Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.
Management and Healthcare Laboratory, Institute of Management and Department EMbeDS, Sant'Anna School of Advanced Studies, Pisa, Italy.
PLoS One. 2022 Mar 31;17(3):e0266225. doi: 10.1371/journal.pone.0266225. eCollection 2022.
The last two decades saw an extensive effort to design, develop and implement integrated and multidimensional healthcare evaluation systems in high-income countries. However, in low- and middle-income countries, few experiences of such systems implementation have been reported in the scientific literature. We developed and piloted an innovative evaluation tool to assess the performance of health services provision for communicable diseases in three sub-Saharan African countries.
A total of 42 indicators, 14 per each communicable disease care pathway, were developed. A sub-set of 23 indicators was included in the evaluation process. The communicable diseases care pathways were developed for Tuberculosis, Gastroenteritis, and HIV/AIDS, including indicators grouped in four care phases: prevention (or screening), diagnosis, treatment, and outcome. All indicators were calculated for the period 2017-2019, while performance evaluation was performed for the year 2019. The analysis involved four health districts and their relative hospitals in Ethiopia, Tanzania, and Uganda.
Substantial variability was observed over time and across the four different districts. In the Tuberculosis pathway, the majority of indicators scored below the standards and below-average performance was mainly reported for prevention and diagnosis phases. Along the Gastroenteritis pathway, excellent performance was instead evaluated for most indicators and the highest scores were reported in prevention and treatment phases. The HIV/AIDS pathway indicators related to screening and outcome phases were below the average score, while good or excellent performance was registered within the treatment phase.
The bottom-up approach and stakeholders' engagement increased local ownership of the process and the likelihood that findings will inform health services performance and quality of care. Despite the intrinsic limitations of data sources, this framework may contribute to promoting good governance, performance evaluation, outcomes measurement and accountability in settings characterised by multiple healthcare service providers.
过去二十年，高收入国家大力致力于设计、开发和实施综合多维的医疗保健评估系统。然而，在中低收入国家，科学文献中鲜有此类系统实施经验的报道。我们开发并试行一种创新的评估工具，以评估撒哈拉以南非洲三个国家提供传染病服务的绩效。
共开发了 42 项指标，每个传染病护理路径 14 项。评估过程中纳入了 23 项指标的子集。结核病、胃肠炎和艾滋病的传染病护理路径得到了发展，包括分为四个护理阶段的指标：预防（或筛查）、诊断、治疗和结果。所有指标都针对 2017-2019 年进行了计算，而绩效评估则针对 2019 年进行。分析涉及埃塞俄比亚、坦桑尼亚和乌干达的四个卫生区及其所属医院。
随着时间的推移和四个不同地区的变化，存在显著的变异性。在结核病路径中，大多数指标得分低于标准，主要报告预防和诊断阶段的表现不佳。沿着胃肠炎路径，大多数指标的表现被评估为优秀，得分最高的是预防和治疗阶段。艾滋病毒/艾滋病途径与筛查和结果阶段相关的指标低于平均水平，而治疗阶段的表现良好或优秀。
自下而上的方法和利益相关者的参与增加了当地对该过程的所有权，以及发现将为服务绩效和护理质量提供信息的可能性。尽管数据源存在内在限制，但该框架可能有助于促进在具有多个医疗服务提供者的环境中实现良好治理、绩效评估、结果衡量和问责制。
