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\"Decolonizing Global Mental Health offers a critical postcolonial reading of this newly emerging arena, with a particular focus on psychology's and psychiatry's encounters with, and responses to, distress or 'mental illness' in low-income countries. The World Health Organisation and the Movement for Global Mental Health currently push for the 'scale-up' of psychiatric and psychological interventions on to low-income countries, modelled on those from high-income countries. However critiques of psychiatric and psychological services from service users, the survivor movement and professionals, often remain invisible within 'Global Mental Health' literature. This book argues that it is imperative to explore how this alternative 'evidence base' might be mobilized to fruitfully interrogate calls to 'scale up' psychiatric and psychological services in the majority world. The book seeks to de-familiarize current 'Western' conceptions of psychology and psychiatry using postcolonial theory, and seeks to bring into focus a series of questions and problematizations. As such it is ideal reading for undergraduate and postgraduate students, as well as researchers in the fields of critical psychology and psychiatry, social and health psychology, cultural studies, public health and social work\"-- Provided by publisher.

Nigeria's reproductive, maternal, newborn, child, and adolescent health indicators have remained unsatisfactory in the face of poor-quality healthcare services. Nigeria initiated the reproductive, maternal, newborn, child, and adolescent, elderly + nutrition (RMNCAEH+N) quality of care (QoC) agenda to address the challenge. The health management information system (HMIS) is integral to the agenda but there is sparse evidence on its performance so far. This study assessed the performance of routine HMIS for RMNCAEH+N QoC in Ondo and Ekiti States. This paper described the review of health facility records and health facility survey components of a multi-component study which employed a mixed-method research design. Using the routine health information system performance diagnostic tool, service data captured for over one year were critically reviewed in randomly selected sample of 169 public health facilities (Ondo:117; Ekiti:52) and information was obtained from facility heads or designates. Performance of routine HMIS for RMNCAEH+N QoC in terms of data collection, data quality, and data use were analysed using univariate and bivariate statistics. Results show that 67.3% of health facilities in Ekiti and 88.9% of facilities in Ondo had all required HMIS tools for selected RMNCAEH+N services (p<0.001). Data accuracy was 70.1% for Ondo and 40.4% for Ekiti (p <0.001); 82.9% of facilities in Ondo and 44.2% in Ekiti had complete data (p <0.001); almost all facilities (Ondo: 99.1%; Ekiti: 96.2%, p = 0.224) demonstrated data consistency; and, 82.9% of facilities in Ondo and 94.2% of facilities in Ekiti demonstrated timeliness in data submission (p = 0.048). Also, 70.1% (Ondo) and 78% (Ekiti) of facilities had quality improvement (QI) teams (p = 0.338); 53.5% (Ondo) and 77.1% (Ekiti) of QI teams regularly extracted data, calculated, and visualised prioritized indicators (p = 0.007); while 72.1% (Ondo) and 79.2% (Ekiti) regularly reviewed data and used it to make QI decisions (p = 0.367). Routine RMNCAEH+N QoC data management system in Ondo and Ekiti States vary in terms of the status of reporting forms, data quality, and data use for decision-making, and there were specific performance gaps. The routine RMNCAEH+N QoC data management system in Ondo and Ekiti States needs improvement and findings from this study can serve as the basis for evidence-based advocacy for the required efforts and investment toward improved performance.

It is increasingly apparent that access to healthcare without adequate quality of care is insufficient to improve population health outcomes. We assess whether the most commonly measured attribute of health facilities in low- and middle-income countries (LMICs)-the structural inputs to care-predicts the clinical quality of care provided to patients. Service Provision Assessments are nationally representative health facility surveys conducted by the Demographic and Health Survey Program with support from the US Agency for International Development. These surveys assess health system capacity in LMICs. We drew data from assessments conducted in 8 countries between 2007 and 2015: Haiti, Kenya, Malawi, Namibia, Rwanda, Senegal, Tanzania, and Uganda. The surveys included an audit of facility infrastructure and direct observation of family planning, antenatal care (ANC), sick-child care, and (in 2 countries) labor and delivery. To measure structural inputs, we constructed indices that measured World Health Organization-recommended amenities, equipment, and medications in each service. For clinical quality, we used data from direct observations of care to calculate providers' adherence to evidence-based care guidelines. We assessed the correlation between these metrics and used spline models to test for the presence of a minimum input threshold associated with good clinical quality. Inclusion criteria were met by 32,531 observations of care in 4,354 facilities. Facilities demonstrated moderate levels of infrastructure, ranging from 0.63 of 1 in sick-child care to 0.75 of 1 for family planning on average. Adherence to evidence-based guidelines was low, with an average of 37% adherence in sick-child care, 46% in family planning, 60% in labor and delivery, and 61% in ANC. Correlation between infrastructure and evidence-based care was low (median 0.20, range from -0.03 for family planning in Senegal to 0.40 for ANC in Tanzania). Facilities with similar infrastructure scores delivered care of widely varying quality in each service. We did not detect a minimum level of infrastructure that was reliably associated with higher quality of care delivered in any service. These findings rely on cross-sectional data, preventing assessment of relationships between structural inputs and clinical quality over time; measurement error may attenuate the estimated associations. Inputs to care are poorly correlated with provision of evidence-based care in these 4 clinical services. Healthcare workers in well-equipped facilities often provided poor care and vice versa. While it is important to have strong infrastructure, it should not be used as a measure of quality. Insight into health system quality requires measurement of processes and outcomes of care.

