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Garcia RM, Shlobin NA, Baticulon RE, Ghotme KA, Lippa L, Borba LA, Qureshi M, Thango N, Khan T, Hutchinson P, Rosseau G. Global Neurosurgery: An Overview. Neurosurgery 2024; 95:501-508. [PMID: 39145649 DOI: 10.1227/neu.0000000000003109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 03/21/2024] [Indexed: 08/16/2024] Open
Abstract
In the following article, we define the practice of global neurosurgery and review the major historical events defining this movement within the larger context of global surgery. The current state of the neurosurgical workforce, disease burden, and ongoing collaborative efforts are highlighted. Ethical practice leading the sustainability is discussed, as well as future targets for the global community as we look beyond the next decade of opportunities to affect the neurosurgical burden of disease.
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Affiliation(s)
- Roxanna M Garcia
- Department of Neurological Surgery, Northwestern University, Chicago, Illinois, USA
| | - Nathan A Shlobin
- McGaw School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Ronnie E Baticulon
- Division of Neurosurgery, Department of Neurosciences, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Kemel A Ghotme
- Translational Neuroscience Research Lab, Faculty of Medicine, Universidad de La Sabana, Chía, Colombia
- Pediatric Neurosurgery, Department of Neurosurgery, Fundacion Santa Fe de Bogota & Universidad de La Sabana, Chía, Colombia
| | - Laura Lippa
- Department of Neurosurgery, ASST, Ospedale Maggiore Niguarda, Milan, Italy
| | - Luis A Borba
- Federal University of Parana, Curitiba, Parana, Brazil
| | | | - Nqobile Thango
- Division of Neurosurgery, Neuroscience Institute, University of Cape Town, Red Cross Children's Hospital, Cape Town, South Africa
| | - Tariq Khan
- Northwest School of Medicine, Peshawar, Pakistan
| | - Peter Hutchinson
- Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Gail Rosseau
- Department of Neurosurgery, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
- Barrow Neurological Institute, Phoenix, Arizona, USA
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Zadey S. Assessing the societal value of health lost to alcohol use in India compared to excise taxes on alcohol sales. Drug Alcohol Rev 2024. [PMID: 39192681 DOI: 10.1111/dar.13932] [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: 10/26/2023] [Revised: 07/24/2024] [Accepted: 08/02/2024] [Indexed: 08/29/2024]
Abstract
INTRODUCTION We retrospectively studied the societal value of lost health due to alcohol use and compared it with excise taxes on alcohol sales for India in 2019. METHODS We estimated the overall alcohol-attributable disease burden using disability-adjusted life-years (DALY) for India and its 30 states for all causes with alcohol use as a risk factor from the GBD 2019 Study. The societal value of lost health was calculated using value of life-year (VLY) approach by multiplying region-specific factors from 'Global Health 2035', 2019-2020 GDP per capita and DALYs. We acquired the national and state-level (top 10 states) alcohol sales excise taxes from the Reserve Bank of India. Net losses were assessed by subtracting the revenue collected from excise taxes from VLY. All values are in Indian rupees (INR). RESULTS The societal value of health lost due to alcohol use in India was 6.2 (95% uncertainty interval 4.8, 7.8) trillion INR in 2019. The absolute state-level values varied from 7.3 (4.7, 10.4) billion INR in Mizoram to 1.1 (0.8, 1.4) trillion INR in Maharashtra. The per capita values ranged from 950.2 (642.9, 1285.3) INR for Bihar to 61,332 (39,273.7, 87,288.5) INR for Mizoram. Nationally, excise tax collection from alcohol sales was 1.8 trillion INR depicting a net loss of 4.4 (3.1, 6.0) trillion. Maharashtra had the largest absolute and per capita net loss. DISCUSSION AND CONCLUSIONS These are novel estimates depicting the net losses due to alcohol use in India with direct policy implications to disincentivise sales and adequately raise taxes.
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Affiliation(s)
- Siddhesh Zadey
- Association for Socially Applicable Research, Pune, India
- GEMINI Research Center, Duke University School of Medicine, Durham, USA
- Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pune, India
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, USA
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Niyibitegeka F, Russell FM, Jit M, Carvalho N. Inequitable Distribution of Global Economic Benefits from Pneumococcal Conjugate Vaccination. Vaccines (Basel) 2024; 12:767. [PMID: 39066405 PMCID: PMC11281544 DOI: 10.3390/vaccines12070767] [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: 06/05/2024] [Revised: 06/27/2024] [Accepted: 07/04/2024] [Indexed: 07/28/2024] Open
Abstract
Many low- and middle-income countries have been slow to introduce the pneumococcal conjugate vaccine (PCV) into their routine childhood immunization schedules despite a high burden of disease. We estimated the global economic surplus of PCV, defined as the sum of the net value to 194 countries (i.e., monetized health benefits minus net costs) and to vaccine manufacturers (i.e., profits). We further explored the distribution of global economic surplus across country income groups and manufacturers and the effect of different pricing strategies based on cross-subsidization, pooled procurement, and various tiered pricing mechanisms. We found that current PCV pricing policies disproportionately benefit high-income countries and manufacturers. Based on the 2021 birth cohort, high-income countries and manufacturers combined received 76.5% of the net economic benefits generated by the vaccine. Over the two decades of PCV availability, low- and middle-income countries have not received the full economic benefits of PCV. Cross-subsidization of the vaccine price for low- and middle-income countries and pooled procurement policies that would relate the vaccine price to the value of economic benefits generated for each country could reduce these inequalities. This analysis offers important considerations that may improve the equitable introduction and use of new and under-utilized vaccines.
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Affiliation(s)
- Fulgence Niyibitegeka
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC 3053, Australia;
| | - Fiona M. Russell
- Asia-Pacific Health, Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia;
- Centre for International Child Health, Department of Paediatrics, The University of Melbourne, Parkville, VIC 3052, Australia
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK;
| | - Natalie Carvalho
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC 3053, Australia;
- Asia-Pacific Health, Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia;
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Virk A, King R, Heneise M, Aier L, Child C, Brown J, Jayne D, Ensor T. How ready is the health care system in Northeast India for surgical delivery? a mixed-methods study on surgical capacity and need. PLoS One 2024; 19:e0287941. [PMID: 38924079 PMCID: PMC11206862 DOI: 10.1371/journal.pone.0287941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 02/13/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Surgical services are scarce with persisting inequalities in access across populations and regions globally. As the world's most populous county, India's surgical need is high and delivery rates estimated to be sub-par to meet need. There is a dearth of evidence, particularly sub-regional data, on surgical provisioning which is needed to aid planning. AIM AND METHOD This mixed-methods study examines the state of surgical care in Northeast India, specifically health care system capacity and barriers to surgical delivery. It involved a facility-based census and semi-structured interviews with surgeons and patients across four states in the region. RESULTS Abdominal conditions constituted a large portion of the overall surgeries across public and private facilities in the region. Workloads varied among surgical providers across facilities. Task-shifting occurred, involving non-specialist nursing staff assisting doctors with surgical procedures or surgeons taking on anaesthetic tasks. Structural factors dis-incentivised facility-level investment in suitable infrastructure. Facility functionality was on average higher in private providers compared to public providers and private facilities offer a wider range of surgical procedures. Facilities in general had adequate laboratory testing capability, infrastructure and equipment. Public facilities often do not have surgeon available around the clock while both public and private facilities frequently lack adequate blood banking. Patients' care pathways were shaped by facility-level shortages as well as personal preferences influenced by cost and distance to facilities. DISCUSSION AND CONCLUSION Skewed workloads across facilities and regions indicate uneven surgical delivery, with potentially variable care quality and provider efficiency. The need for a more system-wide and inter-linked approach to referral coordination and human resource management is evident in the results. Existing task-shifting practices, along with incapacities induced by structural factors, signal the directions for possible policy action.
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Affiliation(s)
- Amrit Virk
- Global Health Policy Unit, School of Social and Political Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Rebecca King
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, West Yorkshire, United Kingdom
| | - Michael Heneise
- Faculty of Humanities, Social Sciences and Teacher Education, Department of Archaeology, History and Religious Studies, UiT The Arctic University of Norway, Tromsø, Norway
| | | | | | - Julia Brown
- School of Medicine, University of Leeds, Leeds, West Yorkshire, United Kingdom
| | - David Jayne
- School of Medicine, University of Leeds, Leeds, West Yorkshire, United Kingdom
| | - Tim Ensor
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, West Yorkshire, United Kingdom
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Alwan A, Jallah W, Baltussen R, Carballo M, Gonyon E, Gudumac I, Haghparast-Bidgoli H, Jacobs G, Abou Jaoude GJ, Kateh FN, Logan G, Skordis J. Designing an evidence-informed package of essential health services for Universal Health Coverage: lessons learnt and challenges to implementation in Liberia. BMJ Glob Health 2024; 9:e014904. [PMID: 38925666 PMCID: PMC11202745 DOI: 10.1136/bmjgh-2023-014904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 03/14/2024] [Indexed: 06/28/2024] Open
Abstract
Liberia developed an evidence-informed package of health services for Universal Health Coverage (UHC) based on the Disease Control Priorities 3 evidence. This paper describes the policy decisions, methods and processes adopted for prioritisation, key features of the package and lessons learnt, with special emphasis on feasibility of implementation. Package design was led by the Ministry of Health. Prioritisation of essential services was based on evidence on disease burden, cost-effectiveness, financial risk, equity, budget impact, and feasibility of implementation. Fiscal space analysis was used to assess package affordability and options for expanding the budget envelope. The final adopted package focuses on primary healthcare and comprises a core subpackage of 78 publicly financed interventions and a complementary subpackage of 50 interventions funded through cost-sharing. The estimated per capita cost to the government is US$12.28, averting around 1.2 million DALYs. Key lessons learnt are described: (1) priority setting is essential for designing affordable packages of essential services; (2) the most realistic and affordable option when domestic resources are critically limited is to focus on basic, high-impact primary health services; (3) Liberia and many other countries will continue to rely on donor funding to expand the range of essential services until more domestic resources become available; (4) national leadership and effective engagement of key stakeholders are critical for a successful package design; (5) effective implementation is less likely unless the package cost is affordable and the health system gaps are assessed and addressed. A framework of action was employed to assess the consistency with the prerequisites for an appropriate package design. Based on the framework, Liberia developed a transparent and affordable package for UHC, but the challenges to implementation require further action by the government.
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Affiliation(s)
- Ala Alwan
- Disease Control Priorities 3 (DCP3) Country Translation Project, London School of Hygiene & Tropical Medicine, London, UK
| | - Wilhemina Jallah
- Republic of Liberia Ministry of Health, Monrovia, Montserrado, Liberia
| | - Rob Baltussen
- Department for Health Evidence, Radboudumc, Nijmegen, The Netherlands
| | - Manuel Carballo
- International Centre for Migration, Health and Development, Geneva, Switzerland
| | - Ernest Gonyon
- Republic of Liberia Ministry of Health, Monrovia, Montserrado, Liberia
| | - Ina Gudumac
- Disease Control Priorities 3 (DCP3) Country Translation Project, London School of Hygiene & Tropical Medicine, London, UK
| | | | - George Jacobs
- Republic of Liberia Ministry of Health, Monrovia, Montserrado, Liberia
| | | | - Francis Nah Kateh
- Republic of Liberia Ministry of Health, Monrovia, Montserrado, Liberia
| | - Gorbee Logan
- Republic of Liberia Ministry of Health, Monrovia, Montserrado, Liberia
| | - Jolene Skordis
- Institute for Global Health, University College London, London, UK
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Aguolu OG, Kiti MC, Nelson K, Liu CY, Sundaram M, Gramacho S, Jenness S, Melegaro A, Sacoor C, Bardaji A, Macicame I, Jose A, Cavele N, Amosse F, Uamba M, Jamisse E, Tchavana C, Giovanni Maldonado Briones H, Jarquín C, Ajsivinac M, Pischel L, Ahmed N, Mohan VR, Srinivasan R, Samuel P, John G, Ellington K, Augusto Joaquim O, Zelaya A, Kim S, Chen H, Kazi M, Malik F, Yildirim I, Lopman B, Omer SB. Comprehensive profiling of social mixing patterns in resource poor countries: A mixed methods research protocol. PLoS One 2024; 19:e0301638. [PMID: 38913670 PMCID: PMC11195963 DOI: 10.1371/journal.pone.0301638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 03/15/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Low-and-middle-income countries (LMICs) bear a disproportionate burden of communicable diseases. Social interaction data inform infectious disease models and disease prevention strategies. The variations in demographics and contact patterns across ages, cultures, and locations significantly impact infectious disease dynamics and pathogen transmission. LMICs lack sufficient social interaction data for infectious disease modeling. METHODS To address this gap, we will collect qualitative and quantitative data from eight study sites (encompassing both rural and urban settings) across Guatemala, India, Pakistan, and Mozambique. We will conduct focus group discussions and cognitive interviews to assess the feasibility and acceptability of our data collection tools at each site. Thematic and rapid analyses will help to identify key themes and categories through coding, guiding the design of quantitative data collection tools (enrollment survey, contact diaries, exit survey, and wearable proximity sensors) and the implementation of study procedures. We will create three age-specific contact matrices (physical, nonphysical, and both) at each study site using data from standardized contact diaries to characterize the patterns of social mixing. Regression analysis will be conducted to identify key drivers of contacts. We will comprehensively profile the frequency, duration, and intensity of infants' interactions with household members using high resolution data from the proximity sensors and calculating infants' proximity score (fraction of time spent by each household member in proximity with the infant, over the total infant contact time) for each household member. DISCUSSION Our qualitative data yielded insights into the perceptions and acceptability of contact diaries and wearable proximity sensors for collecting social mixing data in LMICs. The quantitative data will allow a more accurate representation of human interactions that lead to the transmission of pathogens through close contact in LMICs. Our findings will provide more appropriate social mixing data for parameterizing mathematical models of LMIC populations. Our study tools could be adapted for other studies.
