| DHS-8-PGSSC-OOP-Template [message #16792] |
Mon, 04 March 2019 17:09  |
PGSSC
Messages: 10
Registered: March 2019
Location: Boston, USA
|
Member |
|
|
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. Risk of impoverishing and catastrophic expenditure
Data Utility:
1. World Bank: World Development Indicators
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| Re: DHS-8-PGSSC-OOP-Template [message #17175 is a reply to message #16792] |
Fri, 15 March 2019 15:28  |
Jordan Pyda
Messages: 4
Registered: March 2019
|
Member |
|
|
I worked as surgical care coordinator at a high volume surgical hospital in rural Haiti which served the rural poor. This was in the summer of 2010 and for 13 months between 2012-2013. One of the lasting impressions from that time as an administrative and clinical volunteer, was the incredibly thin financial margin that separated patients between a state of well being or health and severe illness and more frequently death. We saw many patients with traumatic injuries but also very simple, easily treatable conditions such as inguinal hernias. After a few months of the same heart wrenching scenes, I started to talk to patients and families more about their costs. I interviewed about 16 patients who received elective inguinal hernia repairs at our hospital and calculated that on average patients paid 140-160USD for all the out of pocket costs combined. Now while this may seem trivial at first, but this hospital was providing fee free care. FREE care. And yet a simple elective hernia repair cost 150USD when average per capita income was/is still 700-800 USD. There were numerous individual patients who I literally had to hike out to bring for their surgical appointment and the stories were all too similar- can't hire anyone to look after my kids or family, can't hire someone to toil the plot of land, can't leave my other source of income (madame sarah), can't afford the trip...
The proportion of patients who incur impoverishing expenditure for surgery is 58%, 55% or so of those costs are catastrophic.. means families are completely ruined.
This data is very limited, and our understanding of these horrible situations is so incomplete. If we could collect this kind of data on a systematic basis and in organized manner we would have the concrete arguments to direct investments into surgical care recognizing how vitally important it is to the socio-economic viability of people, families, communities, and nations - and yes our world.
Out of pocket health expenditures for surgical care is an absolute imperative for data collection- please, strongly urge USAID to consider inclusion in the DHS.
Jordan Pyda MD, MPH
jpyda@bidmc.harvard.edu
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| Re: DHS-8-PGSSC-OOP-Template [message #17309 is a reply to message #16792] |
Fri, 15 March 2019 17:23 |
Dr. Ernest Barthélemy
Messages: 6
Registered: March 2019
|
Member |
|
|
As a neurosurgeon working in Haiti, I strongly support the inclusion of this indicator in the DHS. Timely, affordable access to surgical care is not only an indispensable component of healthcare, but also an important aspect of the pathway towards poverty reduction and socioeconomic development. It is therefore critical to generate structures for financial accountability as national health systems strategize to scale up access to surgical care, especially in low- and middle-income countries. This indicator will enable such financial accountability.
PGSSC wrote on Mon, 04 March 2019 17:09Thank 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. Risk of impoverishing and catastrophic expenditure
Data Utility:
1. World Bank: World Development Indicators
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
The DHS Program User Forum
Members
Search
Help
Register
Login
Home
