Improving health system quality in low- and middle-income countries that are expanding health coverage: a framework for insurance

Mate, Kedar; Sifrim, Zoë K.; Chalkidou, Kalipso; Cluzeau, Françoise; Cutler, Derek; Kimball, Meredith M.; Morente, Tricia; Smits, Helen L.; Barker, Pierre

doi:10.1093/intqhc/mzt053

Cited by 20 publications

(18 citation statements)

References 29 publications

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“…Moreover, the study is one of few investigations of the association of mental health and HSU, in LMICs. Therefore, the findings could be influential in a region in which momentum for health care reforms aimed at achieving universal health coverage is growing [ 24 ]. Finally, sensitivity analyses of the association of depressive symptom severity (using “previous ICD-10 depressive episode”) with HSU yielded similar results to analyses of this association involving the EURO-D [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

“…The majority of previous research has taken place in high income countries and there is a need to increase knowledge of the variables associated with HSU by older people with depression in low and middle income countries (LMICs), where momentum for health care reforms aimed at achieving universal health care coverage is growing [ 24 ]. Available findings are mostly based on data from the general population (e.g., community-dwelling older people) rather than participants with probable depression.…”

Section: Introductionmentioning

confidence: 99%

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Cross-Sectional Associations of Depressive Symptom Severity and Functioning with Health Service Use by Older People in Low-and-Middle Income Countries

Twomey

Prince

Cieza

et al. 2015

IJERPH

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Background: Comprehensive understanding of the determinants of health service use (HSU) by older people with depression is essential for health service planning for an ageing global population. This study aimed to determine the extent to which depressive symptom severity and functioning are associated with HSU by older people with depression in low and middle income countries (LMICs). Methods: A cross-sectional analysis of the 10/66 Dementia Research Group population-based surveys dataset. Participants (n = 4590) were those aged 65 or older, in the clinical range for depressive symptoms (defined as scoring four or more on the EURO-D), living in 13 urban and/or rural catchment areas in nine LMICs. Associations were calculated using Poisson regression and random-effects meta-analysis. Results: After adjustment for confounding variables, (EURO-D) depressive symptom severity was significantly associated with “any community HSU” (Pooled Prevalence Ratios = 1.02; 95% CI = 1.01–1.03) but not hospital admission. Conversely, after adjustment, (WHODAS-II) functioning was significantly associated with hospital admission (Pooled PR = 1.14; 95% CI = 1.02–1.26) but not “any community HSU”. Conclusions: Depressive symptom severity does not explain a large proportion of the variance in HSU by older people with depression in LMICs. The association of functioning with this HSU is worthy of further investigation. In LMICs, variables related to accessibility may be more important correlates of HSU than variables directly related to health problems.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cross-Sectional Associations of Depressive Symptom Severity and Functioning with Health Service Use by Older People in Low-and-Middle Income Countries

Twomey

Prince

Cieza

et al. 2015

IJERPH

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“…Finally, this study describes only supply side interventions, whereas demand side interventions are also needed in this context, including efforts to improve health care financing [27]. It is necessary to improve both coverage and quality in this state, where only 17% of deliveries occur in a health facility [2].…”

Section: Study Strengths and Limitationsmentioning

confidence: 99%

Monitoring maternal and newborn health outcomes in Bauchi State, Nigeria: an evaluation of a standards-based quality improvement intervention

Kabo

Otolorin²,

Williams³

et al. 2016

Int J Qual Health Care

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ObjectiveThis study assessed the correlation between compliance with set performance standards and maternal and neonatal deaths in health facilities.DesignBaseline and three annual follow-up assessments were conducted, and each was followed by a quality improvement initiative using the Standards Based Management and Recognition (SBM-R) approach.SettingTwenty-three secondary health facilities of Bauchi state, Nigeria.ParticipantsHealth care workers and maternity unit patients.Main outcome measuresWe examined trends in: (i) achievement of SBM-R set performance standards based on annual assessment data, (ii) the use of maternal and newborn health (MNH) service delivery practices based on data from health facility registers and supportive supervision and (iii) MNH outcomes based on routine service statistics.ResultsAt the baseline assessment in 2010, the facilities achieved 4% of SBM-R standards for MNH, on average, and this increased to 86% in 2013. Over the same time period, the study measured an increase in the administration of uterotonic for active management of third stage of labor from 10% to 95% and a decline in the incidence of postpartum hemorrhage from 3.3% to 1.9%. Institutional neonatal mortality rate decreased from 9 to 2 deaths per 1000 live births, while the institutional maternal mortality ratio dropped from 4113 to 1317 deaths per 100 000 live births.ConclusionScaling up SBM-R for quality improvement has the potential to prevent maternal and neonatal deaths in Nigeria and similar settings.

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“…The Joint Learning Network (JLN) for Universal Health Coverage is an international consortium of nine countries in Africa and Asia (Ghana, India, Indonesia, Kenya, Malaysia, Mali, Nigeria, the Philippines and Vietnam); in 2011, the Network published a summary of methods available to improve health care quality within UHC schemes, including accreditation (13). All nine of the JLN countries either have accreditation schemes or are developing them, and an analysis of their experience identified key factors including: legal and governance structure; standards development and management; financing and incentives for accreditation; and the interface between insurance and accreditation (14).…”

Section: Lower-and Middle-income Countriesmentioning

confidence: 99%

Accreditation is not a stand-alone solution

Shaw

2015

Easter Mediterr Health J

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Improving health system quality in low- and middle-income countries that are expanding health coverage: a framework for insurance

Cited by 20 publications

References 29 publications

Cross-Sectional Associations of Depressive Symptom Severity and Functioning with Health Service Use by Older People in Low-and-Middle Income Countries

Cross-Sectional Associations of Depressive Symptom Severity and Functioning with Health Service Use by Older People in Low-and-Middle Income Countries

Monitoring maternal and newborn health outcomes in Bauchi State, Nigeria: an evaluation of a standards-based quality improvement intervention

Accreditation is not a stand-alone solution

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