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Affiliation(s)
- Obianuju Genevieve Aguolu
- Division of Epidemiology, College of Public Heath, The Ohio State University, Columbus, Ohio, United States of America
| | - Moses Chapa Kiti
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Kristin Nelson
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Carol Y. Liu
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Maria Sundaram
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin, United States of America
| | - Sergio Gramacho
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Samuel Jenness
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Alessia Melegaro
- DONDENA Centre for Research in Social Dynamics and Public Policy, Bocconi University, Milan, Italy
| | | | - Azucena Bardaji
- Manhiça Health Research Centre, Manhica, Mozambique
- ISGlobal, Hospital Clinic–Universitat de Barcelona, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Ivalda Macicame
- Polana Caniço Health Research and Training Centre, CISPOC, Maputo, Mozambique
| | - Americo Jose
- Polana Caniço Health Research and Training Centre, CISPOC, Maputo, Mozambique
| | - Nilzio Cavele
- Polana Caniço Health Research and Training Centre, CISPOC, Maputo, Mozambique
| | | | - Migdalia Uamba
- Polana Caniço Health Research and Training Centre, CISPOC, Maputo, Mozambique
| | | | | | | | - Claudia Jarquín
- Centro de Estudios en Salud (CES), Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - María Ajsivinac
- Centro de Estudios en Salud (CES), Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Lauren Pischel
- Yale School of Medicine, Yale University, New Haven, Connecticut, United States of America
| | - Noureen Ahmed
- Peter O’Donnell Jr. School of Public Health at UT Southwestern Medical Center, Dallas, Texas, United States of America
| | | | | | | | - Gifta John
- Christian Medical College Vellore, Vellore, India
| | - Kye Ellington
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | | | - Alana Zelaya
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Sara Kim
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Holin Chen
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Momin Kazi
- The Aga Khan University, Karachi, Pakistán
| | - Fauzia Malik
- Peter O’Donnell Jr. School of Public Health at UT Southwestern Medical Center, Dallas, Texas, United States of America
| | - Inci Yildirim
- Yale School of Medicine, Yale University, New Haven, Connecticut, United States of America
| | - Benjamin Lopman
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Saad B. Omer
- Peter O’Donnell Jr. School of Public Health at UT Southwestern Medical Center, Dallas, Texas, United States of America
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Zeng Z, Luo Y, Tao W, Zhang R, Zeng B, Yao J, Zhang W. Improving access to primary health care through financial innovation in rural China: a quasi-experimental synthetic difference-in-differences approach. BMC PRIMARY CARE 2024; 25:195. [PMID: 38824504 PMCID: PMC11143622 DOI: 10.1186/s12875-024-02450-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 05/27/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Inadequate financing constrains primary healthcare (PHC) capacity in many low- and middle-income countries, particularly in rural areas. This study evaluates an innovative PHC financing reform in rural China that aimed to improve access to healthcare services through supply-side integration and the establishment of a designated PHC fund. METHODS We employed a quasi-experimental synthetic difference-in-differences (SDID) approach to analyze county-level panel data from Chongqing Province, China, spanning from 2009 to 2018. The study compared the impact of the reform on PHC access and per capita health expenditures in Pengshui County with 37 other control counties (districts). We assessed the reform's impact on two key outcomes: the share of outpatient visits at PHC facilities and per capita total PHC expenditure. RESULTS The reform led to a significant increase in the share of outpatient visits at PHC facilities (14.92% points; 95% CI: 6.59-23.24) and an increase in per capita total PHC expenditure (87.30 CNY; 95% CI: 3.71-170.88) in Pengshui County compared to the synthetic control. These effects were robust across alternative model specifications and increased in magnitude over time, highlighting the effectiveness of the integrated financing model in enhancing PHC capacity and access in rural China. CONCLUSIONS This research presents compelling evidence demonstrating that horizontal integration in PHC financing significantly improved utilization and resource allocation in rural primary care settings in China. This reform serves as a pivotal model for resource-limited environments, demonstrating how supply-side financing integration can bolster PHC and facilitate progress toward universal health coverage. The findings underscore the importance of sustainable financing mechanisms and the need for policy commitment to achieve equitable healthcare access.
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Affiliation(s)
- Zhi Zeng
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Office of Policy Research, Chinese Center for Disease Control and Prevention & Chinese Academy of Preventive Medicine, Beijing, China
| | - Yunmei Luo
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wenjuan Tao
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ruiling Zhang
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Bo Zeng
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jianhong Yao
- Chinese Academy of Medical Sciences & Peking Union Medical College, No.9, Dongdan Santiao, Beijing, 100730, China.
| | - Wei Zhang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, No.37, Guoxue Xiang, Chengdu, 610041, Sichuan, China.
- Med-X Center for Informatics, Sichuan University, Chengdu, Sichuan, China.
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Nugent R, Hutchinson B, Mann N, Ngongo C, Spencer G, Grafton D, Small R. Evolving methodology of national tobacco control investment cases. Tob Control 2024; 33:s10-s16. [PMID: 38697658 PMCID: PMC11103330 DOI: 10.1136/tc-2023-058336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 01/19/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND This article describes an investment case methodology for tobacco control that was applied in 36 countries between 2017 and 2022. METHODS The WHO Framework Convention on Tobacco Control (FCTC) investment cases compared two scenarios: a base case that calculated the tobacco-attributable mortality, morbidity and economic costs with status quo tobacco control, and an intervention scenario that described changes in those same outcomes from fully implementing and enforcing a variety of proven, evidence-based tobacco control policies and interventions. Health consequences included the tobacco-attributable share of mortality and morbidity from 38 diseases. The healthcare expenditures and the socioeconomic costs from the prevalence of those conditions were combined to calculate the total losses due to tobacco. The monetised benefits of improvements in health resulting from tobacco control implementation were compared with costs of expanding tobacco control to assess returns on investment in each country. An institutional and context analysis assessed the political and economic dimensions of tobacco control in each context. RESULTS We applied a rigorous yet flexible methodology in 36 countries over 5 years. The replicable model and framework may be used to inform development of tobacco control cases in countries worldwide. CONCLUSION Investment cases constitute a tool that development partners and advocates have demanded in even greater numbers. The economic argument for tobacco control provided by this set of country-contextualised analyses can be a strong tool for policy change.
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Affiliation(s)
- Rachel Nugent
- Department of Global Health, University of Washington, Seattle, Washington, USA
- RTI International, Research Triangle Park, North Carolina, USA
| | | | - Nathan Mann
- RTI International, Research Triangle Park, North Carolina, USA
| | - Carrie Ngongo
- RTI International, Research Triangle Park, North Carolina, USA
| | | | | | - Roy Small
- HIV, Health and Development Group, United Nations Development Programme, New York, New York, USA
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Alqahtani SA, AlAhmed R, Hamza MM, Alessy SA, Alqunaibet A, AlGhammas A, Watkins D, Msemburi W, Alkhattabi F, Pickersgill S, Rakic S, Alsukait RF, Herbst CH, Al-Hazzaa HM. Health and economic burden of insufficient physical activity in Saudi Arabia. PLoS One 2024; 19:e0297278. [PMID: 38598509 PMCID: PMC11006127 DOI: 10.1371/journal.pone.0297278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/02/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Insufficient physical activity (PA) was estimated to cause 4.8% of deaths and 2.6% of disability-adjusted life-years (DALYs) due to noncommunicable diseases in Saudi Arabia in 2019. While Saudi Arabia is already achieving great improvements, we predict the health and economic burden of insufficient PA up to 2040 to present a case for policy makers to invest more in the uptake of PA. METHODS Using a population health model to estimate avoidable health loss, we identified four causes of health loss related to low PA (cardiovascular diseases, diabetes, breast cancer, and colorectal cancer) and estimated the deaths and DALYs from these causes. We projected the expected disease burden until 2040 under alternative assumptions about future PA levels and trends by using three health scenarios: baseline (no change in 2019 PA levels), intervention (81% of the population achieving sufficient PA levels), and ideal (65% of population: moderate PA, 30%: high PA, and 5%: inactive). We applied an "intrinsic value" approach to estimate the economic impact of each scenario. RESULTS Overall, we estimate that between 2023 and 2040, about 80,000 to 110,000 deaths from all causes and 2.0 million to 2.9 million DALYs could be avoided by increasing PA levels in Saudi Arabia. The average annual economic loss from insufficient PA is valued at 0.49% to 0.68% of the current gross domestic product, with an average of US$5.4 billion to US$7.6 billion annually till 2040. The most avoidable disease burden and economic losses are expected among males and because of ischemic heart disease. CONCLUSIONS This study highlights that low PA levels will have considerable health and economic impacts in Saudi Arabia if people remain inactive and do not start following interventions. There is an urgent need to develop innovative programs and policies to encourage PA among all age and sex groups.
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Affiliation(s)
- Saleh A. Alqahtani
- Organ Transplant Center of Excellence, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
- Division of Gastroenterology & Hepatology, Johns Hopkins University, Baltimore, MD, United States of America
| | - Reem AlAhmed
- Biostatistics, Epidemiology and Scientific Computing Department, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Mariam M. Hamza
- The World Bank Group, Washington, DC, United States of America
| | - Saleh A. Alessy
- Public Health Department, College of Health Sciences, Saudi Electronic University, Riyadh, Saudi Arabia
- Centre for Cancer, Society & Public Health, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | | | - Amal AlGhammas
- Academic and Training Affairs Department, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - David Watkins
- Independent Consultant, Seattle, WA, United States of America
| | | | - Fadiah Alkhattabi
- Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | | | - Severin Rakic
- The World Bank Group, Washington, DC, United States of America
| | - Reem F. Alsukait
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | | | - Hazzaa M. Al-Hazzaa
- Lifestyle and Health Research Center, Health Science Research Center, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
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Yerramilli P, Chopra M, Rasanathan K. The cost of inaction on health equity and its social determinants. BMJ Glob Health 2024; 9:e012690. [PMID: 38589049 PMCID: PMC11015166 DOI: 10.1136/bmjgh-2023-012690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/25/2023] [Indexed: 04/10/2024] Open
Abstract
Rising levels of inflation, debt and macrofiscal tightening are putting expenditures on the social sectors including health under immense scrutiny. Already, there are worrying signs of reductions in social sector investments. However, even before the pandemic, evidence showed the significant returns on investments in health equity and its social determinants. Emerging data and trends show that these potential returns have increased during the COVID-19 pandemic - investments in social determinants can mitigate widespread reductions in human capital and the increasing likelihood of costly syndemics, while promoting access to healthcare innovations that have thus far been inequitably distributed. Therefore, we argue that, despite immediate fiscal pressures, this is exactly the time to invest in health equity and its broader social determinants, as the returns on such investments have never been greater.
