Quality of Health Care in Ghana: Mapping of Interventions and the Way Forward

Background. Ghana has made major strides in improving access to health services. Despite these improvements, Ghana did not meet the Millennium Development Goals 4 and 5. Quality of care is a major factor that could explain this shortfall.Objective. To understand current practice and to identify needs in the area of quality of care in Ghana for improving health outcomes and to guide the National Institute for Health and Care Excellence (NICE) in supporting the care quality improvement efforts in Ghana.Methods. The directory of existing standards, guidelines and protocols of the Ghana Health Service was reviewed and sixteen in-depth interviews were conducted to identify interventions that addressed quality of care. Additional information was obtained during a NICE scoping visit to Accra followed by a study tour of Ghanaian stakeholders to NICE and to the National Health Service.Results. Since 1988, 489 policy interventions have been identified that address quality of care. Among them, the development of health protocols and guidelines were the most frequent interventions (n=150), followed by health policies and strategies (n=106); interventions related to health information (n=77); development of training manuals and staff training (n=69); development of regulations (n=38) and interventions related to organisation of services (n=15).Conclusions. Ghana has made significant efforts in developing guidelines, policies and conducting in-service training.Supervision, monitoring and evaluation have also received attention. However, less effort has been made in developing processes and systems and involving communities and service users. Some recommendations were made to guide the future work on quality of care.Funding: Rockefeller FoundationKeywords: quality of health care; policy; guideline/clinical protocol; regulations; Technology Assessments/ biomedical; in-service training; supervision; Ghan

Turning evidence into recommendations: Protocol of a study guideline development groups

<p>Abstract</p> <p>Background</p> <p>Health care practice based on research evidence requires that evidence is synthesised, and that recommendations based on this evidence are implemented. It also requires an intermediate step: translating synthesised evidence into practice recommendations. There is considerable literature on evidence synthesis and implementation, but little on how guideline development groups (GDGs) produce recommendations. This is a complex process, with many influences on communication and decision-making, <it>e.g</it>., the quality of evidence, methods of presentation, practical/resource constraints, individual values, professional and scientific interests, social and psychological processes. To make this process more transparent and potentially effective, we need to understand these influences. Psychological theories of decision-making and social influence provide a framework for this understanding.</p> <p>Objectives</p> <p>This study aims to investigate the processes by which GDGs formulate recommendations, drawing on psychological theories of decision-making and social influence. The findings will potentially inform the further evolution of GDG methods, such as choice of members and procedures for presenting evidence, conducting discussion and formulating recommendations.</p> <p>Methods</p> <p>Longitudinal observation of the meetings of three National Institute of Health and Clinical Excellence (NICE) GDGs, one from each of acute, mental health and public health, will be tape recorded and transcribed. Interviews with a sample of GDG members at the beginning, middle, and end of the GDG's work will be recorded and transcribed. Site documents including relevant e-mail interchanges, GDG meeting minutes, and stakeholders' responses to the drafts of the recommendations will be collected. Data will be selected for analysis if they refer to either evidence or recommendations; the focus is on "hot spots", <it>e.g</it>., dilemmas, conflicts, and uncertainty. Data will be analysed thematically and by content analysis, drawing on psychological theories of decision-making and social influence.</p

Validity and usability testing of a health systems guidance appraisal tool, the AGREE-HS

