Telehealth quality of care tool: web annex

Quality of care in services provided at a distance through modern telehealth technologies and methodologies is ever more relevant as this growing approach to the provision of health care, including its application in health promotion and disease prevention, has seen an exponential increase during and after the COVID-19 pandemic. Such fast growth calls for attention to quality, and so, it is critically important to implement appropriate audit and quality assurance in telehealth. The evaluation of telehealth services may require comparisons of health and health-care outcomes between the new telehealth service and the service provided in person, as well as an evaluation of the conditions and processes, which are unique to it. Quality strategies can assess or measure; assure by avoiding risk and error; and improve the quality of care by striving for change. Regarding quality assurance, the enabling service that needs to be set in place is that which assures high levels of care are offered via telehealth solutions. Based on previous recommendations and assessment frameworks, the WHO Regional Office for Europe developed a tool that serves as both a guidance and self-assessment instrument for telehealth services quality improvement that is useful at local, regional and national levels. The Telehealth Quality of Care Tool (TQoCT) was created through an iterative process, combining desk research and gathering knowledge from topic and country experts, and using a set of validation exercises. It is work-in-progress, to be used now by Member States, and it can benefit from their feedback for further improvements. An initial alignment with the ISO 13131:2021 standard was ensured as this guidance was regarded highly by several experts. However, more detailed work to integrate it would have required a longer period and further iterations. This tool should not be used or implemented by one individual in isolation. We envision that using the tool requires gathering a group of stakeholders to agree on the maturity level of a telehealth system through three components of quality of care – people centricity, clinical effectiveness, and safety – be it at the national, regional or organizational level. The creation of a network or ecosystem for telehealth, and a common understanding around quality of telecare, are immediate quick wins that can foster strategies for continuous improvement.

Telehealth quality of care tool

This first version of the Telehealth quality of care tool (TQoCT) is intended to be used by Member States (namely by focal points for patient safety and quality of care (QoC) and all other relevant parties of national telehealth ecosystems) or by individual health-care provider organizations. As more health and care moves to digital-based service provision, including the use of digital tools for supporting health interventions and care services provided at a distance, the quality of the care that is provided becomes more relevant. The quality of telehealth ultimately matters for increasing the adoption of this new paradigm of care because significant patient safety or QoC issues will ultimately undermine the trust populations and professionals have on this still somehow new way of practicing medicine and supporting the provision of modern and integrated care. Approaches to such quality standards benefit from common reference materials, and the TQoCT aims to aggregate these in a manner that stimulates reflection and action, helping countries and health-care organizations on their journey to mature, safe and high-quality telehealth service provision.

Фазои буҷетӣ барои тандурустӣ дар Ҷумҳурии Тоҷикистон: имкониятҳои ҷалби захираҳои давлатии иловагӣ

Барномаи ислоҳоти соҳаи тандурустии Ҷумҳурии Тоҷикистон ҷиҳати ноил шудан ба фарогирии умумӣ бо хизматрасониҳои тандурустӣ (ФУХТ) аз беҳтар намудани дастрасии тамоми аҳолӣ ба хизматрасонии тиббии баландсифат ва истифодаи самараноки захираҳои давлатӣ иборат аст. Стратегияи миллии тандурустии ба наздикӣ қабулшуда (Стратегияи ҳифзи солимии аҳолии Ҷумҳурии Тоҷикистон барои давраи то соли 2030) ба далелҳо ва тавсияҳои глобалӣ пайравӣ намуда, ба тавсеаи кумаки аввалияи тиббию санитарӣ такя мекунад. Барои татбиқи стратегия ба Ҷумҳурии Тоҷикистон лозим аст, ки маблағгузории давлатиро ба соҳаи тандурустӣ ба таври қобили мулоҳиза зиёд намояд ва захираҳоро ба он соҳае ҷудо намояд, ки онҳо самараи бештар доранд. Дар айни замон, захираҳои буҷетӣ барои кӯмаки аввалияи тиббию санитарӣ кофӣ нестанд ва дар саросари кишвар нобаробар тақсим карда мешаванд, ки дар натиҷа камбудиҳои ноодилона дар дастрасии хизматрасонии тиббӣ ба вуҷуд меоянд. Аз ин рӯ, дар истифодаи соҳаи тандурустӣ фарқиятҳои беасос вуҷуд доранд. Дар гузориши мазкур имкониятҳои алтернативии зиёд кардани фазои буҷетӣ барои саломатӣ, аз ҷумла захираҳои кӯмаки аввалияи тиббию санитарӣ тавсиф, таҳлил ва муқоиса шудаанд.

