Peer Review History

Original SubmissionFebruary 18, 2020
Decision Letter - William Joe, Editor

PONE-D-20-04694

Monitoring Universal Health Coverage reforms in primary health care facilities: creating a framework, selecting and field-testing indicators in Kerala, India

PLOS ONE

Dear Dr sankar,

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William Joe

Academic Editor

PLOS ONE

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"This work was supported by the Wellcome Trust/DBT India Alliance Fellowship (https://www.indiaalliance.org/ ). Grant number IA/CPHI/16/1/502653) awarded to Dr Devaki Nambiar. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript"

    

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The manuscript is suitable for publication as such. There are no suggestions for improvement from my review. The background is comprehensive with relevant references. The methodology is described in detail involving the various steps in the Delphi method to get feedback from experts. The discussion component is also well written.

Universal health coverage has always been a important concept and the key domain in all WHO initiatives. Hence it is a important manuscript highlighting findings which are of value for policy markers and designing future interventions pertaining to Primary Health Care.

Reviewer #2: Thanks for sending this paper for review to me. I have read this interesting and very policy-relevant piece titled “Monitoring Universal Health Coverage reforms in primary health care facilities: creating a framework, selecting and field-testing indicators in Kerala, India”. Amid COVID-10 outbreak much has been discussed about Kerala Health System, with the help of this review, I got a chance to read about it.

At an outset, I must appreciate the authors for putting together an outstanding piece of work. The work is well conceptualized, methods are standard and the paper is also drafted well. My comments on this piece are minor.

Following important details are missing from the methods section. Adding them will help the readers to judge the robustness of Delphi technique applied in this study.

1. It would have been useful if authors present descriptive statistics (age, gender, occupation/specialisation and years of experience in the particular service) of the participants (or expert panel).

2. How many people were contacted and what is the rate of participation. At one place authors stated that a large group of experts were contacted, but did not mention how many and what are their basic profiles. How did they reduce biased opinions? What is the selection procedure?

3. What kinds of scales are used to assess the agreement on the subjects/items/indicators? It is good if authors present some descriptive statistics of those results.

4. It will also benefit the readers to know at what level consensus or item consolidation was achieved in both the rounds. At what confidence level, authors have decided to include or exclude an indicator/item.

I hope above comments may help the authors.

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Reviewer #1: Yes: Dr Muslim Abbas Syed

Reviewer #2: Yes: Srinivas Goli

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Revision 1
Decision Letter - William Joe, Editor

Monitoring Universal Health Coverage reforms in primary health care facilities: creating a framework, selecting and field-testing indicators in Kerala, India

PONE-D-20-04694R1

Dear Dr. sankar,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

William Joe

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Thank you for successfully addressing all the points that were mentioned in the previous review. The manuscript is now suitable for publication.

Reviewer #2: Thanks for accepting the suggestion and also providing the additional details. The revised paper is acceptable.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: Yes: Srinivas Goli

We thank Reviewer 1 for the comments and support.

Reviewer 2 comments and author responses

1. It would have been useful if authors present descriptive statistics (age, gender, occupation/specialisation and years of experience in the particular service) of the participants (or expert panel).

We have added a Table 2 (see page 14, line 211) and text (see page 13, lines 201-208, underlined in the manuscript) that describe the characteristics of participants. The text is reproduced below

Nearly half of the experts (48%) who participated in two rounds of the exercise were above fifty years of age and almost two-thirds were male (64%) (see Table 2). Most experts had a domain experience of more than ten years (76%) and nearly half of them (48%) were currently serving as state level specialist consultants or program officers (48%) for public health programs. Participants also included those working in a grassroots implementation like field-level health workers, and primary care doctors – almost all experts had experience delivering primary health care at some stage of their careers.

2. How many people were contacted and what is the rate of participation? At one place authors stated that a large group of experts were contacted but did not mention how many and what are their basic profiles. How did they reduce biased opinions? What is the selection procedure?

This text has been added to the manuscript on pages 13 and line number 199-200. It is reproduced below

A total of 31 participants were invited to participate in two Delphi rounds, out of whom 25 responded (a response rate of 80%, see Figure 2).

The measures to reduce bias in opinion have been added in the manuscript on page 8 line number 169-174 and are reproduced below:

To reduce bias in ranking, the tool consisted of specific information on consideration of how to rank an indicator (S1_File). Experts were encouraged to discuss with their colleagues in the respective domain about the relevance of individual indicators in a comprehensive monitoring framework. A team member visited the experts individually after sending them ranking tool to clarify and doubts in ranking procedure and reiterated the principles to rank them

Information on sampling and the selection procedure has been added on page 7 line number 143-145, It is reproduced below. Profile information, as indicated above is given in table 2 and included in the manuscript on page 14.

Eligibility criteria for participation were: experience of more than five years in relevant domain; first hand experience with primary care in Kerala; and past or present formal role in design and/or delivery of the FHC program

3. What kinds of scales are used to assess the agreement on the subjects/items/indicators? It is good if authors present some descriptive statistics of those results

Details regarding the scale used are included in the manuscript on page 9 line number 175-181 and added to table 1 on page 10. The text is reproduced below

Following standard convention and the procedure undertaken in prior ranking exercises [22], mean and median priority scores were calculated for each indicator by creating decision rules based on the distribution of ranks. For the final indicator list, indicators that received a median rank of 1 were included Table 1). Further, Indicators that received a median rank greater than 1 were included only if the mean rank of the indicator was higher than 2.5.

4. It will also benefit the readers to know at what level consensus or item consolidation was achieved in both the rounds. At what confidence level, authors have decided to include or exclude an indicator/item.

As is the convention, the level of consensus was determined quantitatively by obtaining mean and median of ranking of each indicator provided by the experts. We have decided to include or exclude an indicator/item based on the decision rule indicated on page 9, reproduced above.

Attachments
Attachment
Submitted filename: Response to Reviewers.docx
Formally Accepted
Acceptance Letter - William Joe, Editor

PONE-D-20-04694R1

Monitoring Universal Health Coverage reforms in primary health care facilities: creating a framework, selecting and field-testing indicators in Kerala, India

Dear Dr. Sankar D:

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department.

If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org.

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Thank you for submitting your work to PLOS ONE and supporting open access.

Kind regards,

PLOS ONE Editorial Office Staff

on behalf of

Dr. William Joe

Academic Editor

PLOS ONE

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