Creating responsive health systems: improving the use of feedback from service users in quality assurance and human resource management in Bangladesh

创建响应式卫生系统：改善孟加拉国质量保证和人力资源管理中服务使用者反馈的使用

• 批准号: MR/P004105/1
• 负责人: Tolib Mirzoev
• 金额: $ 12.83万
• 依托单位: University of Leeds
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2017
• 资助国家: 英国
• 起止时间: 2017 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FP004105%2F1
• 关键词: Creating; responsive; health; systems; improving

This project aims to improve the responsiveness of the health system in Bangladesh. This addresses an issue of high interest to the country's policymakers. Effective interaction and engagement between the health service users and practitioners and policymakers is an important attribute of responsive health systems. Central to this concept is the opportunity for users to provide feedback on their experiences engaging with the health system, and vitally the ability of the health system to respond to users' suggestions. This project focuses on Bangladesh, a low income Asian country where the Ministry of Health and Family Welfare (MOHFW) is implementing a program allowing service users to send feedback via SMS texts. The texts from the whole country are aggregated in a web portal, which is monitored by the MOHFW staff, who are then expected to follow up each issue with both a sender and local authorities. Service users can also provide feedback directly to health management committees at Upazila level, and through suggestion boxes in each health facility. However, it is unclear how issues received directly at the Upazila level are followed-up and by whom. .The AIM of this project is to assist the policymakers in designing a comprehensive health systems intervention to make Bangladesh's health system more responsive. Specific project OBJECTIVES are to work closely with national and local decision-makers to:1. Develop an in-depth understanding of the nature and contents of, and key reasons for, feedback received from health service users at Upazila level;2. Analyse the processes of collecting and responding to service users' feedback at Upazila level, as well as the key contextual facilitators and constraints influencing these processes;3. Assess the approach to, and processes of, service quality assurance and human resource management, focusing specifically on the use of feedback from service users at Upazila level; 4. Using results of objectives 1-3, develop a comprehensive health systems intervention to improve the use of feedback from service users in quality assurance and human resource management processes at Upazila level.This 18-months project will analyse the national-level user feedback data and collect more detailed qualitative information in one district in Bangladesh. Within the district, we will focus on two Upazila Health Complexes (UHC) which, being the first level referral services from the primary health care, are the backbone of the health system.We will implement a multi-method health systems research using realist evaluation. Qualitative and quantitative data will be collected using combinations of: 1) in-depth interviews with purposefully-identified service users and gender and age-specific focus groups with communities to explore their knowledge of and use of feedback systems; 2) in-depth interviews to explore views of purposefully-selected service providers and managers at the UHC about the user feedback systems; 3) analysis of country-level secondary data on user feedback from the government web portal, to understand types of issues, their location and gender and age of users who initiated issues; 4) non-participant observation of: feedback environment in the district, health management committee meetings and UHC routine quality assurance and staff management practices; 5) review of key documents (e.g. feedback to users and actions taken, meeting minutes, quality assurance guidelines, staff performance appraisal and supervision records). Throughout the project, we will work closely with decision-makers, to facilitate the shared understanding, adoption of results into policy and practice and achieving its highest impact. Project results will be communicated widely through policy briefs, presentations at management meetings, development of newsletters and press-releases, to ensure their uptake in policy and practice in Bangladesh and wider.

