Cervical Cancer Screening in rural Uganda

Naima Joseph is an HQSS researcher, attending physician in obstetrics and gynecology at Massachusetts General Hospital and Brigham & Women’s Global Women’s Health Fellow. She has been working with the Mbarara Regional Referral Hospital in Uganda on cervical cancer screening availability and quality. Here, she shares some reflections on quality of care from her recent trip. On Kampala-Masaka road, approximately 420 kilometers from Kampala, Uganda’s capital city, lies the Equator.…

Working group 3: Our 3-month update

Our last five months have been busy focusing on how to achieve the quality defined by Working Group 1, utilize the measures being developed by Working Group 2 and align with Working Group 4 to achieve quality health care for all. Our work is framed by the recognition that to achieve these goals we will need to expand our thinking beyond micro (local) level quality improvement approaches and instead consider…

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: To describe quality across SDG conditions and health system platforms. To describe the variation in quality and its determinants 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…

Emilia Ling and Anna Gage: Our three month update

It has been just over three months since our inception Commission meeting in March. Since then, Commissioners, the HQSS secretariat, and National Commissions have been busy compiling data and conducting analyses to better understand, measure, and improve quality across low and middle-income countries. On Monday, July 10th, working group chairs, research leads, and the research secretariat convened in Boston to discuss the Commission’s overall progress. This meeting served as an…

Pay for Performance in Rwanda – evidence from DHS data

Sherry, Tisamarie B., Sebastian Bauhoff, and Manoj Mohanan. 2017. Multitasking and Heterogeneous Treatment Effects in Pay-for-Performance in Health Care: Evidence from Rwanda. American Journal of Health Economics, 3, 192-226. Although performance-based contracting in health is becoming much more widespread in developing countries, there is limited evidence on the unintended impacts of these types of contracts, as predicted by contract theory.   In our recent paper in the American Journal of Health Economics, we focus…

Working group 4: where ethics and equity fits

By Keely Jordan and Ole F. Norheim The HQSS ethics and equity working group has identified several important themes and questions that we are exploring through working papers, commissioned publications, and collaborations with other working groups. Key questions about the ethics and equity of quality include: What is the right to quality care in settings with few resources? The right to health must take a country’s level of development and…

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…

(No) Impact of large-scale social franchising and telemedicine intervention in India

Mohanan, M., Giardili, S., Das, V., Rabin, T.L., Raj, S.S., Schwartz, J.I., Seth, A., Goldhaber-Fiebert, J.D., Miller, G. and Vera-Hernández, M., 2017. Evaluation of a social franchising and telemedicine programme and the care provided for childhood diarrhoea and pneumonia, Bihar, India. Bulletin of the World Health Organization, 95(5), p.343 Social franchising is considered to be a potential solution to the problem of low quality of care available in rural areas in developing…

What do we think we are doing? Can a clinical information network improve pediatric care practices in Kenya?

English, Mike, et al. “What do we think we are doing? How might a clinical information network be promoting implementation of recommended paediatric care practices in Kenyan hospitals?” Health research policy and systems 15.1 (2017): 4 In a recently published paper titled “What do we think we are doing? How might a clinical information network be promoting implementation of recommended pediatric care practices in Kenyan hospitals?” Mike English and colleagues describe a…

Emilia Ling, Researcher: Part 2. Our progress to date and current HQSS challenges

By HQSS researcher and communications lead, Emilia Ling Since completing Bootcamp, HQSS Commissioners and the research secretariat have kept busy. In addition to hosting the HQSS Inception Meeting in March, we have begun our work on quality description, measurement, improvement, and ethics and equity. Across these four areas, we have focused our work on health conditions and service platforms outlined in the Sustainable Development Goals (SDGs). The field of health…

Adriana Ramirez, Researcher: Part 1. Flashback to Bootcamp

By HQSS researcher Adriana Ramirez In early January, the HQSS research secretariat underwent a three-week “Commission Bootcamp”. While we didn’t run drills or do pushups, our intensive planning and preparation workshop certainly helped us shape up for the Commission analytic work ahead. We tackled PubMed, wrangled EndNote, and used Stata to query text. Over the course of three weeks, we conducted literature reviews to understand and give definition to existing…

Call for indicators and data sources

The HQSS Commission aims to describe the quality of care provided across as many conditions included in the SDGs as possible, as well as platforms that are responsible for providing care. We would like your help in identifying quality indicators and data sources. We’re interested in indicators that describe the processes and outcomes of care, and data sources that are ideally nationally representative in low and middle income countries. In…

Co-chair Pate: The added value of our Commission

By HQSS Co-chair Muhammad Pate It was my pleasure to launch the HQSS Commission with Dr. Kruk last month in wintry Boston. Since then, I have had a chance to reflect on the significance of the Commission’s work and its direction. In recent travels, I have listened carefully to policymakers, health professionals and others react positively to the idea of a focused look at quality health systems in the era…

What’s the problem? Understanding the double burden of utilization and quality for poor women in Tanzania

