| DHS-8-PGSSC-Maternal_Mortality-Template_and_POMR-REVISED_Template [message #16880] |
Tue, 12 March 2019 18:54  |
PGSSC
Messages: 10
Registered: March 2019
Location: Boston, USA
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Thank you for reviewing our proposal for new indicators within the Demographic and Household Survey (DHS) regarding emergency and essential surgical care. The collection of these indicators is a critical step towards the delivery of safe, affordable, equitable access to surgical services as a component of universal health coverage and we consider the DHS as the best forum to derive these data points.
The questions we propose are a product of the Lancet Commission on Global Surgery (LCoGS), a body of work spanning three years involving 25 commissioners and a diverse group of academic, governmental and civil society collaborators from 110 countries. Of the six indicators proposed by the LCoGS, four were published in the World Development Indicators by the World Bank and all six are included in the World Health Organization's Global Reference List of 100 Core Health Indicators. Nevertheless, there currently are no mechanisms in place to collect the data required for these indicators, creating a critical gap in knowledge for surgical care strengthening.
The new indicators in this proposal span four existing DHS modules. For clarity, they are listed in the table below. Of particular interest are the questions on out-of-pocket expenditure and household expenditure to enable the calculation of financial risk protection for all medical interventions captured by the DHS (both surgical and medical), a core component of Sustainable Development Goal 3.8. The remaining questions were taken from a successful pilot DHS survey in Zambia. In the development of this application, we have been fortunate to count on a number of international partners to provide expert review and the indicators proposed are a culmination of these consensus building discussions. Please refer to Appendix A for a full list of international stakeholders who support this application.
Proposed Indicators:
1. Peri-Operative Mortality Rate
2. Mortality following cesarean section
Data Utility:
1. WHO: 100 Core Health indicators
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| Re: DHS-8-PGSSC-Maternal_Mortality-Template_and_POMR-REVISED_Template [message #17071 is a reply to message #16880] |
Fri, 15 March 2019 10:33  |
Scott Corlew
Messages: 6
Registered: March 2019
Location: Boston, MA
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The issue of peri-operative mortality (POM) is key to gaining a better understanding of the overall capacity of a health care system. In a more resource-limited system, POM gives information about access to health care facilities, referral systems, and transportation as well as in-hospital factors such as infrastructure, anesthesia capacity, infection control, surgical workforce, and quality of care. In a more highly developed system, POM gives more information about the nature of surgical procedures done in the hospital and quality of care. At its essence, POM is a key indicator for surgical care within the context of UHC. Adding overall POM to mortality following Caesarian section in the DHS would be of great benefit to health care implementation and evaluation.
The suggested questions here warrant inclusion in the DHS.
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| Re: DHS-8-PGSSC-Maternal_Mortality-Template_and_POMR-REVISED_Template [message #17171 is a reply to message #16880] |
Fri, 15 March 2019 15:26 |
dnepogodiev
Messages: 1
Registered: March 2019
Location: Birmingham UK
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Thank you for leading this important initiative.
POMR has been included in the WHO 100 Core Health Indicators, yet very few countries produce high quality POMR data (Holmer H, Bekele A, Hagander L et al. Evaluating the collection, comparability and findings of six global surgery indicators. Br J Surg. 2019 Jan;106(2):e138-e150).
An estimated 4.2 million people die within 30 days of surgery each year (Nepogodiev D, Martin J, Biccard B, Makupe A, Bhangu A, on behalf of the NIHR Global Health Research Unit on Global Surgery. Deaths within 30 days of surgery in low-, middle-, and high-income countries. Lancet. 2019 Feb 2;393(10170):401), but there is little contextual data for who these people are or why they died.
Integrating POMR/ c-section mortality in to DHS will support high level health outcome surveillance via the WHO 100 Core Health Indicators, whilst also unlock a huge wealth of contextual data to better inform strategies aimed at improving patients' peri-operative care around the world.
I strongly support inclusion of both indicators in future DHS surveys.
Dmitri Nepogodiev
Research Fellow in Public Health & Surgery
University of Birmingham, UK
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| Re: DHS-8-PGSSC-Maternal_Mortality-Template_and_POMR-REVISED_Template [message #17302 is a reply to message #16880] |
Fri, 15 March 2019 17:11 |
Dr. Ernest Barthélemy
Messages: 6
Registered: March 2019
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These two indicators- Peri-Operative Mortality Rate and Mortality following cesarean section, are vitally important measures of high quality surgical care. Moreover, tracking them will empower all nations committed to universal health coverage to measure their progress towards authentically responsive, equitable, and effective healthcare systems. I fully support the inclusion of these indicators in the DHS, and the underlying effort to strengthen a long neglected aspect of global public health in this manner.
PGSSC wrote on Tue, 12 March 2019 18:54Thank you for reviewing our proposal for new indicators within the Demographic and Household Survey (DHS) regarding emergency and essential surgical care. The collection of these indicators is a critical step towards the delivery of safe, affordable, equitable access to surgical services as a component of universal health coverage and we consider the DHS as the best forum to derive these data points.
The questions we propose are a product of the Lancet Commission on Global Surgery (LCoGS), a body of work spanning three years involving 25 commissioners and a diverse group of academic, governmental and civil society collaborators from 110 countries. Of the six indicators proposed by the LCoGS, four were published in the World Development Indicators by the World Bank and all six are included in the World Health Organization's Global Reference List of 100 Core Health Indicators. Nevertheless, there currently are no mechanisms in place to collect the data required for these indicators, creating a critical gap in knowledge for surgical care strengthening.
The new indicators in this proposal span four existing DHS modules. For clarity, they are listed in the table below. Of particular interest are the questions on out-of-pocket expenditure and household expenditure to enable the calculation of financial risk protection for all medical interventions captured by the DHS (both surgical and medical), a core component of Sustainable Development Goal 3.8. The remaining questions were taken from a successful pilot DHS survey in Zambia. In the development of this application, we have been fortunate to count on a number of international partners to provide expert review and the indicators proposed are a culmination of these consensus building discussions. Please refer to Appendix A for a full list of international stakeholders who support this application.
Proposed Indicators:
1. Peri-Operative Mortality Rate
2. Mortality following cesarean section
Data Utility:
1. WHO: 100 Core Health indicators
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