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

该项目旨在提高孟加拉国卫生系统的响应能力。这解决了该国政策制定者非常感兴趣的一个问题。卫生服务使用者、从业人员和决策者之间的有效互动和参与是响应性卫生系统的一个重要属性。这一概念的核心是让用户有机会就他们与卫生系统接触的经验提供反馈，而且至关重要的是卫生系统有能力回应用户的建议。该项目的重点是亚洲低收入国家孟加拉国，该国卫生和家庭福利部（MOHFW）正在实施一项计划，允许服务用户通过短信发送反馈。来自全国各地的短信被汇总在一个门户网站上，由卫生和家庭福利部的工作人员监控，然后他们将与发送者和地方当局一起跟进每一个问题。服务使用者还可以直接向乌巴齐拉一级的卫生管理委员会提供反馈，也可以通过每个卫生设施的意见箱提供反馈。然而，目前尚不清楚如何跟进直接在Upazila一级收到的问题，以及由谁跟进。该项目的目标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具响应性。具体的项目目标是与国家和地方决策者密切合作，以便：1 .深入了解从Upazila一级卫生服务用户收到的反馈的性质和内容以及主要原因；2 .分析在Upazila层面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情境促进因素和制约因素；评估服务质量保证和人力资源管理的方法和程序，特别注重在Upazila一级使用服务用户的反馈；4. 利用目标1-3的结果，制定一项全面的卫生系统干预措施，以改善在Upazila一级的质量保证和人力资源管理过程中使用服务用户反馈的情况。这个为期18个月的项目将在孟加拉国的一个地区分析国家层面的用户反馈数据，并收集更详细的定性信息。在该地区，我们将重点关注两个Upazila卫生综合体（UHC），它们是初级卫生保健的一级转诊服务，是卫生系统的支柱。我们将采用现实评价方法实施多方法卫生系统研究。定性和定量数据将通过以下方式收集：1)与有目的地确定的服务用户进行深入访谈，并与社区进行特定性别和年龄的焦点小组讨论，以了解他们对反馈系统的了解和使用情况；2)深入访谈，探讨有目的地选择的服务提供商和UHC管理人员对用户反馈系统的看法；3)分析政府门户网站用户反馈的国家级二级数据，了解问题的类型、所在位置以及发起问题的用户的性别和年龄；4)非参与式观察：区内反馈环境、卫生管委会会议、全民健康覆盖日常质量保证和员工管理做法；5)审核关键文件（如对用户的反馈和采取的措施、会议纪要、质量保证指南、员工绩效考核和监督记录）。在整个项目中，我们将与决策者密切合作，促进共同理解，将结果纳入政策和实践，并实现其最大影响。项目成果将通过政策简报、在管理会议上的介绍、编写通讯和新闻稿等方式广泛传播，以确保孟加拉国和更广泛地区的政策和实践采纳这些成果。

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.