Health systems guidance (HSG) provides recommendations to address health systems challenges. No tools exist to inform HSG developers and users about the components of high quality HSG and to differentiate between HSG of varying quality. In response, we developed a tool to assist with the development, reporting and appraisal of HSG - the Appraisal of Guidelines for Research and Evaluation-Health Systems (AGREE-HS). This paper reports on the validity, usability and initial measurement properties of the AGREE-HS.; To establish face validity (Study 1), stakeholders completed a survey about the AGREE-HS and provided feedback on its content and structure. Revisions to the tool were made in response. To establish usability (Study 2), the revised tool was applied to 85 HSG documents and the appraisers provided feedback about their experiences via an online survey. An initial test of the revised tool's measurement properties, including internal consistency, inter-rater reliability and criterion validity, was conducted. Additional revisions to the tool were made in response.; In Study 1, the AGREE-HS Overview, User Manual, quality item content and structure, and overall assessment questions were rated favourably. Participants indicated that the AGREE-HS would be useful, feasible to use, and that they would apply it in their context. In Study 2, participants indicated that the quality items were easy to understand and apply, and the User Manual, usefulness and usability of the tool were rated favourably. Study 2 participants also indicated intentions to use the AGREE-HS.; The AGREE-HS comprises a User Manual, five quality items and two overall assessment questions. It is available at agreetrust.org

Development and application of an appraisal instrument for assessing the methodological quality of clinical practice guidelines

Available from British Library Document Supply Centre- DSC:DXN057458 / BLDSC - British Library Document Supply CentreSIGLEGBUnited Kingdo

Adaptive health technology assessment to facilitate priority setting in low- and middle-income countries.

INTRODUCTION Traditional health technology assessment (HTA) is a policy-based research process, which aims to improve the efficiency and equity of the healthcare system with the limited financial resources available in healthcare.1 In various countries, traditional HTA has been 'institutionalised'-through the development of dedicated agencies with accepted norms and rules that guide explicit priority setting-over years or decades. These agencies use time-consuming, data intensive and systematic methods and processes which require health economics expertise and resources to make recommendations on how to allocate finite resources.2 There is a growing appetite for HTA and its eventual institutionalisation in low-and-middle income countries (LMICs) driven in part by WHO's recommendation for it to be a critical component to achieving universal health coverage.3 While there are notable LMIC exceptions of introducing and institutionalising HTA (eg, Thailand, Colombia, Brazil and India), others may be constrained by limited technical and administrative capacity, paucity of data, time and governance structures to carry out HTA.4 A more pragmatic approach which we define in this paper as 'adaptive HTA' (aHTA) is one which uses various expedited or flexible methods and processes that are 'fit for purpose' and could help to tackle some of these challenges faced by LMICs. Here, we suggest how policy makers, researchers, clinicians and donors can collaborate and support the development and uptake of aHTA for LMICs to enable expedited evidence-based decision making in these countries as one part of the journey towards HTA institutionalisation

Appraisal of maternity management and family planning guidelines using the agree II instrument in India

Introduction: Guideline development gathered pace in India after the inception of National Rural Health Mission (NRHM) in 2005. However, there is a lack of adequate information about guideline development process, review, and update. This paper reports on the systematic appraisal of Indian guidelines related to maternity management (MM) and family planning (FP) using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument, which was one of the components of a pilot research in 2012-13. Materials and Methods: Forty-four selected guidelines about MM and FP, identified through a consensus building workshop, were independently appraised by two appraisers with AGREE instrument having six different domains. Mean item scores, domain scores, and standardized scores were calculated by averaging the scores across the two appraisers. Results: Most guidelines scored high in scope and purpose and clarity of presentation. However, they had little documentation about the development group member details, incorporation of patient views, evidence search method, method chosen for formulating recommendations, tools for application, potential barriers, cost implications, and information about the funding body. Nonclinical guidelines scored higher than clinical guidelines (P = 0.01) for MM in the domain applicability. Clinical FP guidelines scored higher than nonclinical guidelines in the domain of rigor of development (0.01). Conclusion: Despite being clinically sound, Indian guidelines score poorly due to weak documentation about their development process. It is recommended that the guideline development process be improved with systematic documentation for achieving standardization

Diagnostic et déterminants de la pérennité des prairies. Sol et pérennité des prairies : un cercle vertueux

