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Monitoring Universal Health Coverage reforms in primary health care facilities: Creating a framework, selecting and field-testing indicators in Kerala, India

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Listed:
  • Devaki Nambiar
  • Hari Sankar D.
  • Jyotsna Negi
  • Arun Nair
  • Rajeev Sadanandan

Abstract

In line with the Sustainable Development Goals (SDGs) and the target for achieving Universal Health Coverage (UHC), state level initiatives to promote health with “no-one left behind” are underway in India. In Kerala, reforms under the flagship Aardram mission include upgradation of Primary Health Centres (PHCs) to Family Health Centres (FHCs, similar to the national model of health and wellness centres (HWCs)), with the proactive provision of a package of primary care services for the population in an administrative area. We report on a component of Aardram’s monitoring and evaluation framework for primary health care, where tracer input, output, and outcome indicators were selected using a modified Delphi process and field tested. A conceptual framework and indicator inventory were developed drawing upon literature review and stakeholder consultations, followed by mapping of manual registers currently used in PHCs to identify sources of data and processes of monitoring. The indicator inventory was reduced to a list using a modified Delphi method, followed by facility-level field testing across three districts. The modified Delphi comprised 25 participants in two rounds, who brought the list down to 23 approved and 12 recommended indicators. Three types of challenges in monitoring indicators were identified: appropriateness of indicators relative to local use, lack of clarity or procedural differences among those doing the reporting, and validity of data. Further field-testing of indicators, as well as the revision or removal of some may be required to support ongoing health systems reform, learning, monitoring and evaluation.

Suggested Citation

  • Devaki Nambiar & Hari Sankar D. & Jyotsna Negi & Arun Nair & Rajeev Sadanandan, 2020. "Monitoring Universal Health Coverage reforms in primary health care facilities: Creating a framework, selecting and field-testing indicators in Kerala, India," PLOS ONE, Public Library of Science, vol. 15(8), pages 1-15, August.
    • Handle: RePEc:plo:pone00:0236169
    DOI: 10.1371/journal.pone.0236169
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    References listed on IDEAS

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    1. Government of India, 2017. "National Health Policy 2017," Working Papers id:11664, eSocialSciences.
    2. Sabrina T Wong & Annette J Browne & Colleen Varcoe & Josée Lavoie & Alycia Fridkin & Victoria Smye & Olive Godwin & David Tu, 2014. "Development of Health Equity Indicators in Primary Health Care Organizations Using a Modified Delphi," PLOS ONE, Public Library of Science, vol. 9(12), pages 1-15, December.
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