Working group 2: what we’re measuring

By Svetlana Doubova, Hannah Leslie, and Tanya Marchant

Since the inception meeting of the HQSS Commission in March, the Measurement Working Group has refined the focus areas for quality measurement in the HQSS report and has identified a range of key analyses to support the overall findings. In broad strokes, the measurement section of the report will address:

  • Why measure? Linking measures to purpose, placing measurement in a typology that aligns with the HQSS conceptual framework
  • What is measured, what is not? What do current tools – including global indicators, commonly used surveys, and national systems such as DHIS2 – address in terms of quality measurement? What domains or services are excluded?
  • How can gaps in measurement be better addressed? What innovations in data collection, data use, and underlying systems can transform quality measurement to an efficient and purpose-driven endeavor?
  • What should be measured moving forward? For instance, how can quality be added to the Sustainable Development Goals (SDGs) to ensure assessment of effective coverage of health services? What is a minimum set of measures for quality assessment at the national level? What future challenges to measurement should be anticipated today?

Work to date has included compiling indicators from global and national repositories such as the WHO Core 100 Health Indicators, the World Bank Global Development Indicators, and national DHIS2 systems, to identify the extent of existing quality measurement and consider their relationship to the HQSS Conceptual Framework. A second area of effort is a comparison of existing SDG indicators with effective coverage indicators proposed in the literature to date, with the goal of informing recommendations for consistent metrics moving forward.

Beyond the core working group activities, a number of supporting analyses that will inform and expand upon the report have been initiated. These include:

  • Effective coverage estimates using existing data
    • 3 primary care services in 8 low- and middle-income countries
    • Hypertension care and treatment in India
    • Health system effective coverage in Mexico (IMSS)
    • Essential nutrition counseling during antenatal care visits in 9 countries
  • Measurement methods
    • The relationship between measures of inputs to care and the quality of clinical care delivered
    • Patient experience measures in low- and middle-income countries: a review
    • The role of mortality in quality measurement

Many more analyses are in the works – stay tuned for updates!