Key Activities

Study Activities and Process

The programme of work is structured into 3 phases

1.  Preparatory work for a proposal to be approved by an expert panel.  If the recommendation of the panel is that the study should not proceed, then the study stops at this point.

2.a  With approval from the expert panel, field work for  implementation of the validation study where households will be recruited as they access a provider.  Validation study is proposed as a multifactorial design where households will be randomized to one of several questionnaires with varying number of items and recall periods (and any other factor identified during the literature review deemed to be important and where there is no consensus).  The gold standard will be the exit interview for the amount that is paid and provider’s records for diagnosis.  The smartphone methodology will also be piloted at this phase.

2.b.  With successful validation, field work for wider (3000-5000 households) collection of data to identify feasibility and technical concerns in administering the validated set of question in the household survey.  Smart phone methodology will also be deployed more widely to households (1,000 households per site). The number of households will be further discussed with the expert advisory panel given the variation of diseases in the populations. 

Outputs/Deliverables/Milestones

Phase 1

1. Signed contract- release of first tranche

1. Terms of Reference for and nominations for  Expert panel
2. Minutes of first teleconference on role of expert panel, initial thoughts and suggestions for the study

4. Report on literature review on methodological issues on collection of health OOPS in household surveys; including which questions should be asked and which questions should definitely not be asked
5. Report on frequency counts of OOPs questions from available questionnaires of household surveys (health and total) in the past 10 years review
6. Proposed sets of OOP expenditure questions for testing and validation in the field
7. Report on literature review on self reports of diagnosis and algorithmic/probabilistic approaches to determine cause of death or non-fata outcomes.
8. Proposed set of questions for self report of diagnosis and algorithmic/probabilistic approaches for cause of death or diagnosis in case of non-fata outcomes.

The Expert panel  of 7-8 members is proposed to be chaired by Dr. David Evans of WHO, with individuals from the following institutions as members: IHSN, WB/LSMS, USAID/Macro, Eurostat/OECD, regional network of household surveys; e.g. SEDLAC for Latin America, possible representation from national statistics office of 1-2 key countries.  Indepth Network with technical support from WHO (Tessa Tan-Torres/Priyanka Saksena can serve as the secretariat and BMGF as ex-officio member.  Experts can be invited as guests as needed: e.g.  IHME, Lavado from World Bank; Lu from Harvard, Ravi Eliya.Rannan.;  The meetings of the expert panel are expected to rotate through the sites with the final meeting to be held in Basel, Switzerland.  This way, the expert panel will be able to visit all the sites.

1. Report on literature review of utilization questions
2. Proposed set of questions for utilization and reasons for non-use
3. Proposed set of questions for coping strategy
4. Proposed set of questions/items  for socio economic status
5. Proposal for 2-stage validation study, including sampling, data management, analysis
6. Minutes of year 1 first face to face meeting approving the candidate sets of questions for field validation and proposal for 2-stage validation study – release of second tranche for field study

Phase 2- A field implementation of validation study/smartphone methodology

7. Institutional Review Board  approval per country
8. Sampling frames for all types of providers and for households
9. Report with results from first household survey round with validation results from multifactorial randomization of core sets of questions to households plus one set of additional questions for disease attribution, total expenditures/asset indices, coping strategies and utilization (first stage validation)
10. Validated set of questions for second stage
11. Report on feasibility/pilot test  of smartphone methodology
12. Minutes of  Year  1 second   face-to-face meeting reviewing results of first stage validation and discussion and feedback on  validated set of questions for use in second stage and on the use of smartphone methodology

Phase 2-B wider  field implementation of validated questions/smartphone methodology  in DHSS sites

13. Results from second round of household survey with validated set of questions–release of final tranche
14. Minutes of  year 2 face to face meeting of expert group- release of third tranche
15. Results from third round of household survey , completing one year collection of expenditures
16. Final report and recommendations
17. Minutes of  year 3 face to face meeting of expert panel with feedback on final report
18. Revised final report
19. Study publications will be prepared during the life of the project.

Time frame

The process is summarized in the figure below