Peer-reviewed article
Bottlenecks to child health service delivery – how can Health System Performance Assessment help?
Shuftan N, Rajan D ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This paper describes how Health System Performance Assessment (HSPA) frameworks can be adapted to identify bottlenecks in child health service delivery. The authors argue that existing HSPA tools focus on adult health and miss child-specific challenges. They use child health tracer conditions to reveal system weaknesses, particularly weak primary care coverage that causes parents to bypass local clinics and go directly to hospitals for care that could be managed in outpatient settings.
Key points
- Existing HSPA frameworks are adult-centric and not sensitive to child health challenges
- A major bottleneck is weak primary care coverage of maternal, newborn, child and adolescent health services
- Parents bypass primary health care in favour of hospitals due to limited PHC capacity
- Paediatric patients are often admitted to hospitals for conditions that could be safely managed in outpatient settings
- Child health tracer conditions can help identify system under-performance and flag bottlenecks
Limitations
This is a methodological paper describing a framework rather than reporting empirical findings from a formal evaluation. The document does not provide detailed results from the assessments mentioned, limiting what can be concluded about the magnitude or specificity of the identified bottlenecks.
Abstract
Abstract Health System Performance Assessment (HSPA) is an established tool that can help identify issues with the way health systems work to achieve their intended goals, improve transparency and account-ability, and provide stimulus for reform. However, HSPA frameworks tend to be adult-centric and therefore not generally sensitive to child health challenges. Using a new HSPA framework for Universal Health Coverage, we show how child health tracer conditions can be used to pinpoint system under-performance and flag major bottlenecks impeding service delivery overall. Based on the HSPA framework, health system bottlenecks can be traced backwards to explore possible origins (areas to be targeted for improvement) or forwards to understand potential implications for the achievement of health system goals. The following qualitative and quantitative data are used to highlight major bottlenecks to child health service delivery: eight health system-focused child health assessments which show that one of the main bottlenecks is weak primary care coverage of sexual, reproductive, maternal, newborn, child, and adolescent health services, leading to parents bypassing PHC in favour of hospitals; results from WHO missions (e.g. in Romania and Tajikistan) showing that paediatric patients were often admitted to hospitals for treatment, even for conditions that could be safely managed in the outpatient setting; quantitative data on responsiveness, user experience, client satisfaction and people-centredness from publicly available datasets and national datasets obtained in collaboration with WHO Country Offices for national level data, to contextualize the aforementioned findings.