New Signal Functions to Measure the Ability of Health Facilities to Provide Routine and Emergency Newborn Care

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Abstract

Based upon an expert survey and consensus method, Sabine Gabrysch and colleagues recommend new signal functions to monitor and track facilities' provision of routine and emergency newborn care.

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Availability and distribution of, and geographic access to emergency obstetric care in Zambia.

Sabine Gabrysch, Virginia Simushi, Matthew Campbell (2011)

To assess the availability and coverage of emergency obstetric care (EmOC) services in Zambia. Reported provision of EmOC signal functions in the Zambian Health Facility Census and additional criteria on staffing, opening hours, and referral capacity were used to classify all Zambian health facilities as providing comprehensive EmOC, basic EmOC, or more limited care. Geographic accessibility of EmOC services was estimated by linking health facility data with data from the Zambian population census. Few Zambian health facilities provided all basic EmOC signal functions and had qualified health professionals available on a 24-hour basis. Of the 1131 Zambian delivery facilities, 135 (12%) were classified as providing EmOC. Zambia nearly met the UN EmOC density benchmarks nationally, but EmOC facilities and health professionals were unevenly distributed between provinces. Geographic access to EmOC services in rural areas was low; in most provinces, less than 25% of the population lived within 15 km of an EmOC facility. A national Health Facility Census with geographic information is a valuable tool for assessing service availability and coverage at national and subnational levels. Simultaneously assessing health worker density and geographic access adds crucial information. Copyright © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

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Development of paediatric quality of inpatient care indicators for low-income countries - A Delphi study

Stephen Ntoburi, Andrew Hutchings, Colin Sanderson … (2010)

Background Indicators of quality of care for children in hospitals in low-income countries have been proposed, but information on their perceived validity and acceptability is lacking. Methods Potential indicators representing structural and process aspects of care for six common conditions were selected from existing, largely qualitative WHO assessment tools and guidelines. We employed the Delphi technique, which combines expert opinion and existing scientific information, to assess their perceived validity and acceptability. Panels of experts, one representing an international panel and one a national (Kenyan) panel, were asked to rate the indicators over 3 rounds and 2 rounds respectively according to a variety of attributes. Results Based on a pre-specified consensus criteria most of the indicators presented to the experts were accepted: 112/137(82%) and 94/133(71%) for the international and local panels respectively. For the other indicators there was no consensus; none were rejected. Most indicators were rated highly on link to outcomes, reliability, relevance, actionability and priority but rated more poorly on feasibility of data collection under routine conditions. There was moderate to substantial agreement between the two panels of experts. Conclusions This Delphi study provided evidence for the perceived usefulness of most of a set of measures of quality of hospital care for children proposed for use in low-income countries. However, both international and local experts expressed concerns that data for many process-based indicators may not currently be available. The feasibility of widespread quality assessment and responsiveness of indicators to intervention should be examined as part of continued efforts to improve approaches to informative hospital quality assessment.

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Are hospitals prepared to support newborn survival? – an evaluation of eight first-referral level hospitals in Kenya*

Charles Opondo, Stephen Ntoburi, John Wagai … (2009)

Objective To assess the availability of resources that support the provision of basic neonatal care in eight first-referral level (district) hospitals in Kenya. Methods We selected two hospitals each from four of Kenya’s eight provinces with the aim of representing the diversity of this part of the health system in Kenya. We created a checklist of 53 indicator items necessary for providing essential basic care to newborns and assessed their availability at each of the eight hospitals by direct observation, and then compared our observations with the opinions of health workers providing care to newborns on recent availability for some items, using a self-administered structured questionnaire. Results The hospitals surveyed were often unable to maintain a safe hygienic environment for patients and health care workers; staffing was insufficient and sometimes poorly organised to support the provision of care; some key equipment, laboratory tests, drugs and consumables were not available while patient management guidelines were missing in all sites. Conclusion Hospitals appear relatively poorly prepared to fill their proposed role in ensuring newborn survival. More effective interventions are needed to improve them to meet the special needs of this at-risk group.

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Journal

Journal ID (nlm-ta): PLoS Med

Journal ID (iso-abbrev): PLoS Med

Journal ID (publisher-id): PLoS

Journal ID (pmc): plosmed

Title: PLoS Medicine

Publisher: Public Library of Science (San Francisco, USA )

ISSN (Print): 1549-1277

ISSN (Electronic): 1549-1676

Publication date Collection: November 2012

Publication date (Print): November 2012

Publication date (Electronic): 13 November 2012

Volume: 9

Issue: 11

Electronic Location Identifier: e1001340

Affiliations

[1 ]University of Heidelberg, Institute of Public Health, Heidelberg, Germany

[2 ]Sapienza University of Rome, Public Health and Infectious Diseases Department, Rome, Italy

[3 ]University of Western Australia, School of Paediatrics and Child Health, Subiaco, Australia

[4 ]Department of Maternal, Newborn, Child & Adolescent Health, World Health Organization, Geneva, Switzerland

[5 ]Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland

[6 ]Division of Women and Child Health, The Aga Khan University, Karachi, Pakistan

[7 ]London School of Hygiene & Tropical Medicine, Faculty of Epidemiology and Population Health, London, United Kingdom

Author notes

* E-mail: sabine.gabrysch@ 123456uni-heidelberg.de

ZAB is a member of the PLOS Medicine Editorial Board. All other authors have declared that no competing interests exist. MM and MA work for the World Health Organization (WHO); however, this report contains the collective views of an international group of experts, and does not necessarily represent the decisions or the stated policy of the WHO.

Wrote the first draft of the manuscript: SG. Contributed to the writing of the manuscript: SG GC KME MM MA ZAB OMRC. ICMJE criteria for authorship read and met: SG GC KME MM MA ZAB OMRC. Agree with manuscript results and conclusions: SG GC KME MM MA ZAB OMRC. Had idea for study: OMRC SG. Did literature review: GC SG. Did online survey: SG. Assessed survey tools: SG GC.

Provenance: Not commissioned; externally peer reviewed.

The Policy Forum allows health policy makers around the world to discuss challenges and opportunities for improving health care in their societies.

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Publisher ID: PMEDICINE-D-12-01748

DOI: 10.1371/journal.pmed.1001340

PMC ID: 3496666

PubMed ID: 23152724

SO-VID: bdd470e3-a270-4c3e-9681-44590e7425ce

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This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Pages: 7

Funding

SG is paid by the University of Heidelberg through a Margarete von Wrangell Fellowship supported by the European Social Fund and by the Ministry of Science, Research and the Arts Baden-Württemberg, and has received salary support from the Medical Faculty's Rahel Goitein-Straus Programme. GC participated in this work during her internship at the University of Heidelberg as part of her public health specialization training at the Public Health and Infectious Diseases Department at Sapienza University in Rome. OMRC is supported by the London School of Hygiene and Tropical Medicine. No funders had any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

New Signal Functions to Measure the Ability of Health Facilities to Provide Routine and Emergency Newborn Care

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Preventive and Emergency Medicine Insights

Most cited references 5

Availability and distribution of, and geographic access to emergency obstetric care in Zambia.

Development of paediatric quality of inpatient care indicators for low-income countries - A Delphi study

Are hospitals prepared to support newborn survival? – an evaluation of eight first-referral level hospitals in Kenya*

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