Reliability and validity of an innovative high performing healthcare system assessment tool.

BACKGROUND: Universal Health coverage (UHC) is the mantra of the twenty-first century yet knowing when it has been achieved or how to best influence its progression remains elusive. An innovative framework for High Performing Healthcare (HPHC) attempts to address these issues. It focuses on measuring four constructs of Accountable, Affordable, Accessible, and Reliable (AAAR) healthcare that contribute to better health outcomes and impact. The HPHC tool collects information on the perceived functionality of health system processes and provides real-time data analysis on the AAAR constructs, and on processes for health system resilience, responsiveness, and quality, that include roles of community, private sector, as well as both demand, and supply factors affecting health system performance. The tool attempts to capture the multidimensionality of UHC measurement and evidence that links health system strengthening activities to outcomes. This paper provides evidence on the reliability and validity of the tool. METHODS: Internet survey with non-probability sampling was used for testing reliability and validity of the HPHC tool. The volunteers were recruited using international networks and listservs. Two hundred and thirteen people from public, private, civil society and international organizations volunteered from 35 low-and-middle-income countries. Analyses involved testing reliability and validity and validation from other international sources of information as well as applicability in different setting and contexts. RESULTS: The HPHC tool's AAAR constructs, and their sub-domains showed high internal consistency (Cronbach alpha >.80) and construct validity. The tool scores normal distribution displayed variations among respondents. In addition, the tool demonstrated its precision and relevance in different contexts/countries. The triangulation of HPHC findings with other international data sources further confirmed the tool's validity. CONCLUSIONS: Besides being reliable and valid, the HPHC tool adds value to the state of health system measurement by focusing on linkages between AAAR processes and health outcomes. It ensures that health system stakeholders take responsibility and are accountable for better system performance, and the community is empowered to participate in decision-making process. The HPHC tool collects and analyzes data in real time with minimum costs, supports monitoring, and promotes adaptive management, policy, and program development for better health outcomes.

Putting health workers at the centre of health system investments in COVID-19 and beyond.

The COVID-19 pandemic highlights the implications of chronic underinvestment in health workforce development, particularly in resource-constrained health systems. Inadequate health workforce diversity, insufficient training and remuneration, and limited support and protection reduce health system capacity to equitably maintain health service delivery while meeting urgent health emergency demands. Applying the Health Worker Life Cycle Approach provides a useful conceptual framework that adapts a health labour market approach to outline key areas and recommendations for health workforce investment-building, managing and optimising-to systematically meet the needs of health workers and the systems they support. It also emphasises the importance of protecting the workforce as a cross-cutting investment, which is especially important in a health crisis like COVID-19. While the global pandemic has spurred intermittent health workforce investments required to immediately respond to COVID-19, applying this 'lifecycle approach' to guide policy implementation and financing interventions is critical to centering health workers as stewards of health systems, thus strengthening resilience to public health threats, sustainably responding to community needs and providing more equitable, patient-centred care.

Impact of conditional cash transfers on maternal and newborn health.

Maternal and newborn health (MNH) is a high priority for global health and is included among the Millennium Development Goals (MDGs). However, the slow decline in maternal and newborn mortality jeopardizes achievements of the targets of MDGs. According to UNICEF, 60 million women give birth outside of health facilities, and family planning needs are satisfied for only 50%. Further, skilled birth attendance and the use of antenatal care are most inequitably distributed in maternal and newborn health interventions in low- and middle-income countries. Conditional cash transfer (CCT) programmes have been shown to increase health service utilization among the poorest but little is written on the effects of such programmes on maternal and newborn health. We carried out a systematic review of studies on CCT that report maternal and newborn health outcomes, including studies from 8 countries. The CCT programmes have increased antenatal visits, skilled attendance at birth, delivery at a health facility, and tetanus toxoid vaccination for mothers and reduced the incidence of low birthweight. The programmes have not had a significant impact on fertility while the impact on maternal and newborn mortality has not been well-documented thus far. Given these positive effects, we make the case for further investment in CCT programmes for maternal and newborn health, noting gaps in knowledge and providing recommendations for better design and evaluation of such programmes. We recommend more rigorous impact evaluations that document impact pathways and take factors, such as cost-effectiveness, into account.

