A Lancet Global Health editorial discusses 'How do we measure progress in global health?' under the title 'metrics for the people and by the people'. Citation, extracts and a comment from me below. Health workers are not mentioned in the editorial. I propose we need 'Metrics for health workers and by health workers'.
CITATION: Metrics for the people and by the people
The Lancet Global Health,
The Lancet Global Health, Volume 12, Issue 12, e1910
https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(24)00479-0/fulltext
A Lancet Global Health editorial starts:
'How do we measure progress in global health? In dollars invested, in lives saved, in rates, ratios, quality-adjusted life years (QALYs), and disability-adjusted life years (DALYs)?...'
and concludes
'... it is essential that we engage all stakeholders in open discussions and start brainstorming, negotiating, and compromising, to co-create plural participatory metrics in global health.'
COMMENT (NPW): I look forward to your thoughts on 'plural participatory metrics in global health'. My initial thought is to ensure we include process indicators and not just outcome indicators. We need to look at quality of health care (and include not only quality of care in facilities, but also quality of care by lay caregivers in the home and in facilities). This in turn is dependent on meeting the basic needs of healthcare providers, which HIFA has described as SEISMIC (Skills, Equipment, Information, Systems, Medicines, Incentives, Communication facilities). These basic needs would be described differently by different stakeholders, but it should be possible to reach consensus.
No-one doubts that access to relevant, reliable healthcare information is essential for safe, effective care at all levels, from home to tertiary facility. A global consultation by HIFA calls on WHO to (1) explicitly champion the goal of universal access and (2) convene stakeholders to develop a global strategy for its realisation. HIFA and partners stand ready to support. Initial signs from WHO are very encouraging and we believe this will be a game-changer for global health.
A major related challenge is how to measure 'access to relevant, reliable healthcare information', and how to measure the impact of (lack of) availability. There is no single metric that captures this. These issues have been discussed at various times on the HIFA forum and the HIFA Evaluation of Impact working group.
We are also hindered by a lack of understanding on the quantitative contribution of the seven SEISMIC needs (or however one wants to define such needs). Is there a recognised system of metrics that links quality of care with the factors contributing to (lack of) quality?
A final question: All (or nearly all) health workers want to improve, above all, the quality of care for their patients. And yet the basic needs of many (most) of them are not met. Many health workers feel unsupported by the system, whether at local or national level. They seek to move to other better supported systems, or leave the profession altogether, leading to further deterioration in resource-poor areas.
We need 'Metrics for health workers and by health workers'. Such metrics would aim to better quantify the degree to which health workers' needs are met, serving as a transparent monitor of progress.
I look forward to your comments. Email: hifa@hifaforums.org
Best wishes, Neil
HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org
