week 4 notes
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This 3 page Class Notes was uploaded by Isabel Blalock on Monday February 22, 2016. The Class Notes belongs to PHP 1100 at Brown University taught by Dr. Omar Galarraga in Winter 2016. Since its upload, it has received 68 views. For similar materials see Comparative Healthcare Systems in Public Health at Brown University.
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Date Created: 02/22/16
Lecture 4 02/22/2016 ▯ Healthy Systems Measurement and Research ▯ ▯ “Sound information is lacking to monitor trends in mortality, causes of death, morbidity, coverage of interventions, risk factors, health systems and equity” ▯ ▯ The WHO Health Systems Framework ▯ 6 Building blocks of a Health System Service delivery Health workforce Health information system Access to essential medicines Financing Leadership / governance Overall Goals / Outcomes Improved health (level and equity) Responsiveness Social and financial risk protection o All paid for out of pocket Improved efficiency Monitoring and evaluation of health systems strengthening Inputs and processes outputs outcomes impact o Indicator domains Inputs/processes Infrastructure; information and communication technologies; supply chain Outputs Intervention access and services readiness; intervention quality, safety Outcomes Coverage of interventions Impact Improved health outcomes and equity; social and financial risk protection ▯ ▯ Data Collection Routine health facility reporting system o Regular facility data reported to regional and national levels by service providers Health facility census o Period census of all public and private health0care facilities within a country Health facility survey o Periodic survey of a representative sample of public and private health-care facilities within a country ▯ ▯ National data process Statistical system, Health information system ▯ Self-assessment General data dissemination strategy, Health metrics network self- assessment tool ▯ Independent assessment World bank statistical capacity indicator, health information system performance index ▯ ▯ On health systems… ▯ “Systems in general, and health care in particular, are complex, hard to understand, and difficult to manage. Performance indicators alone are not enough; unhappily, unless the nation plan […] reveals evidence of new thinking, performance indicators seem to be the only game in town.” ▯ ▯ Why are process indicators not enough? Can we really distinguish good and bad performance? Summarized, aggregated measures: what part is wrong? What is the “average” facility? (if 50% great and 50% not, then …) be mindful of inequalities Channels: some are obvious (e.g., medical error), most are not Framework for assessing performance Key factors that explain variation Instrumental goals (e.g., number of ITN) vs. intrinsic goals (e.g., reduce malaria) “Each proposed factor represents a hypothesis that should be tested empirically. For this reason, any list is provisional and subject to expansion of contraction as evidence accumulates” 1) vertical and horizontal integration 2) vertical integration and horizontal segmentation 3) vertical segmentation and horizontal integration 4) vertical and horizontal segmentation
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