A Practical Approach to the Management of Cancer Patients During the Novel Coronavirus Disease 2019 (COVID-19) Pandemic: An International Collaborative Group

The outbreak of coronavirus disease 2019 (COVID-19) has rapidly spread globally since being identified as a public health emergency of major international concern and has now been declared a pandemic by the World Health Organization (WHO). In December 2019, an outbreak of atypical pneumonia, known as COVID-19, was identified in Wuhan, China. The newly identified zoonotic coronavirus, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), is characterized by rapid human-to-human transmission. Many cancer patients frequently visit the hospital for treatment and disease surveillance. They may be immunocompromised due to the underlying malignancy or anticancer therapy and are at higher risk of developing infections. Several factors increase the risk of infection, and cancer patients commonly have multiple risk factors. Cancer patients appear to have an estimated twofold increased risk of contracting SARS-CoV-2 than the general population. With the WHO declaring the novel coronavirus outbreak a pandemic, there is an urgent need to address the impact of such a pandemic on cancer patients. This include changes to resource allocation, clinical care, and the consent process during a pandemic. Currently and due to limited data, there are no international guidelines to address the management of cancer patients in any infectious pandemic. In this review, the potential challenges associated with managing cancer patients during the COVID-19 infection pandemic will be addressed, with suggestions of some practical approaches. IMPLICATIONS FOR PRACTICE: The main management strategies for treating cancer patients during the COVID-19 epidemic include clear communication and education about hand hygiene, infection control measures, high-risk exposure, and the signs and symptoms of COVID-19. Consideration of risk and benefit for active intervention in the cancer population must be individualized. Postponing elective surgery or adjuvant chemotherapy for cancer patients with low risk of progression should be considered on a case-by-case basis. Minimizing outpatient visits can help to mitigate exposure and possible further transmission. Telemedicine may be used to support patients to minimize number of visits and risk of exposure. More research is needed to better understand SARS-CoV-2 virology and epidemiology.

Critical care triaging in the shadow of COVID-19: Ethics considerations

Since the World Health Organization declared coronavirus disease 2019 (COVID-19) a Public Health Emergency of International Concern, COVID-19 infection and the associated mortality have increased exponentially, globally. South Africa (SA) is no exception. Concerns abound over whether SA's healthcare system can withstand a demand for care that is disproportionate to current resources, both in the state and private health sectors. While healthcare professionals in SA have become resilient and adept at making difficult decisions in the face of resource limitations, a surge in COVID-19 cases could place a severe strain on the country's critical care services and necessitate unprecedented rationing decisions. This could occur at two critical points: access to ventilation, and withdrawal of intensive care in non- responsive or deteriorating cases. The ethical dimensions of decision-making at both junctures merit urgent consideration.

Integrating the gender dimension in teaching, research content & knowledge and technology transfer: Validating the EFFORTI evaluation framework through three case studies in Europe

Gender equality and gender mainstreaming in research is one of the six European Research Area (ERA) priorities. Integrating the gender dimension in research content and teaching is one of its three objectives. It is arguably the objective where least progress has been made. In this article we contribute to the evidence base by applying the EFFORTI evaluation framework to three empirical case study interventions that aim to integrate the gender dimension in tertiary education and research content. Comparison is based on an evaluation of the design of the intervention, those factors that have enabled/ hindered its implementation as well as an assessment of outcomes and impacts. The findings of the case studies highlight the importance of design, specifically regarding resources, legal status and the definition and operationalisation of the gender concept. Implementation hinges on top-level institutional commitment and mainstreaming gender studies with support of a central unit and crucially gender competence. A lack of recognition and status of gender studies and subsequent innovations was seen to hamper implementation. Outcomes and impacts included an increased awareness and interest in gender, increased gender competence, a push towards gender equality regarding representation and organisational change as well as an improved accreditation process and more and better research.

