Publication: Improving Health Services and Redesigning Health Systems: Using Care Cascade Analytics to Identify Challenges and Solutions, Volume 1. Population-level Cascade Analytics
Loading...
Date
2022-02-11
ISSN
Published
2022-02-11
Author(s)
Editor(s)
Abstract
This practical, interactive guide walks health program implementers through how to use cascade analytics to improve service delivery and client outcomes. For policy-makers, it explains the power of the cascade framework as an analysis tool and how it can help identify bottlenecks and solutions, and inform quality improvements and in-service reforms for more efficient, client-centered services. Cascade analytics also offer a practical way to track progress and demonstrate the concrete impact that specific changes in service delivery have on outcomes. In applications, we have found that cascades provide a powerful visual summary of where care processes stall and impact is lost. The guide helps readers master key concepts and guides them through the process of designing and conducting cascade analytics. It engages the reader and facilitates step-by-step learning with interactive features and real-life examples. The guide contains tried and tested templates for cascade analytics especially for non-communicable disease programs, and a worked example on hypertension care. The tools can also be used to better understand why clients are dropping out of care and what opportunities exist to bring them back and keep them in the program to attain their treatment targets.
Link to Data Set
Citation
“Fraser-Hurt, Nicole; Shubber, Zara; Ward, Katherine. 2022. Improving Health Services and Redesigning Health Systems: Using Care Cascade Analytics to Identify Challenges and Solutions, Volume 1. Population-level Cascade Analytics. © World Bank. http://hdl.handle.net/10986/36993 License: CC BY 3.0 IGO.”
Associated URLs
Associated content
Other publications in this report series
Journal
Journal Volume
Journal Issue
Collections
Related items
Showing items related by metadata.
Publication Improving Health Service Delivery(Washington, DC: World Bank, 2025-06-12)The guide provides an overview of how patient pathway studies can be designed and implemented to meet this goal. The studies featured in the guide offer a wealth of insights and lessons from research carried out in different health systems. By examining the design options of different study types, implementers and decision-makers can incorporate valuable knowledge into their own assessments. The selected studies encompass different world regions, target populations, health programs and implementation settings, underscoring the importance of tailoring research approaches to the specific contexts in which they are implemented. Throughout the process of compiling the guide, the writing team was astonished by the wealth of available research studies on care-seeking journeys and people’s decision-making on provider use. Drawing on the available literature and implementation experience, the guide highlights both design issues and practical aspects of conducting patient pathway analytics. While every researcher will be faced with a new set of questions and local health system characteristics, there are some common study features and generalizable lessons. Through this guide, the reader can learn about different options ranging from qualitative behavioral studies by social scientists to large quantitative assessments, potentially using large routine databases that require data scientist skills. The guide aims to present study methods, tools, resources, and carefully selected examples of PPA methods to assist with study design. It considers that needs vary based on health system, target populations, disease focus, and policy question. This guide provides the ingredients (resources) and some recipes (methods) from our literature search. However, there is room for adaptation, innovation and expansion of the PPA methods to answer the research questions of a particular assessment.Publication Improving Services for Chronic Non-communicable Diseases in Samoa(John Wiley and Sons, Inc., 2021-07-26)Samoa needs to intensify the response to the growing non-communicable disease burden. This study aimed to assess bottlenecks in the care continuum and identify possible solutions. The mixed-methods study used the cascade framework as an analysis tool and hypertension as a tracer condition for chronic non-communicable diseases. Household survey data were integrated with medical record data of hypertension patients and results from focus group discussions with patients and healthcare providers. Hypertension prevalence was 38.1% but only 4.7% of hypertensive individuals had controlled blood pressure. There were large gaps in the care continuum especially at screening and referral due to multiple socio-cultural, economic and service delivery