Outcome assessment in women's mental health.

This is the fifth in a series of six papers that will be published from the 1999 lecture series on "Quality Assessment in Women's Health Care" held at the University of Michigan School of Public Health. The lectures are presented by leaders in women's health research, and they explore key issues in the definition, measurement, and improvement of quality in women's health services. The series is supported by an unrestricted educational grant from Pfizer Inc. and is presented by the Interdepartmental Concentration in Reproductive and Women's Health at the University of Michigan School of Public Health; the University of Michigan National Center of Excellence in Women's Health; and the Michigan Initiative for Women's Health. The series coordinator is Carol S. Weisman, PhD, and Catherine L. Maroney prepared the summary of the discussants' comments.     

Micro-level planning using rapid assessment for primary health care services

This paper describes the use of a rapid assessment technique in micro-level planning for primary health care services which has been developed in India. This methodology involves collecting household-level data through a quick sample survey to estimate client needs, coverage of services and unmet need, and using this data to formulate micro-level plans aimed at improving service coverage and quality for a primary health centre area. Analysis of the data helps to identify village level variations in unmet need and develop village profiles from which general interventions for overall improvement of service coverage and targeted interventions for selected villages are identified. A PHC area plan is developed based on such interventions. This system was tried out in 113 villages of three PHC centres of a district in Gujarat state of India. It demonstrated the feasibility and utility of this approach. However, it also revealed the barriers in the institutionalization of the system on a wider scale. The proposed micro-level planning methodology using rapid assessment would improve client-responsiveness of the health care system and provide a basis for increased decentralization. By focusing attention on under-served areas, it would promote equity in the use of health services. It would also help improve efficiency by making it possible to focus efforts on a small group of villages which account for most of the unmet need for services in an area. Thus the proposed methodology seems to be a feasible and an attractive alternative to the current top-down, target-based health planning in India.     

Information needs in planning spinal cord injury services

Summary The designation by the Department of Health of two new spinal injury units (SIUs) suggests that current provision for spinal injury cases is thought to be either inadequate or badly distributed. The numerical evidence permitting such an inference is examined and it is concluded that the evidence is inadequate for the rational planning of spinal injury services. Proposals for the creation of an information system are put forward.     

中国居民卫生服务需要的转型与未来需要量预测的探讨

目的 揭示过去15年和预测2010-2025年卫生服务需要的变化趋势,为提高卫生工作的预见性提供依据. 方法 采用时间序列分析、年龄别分组分析和国际疾病分类分析的方法,对1993年、1998年、2003年和2008年的国家卫生服务调查资料进行分析,并用趋势外推法对未来的服务需要量进行预测. 结果 中国卫生服务需要结构正在快速向老龄、慢性非感染性疾病转变,未来十几年此趋势将继续发展.但部分感染性疾病未现下降趋势.未来卫生服务总量会不断增加. 结论 中国卫生系统应根据卫生服务需要变化的趋势提出今后防病治病的重点与措施.     

Tailoring health services to the needs of individual communities.

In order to assess the need for community health services in different neighbourhoods within Greater Glasgow, it was decided to present a wide variety of health information for each community as a set of summary profiles. These profiles clearly demonstrate that the same areas have the highest standardised mortality ratios, the least favourable socioeconomic circumstances, the highest hospital admission rates, and the poorest child health characteristics. The greatest benefit in overall health would be achieved by targeting community resources on these disadvantaged communities. Adoption of this policy should reduce existing inequalities in health, and we argue that such 'positive discrimination' is implied in the formulae used in Great Britain for allocation of revenue expenditure for community services. The health profiles that we describe provide the baseline information necessary to target community services to particular communities according to objective measures, and to evaluate the effectiveness of new and existing methods of health promotion.     

The impact of health needs assessment and prioritisation on District Health Board planning in New Zealand

Objectives District Health Boards (DHBs) in New Zealand are mandated to assess and prioritise the health needs of their resident populations. This paper evaluates the impact of those health needs assessments (HNAs) and prioritisation practices on health service planning and purchasing in the first 3 years of the DHBs (2001–2003). Methods DHB HNAs, 5‐yearly strategic plans, and annual plans were evaluated using document analysis to determine the impact of needs assessments on prioritisation and planning by boards. Key informant interviews with DHB senior managers were used to identify differences between boards. Results HNAs had relatively little influence on the direction of planning and purchasing. HNAs conducted in DHBs that focussed on planning at the service level and in relation to population subgroups using a ‘mixed‐scanning’ approach and ‘service planning groups’ had a greater impact on planning and purchasing than more comprehensive approaches. DHBs found prioritisation difficult due to the level of control exercised by central government over their actions. Conclusions HNAs in New Zealand need to be less ambitious, more focussed and more closely institutionally linked to prioritisation, service planning and purchasing processes if they are to have an impact on the allocation of resources. Copyright © 2009 John Wiley & Sons, Ltd.     

Data gaps in planning for comprehensive fertility-related health services.

Using aggregate national data, an attempt was made in 1972 to estimate the numbers of persons who will need each of the fertility-related services (e.g., prenatal and postnatal care for wanted pregnancies, medical care of infant in its first year fertility limitation, and medical treatment of infertility) between then and 1978, and the costs of providing them. The preliminary model was later refined utilizing additional sources of data are needed to help the health care system assist individual members of the community to achieve their family formation goals. The paper includes discussions of the sorts of data that are needed and the reasons for this need, the present sources of data (in terms of providers, households, payers, and carriers), and the types of data gaps (absence, insufficient disaggregation, lack of relatedness, in complete specification). The author contends that attention to the various gaps would increase the potential of our important national surveys to produce data on numbers in need of fertility-related health services, etc. Greater comparability in questions asked and in methods of analyzing and presenting the responses could be achieved at little sacrifice of the basic purposes for which the systems were created. Recommendation is made that a step be taken to convene a small conference of key personnel working on these systems to explore the gaps and incompatibilities, propose means of overcoming them, and identify needed special studies.