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Affiliation(s)
- Pooja Yerramilli
- Department of Medicine, GWU School of Medicine and Health Sciences, Washington, DC, USA
- Health, Nutrition, and Population, World Bank Group, Washington, DC, USA
| | - Mickey Chopra
- Health, Nutrition, and Population, World Bank Group, Washington, DC, USA
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11
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O'Donnell O. Health and health system effects on poverty: A narrative review of global evidence. Health Policy 2024; 142:105018. [PMID: 38382426 DOI: 10.1016/j.healthpol.2024.105018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 02/23/2024]
Abstract
Ill-health causes poverty. The effect runs through multiple mechanisms that span lifetimes and cross generations. Health systems can reduce poverty by improving health and weakening links from ill-health to poverty. This paper maps routes through which ill-health can cause poverty and identifies those that are potentially amenable to health policy. The review confirms that ill-health is an important contributor to poverty and it finds that the effect through health-related loss of earnings is often larger than that through medical expenses. Both effects are smaller in countries that are closer to universal health coverage and have higher social safety nets. The paper also reviews evidence from low- and middle-income countries (LMICs) and the United States (US) on the poverty-reduction effectiveness of public health insurance (PubHI) for low-income households. This reveals that PubHI does not always deliver financial protection to its targeted population in LMICs. Countries that have succeeded in achieving this goal often combine extension of coverage with supply-side interventions to build capacity and avoid perverse provider incentives in response to insurance. In the US, PubHI is effective in reducing poverty by shielding low-income households with children from healthcare costs and, consequently, generating long-run improvements in health that increase lifetime earnings. Poverty reduction is a potentially important co-benefit of health systems.
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Affiliation(s)
- Owen O'Donnell
- Erasmus University Rotterdam, P.O. Box 1738, Rotterdam 3000 DR, the Netherlands.
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12
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Woldegeorgis BZ, Gebrekidan AY, Kassie GA, Azeze GA, Asgedom YS, Alemu HB, Obsa MS. Neonatal birth trauma and associated factors in low and middle-income countries: A systematic review and meta-analysis. PLoS One 2024; 19:e0298519. [PMID: 38512995 PMCID: PMC10957092 DOI: 10.1371/journal.pone.0298519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 01/26/2024] [Indexed: 03/23/2024] Open
Abstract
Neonatal birth trauma, although it has steadily decreased in industrialized nations, constitutes a significant health burden in low-resource settings. Keeping with this, we sought to determine the pooled cumulative incidence (incidence proportion) of birth trauma and identify potential contributing factors in low and middle-income countries. Besides, we aimed to describe the temporal trend, clinical pattern, and immediate adverse neonatal outcomes of birth trauma. We searched articles published in the English language in the Excerpta Medica database, PubMed, Web of Science, Google, African Journals Online, Google Scholar, Scopus, and in the reference list of retrieved articles. Literature search strategies were developed using medical subject headings and text words related to the outcomes of the study. The Joana Briggs Institute quality assessment tool was employed and articles with appraisal scores of seven or more were deemed suitable to be included in the meta-analysis. Data were analyzed using the random-effect Dersimonian-Laird model. The full search identified a total of 827 articles about neonatal birth trauma. Of these, 37 articles involving 365,547 participants met the inclusion criteria. The weighted pooled cumulative incidence of birth trauma was estimated at 34 per 1,000 live births (95% confidence interval (CI) 30.5 to 38.5) with the highest incidence observed in Africa at 52.9 per 1,000 live births (95% CI 46.5 to 59.4). Being born to a mother from rural areas (odds ratio (OR), 1.61; 95% CI1.18 to 2.21); prolonged labor (OR, 5.45; 95% CI 2.30, 9.91); fetal malpresentation at delivery (OR, 4.70; 95% CI1.75 to 12.26); shoulder dystocia (OR, 6.11; 95% CI3.84 to 9.74); operative vaginal delivery (assisted vacuum or forceps extraction) (OR, 3.19; 95% CI 1.92 to 5.31); and macrosomia (OR, 5.06; 95% CI 2.76 to 9.29) were factors associated with neonatal birth trauma. In conclusion, we found a considerably high incidence proportion of neonatal birth trauma in low and middle-income countries. Therefore, early identification of risk factors and prompt decisions on the mode of delivery can potentially contribute to the decreased magnitude and impacts of neonatal birth trauma and promote the newborn's health.
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Affiliation(s)
- Beshada Zerfu Woldegeorgis
- School of Medicine, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Amanuel Yosef Gebrekidan
- School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Gizachew Ambaw Kassie
- School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Gedion Asnake Azeze
- Department of Midwifery, College of Medicine and Health Sciences, Hawassa University, Sidama Region, Ethiopia
| | - Yordanos Sisay Asgedom
- Department of Epidemiology, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Henok Berhanu Alemu
- School of Medicine, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Azmat SK, Thom EM, Arshad M, Hamza HB, Aabroo A, Balal A, Awan MA, Rifaq F, Hemachandra N, Qudsia U. A study protocol for integrating outpatient services at the primary health care level as part of the universal health coverage benefit package within the national health insurance program of Pakistan through private health facilities. Front Public Health 2024; 12:1293278. [PMID: 38532967 PMCID: PMC10964903 DOI: 10.3389/fpubh.2024.1293278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 02/20/2024] [Indexed: 03/28/2024] Open
Abstract
Introduction and aim Pakistan has a mixed-health system where up to 60% of health expenditures are out of pocket. Almost 80% of primary healthcare (PHC) facilities are in the private sector, which is deeply embedded within the country's health system and may account for the unaffordability of healthcare. Since 2016, the existing national health insurance program or Sehat Sahulat Program (SSP), has provided invaluable coverage and financial protection to the millions of low-income families living in Pakistan by providing inpatient services at secondary and tertiary levels. However, a key gap is the non-inclusion of outpatient services at the PHC in the insurance scheme. This study aims to engage a private provider network of general practitioners in select union councils of Islamabad Capital Authority (ICT) of Pakistan to improve access, uptake, and satisfaction and reduce out-of-pocket expenditure on quality outpatient services at the PHC level, including family planning and reproductive health services. Methods and analysis A 24-month research study is proposed with a 12-month intervention period using a mixed method, two-arm, prospective, quasi-experimental controlled before and after design with a sample of 863 beneficiary families from each study arm, i.e., intervention and control groups (N = 1726) will be selected through randomization at the selected beneficiary family/household level from four peri-urban Union Councils of ICT where no public sector PHC-level facility exists. All ethical considerations will be assured, along with quality assurance strategies. Quantitative pre/post surveys and third-party monitoring are proposed to measure the intervention outcomes. Qualitative inquiry with beneficiaries, general practitioners and policymakers will assess their knowledge and practices. Conclusion and knowledge contribution PHC should be the first point of contact for accessing health services and appears to serve as a programmatic engine for universal health coverage (UHC). The research aims to study a service delivery model which harnesses the private sector to deliver an essential package of health services as outpatient services under SSP, ultimately facilitating UHC. Findings will provide a blueprint referral system to reduce unnecessary hospital admissions and improve timely access to healthcare. A robust PHC system can improve population health, lower healthcare expenditure, strengthen the healthcare system, and ultimately make UHC a reality.
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Affiliation(s)
- Syed Khurram Azmat
- Marie Stopes Society, Karachi, Pakistan
- AIPH - AAPNA Institute of Public Health, Jinnah Sindh Medical University, Karachi, Pakistan
| | | | | | - Hasan Bin Hamza
- Ministry of National Health Services, Regulations, and Coordination, Islamabad, Pakistan
| | - Atiya Aabroo
- Ministry of National Health Services, Regulations, and Coordination, Islamabad, Pakistan
| | | | - Muhammad Ali Awan
- Marie Stopes Society, Karachi, Pakistan
- AIPH - AAPNA Institute of Public Health, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Faisal Rifaq
- Federal Sehat Sahulat Program, Islamabad, Pakistan
| | | | - Uzma Qudsia
- World Health Organization, Islamabad, Pakistan
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14
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Sadek A, Abd El Hady AM, Olfat H, Abd El Hady AA, Wafy W, Zaki M, Youness ER. Effect of ozone gas on viral kinetics and liver histopathology in hepatitis C patients. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2024; 21:131-138. [PMID: 38190482 DOI: 10.1515/jcim-2023-0239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 10/30/2023] [Indexed: 01/10/2024]
Abstract
OBJECTIVES We examine how well ozone/oxygen gas therapy treats chronic hepatitis C patients with varying degrees of liver fibrosis. Also to study the effect of giving multiple anti-oxidants with the ozone/oxygen gas mixture, to see if this addition would have any additive or synergistic effect. METHODS Two hundred and twenty three patients with chronic hepatitis C. Liver biopsies were carried out at after 12 weeks of administering an ozone/oxygen gas mixture. RESULTS The mean stage of fibrosis decreased from 1.98 to 1.41 and the mean grade of inflammation decreased from 10.08 to 7.94, both with a p value less than 0.001. After 12 weeks of treatment, mean PCR values increased. No single significant complication was recorded in a total of >9,000 settings of ozone therapy. CONCLUSIONS Ozone oxygen gas mixture is safe and effective in treatment of hepatic fibrosis due to chronic viral hepatitis C.
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Affiliation(s)
- Ahmed Sadek
- Departments of Hepatology & Gastroenterology, Theodor Bilharz Research Institute, Giza, Egypt
| | | | - Hammam Olfat
- Departments of Pathology, Theodor Bilharz Research Institute, Giza, Egypt
| | - Afaf A Abd El Hady
- Departments of Clinical Chemistry, Theodor Bilharz Research Institute, Giza, Egypt
| | - Wafaa Wafy
- Departments of Public Health, Theodor Bilharz Research Institute, Giza, Egypt
| | - Moushira Zaki
- Department of Biological Anthropology, Medical Researches and Clinical Studies Institute, National Research Centre, Cairo, Egypt
| | - Eman R Youness
- Department of Medical Biochemistry, Medical Researches and Clinical Studies Institute, National Research Centre, Cairo, Egypt
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15
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Wang Z, Liang Z, Dong X, Gao L, Zhou S, Yin H, Jin Y, Zheng ZJ. Health policy competencies in regional organizations: a retrospective analysis for 76 regional organizations from 1945 to 2015. Global Health 2024; 20:17. [PMID: 38409001 PMCID: PMC10895825 DOI: 10.1186/s12992-024-01023-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/19/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Health policy competencies of regional organizations include mandates to create regional health laws and policies, as well as authorities that allow member states to undertake collective actions in the health field. The examination of the health policy competencies of regional organizations is essential, as it constitutes an important prerequisite for regional organizations to govern regional health. This study aims to map the development trajectory of health policy competencies in regional organizations worldwide and investigate their potential correlates. This will contribute to the enhanced promotion of both existing and new regional health cooperation. METHODS This retrospective analysis utilized the health policy competencies of the 76 regional organizations worldwide from 1945 to 2015, as investigated in the Regional Organizations Competencies Database. By aggregating member state data from various sources such as the IHME Global Burden of Disease 2019, the World Bank, and the World Trade Organization, we extracted the mean values and coefficients of variation for the covariates in regional organization characteristics, socioeconomic and demographic factors, health status and health-system capacity. The correlation between changes in the health policy scope of regional organizations and independent variables was analyzed using Poisson pseudo-likelihood regression with multiple levels of fixed effects. RESULTS From 1945 to 2015, the number of regional organizations with health policy competencies experienced a slow growth stage before 1991 and an explosive growth stage post-1991. By 2015, 48 out of the 71 existing regional organizations had developed their health policy competencies, yet 26 (54.2%) of these organizations possessed only 1-2 health policy competencies. An enhancement in the health policy scope of a regional organization correlated with its founding year, a greater number of policy fields, higher under-five mortality, and larger disparities in trade and healthcare access and quality indexes among member states. In contrast, larger disparities in population, under-five mortality and health worker density among member states, along with more hospital beds per capita, were negatively correlated with the expansion of a regional organization's health policy scope. CONCLUSION Since 1991, there has been a surge of interest in health among regional organizations, although health remains a secondary priority for them. The health policy competencies of regional organizations are pivotal for promoting social equity within regional communities. Its establishment is also closely linked to the level and disparities among member states in aspects such as trade, population, child mortality rates, and health system capacity.
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Affiliation(s)
- Zongbin Wang
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Zhisheng Liang
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Xuejie Dong
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Liqun Gao
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Shuduo Zhou
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Hui Yin
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Yinzi Jin
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Zhi-Jie Zheng
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China.
- Institute for Global Health and Development, Peking University, Beijing, China.