constraints. In Samoa, care for chronic non-communicable diseases is not effectively addressing patient needs. This calls for better health communication, demand creation, treatment support, nutritional interventions and health service redesign, with a focus on primary healthcare and effective patient and community engagement.Publication Care for Hypertension and Other Chronic Conditions in Samoa(World Bank, Washington, DC, 2020-01-22)The importance of non-communicable diseases (NCD) for the health status of Samoa’s population cannot be overstated - NCD causes are responsible for 7 of 10 pre-mature deaths with 3 of 10 due to cardiovascular causes alone1. Many adults are hypertensive while rates of type diabetes and obesity are among the highest in the world and on an increasing trend. The 2013 Stepwise Approach to Surveillance (STEPS) survey found that 28.9 percent of the Samoa population are hypertensive, and 24.8 percent have diabetes. In response, the Government of Samoa has made NCD control and people, centered health services a priority in its Strategy for the Development of Samoa 2016/17-2019/20 and issued the National NCD Policy 2019-2023. In 2015, it contextualized and piloted WHO’s Package of Essential Non-communicable diseases (PEN) interventions and collected implementation experiences. The PEN Fa’a Samoa is oriented toward community participation and outreach services. It places emphasis on early detection of NCDs, effective referral and increasing population awareness of NCD risk factors. However four years after initiating PEN Fa’a Samoa program, it had only been rolled out to 17 out of total 431 villages in the country indicating the stagnant status of the screening. A World Bank study of NCD cost analysis in 2017 flagged low hypertension (HTN) treatment levels in Samoa as an issue of concern. The widespread HTN and the significant cardiovascular disease burden and high premature deaths suggest that the continuum of HTN care is sub-optimal in Samoa. To support the Government in improving NCD care, the World Bank joined the Ministry of Health (MOH) in 2018 to conduct a study on HTN and chronic care. The primary aim was to identify breakpoints and gaps in the continuum of HTN care and determine issues in chronic care and propose potential solutions. The study findings inform Samoa’s policy formulation, intervention implementation and the World Bank’s Samoa NCD control project. As the first in the Pacific Region to do an implementation cascade study, other Pacific Island Countries (PICs) may also draw on the findings of the study.Publication Challenges and Opportunities in the Continuity of Care for Hypertension(Springer Nature, 2019-12-03)Hypertension, a significant risk factor for ischemic heart disease and other chronic conditions, is the third-highest cause of death and disability in Tajikistan. Thus, ensuring the early detection and appropriate management of hypertension is a core element of strategies to improve population health in Tajikistan. For a strategy to be successful, it should be informed by the causes of gaps in service delivery and feasible solutions to these challenges. The objective of this study was to undertake a systematic assessment of hypertension case detection and retention in care within Tajikistan’s primary health care system, and to identify challenges and appropriate solutions. We review the results for the case detection stage of the cascade of care, which had the most significant gaps. Of the half a million people with hypertension in Khatlon and Sogd Oblasts (administrative regions), about 10% have been diagnosed in Khatlon and only 5% in Sogd. Barriers to case detection include misinformation about hypertension, ambiguous protocols, and limited delivery capacity. Solutions identified to these challenges were mobilizing faith-based organizations, scaling up screening through health caravans, task-shifting to increase provider supply, and introducing job aids for providers. Translating findings on discontinuities in care for hypertension and other chronic diseases to actionable policy insights can be facilitated by collaboration with local stakeholders, triangulation of data sources, and identifying the intersection between the feasible and the effective in defining solutions to service delivery challenges.Publication Improving the Allocative Efficiency of the HIV Response Across the Care Cascade in Zimbabwe(World Bank, Washington, DC, 2019-05)The report summarizes the findings of an allocative and implementation efficiency analysis of Zimbabwe's HIV response across the care cascade, which was conducted using the Optima-HIV model. The analysis was conducted to support Zimbabwe in its decision-making on strategic HIV investments, highlighting opportunities to maximise the impact of HIV financial resources in Zimbabwe through allocative and implementation efficiency gains.
