Quality of Health Care for Children and Adolescents: A Chartbook

Contains 40 charts and analyses that represent the current state of pediatric health care. Provides practical guidance and recommendations for policymakers, health care professionals, and patient advocates

Quality of Health Care for Medicare Beneficiaries: A Chartbook

Provides the results of a review of recently published studies and reports about the quality of health care for elderly Medicare beneficiaries. Includes examples of deficiencies and disparities in care, and some promising quality improvement initiatives

Paying for Quality: Understanding and Assessing Physician Pay-for-Performance Initiatives

Reviews the structure, prevalence, measurement issues, perception, and impact of current quality incentive programs, and discusses how much and under what circumstances they will improve quality of care. Includes descriptions of select programs

Value for money in the English NHS: Summary of the evidence

The extent to which the English National Health Service secures value for money for taxpayers has become a central issue of political and public debate. Questions include: how much expenditure growth has been made available to the NHS? on what has that money been spent? what improvements in the volume and quality of health care have been secured? and what are the implications for productivity? There has been a flurry of research activity designed to address these and similar questions. This report seeks to bring together this research in a concise format and draws some tentative conclusions about recent productivity changes in the NHS. It finds that there is considerable evidence of growth in both the volume and quality of NHS activity. However, this has not in general kept pace with the growth in expenditure. On most measures, therefore, NHS productivity is either static or declining. However, the report highlights a large number of unresolved methodological issues that make it hard to draw any definitive conclusions. We conclude that the measurement of NHS productivity change makes an important contribution to national debate. However, there remains considerable scope for improving both the data and the methods underlying current estimates.

Quality improvement in maternal, neonatal and child health services in sub-Saharan Africa: A look at five resource-poor countries

Background: Quality improvement (QI) practices can advance maternal, neonatal and child (MNC) health outcomes. Hence, accelerating QI activities to achieve better results should be encouraged. Objectives: This study aims to review QI interventions by conducting a synthesis of available data. Methods: A rapid review methodology and the ‘Google Scholar’ search engine were used. We focused on Ethiopia, Ghana, Nigeria, Tanzania and Uganda because their populations are large, they all have a significant burden of MNC deaths, they are all signatories to the Every Newborn Action Plan (ENAP) and members of the Quality of Care (QoC) Network, and all have adopted maternal death surveillance and response (MDSR) systems. We also examined documents on the websites of ENAP, QoC Network, World Health Organization, and the ministries of health of all five countries. Results: There was a paucity of information on clinical practice guidelines (CPGs), audit and feedback. There was weak integration between national quality policies and strategies and UN initiatives. Only 12 articles and two reports met our inclusion criteria. We found a total of just 20 CPGs on the websites of the various ministries of health. All five countries shared a scarcity of CPGs and poor performance in using MDSR systems. Conclusions: For successful implementation of QI interventions, it is necessary to establish a mechanism for producing evidence-based CPGs and to revitalize the MDSR system. UN initiatives need to be integrated with national programs for impact and sustainability. While our findings do not allow us to make a causal link between the scarcity of CPGs and inadequate QoC in MNC healthcare services, evaluation of national programs, including UN initiatives, is required. [Ethiop. J. Health Dev. 2020; 34(1):59-80]. Key-words: Quality improvement; maternal, neonatal and child health; quality of care; Every Newborn Action Plan; Quality of Care Network; clinical practice guidelines; audit and feedbac

Using microfinance to facilitate household investment in sanitation in rural Cambodia

Improved sanitation access is extremely low in rural Cambodia. Non-governmental organizations have helped build local supply side latrine markets to promote household latrine purchase and use, but households cite inability to pay as a key barrier to purchase. To examine the extent to which microfinance can be used to facilitate household investment in sanitation, we applied a two-pronged assessment: (1) to address the gap between interest in and use of microfinance, we conducted a pilot study to assess microfinance demand and feasibility of integration with a sanitation marketing program and (2) using a household survey ( n = 935) at latrine sales events in two rural provinces, we assessed attitudes about microfinance and financing for sanitation. We found substantial stated intent to use a microfinance institution (MFI) loan to purchase a latrine (27%). Five percent of current owners used an MFI loan for latrine purchase. Credit officers attended 159 events, with 4761 individuals attending. Actual loan applications were low, with 4% of sales events attendees applying for a loan immediately following the event (mean = 1.7 loans per event). Ongoing coordination was challenging, requiring management commitment from the sanitation marketing program and commitment to social responsibility from the MFI. Given the importance of improving sanitation coverage and concomitant health impacts, linking functional sanitation markets to already operational finance markets has the potential to give individuals and households more financial flexibility. Further product research and better integration of private vendors and financing modalities are necessary to create a scalable microfinance option for sanitation markets

Group cell phones are feasible and acceptable for promoting optimal breastfeeding practices in a women's microcredit program in Nigeria