[Recommendations for resource management in intensive care units during the COVID-19 pandemic]

This document aims to provide evidence-based recommendations to estimate the personal protective equipments (PPE), medical devices, and drugs commonly used in the Intensive Care Unit during the COVID-19 pandemic. A systematic literature review and gray literature assessment was performed, and the evidence was categorized using the GRADE methodology. Then a predictive model was built to support the estimation of resources needed during 30 days of the pandemic. In the development of these recommendations, 33 publications were included, with variable quality of evidence (low to very low quality). They refer to the use of PPE according to the risk of exposure; management and reuse of PPE, and the stock of drugs and medical devices needed for the care of patients with COVID-19. It is important to remark the difficult in estimating and managing the number of essential supplies and equipment required during a pandemic. The model allowed us to predict the resources required to provide critical care during 30 days of pandemic activity. Given the constant evolution of COVID-19, these recommendations might change as evidence evolves.

Equity in aid allocation and distribution: A qualitative study of key stakeholders in Northern Uganda

The Sustainable Development Goals have spurred a growing interest in and focus on equitable development. In theory, donors can play an important role in promoting equity within a country by providing services, influencing government policies and incorporating equity into decision-making. However, we know little about whether this actually happens on the ground. We conduct what we believe is the first study to explore the extent to which equity is prioritised in the allocation and distribution of aid, based on in-depth interviews with government officials, bilateral and international donors, and implementing partners operating in Northern Uganda. We find that a broad category of people are perceived to be marginalised/vulnerable, with a substantial segment largely untargeted by major donor programmes. Various stakeholders employ a wide range of strategies to identify the most vulnerable individuals and groups, including the use of available data and statistics, consultation and engagement with relevant stakeholders, and undertaking primary data collection. The strategies used to incorporate equity in aid allocation and distribution include: targeting the regions of Northern Uganda and Karamoja in particular, targeting both refugees and host populations in refugee-hosting districts, prioritising the critically vulnerable in any aid distribution process, and using specific tools and consultants to ensure that major equity issues are addressed in proposals. Challenges undermining the process include poor understanding of the concept of equity among some implementing partners, lack of comprehensively disaggregated data, corruption, and political interference in choice of aid location from government officials and donors.

The Social Value Requirement in Research: From the Transactional to the Basic Structure Model of Stakeholder Obligations

The history of research ethics includes ethical norms that do not neatly fit into a rubric of "human subjects protections" but that are nevertheless seen as fundamental ethical dictates. Among these norms is the so-called social value requirement for clinical research. Recently, however, the ethical foundation for the social value requirement has come under criticism. I seek to clarify the terms of this foundational debate. I contend that much of this discussion-both critiques of the social value requirement as well as recent defenses-is predicated on a framework of research ethics that I refer to as the "transactional model of stakeholder obligations." I argue that this model does not fully capture the ethical considerations that ought to inform the design and conduct of clinical research, and I introduce and defend an alternative framework that I call the "basic structure model of stakeholder obligations." The basic structure model is grounded in a claim that clinical research plays a direct role in establishing the justice or injustice of our social organization and should therefore be governed more explicitly by justice-based considerations. As such, the model explicitly accounts for the fundamentally social nature of the research enterprise itself. In addition to defending the basic structure model, I show how it provides a more stable foundation for the social value requirement, and I consider some worries about whether the model may be too demanding in practice.

A Scoping Review of Investment Cases for Vaccines and Immunization Programs

BACKGROUND

Many investment cases have recently been published intending to show the value of new health investments, but without consistent methodological approaches.

OBJECTIVES

To conduct a scoping review of existing investment cases (using vaccines and immunization programs as an example), identify common characteristics that define these investment cases, and examine their role within the broader context of the vaccine development and introduction.

METHODS

A systematic search was conducted from January 1980 to November 2017 to identify investment cases in the area of vaccines and immunization programs from gray literature and electronic bibliographic databases. Investment case outcomes, objectives, key variables, target audiences, and funding sources were extracted and analyzed according to their reporting frequency.

RESULTS

We found 24 investment cases, and most of them aim to provide information for decisions (12 cases) or advocate for a specific agenda (9 cases). Outcomes presented fell into 4 broad categories-burden of disease, cost of investment, impact of investment, and other considerations for implementation. Number of deaths averted (70%), incremental cost-effectiveness ratios (67%), and reduction in health and socioeconomic inequalities (54%) were the most frequently reported outcome measures for impact of investment. Health system capacity (79%) and vaccine financing landscape (75%) were the most common considerations for implementation. A sizable proportion (41.4%) of investment cases did not reveal their funding sources.

