions during intra-partum and immediate postpartum care received in primary level care facilities of Northern Ethiopia against a gold standard of direct observation by a trained third party (n=478). Sensitivity, specificity and individual-level reporting accuracy via the area under the receiver operating curve (AUC) and inflation factor (IF) to estimate population-level accuracy for each indicator was applied for validity analysis. Findings: 455(97.5%) of women completed the survey describing health interventions. Thirty-two (43.2%) of the 93-basic quality child birth care indicators that were assessed could be accurately measure at the facility and population level (AUC>0.60 and 0.75

scholarly journals Beyond Health System Contact: Measuring and Validating Quality of Childbirth Care Indicators in Primary Level Facilities of Northern Ethiopia

2019 ◽  
Author(s):  
Haftom Gebrehiwot Weldearegay ◽  
Araya Abrha Medhanyie ◽  
Hagos Godefay ◽  
Alemayehu Bayray Kahsay
Keyword(s):  
Health System ◽  
Population Level ◽  
Health Interventions ◽  
Receiver Operating Curve ◽  
Northern Ethiopia ◽  
Child Birth ◽  
Primary Level ◽  
Individual Level ◽  
Childbirth Care

Abstract Background: Measurement of quality of health care has been largely overlooked and continues to be a major health system bottleneck in monitoring performance and quality to evaluate progress against defined targets for better decision making. Hence, metrics of maternity care are needed to advance from health service contact alone to content of care. We assessed the accuracy of indicators that describe the quality of basic care for childbirth functions both at the individual level as well as at the population level in Northern Ethiopia. Methods: A validation study was conducted by comparing women’s self-reported coverage of maternal and newborn health interventions during intra-partum and immediate postpartum care received in primary level care facilities of Northern Ethiopia against a gold standard of direct observation by a trained third party (n=478). Sensitivity, specificity and individual-level reporting accuracy via the area under the receiver operating curve (AUC) and inflation factor (IF) to estimate population-level accuracy for each indicator was applied for validity analysis.Findings: 455(97.5%) of women completed the survey describing health interventions. Thirty-two (43.2%) of the 93 basic quality child birth care indicators that were assessed could be accurately measure at the facility and population level (AUC>0.60 and 0.75<IF<1.25). Few of the valid indicators were: whether women and their companion were greeted respectfully, whether an HIV test was offered, and whether severe bleeding (hemorrhage) was experienced by the woman. An additional 21(28.4%) indicators accurately measure at the facility or individual level, but the indicators under or over estimate at population level. Thirteen other indicators could accurately measure at population level. Eight (8.6%) indicators didn’t meet either of the validity criteria. Conclusion: Women were able to accurately report on several indicators of quality for basic child birth care. For those few indicators that required a technical understanding tended to have higher don’t know response from the women. Therefore, valid indicators should be included as a potential measurement of quality for the childbirth care process to ensure that essential interventions are delivered.

scholarly journals Beyond health system contact: measuring and validating quality of childbirth care indicators in primary level facilities of northern Ethiopia

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Haftom Gebrehiwot Weldearegay ◽  
Araya Abrha Medhanyie ◽  
Hagos Godefay ◽  
Alemayehu Bayray Kahsay
Keyword(s):  
Health System ◽  
Northern Ethiopia ◽  
Primary Level ◽  
Childbirth Care

‘It makes you someone who changes with the times’: health worker and client perspectives on a smartphone-based counselling application deployed in rural Tanzania

2019 ◽  
Vol 34 (4) ◽  
pp. 307-315 ◽  
Author(s):  
Kristy Hackett ◽  
Mina Kazemi ◽  
Curtis Lafleur ◽  
Peter Nyella ◽  
Lawelu Godfrey ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Health System ◽  
Data Management ◽  
Low Income ◽  
Community Intervention ◽  
Health Workers ◽  
Low Income Countries ◽  
Maternal And Newborn Health ◽  
Pregnancy And Childbirth

AbstractMobile health (mHealth) applications have been developed for community health workers (CHW) to help simplify tasks, enhance service delivery and promote healthy behaviours. These strategies hold promise, particularly for support of pregnancy and childbirth in low-income countries (LIC), but their design and implementation must incorporate CHW clients’ perspectives to be effective and sustainable. Few studies examine how mHealth influences client and supervisor perceptions of CHW performance and quality of care in LIC. This study was embedded within a larger cluster-randomized, community intervention trial in Singida, Tanzania. CHW in intervention areas were trained to use a smartphone application designed to improve data management, patient tracking and delivery of health messages during prenatal counselling visits with women clients. Qualitative data collected through focus groups and in-depth interviews illustrated mostly positive perceptions of smartphone-assisted counselling among clients and supervisors including: increased quality of care; and improved communication, efficiency and data management. Clients also associated smartphone-assisted counselling with overall health system improvements even though the functions of the smartphones were not well understood. Smartphones were thought to signify modern, up-to-date biomedical information deemed highly desirable during pregnancy and childbirth in this context. In this rural Tanzanian setting, mHealth tools positively influenced community perceptions of health system services and client expectations of health workers; policymakers and implementers must ensure these expectations are met. Such interventions must be deeply embedded into health systems to have long-term impacts on maternal and newborn health outcomes.

scholarly journals Public health for paediatricians:How can behavioural economics help to make paediatric practice more effective?