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16
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Guerra S, Roope LS, Tsiachristas A. Assessing the relationship between coverage of essential health services and poverty levels in low- and middle-income countries. Health Policy Plan 2024; 39:156-167. [PMID: 38300510 PMCID: PMC10883664 DOI: 10.1093/heapol/czae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 12/22/2023] [Accepted: 01/29/2024] [Indexed: 02/02/2024] Open
Abstract
Universal health coverage (UHC) aims to provide essential health services and financial protection to all. This study aimed to assess the relationship between the service coverage aspect of universal health coverage and poverty in low- and middle-income countries (LMICs). Using country-level data from 96 LMICs from 1990 to 2017, we employed fixed-effects and random-effects regressions to investigate the association of eight service coverage indicators (inpatient admissions; antenatal care; skilled birth attendance; full immunization; cervical and breast cancer screening rates; diarrhoea and acute respiratory infection treatment rates) with poverty headcount ratios and gaps at the $1.90, $3.20 and $5.50 poverty lines. Missing data were imputed using within-country linear interpolation or extrapolation. One-unit increases in seven service indicators (breast cancer screening being the only one with no significant associations) were associated with reduced poverty headcounts by 2.54, 2.46 and 1.81 percentage points at the $1.90, $3.20 and $5.50 lines, respectively. The corresponding reductions in poverty gaps were 0.99 ($1.90), 1.83 ($3.20) and 1.89 ($5.50) percentage points. Apart from cervical cancer screening, which was only significant in one poverty headcount model ($5.50 line), all other service indicators were significant in either the poverty headcount or gap models at both $1.90 and $3.20 poverty lines. In LMICs, higher service coverage rates are associated with lower incidence and intensity of poverty. Further research is warranted to identify the causal pathways and specific circumstances in which improved health services in LMICs might help to reduce poverty.
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Affiliation(s)
- Stefanny Guerra
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, United Kingdom
- Department of Population Health Sciences, King’s College London, Guy’s Campus, Great Maze Pond, London SE1 1UL, United Kingdom
| | - Laurence Sj Roope
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, United Kingdom
| | - Apostolos Tsiachristas
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, United Kingdom
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Nonvignon J, Soucat A, Ofori-Adu P, Adeyi O. Making development assistance work for Africa: from aid-dependent disease control to the new public health order. Health Policy Plan 2024; 39:i79-i92. [PMID: 38253444 PMCID: PMC10803194 DOI: 10.1093/heapol/czad092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 09/05/2023] [Accepted: 10/23/2023] [Indexed: 01/24/2024] Open
Abstract
The Coronavirus disease (COVID-19) pandemic has revealed the fragility of pre-crisis African health systems, in which too little was invested over the past decades. Yet, development assistance for health (DAH) more than doubled between 2000 and 2020, raising questions about the role and effectiveness of DAH in triggering and sustaining health systems investments. This paper analyses the inter-regional variations and trends of DAH in Africa in relation to some key indicators of health system financing and service delivery performance, examining (1) the trends of DAH in the five regional economic communities of Africa since 2000; (2) the relationship between DAH spending and health system performance indicators and (3) the quantitative and qualitative dimensions of aid substitution for domestic financing, policy-making and accountability. Africa is diverse and the health financing picture has evolved differently in its subregions. DAH represents 10% of total spending in Africa in 2020, but DAH benefitted Southern Africa significantly more than other regions over the past two decades. Results in terms of progress towards universal health coverage (UHC) are slightly associated with DAH. Overall, DAH may also have substituted for public domestic funding and undermined the formation of sustainable UHC financing models. As the COVID-19 crisis hit, DAH did not increase at the country level. We conclude that the current architecture of official development assistance (ODA) is no longer fit for purpose. It requires urgent transformation to place countries at the centre of its use. Domestic financing of public health institutions should be at the core of African social contracts. We call for a deliberate reassessment of ODA modalities, repurposing DAH on what it could sustainably finance. Finally, we call for a new transparent framework to monitor DAH that captures its contribution to building institutions and systems.
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Affiliation(s)
- Justice Nonvignon
- Africa Centre for Disease Control and Prevention, Addis Ababa, Ethiopia
- School of Public Health, University of Ghana, Accra, Ghana
| | - Agnès Soucat
- Agence Francaise de Developpement, Paris, France
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Paulina Ofori-Adu
- Policy Planning Monitoring and Evaluation Division, Ghana Health Service, Ghana
| | - Olusoji Adeyi
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Resilient Health Systems, Washington, DC, United States
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18
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Adde HA, Oghogho MD, van Duinen AJ, Grimes CE, Hampaye TC, Quaife M, Bolkan HA. The economic burden associated with unmet surgical needs in Liberia: a retrospective macroeconomic analysis based on a nationwide enumeration of surgical procedures. BMJ Open 2024; 14:e076293. [PMID: 38191260 PMCID: PMC10806694 DOI: 10.1136/bmjopen-2023-076293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 12/15/2023] [Indexed: 01/10/2024] Open
Abstract
OBJECTIVES The economic consequences of untreated surgical disease are potentially large. The aim of this study was to estimate the economic burden associated with unmet surgical needs in Liberia. DESIGN A nationwide enumeration of surgical procedures and providers was conducted in Liberia in 2018. We estimated the number of disability-adjusted life years (DALYs) saved by operative activities and converted these into economic losses averted using gross national income per capita and value of a statistical life (VSL) approaches. The total, the met and the unmet needs for surgery were determined, and economic losses caused by unmet surgical needs were estimated. Finally, we valued the economic losses avoided by various surgical provider groups. RESULTS A total of 55 890 DALYs were averted by surgical activities in 2018; these activities prevented an economic loss of between US$35 and US$141 million. About half of these values were generated by the non-specialist physician workforce. Furthermore, a non-specialist physician working a full-time position for 1 year prevented an economic loss of US$717 069 using the VSL approach, while a specialist resident and a certified specialist saved US$726 606 and US$698 877, respectively. The burden of unmet surgical need was associated with productivity losses of between US$388 million and US$1.6 billion; these losses equate to 11% and 46% of the annual gross domestic product for Liberia. CONCLUSION The economic burden of untreated surgical disease is large in Liberia. There is a need to strengthen the surgical system to reduce ongoing economic losses; a framework where specialist and non-specialist physicians collaborate may result in better economic return than a narrower focus on training specialists alone.
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Affiliation(s)
- Håvard A Adde
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
- Department of Surgery, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway
- CapaCare, Trondheim, Norway, & Tappita, Liberia
| | | | - Alex J van Duinen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
- CapaCare, Trondheim, Norway, & Tappita, Liberia
- Department of Surgery, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Surgery, ELWA Hospital, Monrovia, Liberia
| | - Caris E Grimes
- King's Centre for Global Health and Health Partnerships, King's College, London, UK
- Medway NHS Foundation Trust, Gillingham, UK
| | | | - Matthew Quaife
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
- Evidera Ltd, London, UK
| | - Håkon A Bolkan
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
- CapaCare, Trondheim, Norway, & Tappita, Liberia
- Department of Surgery, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
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19
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Jinyi W, Zhang Y, Wang K, Peng P. Global, regional, and national mortality of tuberculosis attributable to alcohol and tobacco from 1990 to 2019: A modelling study based on the Global Burden of Disease study 2019. J Glob Health 2024; 14:04023. [PMID: 38175959 PMCID: PMC10767425 DOI: 10.7189/jogh.14.04023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024] Open
Abstract
Background Tuberculosis (TB) is expected to become the second leading single cause of death with several risk factors, but the related disease burden is currently unknown. We aimed to analyse the pre-coronavirus disease 2019 (COVID-19) changes in mortality of TB attributable to alcohol and tobacco worldwide from 1990 to 2019. Methods We obtained data of TB deaths and age-standardised death rates attributed to alcohol and cigarette in 204 countries and territories from the Global Burden of Disease 2019 public database. We performed a spatial-temporal analysis of age-standardised death rate and the average annual per cent change (AAPC), after which we analysed the effects of gender and socio-demographic index on age-standardised death rate using an age-period-cohort model. Finally, we built machine learning models to predict the TB age-standardised death rate in 2035. Results We found that the global age-standardised death rate of TB attributable to alcohol consumption declined from 5.35 (95% uncertainty interval (UI) = 3.51, 7.00) in 1990 to 2.54 (95% UI = 1.65, 3.33) in 2019, with significant declines in Andean Latin America (AAPC = -7.59; 95% confidence interval (CI) = -8, -7.16, P < 0.05), East Asia (AAPC = -7.32; 95% CI = -8.00, -6.62, P < 0.05), and Central Latin America (AAPC = -7.31; 95% CI = -7.63, -6.99, P < 0.05). However, there was an increase in a few regions, especially in parts of Central Asia. The age-standardised death rate for TB attributable to cigarette smoking declined more rapidly than that for TB attributable to alcohol, from 7.45 (95% UI = 6.17, 8.72) to 2.21 (95% UI = 1.78, 2.64), especially in East Asia (AAPC = -6.64; 95% CI = -7.07, -6.2, P < 0.05), North Africa and Middle East (AAPC = -6.47; 95% CI = -6.67, -6.28, P < 0.05), and Andean Latin America (AAPC = -6.31; 95% CI = -6.87, -5.75, P < 0.05). However, TB attributable to cigarette smoking increased in parts of Eastern Europe. In both TB attributable to alcohol consumption and to cigarette smoking, the age-standardised death rate was much higher in men than in women. The age-period-cohort model results showed that TB attributable to alcohol consumption was the highest in older adults aged 60-80 years, while TB attributable to cigarette smoking was the highest in adults aged 40-60 years. Machine learning models projected that by 2035, the age-standardised death rate for TB attributable to alcohol consumption would be 1.29 (per 100 000 population), while the age-standardised death rate for TB attributable to cigarette consumption would be 0.37 (per 100 000 population), which might not achieve the 2035 global target for eliminating TB. Conclusions Globally, the age-standardised death rate for TB attributable to alcohol consumption declined slower than that attributable to cigarette smoking. Controlling these two factors would help achieve the global goal of TB elimination, especially for the elderly who are at high risk.
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Affiliation(s)
- Wu Jinyi
- Wuhan Fourth Hospital, Wuhan, China
| | - Yue Zhang
- Shanxi Medical University, Taiyuan, China
| | - Kai Wang
- Wuhan Fourth Hospital, Wuhan, China
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20
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Kruk ME, Kapoor NR, Lewis TP, Arsenault C, Boutsikari EC, Breda J, Carai S, Croke K, Dayalu R, Fink G, Garcia PJ, Kassa M, Mohan S, Moshabela M, Nzinga J, Oh J, Okiro EA, Prabhakaran D, SteelFisher GK, Tarricone R, Garcia-Elorrio E. Population confidence in the health system in 15 countries: results from the first round of the People's Voice Survey. Lancet Glob Health 2024; 12:e100-e111. [PMID: 38096882 PMCID: PMC10716625 DOI: 10.1016/s2214-109x(23)00499-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 09/11/2023] [Accepted: 10/18/2023] [Indexed: 12/17/2023]
Abstract
Population confidence is essential to a well functioning health system. Using data from the People's Voice Survey-a novel population survey conducted in 15 low-income, middle-income, and high-income countries-we report health system confidence among the general population and analyse its associated factors. Across the 15 countries, fewer than half of respondents were health secure and reported being somewhat or very confident that they could get and afford good-quality care if very sick. Only a quarter of respondents endorsed their current health system, deeming it to work well with no need for major reform. The lowest support was in Peru, the UK, and Greece-countries experiencing substantial health system challenges. Wealthy, more educated, young, and female respondents were less likely to endorse the health system in many countries, portending future challenges for maintaining social solidarity for publicly financed health systems. In pooled analyses, the perceived quality of the public health system and government responsiveness to public input were strongly associated with all confidence measures. These results provide a post-COVID-19 pandemic baseline of public confidence in the health system. The survey should be repeated regularly to inform policy and improve health system accountability.