Фискальное пространство для сектора здравоохранения в Республике Таджикистан: варианты получения дополнительных финансовых ресурсов

Программа реформы здравоохранения Республики Таджикистан для достижения всеобщего охвата услугами здравоохранения (ВОУЗ) включает в себя улучшение доступа к качественной медицинской помощи для всего населения и более эффективное использование государственных ресурсов. Недавно принятая Национальная стратегия здравоохранения (Стратегия охраны здоровья населения Республики Таджикистан на период до 2030 г.) следует глобальным фактическим данным и рекомендациям и основывается на расширении первичной медико-санитарной помощи. Для реализации стратегии Республике Таджикистан необходимо в значительной степени увеличить государственное финансирование здравоохранения и направить ресурсы туда, где они дадут наибольший эффект. В настоящее время бюджетные ресурсы на первичную медико-санитарную помощь отстают и неравномерно распределяются по стране, что приводит к несправедливым пробелам в доступе к медицинской помощи. Следовательно, существуют необоснованные различия в использовании медицинских услуг. В этом отчете описываются, анализируются и сравниваются альтернативные возможности увеличения фискального пространства для здравоохранения, в частности ресурсов для первичной медико-санитарной помощи.

Budgetary space for health in the Republic of Tajikistan: options for more public resources

The Republic of Tajikistan’s health reform agenda to achieve universal health coverage includes improved access to high-quality health care for the entire population and more efficient use of public resources. The recently adopted National Health Strategy (Strategy for the Healthcare of the Population of the Republic of Tajikistan, 2021–2030) follows global evidence and recommendations, and builds on expanding primary health care. To implement the strategy, Tajikistan needs to increase considerably public funding for health and allocate resources to where they will have the most effect. Currently, budget resources for primary health care are lagging behind, and are unevenly distributed across the country, resulting in unjust gaps in health care access. Consequently, there are unjustified differences in health care utilization.This report describes, analyses and compares alternative opportunities to increase budgetary space for health, in particular resources for primary health care.

Health systems resilience during COVID-19: lessons for building back better

COVID-19 has created huge challenges. The lessons it has generated on preparing for future pandemics are clear but they are by no means the only learning. All health systems are vulnerable and there are practical steps that all countries can take, not simply to increase the resources available, but to ensure the capacity to mobilize, adapt and use those resources in different shock scenarios. The Health systems resilience during COVID-19: Lessons for building back better study gathers the evidence of how countries have managed (or not managed) to re-engineer what they do, who does what and how, and draws out the implications for future resilience. The study understands resilience as the ability of the health system to prepare for, manage and learn from a sudden and extreme disturbance. It is about maintaining the performance of core heath system functions. While the focus here is on responding to shock, it is increasingly evident that the ability to transform and evolve will also be critical in meeting long-term structural challenges to health systems.

Управление финансированием здравоохранения и стратегическими закупками услуг в Кыргызстане

В данном документе подводятся итоги трех циклов реформы финансирования здравоохранения в Кыргызстане в рамках трех национальных стратегий здравоохранения, реализованных за последние 20 лет. В этом докладе рассматриваются и обобщаются извлеченные уроки и рекомендации, содержащиеся в предыдущих отчетах, подготовленных национальными и международными партнерами по исследованиям и развитию. В нем отмечается, что основные цели реформы финансирования здравоохранения в стране – обеспечение финансовой защиты и финансовой устойчивости – могут быть достигнуты в ближайшее десятилетие только при условии тесной координации с процессом разработки и осуществления других компонентов стратегии здравоохранения, таких как фармацевтическая политика и оптимизация предоставления услуг. В документе также отмечается, в каких сферах потребуется стратегическое использование финансовых инструментов для поддержки эффективного осуществления других основных компонентов национальной стратегии в секторе здравоохранения «Здоровый человек – процветающая страна» (Государственная программа развития здравоохранения до 2030 года).

Governance of health financing and strategic purchasing of services in Kyrgyzstan

This paper takes stock of three cycles of health financing reform in Kyrgyzstan under three national health strategies implemented over the last 20 years. The report reviews and synthesizes lessons learned and recommendations of previous reports produced by national and international research and development partners. It notes that the main goals of health financing reform in the country – financial protection and financial sustainability – can only be achieved in the coming decade through close coordination with the design and implementation of other components of the health strategy, such as pharmaceutical policy and service delivery optimization. Equally, the paper notes where strategic use of financing tools will be needed to support effective implementation of other pillars of the national health sector strategy: Healthy population – prosperous country, the State Programme for Health Development 2030.

Eurohealth: measuring efficiency in health care

Being able to measure efficiency is one of the cornerstones of assessing the performance of health systems and can help to achieve several objectives, such as allocating resources in the best possible way to meet population needs and health system goals; maximizing value for money in terms of the resources spent; contributing to improving quality of care for health services users; and improving population health outcomes. Eurohealth Observer - Identify the causes of inefficiencies in health systems, The challenges of using cross-national comparisons of efficiency to inform health policy; Eurohealth International – Big data for public health: Does the data promise a better quality of life?, The SELFIE framework for integrated care for multi-morbidity, Time to focus on benefits beyond the health sector: the example of health literacy, New draft EU Directive submits the regulation of health professions to a proportionality test; Eurohealth Systems and Policies - New measures to increase the health budget in Romania and Eurohealth Monitor.