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Atake EH. Health system productivity in sub-Saharan Africa: tuberculosis control in high burden countries. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2023; 21:90. [PMID: 38007522 PMCID: PMC10676588 DOI: 10.1186/s12962-023-00485-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 10/05/2023] [Indexed: 11/27/2023] Open
Abstract
BACKGROUND Sixteen of the 30 countries with a high tuberculosis (TB) burden are in Sub-Saharan Africa (SSA). Over 25% of TB deaths occur in the Africa region. This study aims to estimate the productivity changes of TB programs in 16 SSA countries where TB is endemic. METHODS We used Hicks-Moorsteen index to compute and decompose Total factor productivity (TFP), and the β-convergence and σ-convergence tests to check for convergence patterns among SSA countries. RESULTS We found that technological change has been the main driver of the TFP growth, and that increasing technical efficiency may be the first objective in efforts to improve TFP of TB programs. Moreover, the convergence tests reveal significant homogeneity in terms of TFP change between SSA countries studied. CONCLUSION The findings suggest that improving technical efficiency of TB programs mainly calls for better resource allocation, capacity building in governance and management of programs, improved training of the health providers and stronger prevention policies. Policymakers must design models for integration of TB treatment under the universal health insurance schemes.
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Affiliation(s)
- Esso-Hanam Atake
- Department of Economics Sciences, University of Lome (Togo), Lomé, Togo.
- University of Lomé (FASEG), 01BP1515, Lomé, Togo.
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Shafie AA, Mohammed NS, See KF, Ibrahim HM, Wong JHY, Chhabra IK. Efficiency and management factors: finding the balance in Thalassaemia care centres. HEALTH ECONOMICS REVIEW 2022; 12:9. [PMID: 35080678 PMCID: PMC8793162 DOI: 10.1186/s13561-021-00351-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 12/20/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Optimizing efficiency has become increasingly critical with the growing demand for finite healthcare resources driven by population growth and an ageing society. Hence, policymakers are urgently finding more efficient ways to deliver health services. Thalassemia is a complex inherited blood disorder with significant prevalence in Malaysia. The high number of patients put substantial strain on the healthcare system. This study aims to evaluate the technical efficiency of thalassaemia care centres throughout Malaysia and the determinants that affect the efficiency. METHOD Data from 30 public hospitals with thalassaemia care centres were collected. A double bootstrap data envelopment analysis (DEA) approach is used with the assumption of input-oriented and variable-to-scale DEA models to generate technical efficiency scores. Bootstrap truncated regression was later conducted to identify the factors affecting the efficiency scores. RESULTS The mean bias-corrected technical efficiency score has improved to 0.75 in 2017 from 0.71 in 2016. In both years, more than 50% of thalassaemia care centres showed good efficiency scores (0.8-1.0). Management factors that affect the efficiency scores include separation of patient management (β = 0.0653) and budget (β = 0.0843), where they are found to positively affect the efficiency scores. In contrast, having longer operating hours is found to inversely influence the performance levels (β = - 0.4023). CONCLUSIONS The study provides a pioneering framework to evaluate the technical efficiency of thalassaemia treatment centres in public healthcare settings and could provide a useful guide for policymaker and thalassaemia care centre managers to improve efficiency in service delivery to thalassaemia patients and their caregivers without compromising quality of care.
