Gouws Eleanor, Bryce Jennifer, Pariyo George, Armstrong Schellenberg Joanna, Amaral João, Habicht Jean-Pierre
Department of Child and Adolescent Health and Development, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland.
Soc Sci Med. 2005 Aug;61(3):613-25. doi: 10.1016/j.socscimed.2004.12.019. Epub 2005 Feb 23.
Sound policy and program decisions require timely information based on valid and relevant measures. Recent findings suggest that despite the availability of effective and affordable guidelines for the management of sick children in first-level health facilities in developing countries, the quality and coverage of these services remains low. We report on the development and evaluation of a set of summary indices reflecting the quality of care received by sick children in first-level facilities. The indices were first developed through a consultative process to achieve face validity by involving technical experts and policymakers. The definition of evaluation measures for many public health programs stops at this point. We added a second phase in which standard statistical techniques were used to evaluate the content and construct validity of the indices and their reliability, drawing on data sets from the multi-country evaluation of integrated management of childhood illness (MCE) in Brazil, Tanzania and Uganda. The statistical evaluation identified important conceptual errors in the indices arising from the theory-driven expert review. The experts had combined items into inappropriate indicators resulting in summary indices that were difficult to interpret and had limited validity for program decision making. We propose a revised set of summary indices for the measurement of child health care in developing countries that is supported by both expert and statistical reviews and that led to similar programmatic insights across the three countries. We advocate increased cross-disciplinary research within public health to improve measurement approaches. Child survival policymakers, program planners and implementers can use these tools to improve their monitoring and so increase the health impact of investments in health facility care.
合理的政策和项目决策需要基于有效且相关的措施所提供的及时信息。近期研究结果表明，尽管发展中国家一级卫生机构有针对患病儿童管理的有效且经济实惠的指南，但这些服务的质量和覆盖范围仍然很低。我们报告了一组反映一级医疗机构中患病儿童所接受护理质量的汇总指标的制定和评估情况。这些指标最初是通过一个协商过程制定的，通过让技术专家和政策制定者参与来实现表面效度。许多公共卫生项目的评估措施定义到此为止。我们增加了第二阶段，在该阶段运用标准统计技术，利用巴西、坦桑尼亚和乌干达的儿童疾病综合管理多国评估（MCE）数据集，来评估这些指标的内容、结构效度及其可靠性。统计评估发现了理论驱动的专家评审导致的指标中重要的概念性错误。专家们将项目组合成了不恰当的指标，导致汇总指标难以解释，对项目决策的效度有限。我们提出了一套经修订的用于衡量发展中国家儿童医疗保健的汇总指标，该指标得到了专家和统计评审的支持，并且在三个国家都得出了类似的项目见解。我们主张在公共卫生领域加强跨学科研究以改进测量方法。儿童生存领域的政策制定者、项目规划者和实施者可以使用这些工具来改善他们的监测，从而增强对卫生机构护理投资的健康影响。
