Effectiveness

In the effectiveness domain, we constructed eleven indicators relating to the prevention and management of common chronic conditions, in the areas of: (1) management of hypertension; (2) management of diabetes; (3) medical treatment for depression; (4) breast cancer screening; (5) cervical cancer screening; (6) eye care; and (7) dental care. Respondents self-reported the management and prevention services of common chronic conditions they received. In the case of hypertension, respondents were considered to have hypertension if they self-reported having a diagnosis of hypertension, or if they had a mean systolic blood pressure of ≥140 mmHg or diastolic blood pressure of ≥90 mmHg. Those respondents identified as having hypertension, but not self-reporting the condition, were defined as being undiagnosed hypertensive. Controlled hypertension was defined as those who had hypertension but having a mean systolic blood pressure of ≤140 mmHg and diastolic blood pressure of ≤90 mmHg.

The assessment of coverage of cancer screening was based on the responses to the following questions from the SAGE: “When was the last time you had a mammography?” and “When was the last time you had a pelvic examination?” Respondents who answered positively for pelvic examination were then asked: “The last time you had a pelvic examination, did you have a Pap smear test?” Following commonly used guidelines for breast and cervical cancer screening in LMICs, coverage of breast cancer screening was defined as the percentage of women aged 50–74 years old who had a mammography in the past 3 years, and coverage of cervical cancer screening was defined as the percentage of women aged 25–69 years old who had a pap smear in the past 3 years [23].