Health System Design: Best approaches for effective/efficient health system UHC framework (Evans 2012) Quality IHI “Triple Aim”

Most pressing methodological issues: 1. Joining the “2 knowledges” Evidence-based Subject Matter Knowledge The “what”…. Protocols/ Guidelines, Physical resources, Clinical Training Implementation and Improvement Implementation Knowledge The “how”…. Ambitious Aim to close the measured gap. Adaptive Content Theory Implementation Strategies that are supported by measurement and feedback learning systems

Most pressing methodological issues: 2. Getting to full scale – framework to escape from “pilot” thinking Best Practice exists Phases of Scale-up Build Scalable Unit Test Scale- Up Set-up Go to Full-Scale New Scale-up Idea Adoption Mechanisms Leadership, communication, social networks, culture of urgency and persistence Learning systems, data systems, infrastructure for scale-up, human capacity for scale-up, capability for scale-up, sustainability Support Systems

Improvements in Quantitative Methodology Data collected in Clinic Registers Register Data Aggregated into Monthly Reports Facility sends aggregate report to District District Health information System 1 2 3 4

What happens to routinely collected data? Register Data vs Monthly Summary Monthly Summary vs DHIS Report

Can routine data systems be fixed? Register Data vs Monthly Summary Monthly Summary vs DHIS Report