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Reflecting on Unconventional Methods in Primary Health Care Measurement: Q&A with Professor Justine Davies

We are coming to our last stretch of the Novel Measurement for Performance Improvement Challenge, developed by MIT Solve and the Bill and Melinda Gates Foundation. A key component of the Custom Challenge is to call upon “unconventional methods” to measure primary health care in low- and middle-income countries (LMICs).

Justine Davies, Professor at the University of Birmingham, is a distinguished judge for this challenge and a public health expert with a broad range of research portfolios focusing on improving health systems access, health economics and prediction modeling, and epidemiology. She shares her reflections on the Challenge, including thoughts on what might constitute “unconventional methods" in primary health care measurement. 

Why is the Novel Measurement Challenge such a pressing issue for us to explore right now?

Data collection in low-resource settings is really difficult because the systems aren't there to collect data. And even if the systems were present, the personnel aren’t there to manage the process. Additionally, with multiple reporting requests from different vendors like governments and research organizations, many people in low-resource areas often end up inputting the same data into lots of different systems for various requirements. 

Data for effectiveness measurements are neglected as well as data for other quality measurements. Quality measurements are conceptualized by the Institute of Medicine Quality Outcomes Framework. This includes six domains: things such as the timeliness of care, as well as the effectiveness of care, and whether that care is patient centered. All of these things affect effectiveness. For example, if patients find that care is not patient-centered and they are treated badly they're not likely to return for help. 

During our Application Clinic, there were a few questions regarding the concept of “unconventional methods” in primary health care measurement. Could you please share your personal reflection on this concept?

Unconventional measures or methods are quite difficult to define because it is difficult to think outside of our normal daily experience. Also what is unconventional in one setting may be completely conventional in another. 

It’s also important to consider the utility of unconventional measures or methods; what is the purpose of them? When they have a purpose they can absolutely leapfrog over other conventional means of collecting data leading to measures and methods that are pioneering in LMICs.

The other thing is the feasibility of collecting data using them. Unconventional measures and methods can be highly useful and contextually unconventional but also they might not be feasible to collect. So unconventional methods need to check multiple boxes; they need to be unconventional in a specific setting, they need to be feasible to collect data with, and the data they collect needs to be of high utility. 

What role can technology play in improving measurement practices for primary health care outcomes in low-resource settings? 

I think technology is absolutely essential. Finding a technological solution to collect data in whatever form that data comes, whether numerical, picture format, or video format, is crucial. However, one needs to bear in mind the technological constraints of different countries and how it is possible to overcome those technological constraints.

Why are you excited about this challenge and joining us as a judge? What are some characteristics of the selected solution you are hoping to see? 

Health systems in LMICs are in need of good, quality data to be captured to enable them to improve. During the development of the Millennium Development Goals, everybody focused on silos of care—for example, infectious diseases and the data for that can more or less be easily collected onto paper. Now the world has woken up to the fact that chronic conditions are a problem and that poses a real challenge for data collection in low-resource settings because not only does high-quality data need to be collected, it needs to be collected in a linked manner for individuals with conditions who are going to be returning to care many times for the same condition. That is what excites me because it's a really difficult challenge to solve and anything by nature of being difficult is very exciting!

And what excites me about being a judge on this is also to learn what novel solutions people will pose that may actually propel us forward in solving health challenges. What I am looking for is something that makes me think, “wow, that will really bring together primary health care measurement in a way that will revolutionize solving people's problems.” I spend my days and nights looking at solutions that don't quite work, so I'm hoping to see solutions that work, in terms of novelty, utility, feasibility, and sustainability so once the funding is gone, this solution will be one that people in the country want to maintain and can maintain.

Applications for the Novel Measurement for Performance Improvement Challenge close at 8pm EDT on August 9, 2022. If you are passionate about primary health care measurement and if you have a solution you believe can address one/all of the challenge’s dimensions, we strongly encourage you to apply! Please contact Khanh Vu at you have any questions.e look forward to reading your novel solutions! 

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