Abstract:
Background: There is increasing focus on the strength of primary health care systems in
low and middle-income countries (LMIC). There are important roles for higher quality
district hospital care within these systems. These hospitals are also sources of
information of considerable importance to health systems, but this role, as with the wider
roles of district hospitals, has been neglected.
Key messages: As we make efforts to develop higher quality health systems in LMIC we
highlight the critical importance of district hospitals focusing here on how data on
hospital mortality offers value: i) in understanding disease burden; ii) as part of
surveillance and impact monitoring; iii) as an entry point to exploring system failures;
and iv) as a lens to examine variability in health system performance and possibly as a
measure of health system quality in its own right. However, attention needs paying to
improving data quality by addressing reporting gaps and cause of death reporting. Ideally
enabling the collection of basic, standardised patient level data might support at least
simple case-mix and case-severity adjustment helping us understand variation. Better
mortality data could support impact evaluation, benchmarking, exploration of links
between health system inputs and outcomes and critical scrutiny of geographic variation
in quality and outcomes of care. Improved hospital information is a neglected but broadly
valuable public good.
Conclusion: Accurate, complete and timely hospital mortality reporting is a key attribute
of a functioning health system. It can support countries' efforts to transition to higher
quality health systems in LMIC enabling national and local advocacy, accountability and
action.