International audienceThe physical, chemical and biological properties of the soil will affect plant growth and condition the sustainability of the grasslands. Thus, soil compaction due to grazing or machine traffic will result in a loss of yield, the effects being variable according to texture (more pronounced on more clayey soils) and season. On the other hand, the preservation of soil organisms and associated functions will contribute to increasing yields. On the other hand, grassland management will also impact soil properties. Thus, the introduction of grassland in the crop rotation will quickly allow, from the second year, to favor soil biodiversity (fauna, microorganisms) and their activities. More broadly, the introduction of grassland into an annual crop rotation positively influences the maintenance of soil structure and the conservation of biodiversity, without modifying water regulation. The positive effect inherited from grasslands in the rotation can be observed even three years after recultivation. The sustainability of the grasslands will be conditioned by several factors: the duration of the grassland in the rotation, grazing management (load, period), fertilization and plant diversity. Levers exist to ensure the sustainability of these temporary or permanent grassland systems.Les propriétés physiques, chimiques et biologiques des sols vont agir sur la croissance des plantes et conditionner la pérennité des prairies. Ainsi, la compaction d’un sol, sous l’action du pâturage ou du trafic d’engins, va aboutir à une perte de rendement, les effets étant variables selon la texture (plus marqués sur des sols plus argileux) et la saison. A contrario, la préservation des organismes des sols et des fonctions associées va contribuer à augmenter les rendements. En contrepartie, la gestion des prairies va aussi impacter les propriétés des sols. Ainsi, l’introduction de prairie dans la rotation culturale, va permettre rapidement dès la deuxième année de favoriser la biodiversité des sols (faune, microorganismes) et leurs activités. Plus largement, l’introduction de prairies dans une rotation de cultures annuelles influence positivement le maintien de la structure du sol et la conservation de la biodiversité, sans modifier la régulation hydrique. L’effet positif hérité de prairies dans la rotation est observable même trois années après la remise en culture. La pérennité des prairies va être conditionnée par plusieurs facteurs : la durée de prairie dans la rotation, la gestion du pâturage (chargement, période), la fertilisation et la diversité végétale. Des leviers existent pour assurer la durabilité de ces systèmes prairiaux temporaires ou permanents.Cet article de la revue Fourrages, est édité par l'Association Francophone pour les Prairies et les Fourrages Pour toute recherche dans la base de données et pour vous abonner : www.afpf-asso.fr Association Francophone pour les Prairies et les Fourrages AFPF-Maison Nationale des Eleveurs-149 rue de Bercy-75595 Paris Cedex 1

Diagnostic et déterminants de la pérennité des prairies. Sol et pérennité des prairies : un cercle vertueux

International audienceThe physical, chemical and biological properties of the soil will affect plant growth and condition the sustainability of the grasslands. Thus, soil compaction due to grazing or machine traffic will result in a loss of yield, the effects being variable according to texture (more pronounced on more clayey soils) and season. On the other hand, the preservation of soil organisms and associated functions will contribute to increasing yields. On the other hand, grassland management will also impact soil properties. Thus, the introduction of grassland in the crop rotation will quickly allow, from the second year, to favor soil biodiversity (fauna, microorganisms) and their activities. More broadly, the introduction of grassland into an annual crop rotation positively influences the maintenance of soil structure and the conservation of biodiversity, without modifying water regulation. The positive effect inherited from grasslands in the rotation can be observed even three years after recultivation. The sustainability of the grasslands will be conditioned by several factors: the duration of the grassland in the rotation, grazing management (load, period), fertilization and plant diversity. Levers exist to ensure the sustainability of these temporary or permanent grassland systems.Les propriétés physiques, chimiques et biologiques des sols vont agir sur la croissance des plantes et conditionner la pérennité des prairies. Ainsi, la compaction d’un sol, sous l’action du pâturage ou du trafic d’engins, va aboutir à une perte de rendement, les effets étant variables selon la texture (plus marqués sur des sols plus argileux) et la saison. A contrario, la préservation des organismes des sols et des fonctions associées va contribuer à augmenter les rendements. En contrepartie, la gestion des prairies va aussi impacter les propriétés des sols. Ainsi, l’introduction de prairie dans la rotation culturale, va permettre rapidement dès la deuxième année de favoriser la biodiversité des sols (faune, microorganismes) et leurs activités. Plus largement, l’introduction de prairies dans une rotation de cultures annuelles influence positivement le maintien de la structure du sol et la conservation de la biodiversité, sans modifier la régulation hydrique. L’effet positif hérité de prairies dans la rotation est observable même trois années après la remise en culture. La pérennité des prairies va être conditionnée par plusieurs facteurs : la durée de prairie dans la rotation, la gestion du pâturage (chargement, période), la fertilisation et la diversité végétale. Des leviers existent pour assurer la durabilité de ces systèmes prairiaux temporaires ou permanents.Cet article de la revue Fourrages, est édité par l'Association Francophone pour les Prairies et les Fourrages Pour toute recherche dans la base de données et pour vous abonner : www.afpf-asso.fr Association Francophone pour les Prairies et les Fourrages AFPF-Maison Nationale des Eleveurs-149 rue de Bercy-75595 Paris Cedex 1

