02487nas a2200241   4500000000100000008004100001260003700042653005700079653004900136653002100185100001400206700001600220700001100236700001100247700001700258700001000275245016200285856009800447300001300545490000700558520166600565022001402231       2020                            d  bPublic Library of Science (PLoS)10aGeneral Biochemistry, Genetics and Molecular Biology10aGeneral Agricultural and Biological Sciences10aGeneral Medicine1 aNambiar D1 aSankar D. H1 aNegi J1 aNair A1 aSadanandan R1 aJoe W00aMonitoring Universal Health Coverage reforms in primary health care facilities: Creating a framework, selecting and field-testing indicators in Kerala, India  uhttps://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0236169&type=printable  ae02361690 v153 aIn line with the Sustainable Development Goals (SDGs) and the target for achieving Universal Health Coverage (UHC), state level initiatives to promote health with “no-one left behind” are underway in India. In Kerala, reforms under the flagship Aardram mission include upgradation of Primary Health Centres (PHCs) to Family Health Centres (FHCs, similar to the national model of health and wellness centres (HWCs)), with the proactive provision of a package of primary care services for the population in an administrative area. We report on a component of Aardram’s monitoring and evaluation framework for primary health care, where tracer input, output, and outcome indicators were selected using a modified Delphi process and field tested. A conceptual framework and indicator inventory were developed drawing upon literature review and stakeholder consultations, followed by mapping of manual registers currently used in PHCs to identify sources of data and processes of monitoring. The indicator inventory was reduced to a list using a modified Delphi method, followed by facility-level field testing across three districts. The modified Delphi comprised 25 participants in two rounds, who brought the list down to 23 approved and 12 recommended indicators. Three types of challenges in monitoring indicators were identified: appropriateness of indicators relative to local use, lack of clarity or procedural differences among those doing the reporting, and validity of data. Further field-testing of indicators, as well as the revision or removal of some may be required to support ongoing health systems reform, learning, monitoring and evaluation.  a1932-6203