The non-communicable disease e-Cohort for hypertension in Latin America: concept, survey development and study protocol.

Non-communicable diseases like hypertension cause substantial morbidity and mortality in low- and middle-income countries, where limited access to high-quality care contributes to millions of preventable deaths annually. Traditional assessments of health system performance often rely on structural indicators and cross-sectional, overlooking patient experiences and care processes. In Latin America, amid rising cardiovascular disease, longitudinal tools are needed to guide improvements in healthcare delivery models, particularly for chronic diseases such as hypertension.

Trends in vaccination coverage and equity in the Democratic Republic of the Congo from 2017 to 2023.

Introduction: Several routine immunization (RI) strengthening efforts have been implemented in the Democratic Republic of the Congo (DRC) in the last decade. However, there has been no assessment of national or provincial-level trends in inequalities in RI coverage since the implementation of these programs. In this analysis, we aimed to describe trends in childhood vaccination coverage and inequalities from 2017 to 2023 at the national and provincial levels and to compare these trends among groups of provinces where two initiatives have been in place: the Mashako plan and a provincial level public-private partnership using a memorandum of understanding (MOU) approach.

Factors affecting antenatal corticosteroid use in low- and middle-income countries: Facility characteristics, structural readiness, and past performance of CEmONC signal functions.

Antenatal corticosteroids (ACS) utilization is disproportionately limited in low- and middle-income countries where most global preterm newborns who could benefit from this intervention are born. Understanding the factors affecting ACS use is crucial for improving its uptake. This study aimed to investigate facility-level factors associated with ACS use in low-resource countries.

Quality of postnatal care for mothers and neonates in Mexico: Insights from the maternal eCohort study.

Objective: The study aimed to evaluate healthcare use during the postnatal period for mothers and their babies, the content of care received, mothers' perceived quality of care, and the factors influencing these perceptions.

Methods: The study analyzed data from a postnatal survey conducted within the maternal eCohort at the Mexican Institute of Social Security (IMSS). The research involved 973 women aged 18-49 who were recruited following their first antenatal care visit with a family physician at 48 family medicine clinics across eight Mexican states.

Antenatal corticosteroids for pregnant women at risk of preterm labour in low- and middle-income countries: utilisation and facility readiness.

Background: Administering antenatal corticosteroids (ACS) to pregnant women at risk of imminent preterm labour improves newborn survival. However, ACS remains substantially underused in low- and middle-income countries (LMICs), where most preterm births occur globally. Providing ACS in inadequately equipped settings can be harmful.

The role of health systems in shaping vaccine decisions: Insights from Italy, Mexico, the United Kingdom, and the United States.

Background: The demographic drivers of vaccine uptake and confidence have been well-documented in diverse contexts. However, the role of health systems in improving vaccine uptake and confidence has been less discussed particularly in the post-pandemic period.

Methods: Using nationally representative surveys of adults conducted between December 2022 and April 2023 in Italy, Mexico, the United Kingdom (UK), and the United States (US), we examined demographic, health, and health system determinants of vaccine confidence and uptake of four vaccines for adult respondents or their children: COVID-19, influenza, human papillomavirus (HPV), and measles, mumps, and rubella (MMR).

Assessing the quality of childbirth care in Mexico: findings from the maternal eCohort.

Background: In 2022, the Mexican Institute of Social Security (IMSS) launched the "Comprehensive Women-Centered Maternal Health Care Model" (AMIIMSS program) to improve maternal healthcare. This research evaluated the childbirth care quality, comparing outcomes between IMSS and private hospitals and between IMSS hospitals with high and low adherence to the AMIIMSS program, and assessed whether the type of healthcare provider and delivery, the content of care, and the occurrence of obstetric violence were associated with the perceived quality of childbirth care, after controlling for other relevant demographic and clinical covariates.

Methods: Data were collected from an observational IMSS-affiliated eCohort of pregnant women aged 18 to 49, focusing on their experiences, perceptions of healthcare quality, obstetric violence, and health outcomes.

Using an Interactive Voice Response Survey to Assess Patient Satisfaction in Ethiopia: Development and Feasibility Study.

Background: Patient satisfaction surveys can offer crucial information on the quality of care but are rarely conducted in low-income settings. In contrast with in-person exit interviews, phone-based interactive voice response (IVR) surveys may offer benefits including standardization, patient privacy, reduced social desirability bias, and cost and time efficiency. IVR surveys have rarely been tested in low-income settings, particularly for patient satisfaction surveys.

A comprehensive assessment of care competence and maternal experience of first antenatal care visits in Mexico: Insights from the baseline survey of an observational cohort study.

Background: Comprehensive antenatal care (ANC) must prioritize competent, evidence-based medical attention to ensure a positive experience and value for its users. Unfortunately, there is scarce evidence of implementing this holistic approach to ANC in low- and middle-income countries, leading to gaps in quality and accountability. This study assessed care competence, women's experiences during the first ANC visit, and the factors associated with these care attributes.

Antenatal care quality and detection of risk among pregnant women: An observational study in Ethiopia, India, Kenya, and South Africa.

Background: Antenatal care (ANC) is an essential platform to improve maternal and newborn health (MNH). While several articles have described the content of ANC in low- and middle-income countries (LMICs), few have investigated the quality of detection and management of pregnancy risk factors during ANC. It remains unclear whether women with pregnancy risk factors receive targeted management and additional ANC.

Association between achieving adequate antenatal care and health-seeking behaviors: A study of Demographic and Health Surveys in 47 low- and middle-income countries.

