Working group 1: describing the state of quality

By Catherine Arsenault

Since the launch of the HQSS commission, our working group’s approach to describing quality has considerably evolved. Our group has three broad objectives:

  1. To describe quality across SDG conditions and health system platforms.
  2. To describe the variation in quality and its determinants
  3. To describe the impact of poor quality on health outcomes, utilization and out of pocket spending.

To achieve our objectives, we’ve identified cross-national data sources (e.g. DHS, SPA, MICS, SDI, PMA, SAGE, STEPS, UNAIDS, among others) and have started defining and compiling quality indicators. These indicators relate to the provision of evidence-based care and to dimensions of quality such as user experience, safety, coordination and timely action among others.

Nonetheless, there are still many challenges for our working group:

  • Data types: How can we comparably describe data from heterogeneous sources such as observations of clinical consultations, household surveys, healthcare provider vignettes, clinical chart extractions etc.?
  • Indicator organization: How should we present these results in a way that leads to meaningful conclusions and sheds light on areas of health systems where quality is most deficient?

Other supporting analyses are underway to help answer our objectives including:

  • Estimating the global mortality burden of poor quality
  • Identifying the determinants of variation in labor and delivery care quality in Kenya and Malawi
  • Conducting a meta-analyss of post-operative mortality rates

And last but not least, our online “RIWI” survey on user experience and demand for quality has been piloted. More results to come soon!