Diagnostic et déterminants de la pérennité des prairies. Sol et pérennité des prairies : un cercle vertueux

International audienceThe physical, chemical and biological properties of the soil will affect plant growth and condition the sustainability of the grasslands. Thus, soil compaction due to grazing or machine traffic will result in a loss of yield, the effects being variable according to texture (more pronounced on more clayey soils) and season. On the other hand, the preservation of soil organisms and associated functions will contribute to increasing yields. On the other hand, grassland management will also impact soil properties. Thus, the introduction of grassland in the crop rotation will quickly allow, from the second year, to favor soil biodiversity (fauna, microorganisms) and their activities. More broadly, the introduction of grassland into an annual crop rotation positively influences the maintenance of soil structure and the conservation of biodiversity, without modifying water regulation. The positive effect inherited from grasslands in the rotation can be observed even three years after recultivation. The sustainability of the grasslands will be conditioned by several factors: the duration of the grassland in the rotation, grazing management (load, period), fertilization and plant diversity. Levers exist to ensure the sustainability of these temporary or permanent grassland systems.Les propriétés physiques, chimiques et biologiques des sols vont agir sur la croissance des plantes et conditionner la pérennité des prairies. Ainsi, la compaction d’un sol, sous l’action du pâturage ou du trafic d’engins, va aboutir à une perte de rendement, les effets étant variables selon la texture (plus marqués sur des sols plus argileux) et la saison. A contrario, la préservation des organismes des sols et des fonctions associées va contribuer à augmenter les rendements. En contrepartie, la gestion des prairies va aussi impacter les propriétés des sols. Ainsi, l’introduction de prairie dans la rotation culturale, va permettre rapidement dès la deuxième année de favoriser la biodiversité des sols (faune, microorganismes) et leurs activités. Plus largement, l’introduction de prairies dans une rotation de cultures annuelles influence positivement le maintien de la structure du sol et la conservation de la biodiversité, sans modifier la régulation hydrique. L’effet positif hérité de prairies dans la rotation est observable même trois années après la remise en culture. La pérennité des prairies va être conditionnée par plusieurs facteurs : la durée de prairie dans la rotation, la gestion du pâturage (chargement, période), la fertilisation et la diversité végétale. Des leviers existent pour assurer la durabilité de ces systèmes prairiaux temporaires ou permanents.Cet article de la revue Fourrages, est édité par l'Association Francophone pour les Prairies et les Fourrages Pour toute recherche dans la base de données et pour vous abonner : www.afpf-asso.fr Association Francophone pour les Prairies et les Fourrages AFPF-Maison Nationale des Eleveurs-149 rue de Bercy-75595 Paris Cedex 1