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Inclusion of Community module in DHS
https://userforum.dhsprogram.com/index.phpindex.php?t=rview&goto=1980&th=1157#msg_1980
Community factors or characteristics: should viewed as data elements or indicators that give describe the environments in the context of social, physical, and economic sphere in which people are born, live, and work. The factors will include cultural norms and practices, program interventions, and institutions and as well as other aspects of the social structure. Overall, the community factors can be clustered into 4 namely; equitable opportunity, place, people and health care services. Below is a brief description of each cluster
• Equitable opportunity relates to the fair and equal distribution of things like quality jobs and education;
• Place relates to the physical structures of a space like community centres/parks, streets and commercial retail;
• The people cluster includes how people interact with one another and civic engagement; and,
• Health care services relate to the availability and accessibility of high quality affordable health services
In this context, DHS should include indicators or measurement of:
• Ethnic diversity within cluster or community. This will measure the heterogeneity in a community
• Social disorganization that is the social networks (e.g. formal and informal social network)
• Social diffusion
• Community security e.g crime rate, violence
• Community economic opportunities for women
• Commercial activities
• Infrastructural development e.g. schools, hospital, electricity, recreational,
]]>kboyediran2014-04-11T20:42:00-00:00USAID Office of Health Systems recommendations for HHE module
https://userforum.dhsprogram.com/index.phpindex.php?t=rview&goto=1979&th=1156#msg_1979
There are very few options for robust, routinized data collection for household expenditure data for health, which is necessary for calculating out-of-pocket expenditures for health (OOP). These data are critical indicators of the condition of countries' health financing situations.
In order to ensure accurate and timely measurement of household expenditures (HHE) on health, and to measure trend data, it is important that that data be collected routinely, i.e., every 2-3 years. For example, estimates of OOP, based on primary data collection, should be 3 years old or less in order to be used in a Health Accounts (HA) exercise. While the DHS is generally conducted every 5 years, it provides one of the few standardized and high-quality sources of HHE heath data.
The USAID Office of Health Systems in the Bureau for Global Health proposes the following for this iteration of the DHS:
--We recognize the need to gain more experience with the DHS HHE module before assessing the feasibility of including it in the core questionnaire. We, therefore, recommend that the DHS HHE module be maintained as an optional module to the core DHS questionnaire.
--We strongly recommend that the DHS HHE module be included in the DHS for all USAID priority countries under the goals of ending preventable maternal and child deaths (EPCMD) and achieving an AIDS-free generation (AFG) when a DHS is carried out.
--We also strongly recommend that the DHS HHE optional module be included in the DHS for all countries where estimates of OOP, based on primary data collection, is 2 years old or older.
]]>jcharles2014-04-11T20:25:27-00:00Re: Community questionnaire for availability of health services
https://userforum.dhsprogram.com/index.phpindex.php?t=rview&goto=1978&th=1045#msg_1978
kboyediran2014-04-11T20:22:56-00:00Re: PSI Suggested Changes to Health Systems Questions
https://userforum.dhsprogram.com/index.phpindex.php?t=rview&goto=1885&th=1067#msg_1885
david.watkins2014-04-04T23:43:17-00:00PSI Suggested Changes to Health Systems Questions
https://userforum.dhsprogram.com/index.phpindex.php?t=rview&goto=1847&th=1067#msg_1847
olupu2014-04-04T13:34:49-00:00Re: Community questionnaire for availability of health services
https://userforum.dhsprogram.com/index.phpindex.php?t=rview&goto=1815&th=1045#msg_1815
1. Is there a correlation between access and use of health services?
2. Is there a correlation between access to certain facility types and use of specific health services?
3. Is there a correlation between price and use of health services?
In addition, since this data would be collected at the PSU-level, the marginal effort required to collect this data would be very small and the addition of these questions would not increase respondent burden. ]]>dougj8922014-04-03T21:25:17-00:00Health expenses
https://userforum.dhsprogram.com/index.phpindex.php?t=rview&goto=1814&th=1046#msg_1814
Recent expenditure on health expenses
2. What questions will elicit this information?
LSMS questionnaires typically include questions on health expenditure and provide one example of how this data may be collected. LSMS questionnaires typically ask about all visits to a health care provider in the past 4 weeks and any costs associated with these visits.
The LSMS approach to gathering data on health expenditure has the advantage of also gathering data on recent provider visits and is quick to administer but, as pointed out by Gertler, Rose, and Glewwe (p 188) in Grosh and Glewwe (2000) probably underestimates total health expenditure. A longer set of questions which broke out expenses by in-patient versus out-patient (with an in-patient recall window of 1 year) and type of service and which also asked about expenses on medicine purchased without a visit to a provider would lead to more accurate data on health expenditure but would take longer to administer.