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Affiliation(s)
- Asrul Akmal Shafie
- Discipline of Social & Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pulau Pinang, Malaysia
| | - Noor Syahireen Mohammed
- Discipline of Social & Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pulau Pinang, Malaysia
- Clinical Research Centre, Hospital Sultanah Bahiyah, Kedah, Malaysia
| | - Kok Fong See
- Economics Programme, School of Distance Education, Universiti Sains Malaysia, Pulau Pinang, Malaysia
- Department of Operations and Information Systems, Manning School of Business, University of Massachusetts at Lowell, MA, USA
| | - Hishamshah Mohd Ibrahim
- Deputy Director General’s (Research & Technical Support), Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Jacqueline Hui Yi Wong
- Discipline of Social & Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pulau Pinang, Malaysia
- Pharmacy Department, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Irwinder Kaur Chhabra
- Discipline of Social & Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pulau Pinang, Malaysia
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Djahini-Afawoubo DM, Atake EH. Extension of mandatory health insurance to informal sector workers in Togo. HEALTH ECONOMICS REVIEW 2018; 8:22. [PMID: 30225617 PMCID: PMC6755594 DOI: 10.1186/s13561-018-0208-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 09/06/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND About 90.4% of Togolese workers operate in the informal sector and account for between 20 and 30% of Togo's Gross Domestic Product. Despite their importance in the Togolese economy, informal sector workers (ISW) do not have a health insurance scheme. This paper aims to estimate the willingness-to-pay (WTP) of ISW in order to have access to Mandatory Health Insurance (MHI), and to analyze the main determinants of WTP. METHODS This study used data from the Community-Based Monitoring System (CBMS) project implemented in 2015 by the Partnership for Economic Policy (PEP). It focusses on 4,296 ISW (2,374 in urban areas and 1,922 in rural areas, respectively). The contingent valuation method was used to determine the WTP for the MHI while the Tobit model is used to analyze its determinants. RESULTS AND DISCUSSION Findings indicate that about 92% of ISW agreed to have access to MHI, like for formal sector workers. Overall, ISW are willing to pay 2,569 FCFA (USD 4.7) per month. ISW in the poorest quintiles are willing to allocate a higher proportion of their income (15%) to the premium than the richest quintiles (2.5%). Generally, women are more interested in MHI than men, although men are willing to pay higher premiums (3,168.9 FCFA or USD 5.8) than women (2,077 FCFA or USD 3.8). Women's lower WTP can be explained by their low levels of education and income, and a lack of employment opportunities compared to men. The gender of the head of the household, the size of the household and the education and income levels are the main determinants of WTP. CONCLUSION We conclude that it is possible to extend MHI to ISW as long as their premiums are subsidized. The annual subsidy is estimated at 4.1% of the state current general budget or 96% of the health sector budget. In setting the premium, policy makers should take into account the MHI benefits package, subsidies from the government, and information about the WTP. It is important to emphasize that resource mobilization and management, as well as health services delivery, would be effective only in a context of improved governance.
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Affiliation(s)
| | - Esso-Hanam Atake
- Department of Economic Sciences, University of Lomé (Togo), Lome, West africa Togo
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Guillon J, Cohen A, Das RN, Boudot C, Gueddouda NM, Moreau S, Ronga L, Savrimoutou S, Basmaciyan L, Tisnerat C, Mestanier S, Rubio S, Amaziane S, Dassonville-Klimpt A, Azas N, Courtioux B, Mergny JL, Mullié C, Sonnet P. Design, synthesis, and antiprotozoal evaluation of new 2,9-bis[(substituted-aminomethyl)phenyl]-1,10-phenanthroline derivatives. Chem Biol Drug Des 2018; 91:974-995. [PMID: 29266861 DOI: 10.1111/cbdd.13164] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/04/2017] [Accepted: 12/07/2017] [Indexed: 01/06/2023]
Abstract
A series of new 2,9-bis[(substituted-aminomethyl)phenyl]-1,10-phenanthroline derivatives was synthesized, and the compounds were screened in vitro against three protozoan parasites (Plasmodium falciparum, Leishmania donovani, and Trypanosoma brucei brucei). Biological results showed antiparasitic activity with IC50 values in the μm range. The in vitro cytotoxicity of these molecules was assessed by incubation with human HepG2 cells; for some derivatives, cytotoxicity was observed at significantly higher concentrations than antiparasitic activity. The 2,9-bis[(substituted-aminomethyl)phenyl]-1,10-phenanthroline 1h was identified as the most potent antimalarial candidate with ratios of cytotoxic-to-antiparasitic activities of 107 and 39 against a chloroquine-sensitive and a chloroquine-resistant strain of P. falciparum, respectively. As the telomeres of the parasite P. falciparum are the likely target of this compound, we investigated stabilization of the Plasmodium telomeric G-quadruplexes by our phenanthroline derivatives through a FRET melting assay. The ligands 1f and 1m were noticed to be more specific for FPf8T with higher stabilization for FPf8T than for the human F21T sequence.