CONCLUSIONS

This review describes information that is critical to decision making about resource mobilization and allocation concerning vaccines. Global efforts to harmonize investment cases more broadly will increase transparency and comparability.

Supply chain management and accessibility to point-of-care testing in resource-limited settings: a systematic scoping review

BACKGROUND

World Health Organization (WHO) has created an essential list of in-vitro diagnostics. Supply chain management (SCM) is said to be the vehicle that ensures that developed point-of-care (POC) tests reach their targeted settings for use. We therefore, mapped evidence on SCM of and accessibility to POC testing (availability and use of POC tests) in low- and middle-income countries (LMICs).

METHODS

We conducted a systematic scoping review using Arksey and O'Malley's framework as a guide. We searched PubMed; CINAHL; MEDLINE; WEB of Science; Science Direct; and Google Scholar databases for studies that focused on POC diagnostic tests and SCM. The review included studies that were undertaken in 140 countries defined by the World Bank as LMICs published up to August 2017. Two reviewers independently screened the abstracts and full articles against the eligibility criteria. The study used the mixed methods appraisal tool version 2011 to assess the risk of bias for the included studies. NVivo version 11 was employed to extract themes from all included studies and results presented using a narrative approach.

RESULTS

Of 292 studies identified in this review, only 15 published between 2009 and 2017 included evidence on POC diagnostics and SCM. Of the 15 studies, three were conducted in Zambia, one each in Mozambique, Uganda, Guatemala; South Africa, one in Burkina Faso, Zimbabwe, and one multi-country study (Tanzania, Uganda, China, Peru and Zambia and Brazil). Six studies were not country specific since they were not primary studies. Majority of the studies reported stock-outs of HIV, syphilis, and malaria POC tests. There was a moderate to substantial level of agreement between the reviewers' responses at full article screening stage (Kappa statistic = 0.80, p < 0.01). Nine studies underwent methodological quality appraisal and all, scored between 90 and 100%.

CONCLUSIONS

The results demonstrated limited published research on SCM of and accessibility to POC testing in LMICs. Further studies aimed at investigating SCM of POC tests in resource-limited settings to identify the barriers/challenges and provide a context-specific evidence-based solutions for policy/decision makers, implementers, and POC developers, funders, and development partners would be essential.

PROSPERO REGISTRATION NUMBER

CRD42016043711.

The burden of femoral shaft fractures in Tanzania

BACKGROUND

Road traffic injuries disproportionately affect low- and middle-income countries (LMICs) and are associated with femur fractures that lead to long-term disability. Information about these injuries is crucial for appropriate healthcare resource allocation. The purpose of this study is to estimate the incidence of femoral shaft fractures in Tanzania and describe the unmet surgical burden.

METHODS

Study sites included six government hospitals across Tanzania. Investigators collected data from hospital admission and procedural logbooks to estimate femoral shaft fracture incidence and their treatment methods. Semi-quantitative interviews were conducted with relevant hospital personnel to validate estimates obtained from hospital records. Investigators gathered road traffic incident (RTI) statistics from national police reports and calculated femur fracture:RTI ratios.

RESULTS

Femoral shaft fracture annual incidence rate ranged from 2.1 to 18.4 per 100,000 people. Median low and high femur fracture:RTI ratio were 0.54 and 0.73, respectively. At smaller hospitals, many patients (5-25%) were treated with traction, and a majority (70-90%) are referred to other centers. Barriers to surgery at each hospital include a lack of surgical implants, equipment, and personnel.

CONCLUSIONS

The incidence rate is similar to previous estimations, and it is consistent with an increased femoral shaft fracture incidence in Tanzania when compared to higher income countries. The femur fracture:RTI ratio may be a valid tool for estimating femur fracture incidence rates. There is an unmet orthopaedic surgical burden for femur fractures treatment at rural hospitals in Tanzania, and the barriers to treatment could be targets for future interventions.

