Dear Dr. Rawlinson and Dr. El-Sadr
Dr. Rawlinson, thank you for writing this message and alerting me to the El-Sadr / De Cock paper.
I have been interested in the challenge of measurement since my student days in engineering (mechanical sciences) ... and then in different ways as an economics student and later again as an accountant. In some ways the corporate world and accountancy are better at measurement than other parts of society ... but as many have noted, including Dr. Muhammad Yunus, accountants only measure money profit and that is not enough. The corporate world has solved this for its own purposes by having a deep system of performance metrics and management information, but nothing has happened yet for the society at large, though people are trying.
In society ... and in the health sector ... from my perspective it is not that data are lacking ... it is more that data are disorganized ... and either too much about something and not enough about something else ... and the techniques for validating the data usually missing. In other words, the whole area of data management is missing ... and before that, the work on data architecture is also missing. Techniques for the efficient use of data that are used in accountancy are rarely if ever used in the socio-economic arena.
Why do we need data? I have always used to data to get good decisions made ... as an accountant I have seen my job to be to get good decisions made, not to make good decisions ... and a good decision is one that does the job at the least possible cost. In the corporate world, that is making profit with the least investment ... in the health sector I would imagine it is the most good health at the least cost.
The most good health may be quite difficult to quantify ... but not impossible. The DALY (disability adjusted life year) measure is an attempt to do this ... but not, in my view, really suitable for what I believe is needed. I have chosen to use a standard value approach. In a perfect world everyone would have good health ... so premature death and morbidity detract from the perfect world. These events can be quantified as negative quantities. Good health in the population has a value ... calculated on a standard basis ... and these health negatives reduce this value.
Costs are money, but also the consumption of value even where it is not monetized. Donated medical supplies are free to the user but are not free to the donor that had to purchase the items. Potable water may not have a price ... but it does have a cost nevertheless. Cost efficiency is when the cost is what it should be ... and good cost data will show what elements of cost are out of control and need addressing.
When the costs of healthcare in the community improve the health status in the community, there is a positive outcome ... and it is this that we should be optimizing. How best to do this will vary in some way community by community.
In some places where there are multiple diseases, it makes sense for the infrastructure to be shared ... for the staff to combine where it makes sense ... for the disease specific programs to share resources. A patient in a community needs to be diagnosed after they have presented at a health facility, and not have to self-diagnose before going to a disease specific clinic!
While I have heard since I was very young that prevention is better than cure ... most health systems do rather little to ensure that there is the maximum of prevention. The prevailing system of measurement does not encourage prevention ... but worse, the present systems of remuneration and incentive ... the present system of program funding ... actively discourage prevention. I would respectfully suggest that data about health outcomes in communities where there is no possibility of active prevention and early diagnosis will be very different from data about health in communities where there is a competent community health worker and easy access to a reasonably well equipped health clinic.
I have made considerable progress in developing a system of Community Analytics (CA) ... this system aims to be easy and useful ... low cost and valuable. In part it embraces old ideas ... but it works on top of technology that is 21st century ... mobile phones, text messages, relational databases and uses FrontlineSMS to link the bits together. The aim is to do what is important ... management information that helps get good decisions made so that there may be sustainable socio-economic progress for real people
This is getting long ... as I think you can sense ... your points resonated with me. Thanks
Sincerely
Peter Burgess
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Peter Burgess
Tr-Ac-Net Inc ... The Transparency and Accountability Network
Community Analytics (CA)
Integrated Malaria Management (IMM)
Microfinance Focus Magazine in New York
website: www.tr-ac-net.org
tel: 917 432 1191 or 212 772 6918 or 212 744 6469
skype: peterburgessnyc
Books: Search Peter Burgess at www.lulu.com
mailto:peterbnyc@gmail.com