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Affiliation(s)
- Margaret E Kruk
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA.
| | - Neena R Kapoor
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Todd P Lewis
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Catherine Arsenault
- Department of Global Health, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Eleni C Boutsikari
- Division of Country Health Policies and Systems, WHO Athens Quality of Care Office, WHO Regional Office for Europe, Athens, Greece
| | - João Breda
- Division of Country Health Policies and Systems, WHO Athens Quality of Care Office, WHO Regional Office for Europe, Athens, Greece
| | - Susanne Carai
- Division of Country Health Policies and Systems, WHO Athens Quality of Care Office, WHO Regional Office for Europe, Athens, Greece
| | - Kevin Croke
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Rashmi Dayalu
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Günther Fink
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute and University of Basel, Basel, Switzerland
| | - Patricia J Garcia
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Munir Kassa
- Minister's Office, Ministry of Health, Addis Ababa, Ethiopia
| | | | - Mosa Moshabela
- College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Jacinta Nzinga
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Juhwan Oh
- Seoul National University College of Medicine, Seoul, South Korea
| | - Emelda A Okiro
- Population and Health Impact Surveillance Group, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Gillian K SteelFisher
- Department of Health Policy and Management, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Rosanna Tarricone
- Department of Social and Political Science, Bocconi University, Milan, Italy
| | - Ezequiel Garcia-Elorrio
- School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru; Health Care Quality and Patient Safety, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
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21
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Alwan A, Siddiqi S, Safi M, Zaidi R, Khalid M, Baltussen R, Gudumac I, Huda M, Jansen M, Raza W, Torres-Rueda S, Zulfiqar W, Vassall A. Addressing the UHC Challenge Using the Disease Control Priorities 3 Approach: Lessons Learned and an Overview of the Pakistan Experience. Int J Health Policy Manag 2023; 13:8003. [PMID: 39099517 DOI: 10.34172/ijhpm.2023.8003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 10/07/2023] [Indexed: 08/06/2024] Open
Abstract
BACKGROUND Pakistan developed its first national Essential Package of Health Services (EPHS) as a key step towards accelerating progress in achieving Universal Health Coverage (UHC). We describe the rationale, aims, the systematic approach followed to EPHS development, methods adopted, outcomes of the process, challenges encountered, and lessons learned. METHODS EPHS design was led by the Ministry of National Health Services, Regulations & Coordination. The methods adopted were technically guided by the Disease Control Priorities 3 Country Translation project and existing country experience. It followed a participatory and evidence-informed prioritisation and decision-making processes. RESULTS The full EPHS covers 117 interventions delivered at the community, health centre and first-level hospital platforms at a per capita cost of US$29.7. The EPHS also includes an additional set of 12 population-based interventions at US$0.78 per capita. An immediate implementation package (IIP) of 88 district-level interventions costing US$12.98 per capita will be implemented initially together with the population-based interventions until government health allocations increase to the level required to implement the full EPHS. Interventions delivered at the tertiary care platform were also prioritised and costed at US$6.5 per capita, but they were not included in the district-level package. The national EPHS guided the development of provincial packages using the same evidence-informed process. The government and development partners are in the process of initiating a phased approach to implement the IIP. CONCLUSION Key ingredients for a successful EPHS design requires a focus on package feasibility and affordability, national ownership and leadership, and solid engagement of national stakeholders and development partners. Major challenges to the transition to implementation are to continue strengthening the national technical capacity, institutionalise priority setting and package design and its revision in ministries of health, address health system gaps and bridge the current gap in financing with the progressive increase in coverage towards 2030.
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Affiliation(s)
- Ala Alwan
- DCP3 Country Translation Project, London School of Hygiene and Tropical Medicine, London, UK
| | - Sameen Siddiqi
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Malik Safi
- Ministry of National Health Services, Regulations and Coordination, Islamabad, Pakistan
| | - Raza Zaidi
- Ministry of National Health Services, Regulations and Coordination, Islamabad, Pakistan
| | - Muhammad Khalid
- Ministry of National Health Services, Regulations and Coordination, Islamabad, Pakistan
| | - Rob Baltussen
- Department of Health Evidence, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ina Gudumac
- DCP3 Country Translation Project, London School of Hygiene and Tropical Medicine, London, UK
| | - Maryam Huda
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Maarten Jansen
- Department of Health Evidence, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Wajeeha Raza
- Centre for Health Economics, University of York, York, UK
| | - Sergio Torres-Rueda
- Department of Global Health & Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Wahaj Zulfiqar
- Ministry of National Health Services, Regulations and Coordination, Islamabad, Pakistan
| | - Anna Vassall
- Department of Global Health & Development, London School of Hygiene and Tropical Medicine, London, UK
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22
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Kasper T, Yamey G, Dwyer S, McDade KK, Lidén J, Lüdemann C, Diab MM, Ogbuoji O, Poodla P, Schrade C, Thoumi A, Zimmerman A, Assefa Y, Allen LN, Basinga P, Garcia PJ, Jackson D, Mwanyika H, Nugent R, Ofosu A, Rawaf S, Reddy KS, Settle D, Tritter B, Benn C. Rethinking how development assistance for health can catalyse progress on primary health care. Lancet 2023; 402:2253-2264. [PMID: 37967568 DOI: 10.1016/s0140-6736(23)01813-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/16/2023] [Accepted: 08/24/2023] [Indexed: 11/17/2023]
Abstract
Global campaigns to control HIV, tuberculosis, malaria, and vaccine-preventable illnesses showed that large-scale impact can be achieved by using additional international financing to support selected, evidence-based, high-impact investment areas and to catalyse domestic resource mobilisation. Building on this paradigm, we make the case for targeting additional international funding for selected high-impact investments in primary health care. We have identified and costed a set of concrete, evidence-based investments that donors could support, which would be expected to have major impacts at an affordable cost. These investments are in: (1) individuals and communities empowered to engage in health decision making, (2) a new model of people-centred primary care, and (3) next generation community health workers. These three areas would be supported by strengthening two cross-cutting elements of national systems. The first is the digital tools and data that support facility, district, and national managers to improve processes, quality of care, and accountability across primary health care. The second is the educational, training, and supervisory systems needed to improve the quality of care. We estimate that with an additional international investment of between US$1·87 billion in a low-investment scenario and $3·85 billion in a high-investment scenario annually over the next 3 years, the international community could support the scale-up of this evidence-based package of investments in the 59 low-income and middle-income countries that are eligible for external financing from the World Bank Group's International Development Association.
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Affiliation(s)
| | - Gavin Yamey
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University, Durham, NC, USA.
| | | | - Kaci Kennedy McDade
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University, Durham, NC, USA
| | | | | | - Mohamed Mustafa Diab
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Osondu Ogbuoji
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University, Durham, NC, USA
| | | | | | - Andrea Thoumi
- Margolis Center for Health Policy, Duke University, Durham, NC, USA
| | - Armand Zimmerman
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Yibeltal Assefa
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - Luke N Allen
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Paulin Basinga
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Patricia J Garcia
- School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Debra Jackson
- Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Rachel Nugent
- Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Salman Rawaf
- Department of Primary Care and Public Health, Imperial College London, London, UK
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23
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Aguolu OG, Kiti MC, Nelson K, Liu CY, Sundaram M, Gramacho S, Jenness S, Melegaro A, Sacoor C, Bardaji A, Macicame I, Jose A, Cavele N, Amosse F, Uamba M, Jamisse E, Tchavana C, Briones HGM, Jarquín C, Ajsivinac M, Pischel L, Ahmed N, Mohan VR, Srinivasan R, Samuel P, John G, Ellington K, Joaquim OA, Zelaya A, Kim S, Chen H, Kazi M, Malik F, Yildirim I, Lopman B, Omer SB. Comprehensive profiling of social mixing patterns in resource poor countries: a mixed methods research protocol. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.12.05.23299472. [PMID: 38105989 PMCID: PMC10723497 DOI: 10.1101/2023.12.05.23299472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Background Low-and-middle-income countries (LMICs) bear a disproportionate burden of communicable diseases. Social interaction data inform infectious disease models and disease prevention strategies. The variations in demographics and contact patterns across ages, cultures, and locations significantly impact infectious disease dynamics and pathogen transmission. LMICs lack sufficient social interaction data for infectious disease modeling. Methods To address this gap, we will collect qualitative and quantitative data from eight study sites (encompassing both rural and urban settings) across Guatemala, India, Pakistan, and Mozambique. We will conduct focus group discussions and cognitive interviews to assess the feasibility and acceptability of our data collection tools at each site. Thematic and rapid analyses will help to identify key themes and categories through coding, guiding the design of quantitative data collection tools (enrollment survey, contact diaries, exit survey, and wearable proximity sensors) and the implementation of study procedures.We will create three age-specific contact matrices (physical, nonphysical, and both) at each study site using data from standardized contact diaries to characterize the patterns of social mixing. Regression analysis will be conducted to identify key drivers of contacts. We will comprehensively profile the frequency, duration, and intensity of infants' interactions with household members using high resolution data from the proximity sensors and calculating infants' proximity score (fraction of time spent by each household member in proximity with the infant, over the total infant contact time) for each household member. Discussion Our qualitative data yielded insights into the perceptions and acceptability of contact diaries and wearable proximity sensors for collecting social mixing data in LMICs. The quantitative data will allow a more accurate representation of human interactions that lead to the transmission of pathogens through close contact in LMICs. Our findings will provide more appropriate social mixing data for parameterizing mathematical models of LMIC populations. Our study tools could be adapted for other studies.
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Affiliation(s)
| | | | - Kristin Nelson
- Rollins School of Public Health, Emory University, Georgia, USA
| | - Carol Y. Liu
- Rollins School of Public Health, Emory University, Georgia, USA
| | - Maria Sundaram
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | - Sergio Gramacho
- Rollins School of Public Health, Emory University, Georgia, USA
| | - Samuel Jenness
- Rollins School of Public Health, Emory University, Georgia, USA
| | - Alessia Melegaro
- DONDENA Centre for Research in Social Dynamics and Public Policy, Bocconi University, Italy
| | | | - Azucena Bardaji
- Manhiça Health Research Centre, Manhica, Mozambique
- ISGlobal, Hospital Clinic – Universitat de Barcelona, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Ivalda Macicame
- Polana Caniço Health Research and Training Centre, CISPOC, Mozambique
| | - Americo Jose
- Polana Caniço Health Research and Training Centre, CISPOC, Mozambique
| | - Nilzio Cavele
- Polana Caniço Health Research and Training Centre, CISPOC, Mozambique
| | | | - Migdalia Uamba
- Polana Caniço Health Research and Training Centre, CISPOC, Mozambique
| | | | | | | | - Claudia Jarquín
- Centro de Estudios en Salud (CES), Universidad del Valle de Guatemala
| | - María Ajsivinac
- Centro de Estudios en Salud (CES), Universidad del Valle de Guatemala
| | - Lauren Pischel
- Yale School of Medicine, Yale University, Connecticut, USA
| | - Noureen Ahmed
- Peter O’Donnell Jr. School of Public Health at UT Southwestern Medical Center, Dallas, Texas
| | | | | | | | - Gifta John
- Christian Medical College Vellore, India
| | - Kye Ellington
- Rollins School of Public Health, Emory University, Georgia, USA
| | | | - Alana Zelaya
- Rollins School of Public Health, Emory University, Georgia, USA
| | - Sara Kim
- Rollins School of Public Health, Emory University, Georgia, USA
| | - Holin Chen
- Rollins School of Public Health, Emory University, Georgia, USA
| | - Momin Kazi
- The Aga Khan University, Karachi, Pakistán
| | - Fauzia Malik
- Peter O’Donnell Jr. School of Public Health at UT Southwestern Medical Center, Dallas, Texas
| | - Inci Yildirim
- Yale School of Medicine, Yale University, Connecticut, USA
| | - Benjamin Lopman
- Rollins School of Public Health, Emory University, Georgia, USA
| | - Saad B. Omer
- Peter O’Donnell Jr. School of Public Health at UT Southwestern Medical Center, Dallas, Texas
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24
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Ginsburg O, Vanderpuye V, Beddoe AM, Bhoo-Pathy N, Bray F, Caduff C, Florez N, Fadhil I, Hammad N, Heidari S, Kataria I, Kumar S, Liebermann E, Moodley J, Mutebi M, Mukherji D, Nugent R, So WKW, Soto-Perez-de-Celis E, Unger-Saldaña K, Allman G, Bhimani J, Bourlon MT, Eala MAB, Hovmand PS, Kong YC, Menon S, Taylor CD, Soerjomataram I. Women, power, and cancer: a Lancet Commission. Lancet 2023; 402:2113-2166. [PMID: 37774725 DOI: 10.1016/s0140-6736(23)01701-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 06/27/2023] [Accepted: 08/11/2023] [Indexed: 10/01/2023]
Affiliation(s)
- Ophira Ginsburg
- Centre for Global Health, US National Cancer Institute, Rockville, MD, USA.