Putting your money where your mouth is: Geographic targeting of World Bank projects to the bottom 40 percent

The adoption of the shared prosperity goal by the World Bank in 2013 and Sustainable Development Goal 10, on inequality, by the United Nations in 2015 should strengthen the focus of development interventions and cooperation on the income growth of the bottom 40 percent of the income distribution. This paper contributes to the incipient literature on within-country allocations of development institutions and assesses the geographic targeting of World Bank projects to the bottom 40 percent. Bivariate correlations between the allocation of project funding approved over 2005–14 and the geographical distribution of the bottom 40 as measured by survey income or consumption data are complemented by regressions with population and other potential factors affecting the within-country allocations as controls. The correlation analysis shows that, of the 58 countries in the sample, 41 exhibit a positive correlation between the shares of the bottom 40 and World Bank funding, and, in almost half of these, the correlation is above 0.5. Slightly more than a quarter of the countries, mostly in Sub-Saharan Africa, exhibit a negative correlation. The regression analysis shows that, once one controls for population, the correlation between the bottom 40 and World Bank funding switches sign and becomes significant and negative on average. This is entirely driven by Sub-Saharan Africa and not observed in the other regions. Hence, the significant and positive correlation in the estimations without controlling for population suggests that World Bank project funding is concentrated in administrative areas in which more people live (including the bottom 40) rather than in poorer administrative areas. Furthermore, capital cities receive disproportionally high shares of World Bank funding on average.

A new approach for resource allocation for black spot treatment (case study: The road network of Iran)

Currently, spatial and temporal distribution of safety resources in Iran is entirely based on expert opinions, regardless of network priorities. Considering the lack of resources for implementing safety treatments, prioritizing unsafe points is an important and complicated issue where the effectiveness of each safety treatment option should be thoroughly investigated. The political, social, and environmental aspects should also be taken into consideration, including social and political pressures and officials talks on less important topics. Obviously, this inappropriate resource allocation poses a serious challenge to the expected goals. In this study, a methodology based on economic and social issues is proposed to optimize the annual budget allocation for eliminating or reducing the risk of accident-prone points. In this methodology, the spatial and temporal distribution of budget is determined using a mathematical model aimed to maximize the benefits of reducing the accidents after deducting the costs of implementing the safety countermeasures. The outputs of this model include the safety countermeasure alternatives and a five-year time schedule for implementing them, or the alternative of no action with regard to budget, social, and judicial constraints. In order to evaluate the proposed method, it is applied to the road network of Iran and the results are compared with those of the conventional method that is currently used for resource allocation in this country. The results show that the proposed method leads to 15% higher benefits compared to the conventional method. Moreover, this method makes 641 safe points, which is about 17% more than the safe points resulted from the existing method. Therefore, the proposed method brings about a safer network as a result of the optimal allocation of available resources.

Measuring Public Preferences for Health Outcomes and Expenditures in a Context of Healthcare Resource Re-Allocation

BACKGROUND

The final outcome of any resource allocation decision in healthcare cannot be determined in advance. Thus, decision makers, in deciding which new program to implement (or not), need to accommodate the uncertainty of different potential outcomes (i.e., change in both health and costs) that can occur, the size and nature (i.e., 'bad' or 'good') of these outcomes, and how they are being valued. Using the decision-making plane, which explicitly incorporates opportunity costs and relaxes the assumptions of perfect divisibility and constant returns to scale of the cost-effectiveness plane, all the potential outcomes of each resource allocation decision can be described.

OBJECTIVE

In this study, we describe the development and testing of an instrument, using a discrete choice experiment methodology, allowing the measurement of public preferences for potential outcomes falling in different quadrants of the decision-making plane.

METHOD

In a sample of 200 participants providing 4200 observations, we compared four versions of the preference-elicitation instrument using a range of indicators.

RESULTS

We identified one version that was well accepted by the participants and with good measurement properties.

CONCLUSION

This validated instrument can now be used in a larger representative sample to study the preferences of the public for potential outcomes stemming from re-allocation of healthcare resources.

