Public-private partnership as a solution for integrating genetic services into health care of countries with low and middle incomes

Has translational genomics come of age in Africa?

The rapid increase in genomics research in Africa and the growing promise of precision public health begs the question of whether African genomics has come of age and is being translated into improved healthcare for Africans. An assessment of the continent's readiness suggests that genetic service delivery remains limited and extremely fragile. The paucity of data on mutation profiles for monogenic disorders and lack of large genome-wide association cohorts for complex traits in African populations is a significant barrier, coupled with extreme genetic variation across different regions and ethnic groups. Data from many different populations is essential to developing appropriate genetic services. Of the proposed genetic service delivery models currently used in Africa-Uncharacterized, Limited, Disease-focused, Emerging and Established-the first three best describe the situation in most African countries. Implementation is fraught with difficulties related to the scarcity of an appropriately skilled medical genetic workforce, limited infrastructure and processes, insufficient health funding and lack of political support, and overstretched health systems. There is a strong nucleus of determined and optimistic clinicians and scientists with a clear vision, and there is hope for innovative solutions and technological leapfrogging. However, a multi-dimensional approach with active interventions to stimulate genomic research, clinical genetics and overarching healthcare systems is needed to reduce genetic service inequalities and accelerate precision public health on the continent. Human and infrastructure capacity development, dedicated funding, political will and supporting legislation, and public education and awareness, are critical elements for success. Africa-relevant genomic and related health economics research remains imperative with an overarching need to translate knowledge into improved healthcare. Given the limited data and genetic services across most of Africa, the continent has not yet come of 'genomics' age.

Real-Life Incentives Driving Public-Private Partnership in Diagnostic Services

Background

Diagnostic services are highly critical in the success of treatment processes, overly costly nonetheless. Accordingly, hospitals generally seek the private partnership in the provision of such services. This study intends to explore the incentives owned by both public and private sector in their joint provision of diagnostic services under the public-private partnership agreement.

Method

A qualitative, exploratory study was employed in Tehran hospitals from October 2017 to March 2018. Around 25 face-to-face, semi-structured interviews were conducted with the purposively recruited hospital managers, heads of diagnostic services and managers of private companies. Interviews were transcribed and analyzed using conventional content analysis, assisted by "MAXQDA-12".

Results

Three main categories and nine sub-categories represented the incentives of public sector, and four main categories and seven sub-categories signified those of private sector. The incentives of public sector included the status-quo remediation, upstream requirements, and personal reasons. As such, the individual, social and economic incentives and legal constraints were driving the behavior of the private sector.

Conclusions

Financial problem and gain were the most noted incentives by the partners. Attention to the either side's incentives and aims is likely to ensure the durability and effectiveness of such partnerships in the health sector.

Satisfaction of Nigerian patients with health services: a protocol for a systematic review

BACKGROUND

Patient-based assessment of health services is becoming popular in measuring the standard of care. Both quantitative and qualitative methods are available. Patient satisfaction surveys are commonly used to record the experiences of patients in hospitals, whereas qualitative designs (e.g., interviews and focus group discussions) are used less frequently. To date, there has been no systematic review published devoted to patient satisfaction with health services in Nigeria. We aim to (1) systematically analyze relevant quantitative studies to pinpoint excellent procedures in measuring patient satisfaction with health services, (2) to investigate if a reference method (gold standard method) exists, and (3) to identify relevant topics which are recognized by patients as important for the delivery of a high-quality health service in Nigeria.

METHODS

Searches of eight electronic journal databases, including MEDLINE, EMBASE, CINAHL, PsycINFO, AJOL, CDSR, DARE, and HTA will be conducted to identify studies assessing patient satisfaction with health services in Nigeria. The searches will be supported by manual searches in reference lists of relevant primary studies and systematic reviews. The review will be limited to studies published since 2007. After a stepwise screening process by two reviewers, data from included studies will be extracted and reviewed. The COSMIN RoB checklist will be used to critically appraise included studies. We will carry out an extensive data synthesis to answer the review questions.

DISCUSSION

The intended systematic review will provide information on how the satisfaction of patients with health services has earlier been described and assessed in Nigerian studies. It will establish if a gold standard method exists and synthesize information on topics which might be of special interest to patients. Review findings will enrich the debate on patient-centered care and overall performance of health quality standards in Nigeria.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42018108140.

Knowledge of Genetic Counseling Among Patients With Breast Cancer and Their Relatives at a Nigerian Teaching Hospital

Breast cancer prevalence continues to increase globally, and a significant proportion of the disease has been linked to genetic susceptibility. As we enter the era of precision medicine, genetics knowledge and skills are increasingly essential for achieving optimal cancer prevention and care. However, in Nigeria, patients with breast cancer and their relatives are less knowledgeable about genetic susceptibility to chronic diseases. This pilot study collected qualitative data during in-depth interviews with 21 participants. Of these, 19 participants were patients with breast cancer and two were relatives of patients with breast cancer. Participants were asked questions regarding their knowledge of breast cancer, views on heredity and breast cancer, and views on genetic counseling. Participants' family histories were used as a basis with which to assess their hereditary risk of breast cancer. Participant responses were audio recorded and transcribed manually. The study evaluated patients' and relatives' knowledge of genetic counseling and the use of family history for the assessment of familial risk of breast cancer. This will serve as a guide to the processes of establishing a cancer risk assessment clinic.