\"A chronicle of one of the most unusual series of events in the history of medicine, this book tells the story a group of men and women clinicians, administrators, frontline workers, trustees, and leaders blessed with vision, courage, and a relentless determination to improve. It is the story of a medical center transformed. Ultimately, it is the story of a new and possibly better way to take on the challenge we face in the United States today to provide superb medical care to our people while at the same time controlling costs\"--Provided by publisher.

Considerable progress has been made in reducing maternal, newborn, and child mortality worldwide, but many more deaths could be prevented if effective interventions were available to all who could benefit from them. Timely, high-quality measurements of intervention coverage--the proportion of a population in need of a health intervention that actually receives it--are essential to support sound decisions about progress and investments in women's and children's health. The PLOS Medicine \"Measuring Coverage in MNCH\" Collection of research studies and reviews presents systematic assessments of the validity of health intervention coverage measurement based on household surveys, the primary method for estimating population-level intervention coverage in low- and middle-income countries. In this overview of the Collection, we discuss how and why some of the indicators now being used to track intervention coverage may not provide fully reliable coverage measurements, and how a better understanding of the systematic and random error inherent in these coverage indicators can help in their interpretation and use. We draw together strategies proposed across the Collection for improving coverage measurement, and recommend continued support for high-quality household surveys at national and sub-national levels, supplemented by surveys with lighter tools that can be implemented every 1-2 years and by complementary health-facility-based assessments of service quality. Finally, we stress the importance of learning more about coverage measurement to strengthen the foundation for assessing and improving the progress of maternal, newborn, and child health programs.

Background Social accountability interventions such as CARE’s Community Score Card© show promise for improving sexual, reproductive, and maternal health outcomes. A key component of the intervention is creation of spaces where community members, healthcare workers, and district officials can safely interact and collaborate to improve health-related outcomes. Here, we evaluate the intervention’s effect on governance constructs such as power sharing and equity that are central to our theory of change. Methods We randomly assigned ten matched pairs of communities to intervention and control arms, administering endline surveys to women in each arm who had given birth in the last 12 months. Forty-six governance items were reduced by factor analysis into eight underlying scales. We evaluated the intervention’s impact on these constructs using local average treatment effect estimates. Results Among intervention-area women who reported a community meeting, we further evaluated the influence of the governance constructs on health-related outcomes: home visit from a community health worker, modern family planning, and satisfaction with health services. A significantly greater proportion of intervention-area women compared to control reported the existence of community groups that provide and facilitate negotiated space between community members and healthcare workers ( p  = .003). Several governance constructs were positively associated with the health-related outcomes. Further, active participation in the intervention was also positively associated with several governance constructs. Conclusions CARE’s Community Score Card© facilitated the creation and claiming of effective and inclusive negotiated spaces in which community members and healthcare workers could vocalize service delivery issues and prioritize actions for improvement. We argue that reliable measurement of governance concepts such as power sharing, equity and quality of negotiated space, collective efficacy, and mutual responsibility will enhance our ability to evaluate social accountability interventions and understand the processes by which they affect change.

