Boerma Ties, AbouZahr Carla, Evans David, Evans Tim
World Health Organization, Geneva, Switzerland.
Independent consultant.
PLoS Med. 2014 Sep 22;11(9):e1001728. doi: 10.1371/journal.pmed.1001728. eCollection 2014 Sep.
Monitoring universal health coverage (UHC) focuses on information on health intervention coverage and financial protection. This paper addresses monitoring intervention coverage, related to the full spectrum of UHC, including health promotion and disease prevention, treatment, rehabilitation, and palliation. A comprehensive core set of indicators most relevant to the country situation should be monitored on a regular basis as part of health progress and systems performance assessment for all countries. UHC monitoring should be embedded in a broad results framework for the country health system, but focus on indicators related to the coverage of interventions that most directly reflect the results of UHC investments and strategies in each country. A set of tracer coverage indicators can be selected, divided into two groups-promotion/prevention, and treatment/care-as illustrated in this paper. Disaggregation of the indicators by the main equity stratifiers is critical to monitor progress in all population groups. Targets need to be set in accordance with baselines, historical rate of progress, and measurement considerations. Critical measurement gaps also exist, especially for treatment indicators, covering issues such as mental health, injuries, chronic conditions, surgical interventions, rehabilitation, and palliation. Consequently, further research and proxy indicators need to be used in the interim. Ideally, indicators should include a quality of intervention dimension. For some interventions, use of a single indicator is feasible, such as management of hypertension; but in many areas additional indicators are needed to capture quality of service provision. The monitoring of UHC has significant implications for health information systems. Major data gaps will need to be filled. At a minimum, countries will need to administer regular household health surveys with biological and clinical data collection. Countries will also need to improve the production of reliable, comprehensive, and timely health facility data. Please see later in the article for the Editors' Summary.
监测全民健康覆盖(UHC)侧重于健康干预覆盖范围和经济保护方面的信息。本文探讨与UHC全领域相关的干预覆盖范围监测,包括健康促进、疾病预防、治疗、康复和姑息治疗。作为所有国家健康进展和系统绩效评估的一部分,应定期监测一套与国情最相关的综合核心指标。UHC监测应纳入国家卫生系统的广泛结果框架,但重点关注与干预覆盖范围相关的指标,这些指标最直接地反映了每个国家UHC投资和战略的成果。可以选择一组追踪覆盖指标,分为两组——促进/预防和治疗/护理,如本文所示。按主要公平分层因素对指标进行分解对于监测所有人群的进展至关重要。需要根据基线、历史进展速度和测量考虑因素来设定目标。关键的测量差距也存在,特别是对于治疗指标,涵盖心理健康、伤害、慢性病、手术干预、康复和姑息治疗等问题。因此,在此期间需要使用进一步的研究和替代指标。理想情况下,指标应包括干预质量维度。对于某些干预措施,使用单一指标是可行的,如高血压管理;但在许多领域,需要额外的指标来衡量服务提供的质量。UHC监测对卫生信息系统具有重大影响。需要填补主要的数据差距。至少,各国需要进行定期的家庭健康调查,并收集生物和临床数据。各国还需要改进可靠、全面和及时的卫生设施数据的生成。编辑总结请见本文后面部分。