The Data Sources in the Commission Report: A Global Perspective

The HQSS Commission Report has been submitted to the Lancet Global Health! As we begin the review process, we’ll be posting on several aspects of the report that we’re most excited about. This week, Commission Data Manager Dennis Lee discusses the data sources used to describe quality in the report.

Using nationally representative multi-country datasets from the past ten years, the Commission presents recent, significant results on the quality of health systems across 134 LMICs. Covering a broad range of healthcare topics, from antenatal care and sick child treatments to mental health and surgical care, the Commission takes a multifaceted approach to defining, measuring and analyzing healthcare quality and its consequences on patient-outcomes.

Our data sources include global reports (e.g. the WHO Global Health Observatory, UNAIDs 90-90-90 data), multilevel stratified household surveys (e.g. Demographic and Health Surveys, Multiple Indicator Cluster Surveys, WHO Study on global AGEing and adult health) and direct observations of clinical visits (e.g. Baseline from the Results-based Financing evaluations, Service Provision Assessments). In addition to the secondary analyses from publicly-available data, the Commission has also conducted an original Internet survey in 12 countries on healthcare user experience.

Several interesting challenges arise when compiling such a collection of data: 1) ensuring data consistency, 2) demanding more from the data and 3) dealing with the scarcity in certain subjects.

With such diverse datasets, careful examination of the questionnaire structures and exact variable definitions is required to ensure apples-to-apples comparisons of our healthcare quality measures. As a result, even for very similar surveys, such as the DHS and MICS, we have often excluded indices that do not perfectly match in order to exclude systematic biases in our analysis.

In addition, one of our goals has been to dig deeper into the data. For instance, we are not just interested in country-level disparities of healthcare quality, but also in how quality of care is distributed between and within countries. This exploration helps us understand populations who are particularly vulnerable to receiving poor quality.

Finally, when examining the various aspects of healthcare quality, we have found that there is a disparity in the availability of data from certain services. For example, while there is a relative abundance of maternal care and child health indicators, there is a dearth of data for mental health, cancer, trauma, and user experience in LMICs. One way in which the Commission had addressed this challenge is through the Commission-led Internet survey. The survey allows for direct engagement from people in LMICs to delineate an important aspect of healthcare quality: what people perceive as good quality and how they rate the healthcare systems in their own communities.

All in all, we are eager and hopeful for the future impact of this report—both on the healthcare literature and in healthcare systems across LMICs.