Larson E, Vail D, Mbaruku G, Mbatia R, Kruk ME. Beyond utilization: measuring effective coverage of obstetric care along the quality cascade. Intl J for Quality in Health Care 2016. doi: 10.1093/intqhc/mzw141. Coverage of maternal health services is on the rise in many LMIC. However measures of utilization alone do not reflect population benefit when high quality care is not ubiquitous. Effective coverage metrics consider population need, utilization, and quality…

Ashish Jha, Advisory Council: Quality is the next frontier

By Ashish Jha and Liana Woskie We were delighted to co-host the launch of the Lancet Global Health Commission on High Quality Health Systems with Dr. Margaret Kruk and welcome Commissioners to Boston. Across the globe, the need to improve healthcare quality is becoming more and more apparent every day.  In a typical village in India, your chance of getting care that is unnecessary or harmful is greater than the…

Commissioner Guanais: User’s perspective is key

By Commissioner Frederico Guanais I’m thrilled to be a member of the Lancet Global Health Commission on High Quality Health Systems in the SDG Era. Judging by the contents of the discussion during the inception event and the first round of meetings, the Commission is bound to generate a great, positive shake-up on the way we talk about and act upon universal health coverage. In low and middle-income countries, quality…

Does poor quality of delivery facilities contribute to avertable neonatal deaths in Malawi?

Leslie HH, Fink G, Nsona H, Kruk M. (2016) Obstetric Facility Quality and Newborn Mortality in Malawi: A Cross-Sectional Study. PLoS Medicine, 13(10). Despite dramatic increases in women’s access to skilled birth attendants in the past two decades, neonatal mortality has declined slowly – deaths within 28 days of birth are now the largest share of global child mortality. Malawi, one of the poorest countries in the world, achieved dramatic…

Researcher Todd Lewis: No ‘fluoride in the water’ for quality improvement?

By Todd Lewis, Working Group 3 researcher There is a great deal of room for improvement in “quality improvement”—this was a key takeaway from my first discussion with the Commissioners and researchers of Working Group 3, which focuses on quality improvement approaches. As we broached the goals of the working group, we quickly realized that while questions were abundant, clear answers were not. For example, I was surprised to find…

Commissioner Barker: Right timing, right people, and right opportunity

Commissioners Alex Rowe, Frederico Guanais, and Pierre Barker on a panel about quality improvement at scale during the inception meeting of the HQSS Commission.

By Commissioner Pierre Barker I could not be more enthusiastic about the emergence of the Lancet Global Health Commission on High Quality Health Systems in the SDG Era and really honored to be part of this highly talented and influential group of 30 global health experts. The Commission’s timing is prescient. There is an increasing awareness that health system quality has been neglected in the urgent efforts to achieve universal…

Commissioner Rowe: My thoughts on the March 13-15 HQSS inception meeting

By Commissioner Alexander Rowe The first meeting of the Lancet Global Health Commission on High Quality Health Systems in the SDG Era got off to a strong start. I was impressed by the expertise, diversity, and energy of the Commissioners, Commission Advisory Council members, researchers, and support staff. As I looked around the room, I saw senior policy-makers (including the former Minister of Health of Nigeria), epidemiologists, program specialists, measurement…

What % of Haiti’s population has access to good quality primary care?

Gage, A.D., Leslie, H.H., Bitton, A., Jerome, J.G., Thermidor, R., Joseph, J.P. and Kruk, M.E., 2017. Assessing the quality of primary care in Haiti. Bulletin of the World Health Organization, 95(3), p.182. High quality primary health care systems are critical to improving health systems worldwide, yet there are few measures for assessing the quality of the primary care. We adopted the Primary Health Care Performance Initiative’s framework on primary care to define…

Work in progress – Health care coverage for sick children is both low and ineffective in low and middle income countries

By Hannah Leslie   Effective coverage – the fraction of health gain actually delivered by the health system to the population in need – is emerging as a critical indicator of progress towards universal health coverage. Estimates of effective coverage can be calculated based on the population in need, utilization of health services, and quality of the care delivered. Limited research has addressed effective coverage of care for children under…

Does maternal health care quality vary with poverty level in Kenya?

Sharma, J., Leslie, H.H., Kundu, F. and Kruk, M.E., 2017. Poor Quality for Poor Women? Inequities in the Quality of Antenatal and Delivery Care in Kenya. PloS One, 12(1), p.e0171236. We investigated the distributional aspects of quality of maternal healthcare, an important determinant of future progress in global health, but one that has received inadequate attention. We mapped the quality of maternal care in facilities located in poorer versus wealthier areas of…

Welcome to the HQSS Commission website!

On behalf of the HQSS Commission, we are pleased to welcome you to the HQSS Commission website. We will be updating this website frequently with new research, Commission activities, and news related to our work. Why quality? Low and middle income countries have made substantial improvements in health care delivery and coverage of care since the launch of the Millennium Development Goals (MDGs). However, emerging health systems and population research has shown that there is still much…