2018 ◽  
Vol 104 (3) ◽  
pp. 146-149
Author(s):  
Rakhee Shah ◽  
Ann Hagell
Keyword(s):  
Public Health ◽  
Social Influence ◽  
Children And Adolescents ◽  
Population Level ◽  
Behavioural Economics ◽  
Health Interventions ◽  
Paediatric Care ◽  
Paediatric Practice ◽  
Behavioural Economic

Understanding the principles of behavioural economics is important for paediatricians because behavioural economics offers ideas to help improve the quality of paediatric care. It can also be used to inform health interventions/policy at a population level. This paper summarises key behavioural economic concepts such as bounded rationality, bounded willpower and social influence, explaining how they can be used to shape healthy behaviours in children and adolescents. Case studies of interventions that have used behavioural economics principles (sometimes called ‘nudge theory’) are provided.

scholarly journals Operationalising health systems thinking: a pathway to high effective coverage

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Lara M. E. Vaz ◽  
Lynne Franco ◽  
Tanya Guenther ◽  
Kelsey Simmons ◽  
Samantha Herrera ◽  
...  
Keyword(s):  
Strategic Planning ◽  
Global Health ◽  
Health System ◽  
Health Systems ◽  
Systems Thinking ◽  
Monitoring And Evaluation ◽  
Health Interventions ◽  
Maternal And Newborn Health ◽  
High Coverage ◽  
Effective Coverage

Abstract Background The global health community has recognised the importance of defining and measuring the effective coverage of health interventions and their implementation strength to monitor progress towards global mortality and morbidity targets. Existing health system models and frameworks guide thinking around these measurement areas; however, they fall short of adequately capturing the dynamic and multi-level relationships between different components of the health system. These relationships must be articulated for measurement and managed to effectively deliver health interventions of sufficient quality to achieve health impacts. Save the Children’s Saving Newborn Lives programme and EnCompass LLC, its evaluation partner, developed and applied the Pathway to High Effective Coverage as a health systems thinking framework (hereafter referred to as the Pathway) in its strategic planning, monitoring and evaluation. Methods We used an iterative approach to develop, test and refine thinking around the Pathway. The initial framework was developed based on existing literature, then shared and vetted during consultations with global health thought leaders in maternal and newborn health. Results The Pathway is a robust health systems thinking framework that unpacks system, policy and point of intervention delivery factors, thus encouraging specific actions to address gaps in implementation and facilitate the achievement of high effective coverage. The Pathway includes six main components – (1) national readiness; (2) system structures; (3) management capacity; (4) implementation strength; (5) effective coverage; and (6) impact. Each component is comprised of specific elements reflecting the range of facility-, community- and home-based interventions. We describe applications of the Pathway and results for in-country strategic planning, monitoring of progress and implementation strength, and evaluation. Conclusions The Pathway provides a cohesive health systems thinking framework that facilitates assessment and coordinated action to achieve high coverage and impact. Experiences of its application show its utility in guiding strategic planning and in more comprehensive and effective monitoring and evaluation as well as its potential adaptability for use in other health areas and sectors.

scholarly journals Quality of and barriers to routine childbirth care signal functions in primary level facilities of Tigray, Northern Ethiopia: Mixed method study

PLoS ONE ◽  
2020 ◽  
Vol 15 (6) ◽  
pp. e0234318
Author(s):  
Haftom Gebrehiwot Weldearegay ◽  
Alemayehu Bayray Kahsay ◽  
Araya Abrha Medhanyie ◽  
Hagos Godefay ◽  
Pammla Petrucka
Keyword(s):  
Mixed Method ◽  
Mixed Method Study ◽  
Northern Ethiopia ◽  
Primary Level ◽  
Signal Functions ◽  
Childbirth Care

scholarly journals Applying a Capabilities Approach to Understanding Older LGBT People’s Disclosures of Identity in Community Primary Care

2020 ◽  
Vol 17 (20) ◽  
pp. 7614
Author(s):  
Michael Toze ◽  
Julie Fish ◽  
Trish Hafford-Letchfield ◽  
Kathryn Almack
Keyword(s):  
Data Collection ◽  
Population Level ◽  
Good Health ◽  
Capabilities Approach ◽  
Individual Level ◽  
The Uk ◽  
Multiple Domains ◽  
Lgbt Populations

Internationally, there is increasing recognition that lesbian, gay, bisexual and trans (LGBT) populations experience substantial public health inequalities and require interventions to address these inequalities, yet data on this population is often not routinely collected. This paper considers the case study of the UK, where there are proposals to improve government and health data collection on LGBT populations, but also a degree of apparent uncertainty over the purpose and relevance of information about LGBT status in healthcare. This paper applies a health capabilities framework, arguing that the value of health information about LGBT status should be assessed according to whether it improves LGBT people’s capability to achieve good health. We draw upon 36 older LGBT people’s qualitative accounts of disclosing LGBT status within UK general practice healthcare. Participants’ accounts of the benefits and risks of disclosure could be mapped against multiple domains of capability, including those that closely align with biomedical accounts (e.g., longevity and physical health), but also more holistic considerations (e.g., emotion and affiliation). However, across all domains, individuals tend to assess capabilities at an individual level, with relatively little reference to population-level impact of disclosure. Clearer articulation of the benefits of disclosure and data collection for the collective capabilities of LGBT populations may be a beneficial strategy for improving the quality of information on LGBT populations.

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