Department of Global Health, University of Washington, Seattle, Washington, USA
Partners In Health Lesotho, Maseru, Lesotho.
BMJ Open. 2023 May 19;13(5):e071414. doi: 10.1136/bmjopen-2022-071414.
The Ministry of Health of Lesotho and Partners In Health piloted the Lesotho National Primary Health Care Reform (LPHCR) from July 2014 to June 2017 to improve quality and quantity of service delivery and enhance health system management. This initiative included improvement of routine health information systems (RHISs) to map disease burden and reinforce data utilisation for clinical quality improvement.
The WHO Data Quality Assurance framework's core indicators were used to compare the completeness of health data before versus after the LPHCR in 60 health centres and 6 hospitals across four districts. To examine change in data completeness, we conducted an interrupted time series analysis using multivariable logistic mixed-effects regression. Additionally, we conducted 25 key informant interviews with healthcare workers (HCWs) at the different levels of Lesotho's health system, following a purposive sampling approach. Interviews were analysed using deductive coding based on the Performance of Routine Information System Management framework, which inspected organisational, technical and behavioural factors influencing RHIS processes and outputs associated with the LPHCR.
In multivariable analyses, trends in monthly data completion rate were higher after versus before the LPHCR for: documenting first antenatal care visit (adjusted OR (AOR): 1.24, 95% CI: 1.14 to 1.36) and institutional delivery (AOR: 1.19, 95% CI: 1.07 to 1.32). When discussing processes, HCWs highlighted the value of establishing clear roles and responsibilities in reporting under a new organisational structure, improved community programmes among district health management teams, and enhanced data sharing and monitoring by districts.
The Ministry of Health had a strong data completion rate pre-LPHCR, which was sustained throughout the LPHCR despite increased service utilisation. The data completion rate was optimised through improved behavioural, technical and organisational factors introduced as part of the LPHCR.
莱索托卫生部和健康伙伴组织于 2014 年 7 月至 2017 年 6 月试行莱索托国家初级卫生保健改革（LPHCR），以提高服务提供的质量和数量，并加强卫生系统管理。这一举措包括改善常规卫生信息系统（RHIS），以绘制疾病负担图，并加强数据利用以改善临床质量。
我们使用世界卫生组织数据质量保证框架的核心指标，比较了 LPHCR 前后四个地区 60 个卫生中心和 6 家医院的卫生数据的完整性。为了检查数据完整性的变化，我们使用多变量逻辑混合效应回归进行了中断时间序列分析。此外，我们按照目的抽样方法，对莱索托卫生系统不同层次的医疗保健工作者（HCWs）进行了 25 次关键知情人访谈。根据检验与 LPHCR 相关的 RHIS 流程和产出的组织、技术和行为因素的常规信息系统管理绩效框架，对访谈进行了演绎编码分析。
在多变量分析中，与 LPHCR 前相比，LPHCR 后每月数据完成率的趋势更高：记录第一次产前检查（调整后的比值比（AOR）：1.24，95%可信区间（CI）：1.14 至 1.36）和住院分娩（AOR：1.19，95%CI：1.07 至 1.32）。在讨论流程时，HCWs 强调了在新组织结构下建立明确报告角色和责任、改善地区卫生管理团队中的社区方案以及加强地区间数据共享和监测的价值。
卫生部在 LPHCR 前就有较高的数据完成率，尽管服务利用率有所增加，但在 LPHCR 期间仍保持稳定。通过引入 LPHCR 中的改进的行为、技术和组织因素，使数据完成率得到了优化。