A multicriteria resource allocation model for the redesign of services following birth

BACKGROUND

Many healthcare services are under considerable pressure to reduce costs while improving quality. This is particularly true in the United Kingdom's National Health Service where postnatal care is sometimes viewed as having a low priority. There is much debate about the service's redesign and the reallocation of resources, both along care pathways and between groups of mothers and babies with different needs. The aim of this study was to develop a decision support tool that would encourage a systemic approach to service redesign and that could assess the various quality and financial implications of service change options making the consequent trade-offs explicit. The paper describes the development process and an initial implementation as a preliminary exploration of the possible merits of this approach.

METHODS

Other studies have suggested that combining multicriteria decision analysis with programme budgeting and marginal analysis might offer a suitable basis for resource allocation decisions in healthcare systems. The Postnatal care Resource Allocation Model incorporated this approach in a decision support tool to analyse the consequences of varying design parameters, notably staff contacts and time, on the various quality domains and costs. The initial phase of the study focussed on mapping postnatal care, involving interviews and workshops with a variety of stakeholders. This was supplemented with a literature review and the resultant knowledge base was encoded in the decision support tool. The model was then tested with various stakeholders before being used in an NHS Trust in England.

RESULTS

The model provides practical support, helping staff explore options and articulate their proposals for the redesign of postnatal care. The integration of cost and quality domains facilitates trade-offs, allowing staff to explore the benefits of reallocating resources between hospital and community-based care, and different patient-categories.

CONCLUSIONS

The main benefits of the model include its structure for assembling the key data, sharing evidence amongst multi-professional teams and encouraging constructive, systemic debate. Although the model was developed in the context of the routine maternity services for mothers and babies in the days following birth it could be adapted for use in other health care services.

Effective Implementation of Peri-operative Local Guidelines for Metabolic Surgery in Patients with Diabetes Mellitus in a Tier 4 Setting Demonstrate Improved Work Efficiency and Resource Allocation

BACKGROUND

Dynamic changes in glycaemia predominate peri-operatively in patients with type 2 diabetes mellitus (T2DM) undergoing metabolic surgery. There is a lack of consensus and clear guidance on effective glycaemic management of such patients. The aim of this study was to design, pilot, and implement a proforma to improve consistency of glycaemic management and clarity of communication with healthcare professionals following metabolic surgery in patients with T2DM, thereby reducing unnecessary diabetes specialist nurse (DSN) referrals.

METHODS

A proforma was designed and piloted for 12 months to guide healthcare professionals on managing glycaemic therapies for T2DM patients undergoing metabolic surgery. Glycaemic control (HbA1c) and glycaemic therapies were reviewed 3 weeks pre-operatively and a proforma was completed accordingly.

RESULTS

Of the patients with T2DM (n = 34) who underwent metabolic surgery prior to the new proforma being implemented, 71% (n = 24) had a DSN referral. Half of these referrals were deemed unnecessary by the DSNs. Of the patients with T2DM (n = 33) who underwent metabolic surgery following implementation of the proforma, 21% (n = 7) had a DSN referral. Only 10% of these were deemed unnecessary. Despite the reduced DSN input, no diabetes-related complications were reported.

CONCLUSION

Implementation of our proforma effectively halved the proportion of patients with T2DM requiring a DSN referral. Additionally, there was a 40% absolute reduction in the proportion of unnecessary DSN referrals. The proforma improved clarity of communication and guidance for healthcare professionals in the glycaemic management of patients. This also facilitated improved work efficiency and resource allocation.

Urban Resources Selection and Allocation for Emergency Shelters: In a Multi-Hazard Environment

This study explores how emergency shelters can adapt to a multi-hazard environment by geographic information system (GIS) and takes Guangzhou as a case for analysis. The physical suitability of the overall urban resources was first assessed by aiming to select the suitable resources and safe locations for emergency shelters in the context of multiple disasters. Afterward, by analyzing the scale and spatial distribution of affected areas and populations under different types of disaster scenarios, the demand for different kinds of shelters were predicted. Lastly, taking into account the coverage of the affected people, shelters were allocated according to different conditions in the districts. This work will hopefully provide a reference for the construction of emergency shelters and help form emergency operations in order to mitigate the impact of hazards. The issues identified in the study need to be further studied in medium or small-scale cities.

