Assessing health program performance in low- and middle-income countries: building a feasible, credible, and comprehensive framework.

BACKGROUND: Many health service delivery models are adapting health services to meet rising demand and evolving health burdens in low- and middle-income countries. While innovative private sector models provide potential benefits to health care delivery, the evidence base on the characteristics and impact of such approaches is limited. We have developed a performance measurement framework that provides credible (relevant aspects of performance), feasible (available data), and comparable (across different organizations) metrics that can be obtained for private health services organizations that operate in resource-constrained settings. METHODS: We synthesized existing frameworks to define credible measures. We then examined a purposive sample of 80 health organizations from the Center for Health Market Innovations (CHMI) database (healthmarketinnovations.org) to identify what the organizations reported about their programs (to determine feasibility of measurement) and what elements could be compared across the sample. RESULTS: The resulting measurement framework includes fourteen subgroups within three categories of health status, health access, and operations/delivery. CONCLUSIONS: The emphasis on credible, feasible, and comparable measures in the framework can assist funders, program managers, and researchers to support, manage, and evaluate the most promising strategies to improve access to effective health services. Although some of the criteria that the literature views as important - particularly population coverage, pro-poor targeting, and health outcomes - are less frequently reported, the overall comparison provides useful insights.

Translating research into action: WHO evidence-informed guidelines for safe and effective micronutrient interventions.

In 2009 WHO adopted a new process by which recommendations for safe and effective micronutrient interventions are developed, ensuring the use of best practices and available evidence. This process includes nine steps ranging from establishing steering and guideline groups and prioritizing needs to planning the implementation and updating the guidelines. Systematic reviews of evidence are used to address critical outcomes for decision making, considering the balance among risks and benefits, values, preferences, and costs. Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology is used to assess the overall evidence quality and establish the strength of the recommendations. Guideline development is underway for interventions covering iron and vitamin A supplementation, home fortification with multiple micronutrient powders, and fortification of staple foods. Global guidelines are disseminated through the WHO electronic Library of Evidence for Nutrition Actions, a resource of the evidence and tools for scaling-up micronutrient interventions. The WHO Department of Nutrition for Health and Development and the Evidence-Informed Policy Network will support countries to scale-up the delivery of micronutrient interventions by adapting these evidence-informed guidelines and policies to make them context specific. This will be accomplished by providing summaries of the best available evidence on micronutrient interventions, evidence on health systems, and effective delivery systems along with capturing the tacit knowledge of the countries' realities. With a systematic approach that uses the WHO strategy on research for health as the connecting thread, the challenges to successfully implement safe and effective micronutrient programs can be addressed.

Protocol for a pilot, randomised, double-blinded, placebo-controlled trial of prophylactic use of tranexamic acid for preventing postpartum haemorrhage (TAPPH-1).

INTRODUCTION: Postpartum haemorrhage (PPH) is the leading cause of maternal morbidity and mortality worldwide. Despite the availability of multiple uterotonic agents, the incidence of PPH continues to rise. Tranexamic acid (TXA) has been shown to be a safe, effective and inexpensive therapeutic option for the treatment of PPH, however, its use prophylactically in mitigating the risk of PPH is unknown. This pragmatic randomised prospective trial assesses the feasibility and safety of administering TXA at the time of delivery for the prevention of PPH. METHODS AND ANALYSIS: A pilot pragmatic randomised double-blinded placebo-controlled trial will be performed. 58 singleton parturients at term >32 weeks, undergoing either spontaneous vaginal delivery, or caesarean section will be randomised to receive 1 g of TXA or placebo (0.9% saline) intravenously. The primary outcome assessed will be the feasibility of administrating TXA, along with collecting data regarding safety of drug administration. The groups will also be analysed on efficacy of mitigating the onset of PPH and clinically relevant variables. Demographic, feasibility, safety and clinical endpoints will be summarised and the appropriate measures of central tendency and dispersion will be presented. ETHICS AND DISSEMINATION: This protocol was approved by the Sunnybrook Health Sciences Centre Research Ethics Board (number: 418-2016). The results will be disseminated in a peer-reviewed journal and at scientific meetings. TRIAL REGISTRATION NUMBER: NCT03069859; Pre-results.