该项目旨在提高孟加拉国卫生系统的反应能力。这解决了该国决策者高度关注的一个问题。卫生服务使用者与从业人员和决策者之间的有效互动和参与是顺应需求的卫生系统的一个重要特征。这一概念的核心是让用户有机会就其参与卫生系统的经历提供反馈，而卫生系统回应用户建议的能力至关重要。该项目的重点是孟加拉国，这是一个低收入的亚洲国家，卫生和家庭福利部（MOHFW）正在实施一项计划，允许服务用户通过短信发送反馈。来自全国的文本汇集在一个门户网站上，由卫生和家庭福利部工作人员进行监测，然后与发送者和地方当局就每个问题采取后续行动。服务使用者还可以直接向乡一级的卫生管理委员会提供反馈，并通过每个卫生设施的意见箱提供反馈。然而，不清楚如何对在乡一级直接收到的问题采取后续行动，以及由谁采取后续行动。30.该项目的目的是协助决策者设计一项全面的卫生系统干预措施，使孟加拉国的卫生系统更能顺应需要。具体的项目承诺是与国家和地方决策者密切合作，以：1。深入了解乡一级保健服务用户反馈意见的性质、内容和主要原因;2.分析在乡一级收集和回应服务用户反馈的过程，以及影响这些过程的关键背景促进因素和制约因素;3.评估服务质量保证和人力资源管理的方法和程序，特别侧重于使用乡一级服务用户的反馈意见;利用目标1-3的成果，制定一项全面的保健系统干预措施，以改善在乡一级的质量保证和人力资源管理过程中对服务用户反馈的利用，这一为期18个月的项目将分析国家一级的用户反馈数据，并在孟加拉国的一个县收集更详细的质量信息。在该地区，我们将重点关注两个乌帕齐拉卫生综合体，它们是初级卫生保健的第一级转诊服务，是卫生系统的支柱。我们将利用现实主义评估方法开展多方法卫生系统研究。我们会结合以下方法收集质性及量性数据：1）深入访谈特定的服务使用者，以及按性别及年龄划分的社区焦点小组，以探讨他们对意见反馈系统的认识及使用情况; 2）深入访谈特定的服务提供者及全民健康中心管理人员，以探讨他们对使用者意见反馈系统的意见; 3）分析国家一级关于政府门户网站用户反馈的二级数据，以了解问题的类型、位置以及提出问题的用户的性别和年龄;地区的反馈环境、健康管理委员会会议和全民健康中心的日常质量保证和员工管理做法; 5）审阅主要文件（例如向使用者提供的意见及所采取的行动、会议纪录、质素保证指引、员工工作表现评核及督导记录）。在整个项目过程中，我们将与决策者密切合作，以促进共同理解，将结果纳入政策和实践，并实现其最大影响。将通过政策简报、在管理会议上的介绍、编写通讯和新闻稿广泛宣传项目成果，以确保在孟加拉国和更广泛的地方将其纳入政策和实践。

项目成果

How do patient feedback systems work in low-income and middle-income countries? Insights from a realist evaluation in Bangladesh.

• DOI: 10.1136/bmjgh-2020-004357
• 发表时间: 2021-03
• 期刊: BMJ global health
• 影响因子: 8.1
• 作者: Mirzoev T;Kane S;Al Azdi Z;Ebenso B;Chowdhury AA;Huque R
• 通讯作者: Huque R

Key strategies to improve systems for managing patient complaints within health facilities - what can we learn from the existing literature?

• DOI: 10.1080/16549716.2018.1458938
• 发表时间: 2018
• 期刊: Global health action
• 影响因子: 2.6
• 作者: Mirzoev T;Kane S
• 通讯作者: Kane S

Patient Feedback Systems at the Primary Level of Health Care Centres in Bangladesh: A Mixed Methods Study

孟加拉国初级卫生保健中心的患者反馈系统：混合方法研究

• DOI: 10.1177/21582440211011458
• 发表时间: 2021
• 期刊: SAGE Open
• 影响因子: 2
• 作者: Huque R

Protocol for a mixed-methods realist evaluation of a health service user feedback system in Bangladesh.

• DOI: 10.1136/bmjopen-2017-017743
• 发表时间: 2017-07-05
• 期刊: BMJ open
• 影响因子: 2.9
• 作者: Ebenso B;Huque R;Azdi Z;Elsey H;Nasreen S;Mirzoev T
• 通讯作者: Mirzoev T