Monitoring Universal Health Coverage reforms in primary health care facilities: Creating a framework, selecting and field-testing indicators in Kerala, India
Monitoring Universal Health Coverage reforms in primary health care facilities: Creating a framework, selecting and field-testing indicators in Kerala, India
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DOI：
10.1371/journal.pone.0236169
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发表时间：
2020-08-03
期刊：
影响因子：
3.7
通讯作者：
Sadanandan, Rajeev
中科院分区：
文献类型：
--
作者：
Nambiar, Devaki;Sankar D., Hari;Sadanandan, Rajeev
根据可持续发展目标（SDG）和实现全民健康覆盖（UHC）的目标，印度正在采取州一级的举措，以促进健康，“不让任何人掉队”。在喀拉拉邦，根据Aaralan的旗舰使命进行的改革包括将初级保健中心改为家庭保健中心，类似于国家保健和健康中心模式，并在行政区域内积极主动地为人口提供一揽子初级保健服务。我们报告的一个组成部分，Aarabel的监测和评价框架的初级卫生保健，示踪输入，输出和结果指标的选择使用修改后的德尔菲过程和实地测试。在文献审查和利益攸关方协商的基础上，制定了一个概念框架和指标清单，随后绘制了初级保健中心目前使用的人工登记册，以确定数据来源和监测程序。指标清单减少到一个列表使用修改后的德尔菲方法，然后在三个地区的设施一级的实地测试。经过修改的德尔菲评估包括两轮的25名参与者，他们将清单减少到23个核准指标和12个建议指标。确定了监测指标方面的三种挑战：指标相对于当地使用的适当性、报告者之间缺乏明确性或程序差异，以及数据的有效性。可能需要对指标进行进一步的实地测试，并修订或取消一些指标，以支持正在进行的卫生系统改革、学习、监测和评价。
In line with the Sustainable Development Goals (SDGs) and the target for achieving Universal Health Coverage (UHC), state level initiatives to promote health with "no-one left behind" are underway in India. In Kerala, reforms under the flagship Aardram mission include upgradation of Primary Health Centres (PHCs) to Family Health Centres (FHCs, similar to the national model of health and wellness centres (HWCs)), with the proactive provision of a package of primary care services for the population in an administrative area. We report on a component of Aardram's monitoring and evaluation framework for primary health care, where tracer input, output, and outcome indicators were selected using a modified Delphi process and field tested. A conceptual framework and indicator inventory were developed drawing upon literature review and stakeholder consultations, followed by mapping of manual registers currently used in PHCs to identify sources of data and processes of monitoring. The indicator inventory was reduced to a list using a modified Delphi method, followed by facility-level field testing across three districts. The modified Delphi comprised 25 participants in two rounds, who brought the list down to 23 approved and 12 recommended indicators. Three types of challenges in monitoring indicators were identified: appropriateness of indicators relative to local use, lack of clarity or procedural differences among those doing the reporting, and validity of data. Further field-testing of indicators, as well as the revision or removal of some may be required to support ongoing health systems reform, learning, monitoring and evaluation.