Effectiveness of a nutrition education and counselling training package on antenatal care: a cluster randomized controlled trial in Addis Ababa.

The World Health Organization (WHO) recommends the need for a strong nutrition training package for practitioners, including antenatal care (ANC) providers. Without such a training package, ANC visits remain a missed opportunity to address nutritional problems among pregnant women. This study evaluated the effectiveness of an in-service nutrition education and counselling package on the providers' counselling skills during ANC visits. A cluster randomized controlled trial was conducted in Addis Ababa, Ethiopia. All health-care providers working in ANC units across 20 health centres participated in this study. Health centres were allocated to intervention and control arms using a matched-pair randomization technique. An in-service nutrition education and counselling package, including training for ANC providers, supportive supervision and provision of modules, pamphlets and job aids, was provided for health centres assigned to the intervention arm. Observation checklists were used to assess the counselling skills of health-care providers. We used mixed-effect linear regression to evaluate the impact of the intervention. Significantly more health-care providers in the intervention arm informed pregnant women about the need to have one additional meal (Difference in proportion [DP] 49.17% vs -0.84%; DID 50.0%), about minimum required dietary diversity (DP 72.5% vs -2.5%; DID 75.0%) and about gestational weight gain (DP 68.33% vs -8.33%; DID 76.6%). Furthermore, providers improved in identifying key difficulties that pregnant women face (DP 28.34% vs -2.5%; DID 30.8%), and in recommending simple achievable actions on nutrition during pregnancy (DP 20.8% vs -10.9%; DID 31.6%). The intervention did not have statistically significant effects on how providers informed women about early initiation of breastfeeding (DP 6.67% vs 9.17%; DID -2.5%). The comprehensive in-service nutrition education and counselling package improved how ANC providers engaged with pregnant women and delivered nutrition messages during ANC consultations. This trial was registered in the Pan African Clinical Trial (PACTR registry, PACTR20170900 2477373; Date issued 21 September 2017).

Health system performance assessment in the WHO European Region: which domains and indicators have been used by Member States for its measurement?

Health systems performance assessment (HSPA) varies across the WHO European Region. This review summarizes HSPA domains and indicators used by Member States in their HSPA or health system-related reports. Thirty Member States published in the English language and from their latest documents, 1485 distinct indicators were extracted. The number of indicators reported per Member State ranged from 9 to 146, with a mean of 50. Among the 14 domains of the WHO 2007 framework, service delivery and improved health were covered by virtually all Member States analysed (30 and 29, respectively), but coverage varied for the other 12 domains, with health workforce and financing having good coverage (25 and 26, respectively) but others, such as safety, efficiency, coverage or responsiveness, covered in only 20–30% of documents. Further refinement of frameworks, both in clarity on scope and function and in the conceptual robustness of domains, is warranted and further standardization of generic sets of indicators should be sought.

Оценка эффективности систем здравоохранения в Европейском регионе ВОЗ: какие сферы и показатели используют государства-члены при проведении измерений?

Особенности оценки эффективности систем здравоохранения зависят от конкретных условий в тех или иных странах Европейского региона ВОЗ. В настоящем обзоре вкратце описаны основные сферы такой оценки и показатели, которые государства-члены используют при проведении оценок и при отчетности по системам здравоохранения. Материалы на английском языке публиковались тридцатью государствами-членами, и из новейших документов авторы выделили 1485 четких показателей. Число показателей, по которым предоставляли отчетность государства-члены, варьировалось от 9 до 146 (срединное значение – 50). Из 14 сфер, вошедших в рамочную основу ВОЗ от 2007 г., практически все рассмотренные государства-члены охватили предоставление услуг и улучшение показателей здоровья (соответственно, 30 и 29 стран), однако по другим 12 сферам показатели охвата значительно варьировались. Например, такие сферы, как кадровые ресурсы здравоохранения и финансирование, были охвачены, соответственно, 25 и 26 странами, но вопросы безопасности, эффективности, охвата услугами и отзывчивости освещались лишь в 20–30% документов. Рамочные основы нуждаются в дальнейшей доработке в том, что касается сферы применения и функций, а также концептуальной верности выбранных сфер. Помимо этого, следует стремиться к дальнейшей стандартизации общих наборов показателей.