Organizational determinants of evaluation practice in Australian prevention agencies

Program evaluation is essential to inform decision making, contribute to the evidence base for strategies, and facilitate learning in health promotion and disease prevention organizations. Theoretical frameworks of organizational learning, and studies of evaluation capacity building describe the organization as central to evaluation capacity. Australian prevention organizations recognize limitations to current evaluation effectiveness and are seeking guidance to build evaluation capacity. This qualitative study identifies organizational facilitators and barriers to evaluation practice, and explores their interactions in Australian prevention organizations. We conducted semi-structured interviews with 40 experienced practitioners from government and non-government organizations. Using thematic analysis, we identified seven key themes that influence evaluation practice: leadership, organizational culture, organizational systems and structures, partnerships, resources, workforce development and training and recruitment and skills mix. We found organizational determinants of evaluation to have multi-level interactions. Leadership and organizational culture influenced organizational systems, resource allocation and support of staff. Partnerships were important to overcome resource deficits, and systems were critical to embed evaluation within the organization. Organizational factors also influenced the opportunities for staff to develop skills and confidence. We argue that investment to improve these factors would allow organizations to address evaluation capacity at multiple levels, and ultimately facilitate effective evaluation practice.

The influence of evaluation recommendations on instrumental and conceptual uses: A preliminary analysis

Evaluation recommendations are sometimes included in evaluation reports to highlight specific actions to be taken to improve a program or to make other changes to its operational context. This preliminary study sought to examine evaluation recommendations drawn from 25 evaluation reports published by Canadian federal government departments and agencies, in order to examine the evaluation issues covered and the focus of the recommendations. Our results show that in keeping with policy requirements, the evaluation recommendations focused on program relevance, effectiveness and efficiency and economy. Furthermore, a significant number of recommendations also focused on the implementation of more rigorous performance measurement strategies. The focus of the recommendations did not vary by publication date, recommendation type, and organizational sector. The findings also show that for the most part, the management responses produced as part of the broader evaluation process support the recommendations included in the report and identify specific timelines for implementation.

Improving the Hospital Quality of Care during Winter Periods by Optimizing Budget Allocation Between Rotavirus Vaccination and Bed Expansion

BACKGROUND

During each winter the hospital quality of care (QoC) in pediatric wards decreases due to a surge in pediatric infectious diseases leading to overcrowded units. Bed occupancy rates often surpass the good hospital bed management threshold of 85%, which can result in poor conditions in the workplace. This study explores how QoC-scores could be improved by investing in additional beds and/or better vaccination programs against vaccine-preventable infectious diseases.

METHODS

The Cobb-Douglas model was selected to define the improvement in QoC (%) as a function of two strategies (rotavirus vaccination coverage [%] and addition of extra hospital beds [% of existing beds]), allowing improvement-isocurves to be produced. Subsequently, budget minimization was applied to determine the combination of the two strategies needed to reach a given QoC improvement at the lowest cost. Data from Jessa Hospital (Hasselt, Belgium) were chosen as an example. The annual population in the catchment area to be vaccinated was 7000 children; the winter period was 90 days with 34 pediatric beds available. Rotavirus vaccination cost per course was €118.26 and the daily cost of a pediatric bed was €436.53. The target QoC increase was fixed at 50%. The model was first built with baseline parameter values.

RESULTS

The model predicted that a combination of 64% vaccine coverage and 39% extra hospital beds (≈ 13 extra beds) in winter would improve QoC-scores by 50% for the minimum budget allocation.

CONCLUSION

The model allows determination of the most efficient allocation of the healthcare budget between rotavirus vaccination and bed expansion for improving QoC-scores during the annual epidemic winter seasons.

