Table 1 Definitions of elements and potential data sources
From: Operationalising health systems thinking: a pathway to high effective coverage
Pathway component and related elements | Potential measurement data sources |
|---|---|
NATIONAL READINESS: This component explores the extent to which the service or service package (either community or facility-based or both) has been integrated into national systems and is reflected in policies, plans and resources; national readiness also reflects some of the elements from the WHO building blocks | |
Thematic area on national agenda with convening mechanism and focal person at Ministry of Health (MOH) in place: Technical working/advocacy group established and advocating for health thematic area OR existing working/advocacy groups have integrated the health thematic area into their terms of reference; there is also a focal person established or identified, housed within the MOH, and the position is funded | Document review, e.g. national health policies and plans, national budget or national health accounts, routine health information system data, national health surveys, Every Newborn Action Plan scorecard Key informant interviews (global and country level) |
Policies revised/formulated: National theme-related policies have been updated and/or developed to reflect the latest evidence on key theme-related health services | |
Implementation guidelines, training materials and standards of care developed: Specific guidelines, training materials and standards of care for theme-related health services have been created and approved | |
National operation plans include theme-related services: National operational plans for the health sector include specific mention of implementation of key theme-related health services | |
National budgets updated with sufficient allocation for theme-related services: National budgets have been created for national operational plans that include allocations for implementation of key theme-related health services | |
Drugs on essential list and production plans in place: National essential drug lists include commodities required for key theme-related health services; in addition, plans exist for the procurement of key commodities, including supply forecasting and, where appropriate, production plans | |
Appropriate targets and indicators set: National strategies and policies have established effective coverage targets for key theme-related health services. Indicators to track key theme-related health services have been incorporated into national systems (e.g. health management information system, national surveys) | |
SYSTEMS STRUCTURES: The component explores the platforms through which the service(s) will be delivered are in place and sufficiently resourced | |
Physical infrastructure exists for the delivery of services: Adequate physical structures, such as buildings or mobile units, exist with sufficient space to accommodate the delivery of the services of interest | Document review: routine health information system, human resource information system, Every Newborn Action Plan scorecard, project reports, evaluations, studies, and household/health facility surveys, guidelines (supervision, community health worker) Key informant interviews (country level) |
Health system is accessible: The healthcare delivery system is accessible to the population in need of services. Accessibility includes distance/availability of transport, costs and availability of culturally and linguistically appropriate service delivery to the population in need of services | |
Human resources/cadre exist for delivery of services: Cadres of health providers exist, who can be used for the delivery of services; for example, there exists a cadre of community health workers who could take on home visits for provision of care | |
Information systems exist: Systems exist to manage information on health service delivery: Routine Health Information System, Logistics Management Information System and Human Resources Information Management System, into which health area-specific information can be incorporated | |
Community structures exist: Community structures exist that could be leveraged for social and behavioural communication efforts. | |
Social and behavioural change communication structures exist: Specific structures exist for the provision of social and behavioural change communication such as radio stations or other media stations, local theatre groups, social media | |
Delivery platforms are present into which theme-related health services can be integrated: A delivery platform organises services around similar work, rather than areas of specialisation; for example, existing delivery platforms, such as antenatal care, labour and delivery, could be important for the provision of services for newborn care; this includes platforms at the community level such as community health workers | |
Links exist between levels of health system and with the community: Linkages that permit referral and cross-referral exist between different levels of the health system and between the health system and communities | |
Systems for procuring and distributing commodities exist: Systems for forecasting, procurement and distribution of health-related commodities (e.g. medications and other supplies) are in place, into which required commodities for theme-related care can be incorporated | |
Supportive supervision systems exist: There is a system to provide supervision that incorporates an interactive relationship between supervisors and supervisees, including mentorship, joint problem-solving and active communication | |
Systems for governance and accountability exist: A mechanism is in place to hold health systems accountable across levels of the national structure and functioning structures that permit governance of the health system across multiple levels | |
MANAGEMENT CAPACITY: The component explores the systems and structures at subnational level (e.g. state, district, province), that are required to take on management of service delivery; this component is particularly important for national scale-up to be effective and may vary substantially within a country | |
Policy or strategy disseminated to intermediate management: National policies and strategies related to the health thematic area have been disseminated from the national level to intermediate, sub-national management levels | Document review: routine health information system, human resource information system, project reports, studies, and household/health facility surveys Key informant interviews (country level) |
Guidelines and materials available at sub-national level: Guidelines and materials related to the health thematic area, developed at national level, have been disseminated from national to intermediate, sub-national management levels | |
Skilled focal management people in place at sub-national level: Staff with theme-related health knowledge and skills are in place at sub-national level to serve as focal points for the implementation of national policies, standards and practices | |