Background: Antenatal care (ANC) is essential for ensuring the well-being of pregnant women and their fetuses. This study models the association between achieving adequate ANC and various health and health-seeking indicators across wealth quintiles in low- and middle-income countries (LMICs).

Methods And Findings: We analyzed data from 638,265 women across 47 LMICs using available Demographic and Health Surveys from 2010 to 2022.

Population assessment of health system performance in 16 countries.

Objective: To demonstrate how the new internationally comparable instrument, the People's Voice Survey, can be used to contribute the perspective of the population in assessing health system performance in countries of all levels of income.

Methods: We surveyed representative samples of populations in 16 low-, middle- and high-income countries on health-care utilization, experience and confidence during 2022-2023. We summarized and visualized data corresponding to the key domains of the World Health Organization universal health coverage framework for health system performance assessment.

Routine data in a primary care performance dashboard, Ethiopia.

Objective: To explore the feasibility of building a primary care performance dashboard using DHIS2 data from Ethiopia's largest urban (Addis Ababa), agrarian (Oromia) and pastoral (Somali) regions.

Methods: We extracted 26 data elements reported by 12 062 health facilities to DHIS2 for the period 1 July 2022 to 30 June 2023. Focusing on indicators of effectiveness, safety and user experience, we built 14 indicators of primary care performance covering reproductive, maternal and child health, human immunodeficiency virus, tuberculosis, noncommunicable disease care and antibiotic prescription.

Users' perception of quality as a driver of private healthcare use in Mexico: Insights from the People's Voice Survey.

Objective: The Mexican government has pursued multiple initiatives to improve healthcare coverage and financial protection. Yet, out-of-pocket health spending and use of private sector providers in Mexico remains high. In this paper, we sought to describe the characteristics of public and private healthcare users, describe recent visit quality across provider types, and to assess whether perceiving the public healthcare sector as poor quality is associated with private health sector use.

Data challenges for international health emergencies: lessons learned from ten international COVID-19 driver projects.

The COVID-19 pandemic highlighted the importance of international data sharing and access to improve health outcomes for all. The International COVID-19 Data Alliance (ICODA) programme enabled 12 exemplar or driver projects to use existing health-related data to address major research questions relating to the pandemic, and developed data science approaches that helped each research team to overcome challenges, accelerate the data research cycle, and produce rapid insights and outputs. These approaches also sought to address inequity in data access and use, test approaches to ethical health data use, and make summary datasets and outputs accessible to a wider group of researchers.

Health system quality and COVID-19 vaccination: a cross-sectional analysis in 14 countries.

The social and behavioural determinants of COVID-19 vaccination have been described previously. However, little is known about how vaccinated people use and rate their health system. We used surveys conducted in 14 countries to study the health system correlates of COVID-19 vaccination.

Inequalities in health system coverage and quality: a cross-sectional survey of four Latin American countries.

The premise of health as a human right in Latin America has been challenged by health system fragmentation, quality gaps, a growing burden of chronic disease, sociopolitical upheaval, and the COVID-19 pandemic. We characterised inequities in health system quality in Colombia, Mexico, Peru, and Uruguay. We did a cross-sectional telephone survey with up to 1250 adults in each country.

User-reported quality of care: findings from the first round of the People's Voice Survey in 14 countries.

High-quality care is essential for improving health outcomes, although many health systems struggle to maintain good quality. We use data from the People's Voice Survey-a nationally representative survey conducted in 14 high-income, middle-income, and low-income countries-to describe user-reported quality of most recent health care in the past 12 months. We described ratings for 14 measures of care competence, system competence, and user experience and assessed the relationship between visit quality factors and user recommendation of the facility.

Quality of routine health data at the onset of the COVID-19 pandemic in Ethiopia, Haiti, Laos, Nepal, and South Africa.

Background: During the COVID-19 pandemic, governments and researchers have used routine health data to estimate potential declines in the delivery and uptake of essential health services. This research relies on the data being high quality and, crucially, on the data quality not changing because of the pandemic. In this paper, we investigated those assumptions and assessed data quality before and during COVID-19.

Associations between the stringency of COVID-19 containment policies and health service disruptions in 10 countries.

Background: Disruptions in essential health services during the COVID-19 pandemic have been reported in several countries. Yet, patterns in health service disruption according to country responses remain unclear. In this paper, we investigate associations between the stringency of COVID-19 containment policies and disruptions in 31 health services in 10 low- middle- and high-income countries in 2020.

Effect of the COVID-19 pandemic on health service utilization across regions of Ethiopia: An interrupted time series analysis of health information system data from 2019-2020.

The spread of COVID-19 and associated deaths have remained low in Ethiopia. However, the pandemic could pose a public health crisis indirectly through disruptions in essential health services. The aim of this study was to examine disruptions in health service utilization during the first nine months of the COVID-19 pandemic across 10 regions in Ethiopia.

Tracking health system performance in times of crisis using routine health data: lessons learned from a multicountry consortium.

COVID-19 has prompted the use of readily available administrative data to track health system performance in times of crisis and to monitor disruptions in essential healthcare services. In this commentary we describe our experience working with these data and lessons learned across countries. Since April 2020, the Quality Evidence for Health System Transformation (QuEST) network has used administrative data and routine health information systems (RHIS) to assess health system performance during COVID-19 in Chile, Ethiopia, Ghana, Haiti, Lao People's Democratic Republic, Mexico, Nepal, South Africa, Republic of Korea and Thailand.