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Affiliation(s)
- Jean Guillon
- INSERM U1212, UMR CNRS 5320, ARNA Laboratory, UFR des Sciences Pharmaceutiques, Université de Bordeaux, Bordeaux, France
| | - Anita Cohen
- Laboratory of Parasitology, UMR-MD3, Faculty of Pharmacy, Aix-Marseille University, Marseille, France
| | - Rabindra Nath Das
- INSERM U1212, UMR CNRS 5320, ARNA Laboratory, UFR des Sciences Pharmaceutiques, Université de Bordeaux, Bordeaux, France
| | - Clotilde Boudot
- INSERM U1094, Tropical Neuroepidemiology, Limoges, France.,Institute of Neuroepidemiology and Tropical Neurology, Université de Limoges, Limoges, France
| | - Nassima Meriem Gueddouda
- INSERM U1212, UMR CNRS 5320, ARNA Laboratory, UFR des Sciences Pharmaceutiques, Université de Bordeaux, Bordeaux, France
| | - Stéphane Moreau
- INSERM U1212, UMR CNRS 5320, ARNA Laboratory, UFR des Sciences Pharmaceutiques, Université de Bordeaux, Bordeaux, France
| | - Luisa Ronga
- INSERM U1212, UMR CNRS 5320, ARNA Laboratory, UFR des Sciences Pharmaceutiques, Université de Bordeaux, Bordeaux, France
| | - Solène Savrimoutou
- INSERM U1212, UMR CNRS 5320, ARNA Laboratory, UFR des Sciences Pharmaceutiques, Université de Bordeaux, Bordeaux, France
| | - Louise Basmaciyan
- Laboratory of Parasitology, UMR-MD3, Faculty of Pharmacy, Aix-Marseille University, Marseille, France
| | - Camille Tisnerat
- INSERM U1212, UMR CNRS 5320, ARNA Laboratory, UFR des Sciences Pharmaceutiques, Université de Bordeaux, Bordeaux, France
| | - Sacha Mestanier
- INSERM U1212, UMR CNRS 5320, ARNA Laboratory, UFR des Sciences Pharmaceutiques, Université de Bordeaux, Bordeaux, France
| | - Sandra Rubio
- INSERM U1212, UMR CNRS 5320, ARNA Laboratory, UFR des Sciences Pharmaceutiques, Université de Bordeaux, Bordeaux, France
| | - Sophia Amaziane
- INSERM U1212, UMR CNRS 5320, ARNA Laboratory, UFR des Sciences Pharmaceutiques, Université de Bordeaux, Bordeaux, France
| | - Alexandra Dassonville-Klimpt
- Laboratoire de Glycochimie, des Antimicrobiens et des Agroressouces, UMR CNRS 7378, UFR de Pharmacie, Université de Picardie Jules Verne, Amiens, France
| | - Nadine Azas
- Laboratory of Parasitology, UMR-MD3, Faculty of Pharmacy, Aix-Marseille University, Marseille, France
| | - Bertrand Courtioux
- INSERM U1094, Tropical Neuroepidemiology, Limoges, France.,Institute of Neuroepidemiology and Tropical Neurology, Université de Limoges, Limoges, France
| | - Jean-Louis Mergny
- INSERM U1212, UMR CNRS 5320, ARNA Laboratory, UFR des Sciences Pharmaceutiques, Université de Bordeaux, Bordeaux, France.,Institute of Biophysics of the CAS, v.v.i., Brno, Czech Republic
| | - Catherine Mullié
- Laboratoire de Glycochimie, des Antimicrobiens et des Agroressouces, UMR CNRS 7378, UFR de Pharmacie, Université de Picardie Jules Verne, Amiens, France
| | - Pascal Sonnet
- Laboratoire de Glycochimie, des Antimicrobiens et des Agroressouces, UMR CNRS 7378, UFR de Pharmacie, Université de Picardie Jules Verne, Amiens, France
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