Users also downloaded
Showing related downloaded files
Publication World Development Report 2009(World Bank, 2009)Places do well when they promote transformations along the dimensions of economic geography: higher densities as cities grow; shorter distances as workers and businesses migrate closer to density; and fewer divisions as nations lower their economic borders and enter world markets to take advantage of scale and trade in specialized products. World Development Report 2009 concludes that the transformations along these three dimensions density, distance, and division are essential for development and should be encouraged. The conclusion is controversial. Slum-dwellers now number a billion, but the rush to cities continues. A billion people live in lagging areas of developing nations, remote from globalizations many benefits. And poverty and high mortality persist among the world’s bottom billion, trapped without access to global markets, even as others grow more prosperous and live ever longer lives. Concern for these three intersecting billions often comes with the prescription that growth must be spatially balanced. This report has a different message: economic growth will be unbalanced. To try to spread it out is to discourage it to fight prosperity, not poverty. But development can still be inclusive, even for people who start their lives distant from dense economic activity. For growth to be rapid and shared, governments must promote economic integration, the pivotal concept, as this report argues, in the policy debates on urbanization, territorial development, and regional integration. Instead, all three debates overemphasize place-based interventions. Reshaping Economic Geography reframes these debates to include all the instruments of integration spatially blind institutions, spatially connective infrastructure, and spatially targeted interventions. By calibrating the blend of these instruments, today’s developers can reshape their economic geography. If they do this well, their growth will still be unbalanced, but their development will be inclusive.Publication Impact Evaluation in Practice, Second Edition(Washington, DC: Inter-American Development Bank and World Bank, 2016-09-13)The second edition of the Impact Evaluation in Practice handbook is a comprehensive and accessible introduction to impact evaluation for policy makers and development practitioners. First published in 2011, it has been used widely across the development and academic communities. The book incorporates real-world examples to present practical guidelines for designing and implementing impact evaluations. Readers will gain an understanding of impact evaluations and the best ways to use them to design evidence-based policies and programs. The updated version covers the newest techniques for evaluating programs and includes state-of-the-art implementation advice, as well as an expanded set of examples and case studies that draw on recent development challenges. It also includes new material on research ethics and partnerships to conduct impact evaluation. The handbook is divided into four sections: Part One discusses what to evaluate and why; Part Two presents the main impact evaluation methods; Part Three addresses how to manage impact evaluations; Part Four reviews impact evaluation sampling and data collection. Case studies illustrate different applications of impact evaluations. The book links to complementary instructional material available online, including an applied case as well as questions and answers. The updated second edition will be a valuable resource for the international development community, universities, and policy makers looking to build better evidence around what works in development.Publication World Development Report 2004(World Bank, 2003)Too often, services fail poor people in access, in quality, and in affordability. But the fact that there are striking examples where basic services such as water, sanitation, health, education, and electricity do work for poor people means that governments and citizens can do a better job of providing them. Learning from success and understanding the sources of failure, this year’s World Development Report, argues that services can be improved by putting poor people at the center of service provision. How? By enabling the poor to monitor and discipline service providers, by amplifying their voice in policymaking, and by strengthening the incentives for providers to serve the poor. Freedom from illness and freedom from illiteracy are two of the most important ways poor people can escape from poverty. To achieve these goals, economic growth and financial resources are of course necessary, but they are not enough. The World Development Report provides a practical framework for making the services that contribute to human development work for poor people. With this framework, citizens, governments, and donors can take action and accelerate progress toward the common objective of poverty reduction, as specified in the Millennium Development Goals.Publication Boom, Bust and Up Again? Evolution, Drivers and Impact of Commodity Prices: Implications for Indonesia(World Bank, Jakarta, 2010-12)Indonesia is one of the largest commodity exporters in the world, and given its mineral potential and expected commodity price trends, it could and should expand its leading position. Commodities accounted for one fourth of Indonesia's Gross Domestic Product (GDP) and more than one fifth of total government revenue in 2007. The potential for further commodity growth is considerable. Indonesia is the largest producer of palm oil in the world (export earnings totaled almost US$9 billion in 2007 and employment 3.8 million full-time jobs) and the sector has good growth prospects. It is also one of the countries with the largest mining potential in view of its second-largest copper reserves and third-largest coal and nickel reserves in the world. This report consists of seven chapters. The first six chapters present an examination and an analysis of the factors driving increased commodity prices, price forecasts, economic impact of commodity price increases, effective price stabilization policies, and insights from Indonesia's past growth experience. The final chapter draws on the findings of the previous chapters and suggests a development strategy for Indonesia in the context of high commodity prices. This section summarizes the contents of the chapters and their main findings.Publication Poverty Reduction in Indonesia : Constructing a New Strategy(Washington, DC, 2001-10-29)The objective of the report is to point at the need for a new poverty strategy, and the areas of action it should cover, where each area should be specifically discussed, addressing the lives of Indonesia's poor, and the tradeoffs policymakers will need to consider, based on the belief that this poverty strategy should emerge from a broad dialogue among stakeholders. First, in broadening poverty, the report looks at the facts of the late 1990s crisis, which revealed the precariousness of Indonesia's gains in reducing expenditure-based poverty. Thus to extend those gains, the poverty strategy needs to be defined, and then redeveloped by acknowledging the multidimensional reality of poverty, and, it is this notion which will lead to making the strategic choices. Second, within the country's political transition to a democratic, decentralized mode of governance, a poverty strategy needs to be consistent with an empowered populace, and democratic policymaking mechanisms. In creating a policy environment for raising the incomes of the poor, the report identifies the resumption of rapid sustainable growth, with rising real wages, employment opportunities, and, limited inflation, including the economic empowerment of the poor, enhanced by poverty-focused public expenditures. Inevitably, the provision of core public services is an area which should address the people's will in local governance policies, focusing on education and health, while providing appropriate infrastructure, and developing safety nets.