3. How will the resulting information be used?
Information about recent household health expenses would provide researchers valuable insight into the share of health costs borne directly by households. First, data on total health expenses incurred by households would allow researchers to use DHS data, in combination with other data sources, to create national health accounts showing the share of total health expenditure financed through household contributions, public spending, and other sources.
Health expenditure data would also allow researchers, in certain cases, to estimate the impact of new policies affecting health financing. For instance, if a government-subsidized insurance program was rolled-out in certain regions before others, this data could be used to perform a difference in differences impact evaluation of the program on health expenditure. (For examples of studies using this design see Wagstaff et al, 2009 and Fan et al, 2012) Governments of lower income countries are increasingly turning to subsidized health insurance, rather than direct subsidies for the delivery of medical services, as a means of increasing access to health care. (Wagstaff et al, 2009) (Lagomarsino, Gina, et al, 2012) (Agyepong and Adjei, 2008) (Ensor, 1995) Regular, accurate data on health expenditure will provide researchers and policymakers valuable information on the impact of these new programs.
4. What is the priority of suggested additions compared with what is already in the questionnaires?
High. The proportion of health expenses financed through out-of-pocket payments in a country is a very commonly cited statistic. Unfortunately, the data for these statistics are often very out of date.
5. If suggesting more than one addition, what is the priority among the suggested additions?
6. Should the additional data be collected in all countries, or only in selected types of countries (e.g., countries with a particular type of program, countries with prevalence of a particular infection >5% or 10%)?
All
References
Fabic, Madeleine Short, YoonJoung Choi, and Sandra Bird. 2012. "A systematic review of Demographic and Health Surveys: data availability and utilization for research." Bulletin of the World Health Organization 90.8: 604-612.
Fan, V. Y., Karan, A., & Mahal, A. 2012. State health insurance and out-of-pocket health expenditures in Andhra Pradesh, India. International journal of health care finance and economics, 12(3): 189-215.
Grosh, Margaret, and Paul Glewwe. Designing Household Survey Questionnaires for Developing Countries: Lessons from 15 Years of the Living Standards Measurement Study, Volume 3. Washington, DC: World Bank, 2000.
Wagstaff, Adam, et al. 2009. Extending health insurance to the rural population: An impact evaluation of China's new cooperative medical scheme. Journal of health economics 28.1: 1-19.
]]>dougj8922014-04-03T21:19:48-00:00Community questionnaire for availability of health services
https://userforum.dhsprogram.com/index.phpindex.php?t=rview&goto=1812&th=1045#msg_1812
Suggestion type: Additions
1. What is the information needed?
Community availability of health services
2. What questions will elicit this information?
See attached file for an example of how these data were collected in Bangladesh for health. Community-level information was also collected in Colombia (1986), Indonesia (1994), and Benin (2001). I have attached the community questionnaires for these surveys (extracted from the respective final reports) along with this posting. Some of these surveys also collection information on availability of schools and sanitation in the community.
Indicate whether or not the questions have ever been fielded or validated.
Community questionnaires
3. How will the resulting information be used?
This information can be used to investigate health service use patterns, i.e. child immunizations, family planning, antenatal care, curative care visits for both men and women, etc.
Rationale:
Demand for health care is often influenced by the availability and accessibility of health services. That is, in addition to cultural norms, social network influence, and individual-level knowledge and preferences, individuals make the decision to seek care for themselves or family members after weighing the benefits against monetary/financial costs and opportunity costs (time, distance, etc.). Information on distance, travel time, transportation cost, and price of service is currently not collected in the DHS.
In the past, absent true community-level data, researchers have created "community" aggregate measures. Usually the sampling cluster is chosen as the level of aggregation for these community variables. However, since those aggregate measures are subject to the responses of sampled individuals, these measures may be biased. In his 2006 paper, Kravdal showed through simulations that these biases are generally small (<4%) if the level of aggregation has a "large enough" number of people (>=25) and the intra-cluster correlation (ICC) is "large enough" (>=0.2). In practice, the cluster sizes in the DHS varies by country. Some countries have clusters that are on average >=25 people, and others have clusters that are on average much smaller than 25 people. The best way to create these aggregate measures is also disputed. Some researchers use all observations within a cluster for aggregation, while others favor creating the measures without the index case. Either way, these measures are unstable when the clusters are very small, say 3 or 4 observations in the cluster. Asking these questions of community leaders (or several community leaders, for that matter) removes some of the bias associated with measures derived from the sample.
