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Model for Monitoring and Evaluation of Overall Health System Performance for Comparison

Model for Monitoring and Evaluation of Overall Health System Performance for Comparison Based on the Study Conducted for the Ministry of Health . General Objective

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Model for Monitoring and Evaluation of Overall Health System Performance for Comparison

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  1. Model for Monitoring and Evaluation of Overall Health System Performance for Comparison Based on the Study Conducted for the Ministry of Health

  2. General Objective Comparison of overall health system performance against selected indicators between districts using one index district from each province.

  3. Mandate The mandate was to look at routinely collected and readily generated data at district level to measure the selected indicators.

  4. Do other countries use health system performance indicators?

  5. Cross-Country Comparison of Concepts of Health System Performance

  6. Cross-Country Comparison of Concepts of Health System Performance…contd…

  7. PROCESS

  8. Initially a steering committee was established consisting of ministry officials & the AHF secretariat. Based on the literature review of national and global materials and the documents available with the MoH a draft conceptual framework for measurement of health system performance was presented to Steering Committee and modified taking into account the views of the committee.

  9. Concurrently the study team also looked at the indicators used world wide for performance measurements. After identifying the readily available indicators at provincial and national levels with the concurrence of the steering committee it was decided to place them before high level ministry officials from centre as well as the managers from the provinces.

  10. The following indexed districts one per each province were selected for comparison with the concurrence of the ministry officials & PDHS’s. The selected districts were - Gampaha – Western Province - Ratnapura – Sabaragamuwa -Province - Anuradhapura – North Central-Province - Galle – Southern Province - Matale – Central Province - Trincomalee – North East Province - Badulla – Uva Province Kurunegala – North Western Province

  11. Sri Lankan Health Performance Framework- A Model Health Status and Outcome Tier 1 Health System Performance Framework Tier 3 Responsiveness & Access Tier 2

  12. Routine data was not available for the following indicators: • Prevalence of anaemia among pregnant women • Inpatient to Staff Ratio • Percentage of expenditure for health vs. total budget • Percentage of expenditure on drugs • Patient Transfers • Number of New cases of NCDs in hospital clinics for:Diabetes HypertensionCancer • Percentage of Medical Audits done for still Births

  13. RESULTS - PILOT STUDY

  14. Health Status and Outcome Tier 1 Health Conditions District District

  15. Deaths Anuradhapura 13.55 Kurunegala 12.4 12 Ratnapura Badulla 10.4 Gampaha 10.15 9.9 Average Matale 9.1 Galle 6.3 5.3 Trincomalee 0 2 4 6 8 10 12 14 16 % Infant Mortality Rate (2005) Definition Number of deaths to infants under one year of age per 1,000 live births in a given year District Infant Mortality Rate per 1000 live births

  16. Health System Performance Tier 3 Percentage of pregnant mothers tested for VDRL (2005) Effectiveness Definition Number of mothers tested for VDRL as a percentage of total number of deliveries reported. Percentage of Pregnant mothers Tested for VDRL

  17. Efficiency Average length of stay(2005) Definition The average length of stay a patient spends in a government hospital. It is measured by dividing the total number of days stayed by all inpatients in government hospitals during a year by the number of admissions Average Length of Stay in Hospital

  18. Caesarean Section Rate (2005) Definition The number of caesareans per 100 live births in government hospitals Gampaha 28.6 Matale 23.9 Galle 23.2 District Kurunegala 22.7 Badulla 22.5 Average 21.9 Anuradhapura 20.0 Ratnapura 19.5 Trincomalee 14.6 0 5 10 15 20 25 30 35 Rate Caesarean Section Rate

  19. Sustainability Nurses per 100,000 population(2005)

  20. Health ServicesPercentage of Medical Audits done for:Percentage of Medical Audits done for Maternal deaths(2005) Percentage of medical audits done for maternal deaths

  21. SUMMARY SHEETS FOR OVERALL HEALTH SECTOR PERFORMANCE BY DISTRICT

  22. Direction for Establishing & Using this Model for Systematic Monitoring for Comparison of Health System Performance between Districts in the Future

  23. POLICY ISSUES

  24. For future analysis the level of analysis of costing, whether provincial or district, needs to be identified. At present there is no provision to collect and compile the cost data at the district level as they are not accountable for them. Hence a policy decision needs to be taken whether performance comparison should be at district level or at provincial level.

  25. It is better to look at all inputs from both line ministry and the provincial ministry for an accurate comparison, as the health outcomes etc. will be dependant on all resource inputs to a particular province, rather than through provincial health sources only. This could best be done at the central level.

  26. It is also recommended to review the IMMR and hospital returns sent to the medical statistician and to modify them to include additional information which, at present, is already available at institution level but not collated and reported.

  27. Wherever national figures are available for the selected indicators these should be compiled from them as they are more accurate and reliable. Since the numerator and the denominators used will be same and for comparison across the districts.

  28. RECOMMENDATIONS

  29. A system for regular monitoring of health system performance should be established. Provincial health authorities need to adopt this model for their monitoring purposes & use this at review meetings with the district health authorities For this purpose planning cells of PDHS/DPDHS offices has to be strengthened. Timely & accurate electronic data flow to the DPDHS offices from the periphery for compiling the selected indicators should be established.

  30. PDHS’s should provide expenditure data to DPDHs for monitoring purposes. Expenditure on drugs by individual institutions should be monitored at DPDHS level. These data bases from the DPDHS offices should be linked with the PDHS’s planning units & the MDPU of the MoH For the present the responsibility of M & E of Health System Performance could be a joint effort of both organizations MDPU and the AHF secretariat. This responsibility should be transferred to the D/I of the MDPU of the MoH after AHF secretariat cease to function after the project period.

  31. It is to be noted that in other countries too most of the health status indicators are calculated by a central organization for consistency. It is recommended that to get data for the second tier - responsiveness and access, as well as for NCDs, including the risk factor prevalence a national health survey is carried out every three to four years, depending on the resource availability, or alternatively, to look at the feasibility of combining this with DHS survey to cut down costs to the health ministry.

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