| | | | | | | | - Freddie Bray
- International Agency for Research on Cancer, Lyon, France
| | - Carlo Caduff
- Department of Global Health and Social Medicine, King's College London, London, UK
| | - Narjust Florez
- Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | - Nazik Hammad
- Department of Medicine, Division of Hematology-Oncology, St. Michael's Hospital, University of Toronto, Canada; Department of Oncology, Queens University, Kingston, Canada
| | - Shirin Heidari
- GENDRO, Geneva, Switzerland; Gender Centre, Geneva Graduate Institute, Geneva, Switzerland
| | - Ishu Kataria
- Center for Global Noncommunicable Diseases, RTI International, New Delhi, India
| | - Somesh Kumar
- Jhpiego India, Johns Hopkins University Affiliate, Baltimore, MD, USA
| | - Erica Liebermann
- University of Rhode Island College of Nursing, Providence, RI, USA
| | - Jennifer Moodley
- Cancer Research Initiative, Faculty of Health Sciences, School of Public Health and Family Medicine, and SAMRC Gynaecology Cancer Research Centre, University of Cape Town, Cape Town, South Africa
| | - Miriam Mutebi
- Department of Surgery, Aga Khan University, Nairobi, Kenya
| | - Deborah Mukherji
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon; Clemenceau Medical Center Dubai, Dubai, United Arab Emirates
| | - Rachel Nugent
- Center for Global Noncommunicable Diseases, RTI International, Durham, NC, USA; Department of Global Health, University of Washington, Seattle, WA, USA
| | - Winnie K W So
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong Special Administrative Region, China
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, National Institute of Medical Science and Nutrition Salvador Zubiran, Mexico City, Mexico
| | | | - Gavin Allman
- Center for Global Noncommunicable Diseases, RTI International, Durham, NC, USA
| | - Jenna Bhimani
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - María T Bourlon
- Department of Hemato-Oncology, National Institute of Medical Science and Nutrition Salvador Zubiran, Mexico City, Mexico
| | - Michelle A B Eala
- College of Medicine, University of the Philippines, Manila, Philippines; Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Yek-Ching Kong
- Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Sonia Menon
- Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
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25
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Nag A, Privara A, Gavurova B, Pradhan J. Does club convergence matter in health outcomes? Evidence from Indian states. BMC Public Health 2023; 23:2154. [PMID: 37924059 PMCID: PMC10625292 DOI: 10.1186/s12889-023-16972-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 10/12/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Population health is vital to a nation's overall well-being and development. To achieve sustainable human development, a reduction in health inequalities and an increase in interstate convergence in health indicators is necessary. Evaluation of the convergence patterns can aid the government in monitoring the health progress across the Indian states. This study investigates the progressive changes in the convergence and divergence patterns in health status across major states of India from 1990 to 2018. METHODS Sigma plots (σ), kernel density plots, and log t-test methods are used to test the convergence, divergence, and club convergence patterns in the health indicators at the state level. RESULTS The result of the sigma convergence suggests that life expectancy at birth has converged across all states. After 2006, however, the infant mortality rate, neonatal mortality rate, and total fertility rate experienced a divergence pattern. The study's findings indicate that life expectancy at birth converges in the same direction across all states, falling into the same club (Club One). However, considerable cross-state variations and evidence of clubs' convergence and divergence are observed in the domains of infant mortality rate, neonatal death rate, and total fertility rate. As suggested by the kernel density estimates, life expectancy at birth stratifies, polarizes, and becomes unimodal over time, although with a single stable state. A bimodal distribution was found for infant, neonatal, and total fertility rates. CONCLUSIONS Therefore, healthcare strategies must consider each club's transition path while focusing on divergence states to reduce health variations and improve health outcomes for each group of individuals.
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Affiliation(s)
- Ajit Nag
- Department of Humanities and Social Sciences National Institute of Technology, Rourkela, Odisha, India
| | - Andrej Privara
- Faculty of National Economy University of Economics in Bratislava, Bratislava, Slovak Republic
| | - Beata Gavurova
- Center for Applied Economic Research, Faculty of Management and Economics, Tomas Bata University in Zlin, Zlín, Czech Republic.
| | - Jalandhar Pradhan
- Department of Humanities and Social Sciences National Institute of Technology, Rourkela, Odisha, India
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26
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Mao W, McDade KK, Ogbuoji O, Yamey G, Bermeo SB. Strategic donor behaviour and country vulnerability in health aid transitions. BMJ Glob Health 2023; 8:e012953. [PMID: 37940202 PMCID: PMC10632813 DOI: 10.1136/bmjgh-2023-012953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/12/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND When countries reach the middle-income threshold, many multilateral donors, including Gavi, the Vaccine Alliance (Gavi), begin to withdraw their official development assistance (ODA), known as graduation. We hypothesised that bilateral donors might follow Gavi's lead, except in countries where they have strategic interests. We aim to understand how bilateral donors behave after a recipient country graduates from Gavi support and how bilateral donors might treat Gavi support countries differently, based on 'strategic interest'. We also aim to identify countries that were more vulnerable to 'simultaneous' transitions and financial cliffs after Gavi transition. METHODS This is an observational dyadic analysis using longitudinal data. We collected country-level data on 77 Gavi-eligible countries between 2009 and 2018 and paired donor and recipient country in a specific year to conduct dyadic analysis. We included Gavi graduation status and Gavi disbursement as explanatory variables. We controlled for (1) donor-recipient relationship variables that represent potential strategic relationships (eg, distance between donor and recipient country) and (2) recipient-level characteristics (eg, population, income). We used Odinary Least Squares regression, Tobit and two-part model in Stata SE 15.0. FINDINGS We found a country would receive $3.1 million less all sector ODA from a bilateral donor, and $0.6 million less health ODA, after they graduate from Gavi. For every additional 1% ODA a country would receive from Gavi, it would receive 0.14% more ODA and 0.16% more health ODA from individual bilateral donors. Gavi's graduation status or disbursement brought more change in percentage term to health ODA than to total ODA. Additionally, Gavi's graduation was observed to have a larger negative impact on bilateral ODA in the longer term. Countries that sent more migrants, had been colonised, and received more US military assistance tended to receive more ODA. There are similarities and differences across different donors and bilateral donors tend to provide more ODA to nearby countries and countries receiving fewer exports from the donor. We found that former colonies did not see a decline in aid after Gavi graduation. CONCLUSION Bilateral donors behave in a similar manner to Gavi when it comes to funding health systems in low and middle-income countries. Therefore, some countries may be at risk of losing donor resources for health from a multitude of sources around the same time. However, countries that have a strategic interest in bilateral donors may be spared from such funding cliffs. This research has important implications for global health donors' funding policies and approaches in addition to recipient countries' transition planning.
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Affiliation(s)
- Wenhui Mao
- Center for Policy Impact in Global Health, Duke Global Health Institute, Durham, North Carolina, USA
| | - Kaci Kennedy McDade
- Center for Policy Impact in Global Health, Duke Global Health Institute, Durham, North Carolina, USA
| | - Osondu Ogbuoji
- Center for Policy Impact in Global Health, Duke Global Health Institute, Durham, North Carolina, USA
- Margolis Center for Health Policy, Duke University, Washington, DC, USA
| | - Gavin Yamey
- Center for Policy Impact in Global Health, Duke Global Health Institute, Durham, North Carolina, USA
- Margolis Center for Health Policy, Duke University, Washington, DC, USA
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27
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Reid M, Agbassi YJP, Arinaminpathy N, Bercasio A, Bhargava A, Bhargava M, Bloom A, Cattamanchi A, Chaisson R, Chin D, Churchyard G, Cox H, Denkinger CM, Ditiu L, Dowdy D, Dybul M, Fauci A, Fedaku E, Gidado M, Harrington M, Hauser J, Heitkamp P, Herbert N, Herna Sari A, Hopewell P, Kendall E, Khan A, Kim A, Koek I, Kondratyuk S, Krishnan N, Ku CC, Lessem E, McConnell EV, Nahid P, Oliver M, Pai M, Raviglione M, Ryckman T, Schäferhoff M, Silva S, Small P, Stallworthy G, Temesgen Z, van Weezenbeek K, Vassall A, Velásquez GE, Venkatesan N, Yamey G, Zimmerman A, Jamison D, Swaminathan S, Goosby E. Scientific advances and the end of tuberculosis: a report from the Lancet Commission on Tuberculosis. Lancet 2023; 402:1473-1498. [PMID: 37716363 DOI: 10.1016/s0140-6736(23)01379-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/14/2023] [Accepted: 06/29/2023] [Indexed: 09/18/2023]
Affiliation(s)
- Michael Reid
- University of California San Francisco Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA; Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA.
| | - Yvan Jean Patrick Agbassi
- Global TB Community Advisory Board, Abidjan, Côte d'Ivoire, Yenepoya Medical College, Mangalore, India
| | | | - Alyssa Bercasio
- University of California San Francisco Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA; Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Anurag Bhargava
- Department of General Medicine, Yenepoya Medical College, Mangalore, India
| | - Madhavi Bhargava
- Department of Community Medicine, Yenepoya Medical College, Mangalore, India
| | - Amy Bloom
- Division of Tuberculosis, Bureau of Global Health, USAID, Washington, DC, USA
| | | | - Richard Chaisson
- Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Daniel Chin
- Bill and Melinda Gates Foundation, Seattle, WA, USA
| | | | - Helen Cox
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Claudia M Denkinger
- Heidelberg University Hospital, German Center of Infection Research, Heidelberg, Germany
| | | | - David Dowdy
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Mark Dybul
- Department of Medicine, Center for Global Health Practice and Impact, Georgetown University, Washington, DC, USA
| | - Anthony Fauci
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | | | | | | | | | - Petra Heitkamp
- McGill International TB Centre, McGill University, Montreal, QC, Canada
| | - Nick Herbert
- Global TB Caucus, Houses of Parliament, London, UK
| | | | - Philip Hopewell
- University of California San Francisco Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA
| | - Emily Kendall
- Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Aamir Khan
- Interactive Research & Development, Karachi, Pakistan
| | - Andrew Kim
- University of California San Francisco Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA
| | | | | | - Nalini Krishnan
- Resource Group for Education and Advocacy for Community Health (REACH), Chennai, India
| | - Chu-Chang Ku
- School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Erica Lessem
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | - Payam Nahid
- University of California San Francisco Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA
| | | | - Madhukar Pai
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada; McGill International TB Centre, McGill University, Montreal, QC, Canada
| | - Mario Raviglione
- Centre for Multidisciplinary Research in Health Science, University of Milan, Milan, Italy
| | - Theresa Ryckman
- Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | | | - Sachin Silva
- Harvard TH Chan School of Public Health, Harvard University, Cambridge, MA, USA
| | | | | | | | | | - Anna Vassall
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Gustavo E Velásquez
- University of California San Francisco Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA
| | | | - Gavin Yamey
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University, Durham, NC, USA
| | | | - Dean Jamison
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | | | - Eric Goosby
- University of California San Francisco Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA; Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
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Haacker M. Contributions of declining mortality, overall and from HIV, TB and malaria, to reduced health inequality and inequity across countries. Health Policy Plan 2023; 38:939-948. [PMID: 37409745 PMCID: PMC10506528 DOI: 10.1093/heapol/czad046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/17/2023] [Accepted: 07/04/2023] [Indexed: 07/07/2023] Open
Abstract
The objective to reduce global health inequalities and inequities is integral to the global development agenda, from the Universal Declaration of Human Rights to the sustainable development goals and the ongoing response to coronavirus disease. Yet, summary measures of global health gains or of the cost-effectiveness of global health programmes barely capture how well they improve the lives of the most disadvantaged populations. This paper instead explores the distribution of global health gains across countries and the implications for health inequality and inequity (here referring to health disadvantages that reinforce economic disadvantage, and vice versa) across countries. Specifically, it studies the distribution of gains in life expectancy across countries (overall and owing to reduced mortality from HIV, TB and malaria), using the Gini index and a concentration index ranking countries by gross domestic product (GDP) per capita as indicators of health inequality and inequity. By these counts, global inequality in life expectancy across countries declined by one-third between 2002 and 2019. Reduced mortality from HIV, TB and malaria accounted for one-half of this decline. Fifteen countries in sub-Saharan Africa, containing 5% of the global population, accounted for 40% of the global decline in inequality, with nearly six-tenth of this contribution coming from HIV, TB and malaria. Inequity in life expectancy across countries declined by nearly 37%, with a contribution from HIV, TB and malaria of 39% of this gain. Our findings show how simple indicators on the distribution of health gains across countries usefully complement aggregate measures of global health gains and underscore their positive contribution to the global development agenda.