Sub-national budget has sufficient allocation for theme-related health services: Budgets at sub-national level have been developed with sufficient allocations to permit appropriate implementation of theme-related related services, as per sub-national work plans | |
Sub-national work plans include theme-related health services: Workplans at sub-national level have been developed to reflect national priorities for thematic health area, including key services | |
Stakeholders ready to support theme-related health services: Key stakeholders at subnational level have been sensitised and mobilised to support the implementation of theme-related health services | |
Capacity for monitoring and accountability exists at sub-national level: Staff with adequate skills and knowledge are in place to implement national monitoring systems for theme-related health services; accountability mechanisms, including local governance structures and community accountability structures, where relevant, are in place and actively incorporate review of theme-related services | |
STRENGTH OF IMPLEMENTATION: This component is situated at the point of service delivery; the component corresponds to the process and output components of traditional logic models and monitoring and evaluation frameworks that are structured around inputs–processes–outputs–outcomes–impact; the aim is to measure the extent to which intervention elements are implemented, such as whether the processes in place are producing the outputs expected | |
Elements in place to deliver services: At service delivery level, the processes and materials are in place and functioning in order to deliver the service(s). | |
Service provider is routinely available at service delivery point: Sufficient numbers of defined category of providers (or services, e.g. media outlets) are available at appropriate delivery points (e.g. facilities, health posts, communities) | Document review: routine health information system, project reports, evaluations, studies and health facility surveys Key informant interviews (country level) |
Service provider is capable (skills/knowledge): Specified cadre(s) of providers or service outlets (in the case of media, for example) have received training (initial/refresher) for the specific service, which includes assessment and hands-on practice, and have the knowledge and skills required to provide high quality services | |
Service provider has equipment and supplies: Specified cadre(s) of providers have the necessary equipment (including all supplies and medicines) to provide quality services as delineated in programme guidelines; the supplies and equipment need to be routinely within access and functional (not expired in case of medicines) and in adequate quantities for the numbers of providers identified for service provision and for expected services delivered | |
Service provider is motivated: Specified cadre(s) of providers willing and enabled to provide services that they are trained and equipped to do | |
Functional quality improvement/quality assurance systems with regular review and use of data: Systems are in place to ensure that the programme can ensure that quality services are provided, including systems for quality improvement and quality assurance, routine monitoring to ensure data are available for accountability, supervision and programmatic decision-making | |
Supportive supervision occurring regularly: Supportive supervision visits are being received by service providers engaged in the intervention of interest at regular intervals and provide feedback and support specific to the intervention(s) of interest | |
Referral system functional: Referral processes are in place for referrals between facility levels and between facility-based and community-based programmes; this includes defined processes for where to refer, how to refer, how to document appropriately, and where and how to counter-refer | |
Expense tracking used: Use of resources at the local level are being tracked to ensure adequate resources for continuation of services | |
Community structures mobilised to increase demand for quality services: Existing community structures (e.g. women’s groups, civil society, etc.) are actively engaged in improving services (e.g. availability and quality) and enabling caregivers to seek care and use best practices for newborns | |
Programme Functioning: This describes what is occurring if services are being delivered; it captures the basic outputs of knowledge, practices and services provided | |
Standards of care applied: Service delivery follows quality standards | Document review: routine health information system, record reviews and observations to assess quality and adherence to standards of care Project reports, evaluations, studies, household surveys Key informant interviews (country level) |
Services initiated: The population in need initiating care or treatment for complications or receives preventive services or practices that prevent complications and promote health (this represents the first contact) | |
Services completed: The target population or population in need initiating care or treatment or preventive services and receiving the full course or ‘dose’ (this includes full set or completed services) | |
Individuals or caretakers (parents or guardians) enabled to seek timely care: Individuals or caretakers are aware of services available and are enabled (know when/how) to access care from appropriate service providers (this includes knowing what services are available and being able to access) | |
Individuals or caretakers (parents or guardians) enabled to engage in best practices: Caretakers are aware of and enabled (know how/why) to use best care and treatment practices to treat complications or promote health | |
EFFECTIVE COVERAGE: This component takes coverage from a contact to capture aspects of quality produced by strongly implemented programmes in order to produce the health outcome of interest as well as appropriate reach to those in need of the intervention; effective coverage captures both preventive and curative services as well as household practices that produce health impacts | |
High impact quality services received: Target population receives high impact services in a timely fashion and at acceptable level of quality to make a difference | Document review: household surveys, quality of care surveys (observations, medical record reviews, client exit interviews) |
High impact quality services provided: Individuals or caretakers carry out high impact practices with acceptable level of quality to make a difference | |
IMPACT: This component assesses changes in morbidity and mortality as a result of the delivery of service(s) and/or changes in behaviours and care-seeking | |
Improved survival: Reductions in mortality of the target population of the health area that are a result of the delivery of the service(s) and/or changes in behaviour and care-seeking | Document review: household surveys, routine health information systems; special studies (e.g. mortality, verbal autopsy studies) |
Reduced morbidity: Reductions in morbidity among the target population of the health area that are a result of the delivery of the service(s) and/or changes in behaviour and care-seeking | |