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Table 3 Indicators for the topic health care services

From: Quality of health care for refugees – a systematic review

Source Donabedian framework Indicator
Home Office (2004) [12] Structure/Process Strategies identifiable at health authority/board level for addressing priority health needs among refugee populations
Sphere (2007) [15] Structure/Process No health facility is out of stock of selected essential medicines and tracer products for more than one week
Sphere (2007) [15] Structure/Process A written outbreak investigation and response plan is available or developed at the beginning of a disaster response.
Sphere (2007) [15] Structure/Process All primary health care facilities have clear standard operating procedures for referrals of patients with NCDs to secondary and tertiary care facilities.
Home Office (2004) [12] Structure Proportion of refugees registered with a General Practitioner (compared with general population)
Home Office (2004) [12] Structure The number of refugee doctors and nurses joining professional registers
Sphere (2007) [15] Structure There are an adequate number of health facilities to meet the essential health needs of all the disaster-affected population:
 - one basic health unit/10,000 population members (basic health units are primary health care facilities where general health services are offered),
 - one health center/50,000 people,
 - one district or rural hospital/250,000 people,
 - >  10 inpatient and maternity beds/10,000 people
Sphere (2007) [15] Structure Utilization rates at health facilities are 2–4 new consultations/person/year among the disaster-affected population and > 1 new consultations/person/year among rural and dispersed populations
Sphere (2007) [15] Structure There are:
 - at least 22 qualified health workers (medical doctors, nurses and midwifes)/10,000 population
 - at least one medical doctor/50,000 population,
 - at least one qualified nurse/10,000 population,
 - at least one midwife/10,000 population.
Sphere (2007) [15] Structure There is at least one Community Health Worker (CHW)/1000 population, one supervisor/10 home visitors and one senior supervisor.
Sphere (2007) [15] Structure Clinicians are not required to consult more than 50 patients a day consistently. If this threshold is regularly exceeded, additional clinical staff are recruited.
Sphere (2007) [15] Structure Primary health care services are provided to the disaster-affected population free of charge at all government and non-governmental organization facilities for the duration of the disaster response.
Sphere (2007) [15] Structure All health facilities have trained staff, sufficient supplies and equipment for clinical management of rape survivor services based on national or WHO protocols.
Sphere (2007) [15] Structure All primary health care facilities have antimicrobials to provide syndromic management to patients presenting with symptoms of an STI.
Sphere (2007) [15] Structure All health facilities have trained staff and systems for the management of multiple casualties.
Sphere (2007) [15] Structure All health facilities have trained staff and systems for the management of mental health problems.
Sphere (2007) [15] Structure All primary health care facilities have adequate medication for continuation of treatment of individuals with NCDs who were receiving treatment before the emergency.
UNHCR (2006) [14] Structure Do returnees have access to emergency and primary health care services without discrimination?
UNHCR (2006) [14] Structure Will there be a possibility for returnee to continue ART in returnee area?
UNHCR (2006) [14] Structure Number of persons per primary health care facility
UNHCR (2006) [14] Structure Annual no. of consultations at primary health care facilities per person
UNHCR (2006) [14] Structure Percentage of live births attended by skilled personnel (excl. TBAs)
UNHCR (2006) [14] Structure Do asylum-seekers/refugees have access to antiretroviral therapy from any source, if available in hosting community?
UNHCR (2006) [14] Structure Do asylum-seekers/refugees have access to primary health care services?
UNHCR (2013) [13] Structure Health Insurance Requirement
UNHCR (2013) [13] Structure Access to health care
Home Office (2004) [12] Process Refugee involvement in Patient Advisory & Liaison Services and similar initiatives
Home Office (2004) [12] Process Patient information available in culturally appropriate form regarding service entitlements, provision and relevant health risks.
Sphere (2007) [15] Process All health facilities and agencies regularly provide a HIS report within 48 h of the end of the reporting period to the lead agency.
Sphere (2007) [15] Process All health facilities and agencies report cases of epidemic-prone diseases within 24 h of onset of illness.
Sphere (2007) [15] Process The lead agency produces a regular overall health information report, including analysis and interpretation of epidemiological data, as well as a report on the coverage and utilization of the health services.
Sphere (2007) [15] Process The lead agency has developed a health sector response strategy document to prioritize interventions and define the role of the lead and partner agencies at the onset of an emergency response.
Sphere (2007) [15] Process Standardized case management protocols for the diagnosis and treatment of common infectious diseases are readily available and consistently used.
Sphere (2007) [15] Process Health agencies report suspected outbreaks to the next appropriate level within the health system within 24 h of detection.
Sphere (2007) [15] Process The lead health agency initiates investigation of reported cases of epidemic prone diseases within 48 h of notification.
Sphere (2007) [15] Process All children under 5 years old presenting with malaria have received effective antimalarial treatment within 24 h of onset of their symptoms.
Sphere (2007) [15] Process All children under 5 years of age presenting with diarrhea have received both oral rehydration salts (ORS) and zinc supplementation.
Sphere (2007) [15] Process All children under 5 years of age presenting with pneumonia have received appropriate antibiotics.
Home Office (2004) [12] Outcome Utilization rates of specialized services (e.g., antenatal care, mental health services, chiropody services, NHD Direct, etc.) by refugees (compared with general population)
Home Office (2004) [12] Outcome Refugees reported satisfaction with service provision.
OECD (2015) [11] Outcome Health care
Sphere (2007) [15] Outcome Upon completion of measles vaccination campaign:
 - at least 95% of children aged 6 months to 15 years have received measles vaccination;
 - at least 95% of children aged 6–59 months have received an appropriate dose of Vitamin A.
Sphere (2007) [15] Outcome Once routine EPI services have been re-established, at least 90% of children aged 12 months have had three doses of DPT (diphtheria, pertussis and tetanus), which is the proxy indicator for fully immunized children.
UNHCR (2006) [14] Outcome Measles vaccination coverage rate
UNHCR (2006) [14] Outcome Percentage of female members in asylum seeker/refugee representative bodies
UNHCR (2006) [14] Outcome Percentage of needs met for sanitary materials
  1. STI sexually transmitted infection(s), NCD noncommunicable diseases, ART antiretroviral therapy, TBA traditional birth attendant(s), EPI Expanded Program on Immunization