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Affiliation(s)
- Markus Haacker
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg 69120, Germany
- Center for Global Development, Washington, DC 20036, United States
- Institute for Global Health, University College London, London WC1N 1EH, United Kingdom
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Zadey S. Scale-up costs and societal benefits of psychological interventions for alcohol use and depressive disorders in India. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002017. [PMID: 37708109 PMCID: PMC10501670 DOI: 10.1371/journal.pgph.0002017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/21/2023] [Indexed: 09/16/2023]
Abstract
There is growing evidence for cost-effective psychological interventions by lay health workers for managing mental health problems. In India, Counseling for Alcohol Problems (CAP) and Healthy Activity Program (HAP) have been shown to have sustained cost-effectiveness for improving harmful alcohol use among males and depression remission among both sexes, respectively. We conducted a retrospective analysis of annual costs and economic benefits of CAP and HAP national scale-up with 2019 as the baseline. The CAP and HAP per capita integration costs were obtained from original studies, prevalence and disability-adjusted life-years for alcohol use disorders (AUD) and depressive disorders for 20-64 years old males and females from Global Burden of Disease study, and treatment gaps from National Mental Health Survey. We calculated three outcomes: 1) Programmatic scale-up costs for covering total or unmet needs. 2) Societal benefits from averted disease burden using human capital and value of life-year approaches. 3) Combinations of net benefits as differences between societal benefits and scale-up costs. Values were transformed to 2019 international dollars. CAP scale-up costs ranged from Int$ 2.03 (95%UI: 1.67, 2.44) billion to Int$ 6.34 (5.21, 7.61) billion while HAP ones ranged from Int$ 6.85 (5.61, 8.12) billion to Int$ 23.21 (19.03, 27.52) billion. Societal benefits due to averted AUD burden ranged from Int$ 11.51 (8.75, 14.90) billion to Int$ 38.73 (29.43, 50.11) billion and those due to averted depression burden ranged from Int$ 30.89 (20.77, 43.32) billion to Int$ 105.27 (70.78, 147.61) billion. All scenarios showed net positive benefits for CAP (Int$ 6.05-36.38 billion) and HAP (Int$ 11.12-93.50 billion) scale-up. The novel national-level scale-up estimates have actionable implications for mental health financing in India.
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Affiliation(s)
- Siddhesh Zadey
- GEMINI Research Center, Duke University School of Medicine, Durham, NC, United States of America
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India
- Dr. D.Y. Patil Medical College, Hospital, and Research Centre, Pune, Maharashtra, India
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Weber MB, Baumann AA, Rakhra A, Akwanalo C, Gladys Amaning Adjei K, Andesia J, Apusiga K, Ha DA, Hosseinipour MC, Muula AS, Nguyen HL, Price LN, Ramirez-Zea M, Fitzpatrick AL, Fort MP. Global implementation research capacity building to address cardiovascular disease: An assessment of efforts in eight countries. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002237. [PMID: 37708090 PMCID: PMC10501667 DOI: 10.1371/journal.pgph.0002237] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/01/2023] [Indexed: 09/16/2023]
Abstract
Cardiovascular diseases are the leading causes of morbidity and mortality worldwide, but implementation of evidence-based interventions for risk factors such as hypertension is lacking, particularly in low and middle income countries (LMICs). Building implementation research capacity in LMICs is required to overcome this gap. Members of the Global Research on Implementation and Translation Science (GRIT) Consortium have been collaborating in recent years to establish a research and training infrastructure in dissemination and implementation to improve hypertension care. GRIT includes projects in Ghana, Guatemala, India, Kenya, Malawi, Nepal, Rwanda, and Vietnam. We collected data from each site on capacity building activities using the Potter and Brough (2004) model, mapping formal and informal activities to develop (a) structures, systems and roles, (b) staff and infrastructure, (c) skills, and (d) tools. We captured information about sites' needs assessments and metrics plus program adaptations due to the COVID-19 pandemic. All sites reported capacity building activities in each layer of the Capacity Pyramid, with the largest number of activities in the Skills and Tools categories, the more technical and easier to implement categories. All sites included formal and informal training to build Skills. All sites included a baseline needs assessment to guide capacity building activities or assess context and inform intervention design. Sites implementing evidence-based hypertension interventions used common implementation science frameworks to evaluate implementation outcomes. Although the COVID-19 pandemic affected timelines and in-person events, all projects were able to pivot and carry out planned activities. Although variability in the activities and methods used existed, GRIT programs used needs assessments to guide locally appropriate design and implementation of capacity building activities. COVID-19 related changes were necessary, but strong collaborations and relationships with health ministries were maintained. The GRIT Consortium is a model for planning capacity building in LMICs.
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Affiliation(s)
- Mary Beth Weber
- Hubert Department of Global Health, Emory University, Rollins School of Public Health, Atlanta, Georgia, United States of America
| | - Ana A. Baumann
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Ashlin Rakhra
- Department of Population Health, NYU Grossman School of Medicine, New York City, New York, United States of America
| | | | - Kezia Gladys Amaning Adjei
- Department of Physiology, School of Medicine and Dentistry, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Josephine Andesia
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Kingsley Apusiga
- Department of Physiology, School of Medicine and Dentistry, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Duc A. Ha
- Health Strategy and Policy Institute, Vietnam Ministry of Health, Hanoi, Vietnam
| | - Mina C. Hosseinipour
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Adamson S. Muula
- College of Medicine, University of Malawi and the Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Hoa L. Nguyen
- University of Massachusetts Chan Medical School, Boston, Massachusetts, United States of America
| | - LeShawndra N. Price
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Manuel Ramirez-Zea
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Annette L. Fitzpatrick
- School of Public Health, University of Washington, Seattle, Washington, United States of America
| | - Meredith P. Fort
- Colorado School of Public Health, University of Colorado – Anschutz Medical Campus, Aurora, Colorado, United States of America
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Gerstl JVE, Blitz SE, Qu QR, Yearley AG, Lassarén P, Lindberg R, Gupta S, Kappel AD, Vicenty-Padilla JC, Gaude E, Atchaneeyasakul KC, Desai SM, Yavagal DR, Peruzzotti-Jametti L, Patel NJ, Aziz-Sultan MA, Du R, Smith TR, Bernstock JD. Global, Regional, and National Economic Consequences of Stroke. Stroke 2023; 54:2380-2389. [PMID: 37497672 PMCID: PMC7614992 DOI: 10.1161/strokeaha.123.043131] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/19/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND An understanding of global, regional, and national macroeconomic losses caused by stroke is important for allocation of clinical and research resources. The authors investigated the macroeconomic consequences of stroke disease burden in the year 2019 in 173 countries. METHODS Disability-adjusted life year data for overall stroke and its subtypes (ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage) were collected from the GBD study (Global Burden of Disease) 2019 database. Gross domestic product (GDP, adjusted for purchasing power parity [PPP]) data were collected from the World Bank; GDP and disability-adjusted life year data were combined to estimate macroeconomic losses using a value of lost welfare (VLW) approach. All results are presented in 2017 international US dollars adjusted for PPP. RESULTS Globally, in 2019, VLW due to stroke was $2059.67 billion or 1.66% of the global GDP. Global VLW/GDP for stroke subtypes was 0.78% (VLW=$964.51 billion) for ischemic stroke, 0.71% (VLW=$882.81 billion) for intracerebral hemorrhage, and 0.17% (VLW=$212.36 billion) for subarachnoid hemorrhage. The Central European, Eastern European, and Central Asian GBD super-region reported the highest VLW/GDP for stroke overall (3.01%), ischemic stroke (1.86%), and for subarachnoid hemorrhage (0.26%). The Southeast Asian, East Asian, and Oceanian GBD super-region reported the highest VLW/GDP for intracerebral hemorrhage (1.48%). CONCLUSIONS The global macroeconomic consequences related to stroke are vast even when considering stroke subtypes. The present quantification may be leveraged to help justify increased spending of finite resources on stroke in an effort to improve outcomes for patients with stroke globally.
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Affiliation(s)
- Jakob V. E. Gerstl
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Sarah E. Blitz
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Harvard Medical School, Boston, MA
| | - Qing Rui Qu
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA
| | - Alexander G. Yearley
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Harvard Medical School, Boston, MA
| | - Philipp Lassarén
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
| | - Rebecca Lindberg
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
| | - Saksham Gupta
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Department of Neurosurgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA
| | - Ari D. Kappel
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Department of Neurosurgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA
| | | | | | | | | | - Dileep R. Yavagal
- Department of Neurology, University of Miami & Jackson Memorial Hospitals, FL
| | - Luca Peruzzotti-Jametti
- Department of Clinical Neurosciences and NIHR Biomedical Research Centre, University of Cambridge, Cambridge, UK
- Department of Metabolism, Digestion and Reproduction, Imperial College London
| | - Nirav J. Patel
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Mohammed A. Aziz-Sultan
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Rose Du
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Timothy R. Smith
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Joshua D. Bernstock
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA
- Department of Neurosurgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA
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Mao W, Zimmerman A, Urli Hodges E, Ortiz E, Dods G, Taylor A, Udayakumar K. Comparing research and development, launch, and scale up timelines of 18 vaccines: lessons learnt from COVID-19 and implications for other infectious diseases. BMJ Glob Health 2023; 8:e012855. [PMID: 37696544 PMCID: PMC10496705 DOI: 10.1136/bmjgh-2023-012855] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/30/2023] [Indexed: 09/13/2023] Open
Abstract
Over the next decade, millions of deaths could be prevented by increasing access to vaccines in low-income and middle-income countries (LMICs). The COVID-19 pandemic has demonstrated that the research and development (R&D), launch and scale up timelines of vaccines can be drastically shortened. This study compares such timelines for eighteen vaccines and identifies lessons and implications for accelerating the R&D, launch and scale up process for other vaccine candidates. To replicate the rapid R&D process of the COVID-19 vaccines, future vaccine R&D should capitalise on public-private knowledge sharing partnerships to promote technology innovation, establish regional clinical trial centres and data sharing networks to optimise clinical trial efficiency, and create a funding mechanism to support research into novel vaccine platforms that may prove valuable to quickly developing vaccine candidates in future global health emergencies. To accelerate the launch timeline, future efforts to bring safe and efficacious vaccines to market should include LMICs in the decision-making processes of global procurement and delivery alliances to optimise launch in these countries, strengthen the WHO prequalification and Emergency Use Listing programs to ensure LMICs have a robust and transparent regulatory system to rely on, and invest in LMIC regulatory and manufacturing capacity to ensure these countries are vaccine self-sufficient. Lastly, efforts to accelerate scale up of vaccines should include the creation of regional pooled procurement mechanisms between LMICs to increase purchasing power among these countries and an open line of clear communication with the public regarding pertinent vaccine information to combat misinformation and vaccine hesitancy.
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Affiliation(s)
- Wenhui Mao
- Duke Global Health Innovation Center, Duke Global Health Institute, Durham, North Carolina, USA
- Innovations in Healthcare, Durham, North Carolina, USA
| | - Armand Zimmerman
- Duke Global Health Innovation Center, Duke Global Health Institute, Durham, North Carolina, USA
- Center for Policy Impact in Global Health, Duke Global Health Institute, Durham, North Carolina, USA
| | - Elina Urli Hodges
- Duke Global Health Innovation Center, Duke Global Health Institute, Durham, North Carolina, USA
- Innovations in Healthcare, Durham, North Carolina, USA
| | - Ernesto Ortiz
- Duke Global Health Innovation Center, Duke Global Health Institute, Durham, North Carolina, USA
- Innovations in Healthcare, Durham, North Carolina, USA
| | - Galen Dods
- Science and Society, Duke University, Durham, North Carolina, USA
| | - Andrea Taylor
- Duke Global Health Innovation Center, Duke Global Health Institute, Durham, North Carolina, USA
- Innovations in Healthcare, Durham, North Carolina, USA
| | - Krishna Udayakumar
- Duke Global Health Innovation Center, Duke Global Health Institute, Durham, North Carolina, USA
- Innovations in Healthcare, Durham, North Carolina, USA
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Turner HC, Hori Y, Revill P, Rattanavipapong W, Arai K, Nonvignon J, Jit M, Teerawattananon Y. Analyses of the return on investment of public health interventions: a scoping review and recommendations for future studies. BMJ Glob Health 2023; 8:e012798. [PMID: 37648275 PMCID: PMC10471881 DOI: 10.1136/bmjgh-2023-012798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/20/2023] [Indexed: 09/01/2023] Open
Abstract
Return on investment (ROI) analysis is increasingly being used for evaluating the value for money of public health interventions. Given its potential role for informing health policies, it is important that there is a more comprehensive understanding of ROI analysis within the global health field. To address this gap in the literature, we conducted a scoping review of recent research articles reporting an ROI metric for a health intervention within the public sector in any country setting. The database search was limited to literature published in English and studies published between 1 January 2018 and 14 June 2021. Uses and settings where the ROI metric is being applied, key methodological features of the calculations and the types of economic benefits included were extracted. 118 relevant studies were included within this scoping review. We found that ROI analyses of health interventions differed between those that only included fiscal savings (such as prevented medical expenses) and those which incorporated a wider range of benefits (such as monetised health benefits). This highlights the variation in the definition of ROI analyses and supports the finding that ROI analyses are used for a range of different research questions/purposes within the healthcare sector. We also found that the methodologies used in ROI calculations were inconsistent and often poorly reported. This review demonstrates that there is notable variation in the methodology surrounding recent ROI calculations of healthcare interventions, as well as the definition of ROI analysis. We recommend that ROI metrics should be carefully interpreted before they are used to inform policy decisions regarding the allocation of healthcare resources. To improve the consistency of future studies, we also set out recommended use cases for ROI analysis and a reporting checklist.