Ending Preventable Child and Maternal Deaths in Latin American and Caribbean Countries (LAC) / Fin a las muertes evitables maternas e infantiles en los países de Latinoamérica y del Caribe (LAC)

Many countries in Latin America and the Caribbean (LAC) have reached or exceeded their Millennium Development Goal, despite this progress, significant work remains in order to end the millions of preventable child and maternal deaths that occur annually. This will require increasing coverage of high-impact interventions, strengthening the health systems that support these interventions, and addressing major equity gaps within and among countries. On June 14-15, 2012, in Washington, D.C., the Governments of Ethiopia, India and the United States, together with UNICEF, convened a global "Child Survival Call to Action" (CSCTA) to achieve an ambitious yet achievable goal: to end preventable child deaths. A central premise of the Call to Action is that we already know how to prevent most child deaths and can do so by scaling up existing, practical, affordable interventions. The CSCTA and the follow on activities under A Promise Renewed , led by UNICEF, emphasize the importance of developing country-led planning and marshaling of countries' own resources to improve child health. Under this vision, donor support is to be supplementary -not the primary force shaping developing countries' work to reduce child mortality. As a result of the meeting, 175 countries around the world have signed a pledge committing to address child survival, including 31 countries in the Latin American and Caribbean Region.

La mayoría de países de Latinoamérica y del Caribe (LAC) han alcanzado las metas del milenio; no obstante estos progresos, aún es necesario efectuar un esfuerzo intenso para frenar los millares de muertes maternas e infantiles que ocurren anualmente y que son prevenibles. Este esfuerzo requiere de una serie de intervenciones de alto impacto, el fortalecimiento de los sistemas de salud nacionales y la disminución de las brechas de equidad entre los diferentes países de la región de LAC. En junio de 2012, los gobiernos de Etiopía, India y los Estados Unidos, en conjunto con la UNICEF, convinieron en efectuar un "llamado a la acción por la supervivencia de los niños" (CSCTA), proponiendo la meta de frenar las muertes infantiles prevenibles. La premisa central de este llamado es que ya se debe de saber cómo prevenir estas muertes, y poder llevar a cabo las intervenciones de manera asequible y práctica. El CSCTA, conforme las acciones subsecuentes a llevar a cabo, siguiendo a la UNICEF, enfatiza en la importancia de que cada país planifique y calcule los recursos propios que deberá invertir para reducir las muertes infantiles. Bajo esta visión, los soportes económicos de apoyo de organismos internacionales sólo deberán ser suplementarios, no el recurso principal de los países en desarrollo, para reducir la mortalidad infantil. Como resultado de la reunión de junio de 2012, 175 países alrededor del mundo han firmado los compromisos del CSCTA, incluyendo 31 países de la región de LAC.

Racial and ethnic disparities in childhood immunization coverage in North Carolina.

BACKGROUND/OBJECTIVES: In 2000 the North Carolina Immunization Branch established the Disparities Core Team to address the issue of disparities in immunization coverage in the state. Since no existing research identified disparities in childhood immunization, the Disparities Core Team undertook a kindergarten survey to determine the existence of disparities. Childhood immunization coverage levels were measured retrospectively by race and ethnicity in North Carolina. Completion of the 4-3-1 series (4 DTaP, 3 Polio and 1 MMR) by 24 months was considered up-to-date. METHODS: Immunization, demographic, and healthcare information was collected from school records in the fall of 2001 for a sample of kindergarten students. FINDINGS: Disparities were found on both state and regional levels. Disparities within regions varied. CONCLUSIONS: White children were more likely to be up-to-date by 24 months of age than African American children (OR = 1.60, 95% CI 1.26-2.03), Latino children (OR = 2.24, 95% CI 1.61-3.11), and Asian children (OR = 1.88, 95% CI 1.03-3.4). Discovery of the cause of racial and ethnic disparities requires further study. Implications for interventions to eliminate disparities are discussed.