Allocating external financing for health: a discrete choice experiment of stakeholder preferences

Most donors of external financing for health use allocation policies to determine which countries are eligible to receive financial support and how much support each should receive. Currently, most of these policies place a great deal of weight on income per capita as a determinant of aid allocation but there is increasing interest in putting more weight on other country characteristics in the design of such policies. It is unclear, however, how much weight should be placed on other country characteristics. Using an online discrete choice experiment designed to elicit preferences over country characteristics to guide decisions about the allocation of external financing for health, we find that stakeholders assign a great deal of importance to health inequalities and the burden of disease but put very little weight on income per capita. We also find considerable variation in preferences across stakeholders, with people from low- and middle-income countries putting more weight on the burden of disease and people from high-income countries putting more weight on health inequalities. These findings suggest that stakeholders put more weight on burden of disease and health inequalities than on income per capita in evaluating which countries should received external financing for health and that that people living in aid recipient may have different preferences than people living in donor countries. Donors may wish to take these differences in preferences in mind if they are reconsidering their aid allocation policies.

Using discrete-event simulation to increase the efficiency of point of distribution sites

OBJECTIVE

The objective of this research was to develop a computer simulation model that will provide the most optimal allocation of resources for a point of distribution (POD) site.

DESIGN

A baseline assessment was conducted by participants establishing POD sections with no guidance from the investigator. A computer model was built with four stations: triage, registration, screening, and dispensing. The information from the computer simulation was used to design the allocation of volunteers for the experimental group. Once the data were collected, a two-sample t test was used to determine the significance of the difference between the average times of the two groups to complete the POD.

SETTING

The POD site was conducted indoors with volunteers acting as patients, and volunteer nursing students, and pharmacy students acting as POD workers. Volunteers were divided into two groups, group B, experimental and group A, control. Time was recorded using a digital time-stamp at the beginning and at the end of the POD.

INTERVENTIONS

The researcher inputted the total number of volunteers into the model, and the model generated the most applicable ratio for distribution of human capital: a one-to-one ratio of screeners to dispensers.

MAIN OUTCOME MEASURES

The mean time for Group A was 4.55 minutes (95% CI: 4.27, 4.83). The mean time for group B was 3.05 minutes (95% CI: 2.79, 3.31). A two-sample t test and Analysis of Variance of these data show that the difference is meaningful (p < 0.001).

RESULTS

The results show that a discrete-event computer simulation can be used to identify the most efficient use of resources in order to decrease the amount of time that patients are required to participate.

CONCLUSIONS

The discrete-event computer simulation model was found to be effective at identifying ways to in-crease efficiency and reduce the overall time required by patients to complete the POD.

Strengthening health technology assessment systems in the global south: a comparative analysis of the HTA journeys of China, India and South Africa

BACKGROUND

Resource allocation in health is universally challenging, but especially so in resource-constrained contexts in the Global South. Pursuing a strategy of evidence-based decision-making and using tools such as Health Technology Assessment (HTA), can help address issues relating to both affordability and equity when allocating resources. Three BRICS and Global South countries, China, India and South Africa have committed to strengthening HTA capacity and developing their domestic HTA systems, with the goal of getting evidence translated into policy. Through assessing and comparing the HTA journey of each country it may be possible to identify common problems and shareable insights.

OBJECTIVES

This collaborative paper aimed to share knowledge on strengthening HTA systems to enable enhanced evidence-based decision-making in the Global South by: Identifying common barriers and enablers in three BRICS countries in the Global South; and Exploring how South-South collaboration can strengthen HTA capacity and utilisation for better healthcare decision-making.

METHODS

A descriptive and explorative comparative analysis was conducted comprising a Within-Case analysis to produce a narrative of the HTA journey in each country and an Across-Case analysis to explore both knowledge that could be shared and any potential knowledge gaps.

RESULTS

Analyses revealed that China, India and South Africa share many barriers to strengthening and developing HTA systems such as: (1) Minimal HTA expertise; (2) Weak health data infrastructure; (3) Rising healthcare costs; (4) Fragmented healthcare systems; and (5) Significant growth in non-communicable diseases. Stakeholder engagement and institutionalisation of HTA were identified as two conducive factors for strengthening HTA systems.

CONCLUSION

China, India and South Africa have all committed to establishing robust HTA systems to inform evidence-based priority setting and have experienced similar challenges. Engagement among countries of the Global South can provide a supportive platform to share knowledge that is more applicable and pragmatic.