developing countries would have access to the information they needed to provide the most effective health care possible with the resources available. The world was at the cusp of the information age: information and communication technologies would mean that lack of access to reliable relevant information would no longer be a barrier to effective health care. Although other factors such as lack of drugs and infrastructure might hinder provision of health care, this would not be the case with information.What then has been achieved in the past 10 years? What have we learnt? And if providing access to reliable information is the single most cost-effective and achievable strategy for sustainable improvement in health care, 2 what steps can we now take to bring us nearer to health information for all (panel)? What has been achieved?Important progress has undoubtedly been made. Information and communication technologies are increasingly available; more and better content is available to a growing number of people, especially those in tertiary hospitals, academic institutions, and urban settings; there are more and better free resources on the internet; there is a larger and wider range of healthinformation support programmes; an international community has evolved that is committed to improving health-care information, with governments and other bodies in developing countries playing an increasingly active part; and politically, access to health-care information has become a key international development issue. Equitable and universal access to health-care information is recognised in the latest draft of WHO's World Report on Knowledge for Better Health 3 as an important part of worldwide strategies to reduce global disparities in health and to achieve the health-related Millennium Development Goals.Progress has been patchy, both geographically (with sub-Saharan Africa generally falling far behind most other regions) and across different health sectors (specialist and academic health care is much better served with information than rural primary care), and overall there is little if any evidence that the majority of health professionals, especially those working in primary health care, are any better informed than they were 10 years ago. The few empirical studies we identified 4-7 and many anecdotal reports suggest that lack of physical access to information (absent, slow, or unreliable internet connectivity, expensive paper, and high subscription cost of products) remains the major barrier to knowledge-based health care in developing countries.However, there are now many successful initiatives that could be extended or replicated. An example is BIREME (http://www.bireme.org), the Latin American Can we achieve health information for all by 2015?Fiona Godlee, Neil Pakenham-Walsh, Dan Ncayiyana, Barbara Cohen, Abel Packer Universal access to information for health professionals is a prerequisite for meeting the Millennium Development Goals and achieving Health for All. However, despite the promises of the informati...

Health care workers in developing countries continue to lack access to basic, practical information to enable them to deliver safe, effective care. This paper provides the first phase of a broader literature review of the information and learning needs of health care providers in developing countries.A Medline search revealed 1762 papers, of which 149 were identified as potentially relevant to the review. Thirty-five of these were found to be highly relevant. Eight of the 35 studies looked at information needs as perceived by health workers, patients and family/community members; 14 studies assessed the knowledge of health workers; and 8 looked at health care practice.The studies suggest a gross lack of knowledge about the basics on how to diagnose and manage common diseases, going right across the health workforce and often associated with suboptimal, ineffective and dangerous health care practices. If this level of knowledge and practice is representative, as it appears to be, it indicates that modern medicine, even at a basic level, has largely failed the majority of the world's population. The information and learning needs of family caregivers and primary and district health workers have been ignored for too long. Improving the availability and use of relevant, reliable health care information has enormous potential to radically improve health care worldwide.

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BackgroundWith the 40th anniversary of the Declaration of Alma-Ata, a global effort is underway to re-focus on strengthening primary health care systems, with emphasis on leveraging community health workers (CHWs) towards the goal of achieving universal health coverage for all. Institutionalizing effective, sustainable community health systems is currently limited by a lack of standard metrics for measuring CHW performance and the systems they work within. Developed through iterative consultations, supported by the Bill & Melinda Gates Foundation and in partnership with USAID and UNICEF, this paper details a framework, list of indicators, and measurement considerations for monitoring CHW performance in low- and middle-income countries.MethodsA review of peer-reviewed articles, reports, and global data collection tools was conducted to identify key measurement domains in monitoring CHW performance. Three consultations were successively convened with global stakeholders, community health implementers, advocates, measurement experts, and Ministry of Health representatives using a modified Delphi approach to build consensus on priority indicators. During this process, a structured, web-based survey was administered to identify the importance and value of specific measurement domains, sub-domains, and indicators determined through the literature reviews and initial stakeholder consultations. Indicators with more than 75% support from participants were further refined with expert qualitative input.ResultsTwenty-one sub-domains for measurement were identified including measurement of incentives for CHWs, supervision and performance appraisal, data use, data reporting, service delivery, quality of services, CHW absenteeism and attrition, community use of services, experience of services, referral/counter-referral, credibility/trust, and programmatic costs. Forty-six indicators were agreed upon to measure the sub-domains. In the absence of complete population enumeration and digitized health information systems, the quality of metrics to monitor CHW programs is limited.ConclusionsBetter data collection approaches at the community level are needed to strengthen management of CHW programs and community health systems. The proposed list of metrics balances exhaustive and pragmatic measurement of CHW performance within primary healthcare systems. Adoption of the proposed framework and associated indicators by CHW program implementors may improve programmatic effectiveness, strengthen their accountability to national community health systems, drive programmatic quality improvement, and plausibly improve the impact of these programs.

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