IUHC Key Activities

Kick-off meeting report, Accra, 13 - 17 Feb., 2012

The project activities will include the development of a simple tool (a survey questionnaire) that will be attached to the surveillance system of Navrongo (Ghana) and Filabavi (Vietnam) to enable the capture of information on need, access to health care and utilisation pattern of health care. The tool will also capture information related to the barriers to access of needed health care.

Currently the two HDSSs have 3 (Navrongo) and 4 (Filabavi) rounds of data collection. This means, everybody in these demographic surveillance areas will be visited and their status updated every 3 or 4 months. 

Measuring Need

In measuring need, household survey respondents will be asked if anyone in the household had been ill or injured in the past month. Respondents are asked to mention spontaneously the symptoms/diseases they have had. Given the aforementioned symptoms/diseases, each one of them would be indicated through circling/ticking which had been catalogued in the questionnaire. These symptoms/diseases will be catalogued in the questionnaire based on the commonest symptoms/diseases from community health facility-based data. These symptoms/diseases from the various community health facilities will standardized for use to allow easy comparison between the two (2) countries. Also, respondents will be asked the duration for which they have suffered the mentioned-symptoms/diseases. The reference period for illness requiring hospitalization will be 12 months. The household head or the representative will also be asked if anyone in the household has any chronic disease and additionally, they will be asked to assess their health status on a five point scale, from very good to poor. Ethically it is expected to treat participants after been examined by a medical practitioner to validate self-assessments, but this component of the study would not be met due to budget constraint.

Measuring Access

Access remains a complex concept but it basically involves aiding people to improve the health care through the command of appropriate health care resources. The extent to which a population 'gains access' depends on financial, organisational and social or cultural barriers that limit the utilisation of services (Goddard and Smith, 2001). To a large extent, access is not only merely adequacy of supply health services but also depends on the affordability, physical accessibility and acceptability of services. If the population, particularly the poor are to gain satisfactory services, then the services available must be relevant and effective. The availability of services, and barriers to access, have to be considered in the context of the differing perspectives, health needs and material and cultural settings of diverse groups in society (Ricketts and Goldsmith, 2005, Gulliford M, 2002). Household respondents (both insured and uninsured) will be asked if they have access to health care services in terms of availability, affordability and accessibility and whether there has been a change since the introduction of the various health insurance schemes in Ghana and Vetnam.

Measuring utilisation

In measuring utilization household survey respondents both insured and uninsured will be asked if they have used any health service at all in the past one month and the number of times they have each used the service from a comprehensive list of different providers both public and private. An almost exhaustive list of most possible sources of care will be provided and standardised for comparison between sites and countries. For inpatient care the number of visits per person year or number of admissions per year will be sought. The reference period for inpatient care will be 12 months.

Quality of care

Ensuring good quality of care suggest that providing health service are provided in the right way at the right time and indeed doing the best with the resource available. The delivery of good quality health services is key to improving the health status of the population and results in decreased case fatality rate and complications. Efforts to improve the quality health care service are particularly relevant in resource-constrained setting. Information will be collected on both insured and uninsured on drug stockout, cleanliness of facilities, opening times of facilities and attitude of health staff among others. How have these issues changed since the introduction of the health insurance program in Ghana and Vietnam? With the capacity of the HDSS platform, the study seeks to investigate and will be able to monitor this over time.

Measuring SES

INDEPTH has already developed a standard SES tool that captures data on household assets which enables households or members of households to be categorised into various SES quintiles. This tool is available on the INDEPTH website and have been deployed before by HDSSs in Africa and Asia. The study will make use of this tool by linking the study to the HDSS data on SES. There would not be any need to collect data on household socio-economic status. The key strength of this study is the existence of SES data at the various HDSSs.

In further details, the project activities will include:

  • Tool development
    • Scientific and technical presentation of the tools
    • Harmonization
    • Translation tools into local language
    • Testing of the tools
    • Revising the tools
  • Community entry
  • Ethical clearance
  • Data collection
    • Recruitment of field workers
    • Training of field workers
    • Fieldwork
  • Data processing
    • Data entry, cleaning
    • Data analysis (WS?)
  • Writing report (per centre)
  • Submission of report to INDEPTH
  • Dissemination
    • National level
    • International level
  • Publications