ABSTRACT BACKGROUND Patients at risk for generating high health care expenditures often receive fragmented, low-quality, inefficient health care. Guided Care is designed to provide proactive, coordinated, comprehensive care for such patients. OBJECTIVE We hypothesized that Guided Care, compared to usual care, produces better functional health and quality of care, while reducing the use of expensive health services. DESIGN 32-month, single-blind, matched-pair, cluster-randomized controlled trial of Guided Care, conducted in eight community-based primary care practices. PATIENTS The “Hierarchical Condition Category” (HCC) predictive model was used to identify high-risk older patients who were insured by fee-for-service Medicare, a Medicare Advantage plan or Tricare. Patients with HCC scores in the highest quartile (at risk for generating high health care expenditures during the coming year) were eligible to participate. INTERVENTION A registered nurse collaborated with two to five primary care physicians in providing eight services to participants: comprehensive assessment, evidence-based care planning, proactive monitoring, care coordination, transitional care, coaching for self-management, caregiver support, and access to community-based services. MAIN MEASURES Functional health was measured using the Short Form–36. Quality of care and health services utilization were measured using the Patient Assessment of Chronic Illness Care and health insurance claims, respectively. KEY RESULTS Of the eligible patients, 904 (37.8 %) gave written consent to participate; of these, 477 (52.8 %) completed the final interview, and 848 (93.8 %) provided complete claims data. In intention-to-treat analyses, Guided Care did not significantly improve participants’ functional health, but it was associated with significantly higher participant ratings of the quality of care (difference = 0.27, 95 % CI = 0.08–0.45) and 29 % lower use of home care (95 % CI = 3–48 %). CONCLUSIONS Guided Care improves high-risk older patients’ ratings of the quality of their care, and it reduces their use of home care, but it does not appear to improve their functional health.

Early childhood interventions have potential to offset the negative impact of early adversity. We evaluated the impact of a community-based parenting group intervention on child development in Zambia. We conducted a non-masked cluster-randomized controlled trial in Southern Province, Zambia. Thirty clusters of villages were matched based on population density and distance from the nearest health center, and randomly assigned to intervention (15 clusters, 268 caregiver-child dyads) or control (15 clusters, 258 caregiver-child dyads). Caregivers were eligible if they had a child 6 to 12 months old at baseline. In intervention clusters, caregivers were visited twice per month during the first year of the study by child development agents (CDAs) and were invited to attend fortnightly parenting group meetings. Parenting groups selected \"head mothers\" from their communities who were trained by CDAs to facilitate meetings and deliver a diverse parenting curriculum. The parenting group intervention, originally designed to run for 1 year, was extended, and households were visited for a follow-up assessment at the end of year 2. The control group did not receive any intervention. Intention-to-treat analysis was performed for primary outcomes measured at the year 2 follow-up: stunting and 5 domains of neurocognitive development measured using the Bayley Scales of Infant and Toddler Development-Third Edition (BSID-III). In order to show Cohen's d estimates, BSID-III composite scores were converted to z-scores by standardizing within the study population. In all, 195/268 children (73%) in the intervention group and 182/258 children (71%) in the control group were assessed at endline after 2 years. The intervention significantly reduced stunting (56/195 versus 72/182; adjusted odds ratio 0.45, 95% CI 0.22 to 0.92; p = 0.028) and had a significant positive impact on language (β 0.14, 95% CI 0.01 to 0.27; p = 0.039). The intervention did not significantly impact cognition (β 0.11, 95% CI -0.06 to 0.29; p = 0.196), motor skills (β -0.01, 95% CI -0.25 to 0.24; p = 0.964), adaptive behavior (β 0.21, 95% CI -0.03 to 0.44; p = 0.088), or social-emotional development (β 0.20, 95% CI -0.04 to 0.44; p = 0.098). Observed impacts may have been due in part to home visits by CDAs during the first year of the intervention. The results of this trial suggest that parenting groups hold promise for improving child development, particularly physical growth, in low-resource settings like Zambia. ClinicalTrials.gov NCT02234726.

This study assessed the extent to which recommended pediatric outpatient care is delivered and documented. On average, children received 46.5% of the overall indicated care, 67.6% of the indicated care for acute medical problems, 53.4% of the indicated care for chronic conditions, and 40.7% of the indicated preventive care. This study assessed the extent to which recommended pediatric outpatient care is delivered and documented. On average, children received 46.5% of the overall indicated care. Serious problems with the quality and safety of health care in the United States have been widely documented. 1 – 3 However, this evidence comes mainly from studies of care delivered to adults 1 and the elderly. 4 , 5 Comprehensive, national studies of the quality of care delivered to children and adolescents are needed. Previous studies of children have examined few quality measures 6 – 8 ; have involved self-reported data from parents, patients, or providers 6 , 8 – 10 ; or have been limited to Medicaid enrollees 7 or to one geographic area. 6 , 7 , 11 Research and policy related to children have focused on expanding eligibility for public . . .