As part of a breastfeeding promotion intervention trial in Nigeria, we provided one cell phone per group of 5-7 microcredit clients, and instructed the group's cell phone recipient to share weekly breastfeeding voice and text messages with group members. We measured the feasibility and acceptability of using group cell phones by conducting semi-structured exit interviews with 195 microcredit clients whose babies were born during the intervention (target group), in-depth interviews with 8 phone recipients and 9 non-phone recipients, and 16 focus group discussions (FGDs) with other microcredit clients. Women in the target group said the group phone worked well or very well (64%). They were motivated to try the recommended practices because they trusted the information (58%) and had support from others (35%). Approximately 44% of target women reported that their groups met and shared messages at least once a week. Women in groups that met at least weekly had higher odds of exclusive breastfeeding up to 6 months (OR 5.6, 95% CI 1.6, 19.7) than women in groups that never met. In-depth interviews and FGDs indicated that non-phone recipients had positive feelings toward phone recipients, the group phone met participants’ needs, and messages were often shared outside the group. In conclusion, group cell phone messaging to promote breastfeeding among microcredit clients is feasible and acceptable, and can be part of an effective behavior change package

Achieving high-quality universal health coverage: a perspective from the National Health Service in England

Governments across low-income and middle-income countries have pledged to achieve universal health coverage by 2030, which comes at a time where healthcare systems are subjected to multiple and persistent pressures, such as poor access to care services and insufficient medical supplies. While the political willingness to provide universal health coverage is a step into the right direction, the benefits of it will depend on the quality of healthcare services provided. In this analysis paper, we ask whether there are any lessons that could be learnt from the English National Health Service, a healthcare system that has been providing comprehensive and high-quality universal health coverage for over 70 years. The key areas identified relate to the development of a coherent strategy to improve quality, to boost public health as a measure to reduce disease burden, to adopt evidence-based priority setting methods that ensure efficient spending of financial resources, to introduce an independent way of inspecting and regulating providers, and to allow for task-shifting, specifically in regions where staff retention is low

Integrating Group Counseling, Cell Phone Messaging, and Participant-Generated Songs and Dramas into a Microcredit Program Increases Nigerian Women's Adherence to International Breastfeeding Recommendations

In northern Nigeria, interventions are urgently needed to narrow the large gap between international breastfeeding recommendations and actual breastfeeding practices. Studies of integrated microcredit and community health interventions documented success in modifying health behaviors but typically had uncontrolled designs. We conducted a cluster-randomized controlled trial in Bauchi State, Nigeria, with the aim of increasing early breastfeeding initiation and exclusive breastfeeding among female microcredit clients. The intervention had 3 components. Trained credit officers led monthly breastfeeding learning sessions during regularly scheduled microcredit meetings for 10 mo. Text and voice messages were sent out weekly to a cell phone provided to small groups of microcredit clients (5–7 women). The small groups prepared songs or dramas about the messages and presented them at the monthly microcredit meetings. The control arm continued with the regular microcredit program. Randomization occurred at the level of the monthly meeting groups. Pregnant clients were recruited at baseline and interviewed again when their infants were aged ≥6 mo. Logistic regression models accounting for clustering were used to estimate the odds of performing recommended behaviors. Among the clients who completed the final survey (n = 390), the odds of exclusive breastfeeding to 6 mo (OR: 2.4; 95% CI: 1.4, 4.0) and timely breastfeeding initiation (OR: 2.6; 95% CI: 1.6, 4.1) were increased in the intervention vs. control arm. Delayed introduction of water explained most of the increase in exclusive breastfeeding among clients receiving the intervention. In conclusion, a breastfeeding promotion intervention integrated into microcredit increased the likelihood that women adopted recommended breastfeeding practices. This intervention could be scaled up in Nigeria, where local organizations provide microcredit to >500,000 clients. Furthermore, the intervention could be adopted more widely given that >150 million women, many of childbearing age, are involved in microfinance globally. This trial was registered at clinicaltrials.gov as NCT01352351

The role of digital innovation in improving healthcare quality in extreme adversity: an interpretative phenomenological analysis study

# Background High quality is a necessary feature of healthcare delivery. Healthcare quality challenges are particularly present in conditions of extreme adversity, such as conflict settings or sustained humanitarian crises. Digital health technologies have recently emerged as an innovation to deliver care around the world in a variety of settings. However, there is little insight into how digital health technologies can be used to improve the quality of care where extreme adversity introduces unique challenges. This study aimed to identify how digital health technologies may be most impactful in improving the quality of care and evaluate opportunities for accelerated and meaningful digital innovation in adverse settings. # Methods A phenomenological approach (Interpretative Phenomenological Approach $$IPA$$), using semi-structured interviews, was adopted. Six individuals were interviewed in person based on their expertise in global health, international care delivery, and the application of digital health technologies to improve the quality of care in extreme adversity settings. The interviews were informed by a semi-structured topic guide with open-ended questions. The transcripts were compiled verbatim and were systematically examined by two authors, using the framework analysis method to extract themes and subthemes. # Results The participants identified several areas in which digital health technologies could be most impactful, which include engagement in care, continuity of care, workforce operations, and data collection. Opportunities for accelerated digital innovation include improving terminology, identity, ownership, and interoperability, identifying priority areas for digital innovation, developing tailored solutions, coordination and standardisation, and sustainability and resilience. # Conclusions These results suggest that there are conditions that favour or challenge the application of digital health technologies, even in specific areas in which they could be useful. A better understanding of the drivers and barriers to digitally driven quality improvement in settings of extreme adversity could inform international policies and optimisation strategies for the future