Finally, in the DHS, the questions on barriers to accessing care is asked only of those who are not using the services. Further, the reasons for not accessing services pertain to those services related to maternal and child health, leaving out men's care-seeking patterns. Although some have used the proportion of women reporting "cost too much" as the reason for not delivering their youngest child in a health facility as a proxy measure of "cost as barrier to accessing care," there are serious methodological issues with creating proxy measures for "barrier to care" based on the responses of non-users. For instance, since "cost too much" and "too far" are subjective measures, we do not know what, on average, is an acceptable cost for which people are willing to pay or distance for which people are willing to travel for care. This has policy implications as well, i.e., when planning where to build new health posts, when setting user fees, or when developing community programs to incentivize people to get their children fully vaccinated.
4. What is the priority of suggested additions compared with what is already in the questionnaires?
These questions will be asked of community leaders, rather than sampled women or men, so it should not affect the consistency of responses for the usual respondents, which is a concern listed in the Power Point presentation accompanying the guidelines for suggesting changes. As such, it should be a medium-high priority item.
5. If suggesting more than one addition, what is the priority among the suggested additions?
N/A
6. Should the additional data be collected in all countries, or only in selected types of countries (e.g., countries with a particular type of program, countries with prevalence of a particular infection >5% or 10%)?
These data should be collected in all countries.
References
Kravdal Ø. A simulation-based assessment of the bias produced when using averages from small DHS clusters as contextual variables in multilevel models. Demogr Res. 2006;15:120. doi:10.4054/DemRes.2006.15.1.
]]>user-rhs2014-04-03T21:05:45-00:00Existing Health Systems questions
https://userforum.dhsprogram.com/index.phpindex.php?t=rview&goto=1505&th=901#msg_1505
Questions currently existing in the DHS Core/Model Questionnaires
8. Health Systems (all of the questions listed here are also categorized in other topics)
Household Questionnaire
Qst 20, 124 (utilization of services).
Qst 125 (source of services).
Woman's Questionnaire
Qst 308, 308A, 326, 327, 328, 408, 411, 412, 415, 416, 418-425, 427, 429, 434A, 435-438, 440, 442, 443, 446, 504-506, 508-513, 518, 523, 524, 526, 537, 538, 541, 543, 545, 547, 549, 551, 918, 921-928, 944 (utilization of services).
Qst 305-307, 315, 315A, 323, 325, 409, 410, 439, 444, 433, 434, 445, 519, 533, 534, 536, 630, 633, 917, 929, 931, 945, 1010 (source of services).
Qst 317-321, 414 (quality of services).
Qst 629, 632, 930 (knowledge of available services).
Qst 27, 90-92, 95 (components of health services).
Qst 1001-1003 (safety of medical injections).
Qst 1008-1009 (barriers to women's use).
Qst 940-942 (need for health services).
DHS Core/Model Questionnaires (Household, Woman's, Man's) and Modules are available in the READ ME folder of this Forum.
The Attachment repeats the above information (if you have a need to download the information).]]>DHS QRE Admin2014-03-05T16:26:09-00:00Guidelines for suggesting changes
https://userforum.dhsprogram.com/index.phpindex.php?t=rview&goto=1504&th=900#msg_1504
Please follow these Guidelines for suggesting changes to The DHS Program Core Questionnaires
Focus on questions in areas related to your expertise.
Whenever referring to existing questions, provide question numbers.
DELETIONS: Suggest questions to delete and explain why they can be deleted. Perhaps questions have not produced reliable data, are not policy or program relevant, have not been used widely, or are low priority for other reasons, etc.
REVISIONS: Making recommendations to revise the wording of existing questions: Provide the suggested change in question wording or response categories, and the rationale for the change.
ADDITIONS: Making recommendations to add new questions: When making suggestions for questions to be added, provide the answers to these questions:
1. What is the information needed?
2. What questions will elicit this information?
Specify the content of the recommended question(s) and, if possible, propose exact wording for each question and the accompanying coding categories, presented in a format as close as possible to that currently in the DHS questionnaires. Indicate whether or not the questions have ever been fielded or validated.
3. How will the resulting information be used?
Explain how the data will be used. A clear but brief description of how the requested data will be used as an indicator, in programs, or in critical analysis helps to make the case for inclusion. If the data are to be used to estimate an indicator, fully define the numerator and denominator of the indicator. Describe how the data should be tabulated and presented in the final report.
4. What is the priority of suggested additions compared with what is already in the questionnaires?
Anyone recommending additions is requested to suggest what existing questions in that topical area can be removed (indicate priority). If the recommended new questions will obviate the need for other questions currently being asked, please indicate. Requests for additions to the questionnaires that are accompanied by a list of questions suggested for deletion will have a better chance of receiving favorable consideration.
5. If suggesting more than one addition, what is the priority among the suggested additions?
6. Should the additional data be collected in all countries, or only in selected types of countries (e.g., countries with a particular type of program, countries with prevalence of a particular infection >5% or 10%)?
We welcome your input.
Final decisions on questionnaire content are made by USAID