A critique of the Uganda district league table using a normative health system performance assessment framework
A critique of the Uganda district league table using a normative health system performance assessment framework
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DOI：
10.1186/s12913-018-3126-6
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发表时间：
2018-05-10
影响因子：
2.8
通讯作者：
Criel, Bart
中科院分区：
文献类型：
--
作者：
KirungaTashobya, Christine;Ssengooba, Freddie;Criel, Bart
背景：2003年，乌干达卫生部（MoH）引入了地区排名表（DLT）来跟踪地区绩效。DLT的这一审查的目的是增加全球卫生系统绩效评估（HSPA）的证据基础，重点是低收入和中等收入国家（LMICs），并提供调整建议，以适应当前的乌干达reality.Methods：一个规范的HSPA框架被用来通知一个关键线人访谈（KII）工具的发展。我们采访了30名关键信息提供者，他们是根据开发或使用DLT的情况从乌干达卫生系统中有目的地选择的。KII的数据和信息，从出版和灰色文献乌干达卫生系统进行了分析，使用演绎analysis.Results：利益相关者参与DLT的发展是有限的，包括卫生部官员和发展合作伙伴，和一些地区的技术经理。乌干达的政策文件阐述了一个概念广泛的卫生系统，而DLT侧重于医疗保健系统。乌干达卫生系统的复杂性和动态性没有得到HSPA框架的充分承认。虽然DLT的目标和指标得到了阐述，但没有概念参考模型，构成层面也不明确。DLT的变化机制尚不明确。DLT比较了明显不同的地区，没有确定观察到的表现背后的因素。乌干达缺乏一个指定的机构单位的HSPA数据的分析和介绍，有挑战的数据质量和范围。结论：DLT使用规范模型的批评支持乌干达区HSPA的建议的发展，并为其他低收入国家提供了经验教训。其他地方的研究人员和决策者也可以采用类似的方法来审查和制定其他框架。乌干达地区HSPA的调整应考虑：更广泛的利益相关者参与，更多的地区管理者，包括政治，行政和技术;更好地锚定在国家卫生系统框架内;在框架设计中融入复杂性概念;并强调促进地区决策和学习。有必要提高数据质量和范围，并采取更多的方法进行数据分析和列报。
Background: In 2003 the Uganda Ministry of Health (MoH) introduced the District League Table (DLT) to track district performance. This review of the DLT is intended to add to the evidence base on Health Systems Performance Assessment (HSPA) globally, with emphasis on Low and Middle Income Countries (LMICs), and provide recommendations for adjustments to the current Ugandan reality.Methods: A normative HSPA framework was used to inform the development of a Key Informant Interview (KII) tool. Thirty Key Informants were interviewed, purposively selected from the Ugandan health system on the basis of having developed or used the DLT. KII data and information from published and grey literature on the Uganda health system was analyzed using deductive analysis.Results: Stakeholder involvement in the development of the DLT was limited, including MoH officials and development partners, and a few district technical managers. Uganda policy documents articulate a conceptually broad health system whereas the DLT focuses on a healthcare system. The complexity and dynamism of the Uganda health system was insufficiently acknowledged by the HSPA framework. Though DLT objectives and indicators were articulated, there was no conceptual reference model and lack of clarity on the constitutive dimensions. The DLT mechanisms for change were not explicit. The DLT compared markedly different districts and did not identify factors behind observed performance. Uganda lacks a designated institutional unit for the analysis and presentation of HSPA data, and there are challenges in data quality and range.Conclusions: The critique of the DLT using a normative model supported the development of recommendation for Uganda district HSPA and provides lessons for other LMICs. A similar approach can be used by researchers and policy makers elsewhere for the review and development of other frameworks. Adjustments in Uganda district HSPA should consider: wider stakeholder involvement with more district managers including political, administrative and technical; better anchoring within the national health system framework; integration of the notion of complexity in the design of the framework; and emphasis on facilitating district decision-making and learning. There is need to improve data quality and range and additional approaches for data analysis and presentation.