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Affiliation(s)
- Hugo C Turner
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Yoshiaki Hori
- School of Public Health, Imperial College London, London, UK
| | - Paul Revill
- Centre for Health Economics, University of York, York, UK
| | - Waranya Rattanavipapong
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
| | - Ko Arai
- Graduate School of Business Administration, Hitotsubashi University, Tokyo, Japan
| | - Justice Nonvignon
- School of Public Health, University of Ghana, Accra, Ghana
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Mark Jit
- Centre of Global Change and Health, London School of Hygiene & Tropical Medicine, London, UK
- School of Public Health, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Yi Z, Xu T, Yang J, Yu S, Zhou M, Li H, Guo J, Qian J, Dong W. Comprehensive assessment of resources for prevention and control of chronic and non-communicable diseases in China: a cross-sectional study. BMJ Open 2023; 13:e071407. [PMID: 37474175 PMCID: PMC10360424 DOI: 10.1136/bmjopen-2022-071407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023] Open
Abstract
OBJECTIVE This study aims to comprehensively evaluate the resources for prevention and control of chronic and non-communicable diseases (NCDs) in China to provide a reference basis for optimising the resource allocation for prevention and control of NCDs. METHODS China Chronic Disease and Risk Factor Surveillance sites and National Demonstration Areas for Integrated Chronic and Non-communicable Disease Prevention and Control (NCDDA) were selected as investigation objects. In December 2021, the district (or county) resource allocation for NCD prevention and control was investigated through the NCDDA management information system. According to the index system of NCD prevention and control, 31 indicators of 6 dimensions were collected, and the weighted technique for order preference by similarity to an ideal solution, weighted rank-sum ratio and fuzzy comprehensive evaluation methods were used for comprehensive evaluation of resources for prevention and control of NCDs. RESULTS The 653 districts (or counties) in this study cover 22.96% of China's districts (or counties). The top three weights were full-time staff for NCD prevention and control (0.1066), the amount of funds for NCD prevention and control (0.0967), and the coverage rate of districts (or counties) establishing chronic obstructive pulmonary disease surveillance information system (0.0886). The comprehensive evaluation results for the resources for prevention and control of NCDs by the three methods were basically the same. The results of fuzzy comprehensive evaluation showed that the resource allocation in urban areas (0.9268) was better than that in rural areas (0.3257), the one in eastern region (0.9016) was better than that in central (0.3844) and western regions (0.3868), and the one in NCDDA (0.9625) was better than that in non-NCDDA (0.2901). CONCLUSION The resources in China for NCD prevention and control differ among different regions, which should be taken into account in future policymaking and resource allocation.
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Affiliation(s)
- Zhun Yi
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Tingling Xu
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jing Yang
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shicheng Yu
- Office of Epidemiology, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Maigeng Zhou
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Han Li
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jiahuan Guo
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jing Qian
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
- School of Health Management, China Medical University, Shenyang, China
| | - Wenlan Dong
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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35
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Chisholm D, Lee YY, Baral PP, Bhagwat S, Dombrovskiy V, Grafton D, Kontsevaya A, Huque R, Kalani Okware K, Kulikov A, Marahatta K, Mavunganidze P, Omar N, Prasai D, Putoud N, Tsoyi E, Vergara J. Cross-country analysis of national mental health investment case studies in sub-Saharan Africa and Central, South and South-East Asia. FRONTIERS IN HEALTH SERVICES 2023; 3:1214885. [PMID: 37533704 PMCID: PMC10392930 DOI: 10.3389/frhs.2023.1214885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 07/04/2023] [Indexed: 08/04/2023]
Abstract
Introduction Despite the increasing interest in and political commitment to mental health service development in many regions of the world, there remains a very low level of financial commitment and corresponding investment. Assessment of the projected costs and benefits of scaling up the delivery of effective mental health interventions can help to promote, inform and guide greater investment in public mental health. Methods A series of national mental health investment case studies were carried out (in Bangladesh, Kenya, Nepal, Philippines, Uganda, Uzbekistan and Zimbabwe), using standardized guidance developed by WHO and UNDP and implemented by a multi-disciplinary team. Intervention costs and the monetized value of improved health and production were computed in national currency units and, for comparison, US dollars. Benefit-cost ratios were derived. Findings Across seven countries, the economic burden of mental health conditions was estimated at between 0.5%-1.0% of Gross Domestic Product. Delivery of an evidence-based package of mental health interventions was estimated to cost US$ 0.40-2.40 per capita per year, depending on the country and its scale-up period. For most conditions and country contexts there was a return of >1 for each dollar or unit of local currency invested (range: 0.0-10.6 to 1) when productivity gains alone are included, and >2 (range: 0.4-30.3 to 1) when the intrinsic economic value of health is also considered. There was considerable variation in benefit-cost ratios between intervention areas, with population-based preventive measures and treatment of common mental, neurological and conditions showing the most attractive returns when all assessed benefits are taken into account. Discussion and Conclusion Performing a mental health investment case can provide national-level decision makers with new and contextualized information on the outlays and returns that can be expected from renewed local efforts to enhance access to quality mental health services. Economic evidence from seven low- and middle-income countries indicates that the economic burden of mental health conditions is high, the investment costs are low and the potential returns are substantial.
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Affiliation(s)
- Dan Chisholm
- Department of Mental Health and Substance Use, World Health Organization (WHO), Geneva, Switzerland
| | - Yong Yi Lee
- Health Economics Division, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
- Queensland Centre for Mental Health Research, Brisbane, QLD, Australia
| | - Phanindra Prasad Baral
- Epidemiology and Disease Control Division, Ministry of Health and Population, Kathmandu, Nepal
| | | | | | | | - Anna Kontsevaya
- National Medical Research Center for Therapy and Preventive Medicine, Moscow, Russia
| | - Rumana Huque
- Department of Economics, University of Dhaka, Dhaka, Bangladesh
| | | | - Alexey Kulikov
- United Nations Inter-Agency Task Force on the Prevention and Control of NCDs, Geneva, Switzerland
| | | | | | - Nasri Omar
- Division of Mental Health, Ministry of Health, Nairobi, Kenya
| | - Devi Prasai
- Nepal Development Research Institute, Kathmandu, Nepal
| | - Nadia Putoud
- United Nations Inter-Agency Task Force on the Prevention and Control of NCDs, Geneva, Switzerland
| | - Elena Tsoyi
- Division of Country Health Programmes, WHO Regional Office for Europe, Copenhagen, Denmark
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Oyando R, Were V, Willis R, Koros H, Kamano JH, Naanyu V, Etyang A, Mugo R, Murphy A, Nolte E, Perel P, Barasa E. Examining the responsiveness of the National Health Insurance Fund to people living with hypertension and diabetes in Kenya: a qualitative study. BMJ Open 2023; 13:e069330. [PMID: 37407061 DOI: 10.1136/bmjopen-2022-069330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
OBJECTIVES To assess the responsiveness of the National Health Insurance Fund (NHIF) Supa Cover benefit package to the needs of individuals with diabetes and hypertension in Kenya. DESIGN, SETTING AND PARTICIPANTS We carried out a qualitative study and collected data using key informant interviews (n=39) and focus group discussions (n=4) in two purposively selected counties in Western Kenya. Study participants were drawn from NHIF officials, county government officials, health facility managers, healthcare workers and individuals with hypertension and diabetes who were enrolled in NHIF. We analysed data using a thematic approach. RESULTS Study participants reported that the NHIF Supa Cover benefit package expanded access to services for people living with hypertension and diabetes. However, the NHIF members and healthcare workers had inadequate awareness of the NHIF service entitlements. The NHIF benefit package inadequately covered the range of services needed by people living with hypertension and diabetes and the benefits package did not prioritise preventive and promotive services. Sometimes patients were discriminated against by healthcare providers who preferred cash-paying patients, and some NHIF-empanelled health facilities had inadequate structural inputs essential for quality of care. Study participants felt that the NHIF premium for the general scheme was unaffordable, and NHIF members faced additional out-of-pocket costs because of additional payments for services not available or covered. CONCLUSION Whereas NHIF has reduced financial barriers for hypertension and diabetes patients, to enhance its responsiveness to patient needs, NHIF should implement mechanisms to increase benefit package awareness among members and providers. In addition, preventive and promotive services should be included in NHIF's benefits package and mechanisms to monitor and hold contracted providers accountable should be strengthened.
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Affiliation(s)
- Robinson Oyando
- Health Economics Research Unit (HERU), KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Vincent Were
- Health Economics Research Unit (HERU), KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Ruth Willis
- Department of Health Service Research and Policy, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Hillary Koros
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Jemima H Kamano
- Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Violet Naanyu
- Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
- School of Arts and Social Sciences, Moi University, Eldoret, Kenya
| | - Anthony Etyang
- Department of Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Richard Mugo
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Adrianna Murphy
- Department of Health Service Research and Policy, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Ellen Nolte
- Department of Health Service Research and Policy, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Pablo Perel
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Edwine Barasa
- Health Economics Research Unit (HERU), KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Center for Tropical Medicine and Global Health, University of Oxford, Oxford, 01540, UK
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Aiyegoro OA, Moyane JN, Adegoke AA, Jideani AIO, Reddy P, Okoh AI. Virulence Signatures, Integrons, and Antibiotic Resistance Genes in Bacterial Strains Recovered from Selected Commercial Dairy Products and Fresh Raw Meat. Curr Microbiol 2023; 80:254. [PMID: 37355481 DOI: 10.1007/s00284-023-03371-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 06/09/2023] [Indexed: 06/26/2023]
Abstract
Bacterial species responsible for food infections and intoxication are sometimes carried through the food production and processing. Very few published literatures exist on integrons among antibiotic-resistant staphylococcal strains from foods of animal origin in Gauteng Province, South Africa, hence this study. A total of 720 samples (360 meat and 360 dairies) from a community abattoir of a research farm in South Africa, using conventional bacteriological and molecular methods. Nine (9) bacterial strains, including Bacillus subtilis AYO-123, Acinetobacter baumannii AYO-241, Staphylococcus lentus AYO-352, among others were identified and submitted to GenBank. More bacterial strains were recovered from raw meat (90.5%) than dairy products (9.5%). Resistance was shown (0-100%) to Imipenem, Meropenem, Norfloxacin, Clindamycin, and 22 other antibiotics, without any carbapenem-resistant Acinetobacter baumannii and methicillin/vancomycin-resistant Staphylococcus species (MRSS/VRSS). Virulence genes for fibronectin-binding protein A (FnbA) were predominant (56.24%) followed by the circulating nucleic acids (cna) gene (43.75%). Others were staphylococcal enterotoxin A (sea, 41%), staphylococcal enterotoxin B (seb, 23.5%). Co-presence of sea and seb genes occurred in 11.76% of the isolates, but no coa genes was amplified. Antibiotic resistance genes (ARGs), tetK (70.58%), linA (29.4%), and ermA (11.76%) were detected, but none of the mecA and vat genes was amplified. Class 2 integron (50%) was more predominantly detected than integron 1 (25%), but no Class 3 integron was detected. Bacteria with both the detected virulence and antibiotic resistance genes are of potential risks to human health.
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Affiliation(s)
- Olayinka A Aiyegoro
- Collaborating Partner, Department of Microbiology, Faculty of Science, University of Uyo, Uyo, Nigeria
- Research Unit for Environmental Sciences and Management, North West University, Potchefstroom, 2520, North West, South Africa
| | - Jeremia N Moyane
- School of Agriculture, Department of Food Science and Technology, University of Venda, Thohoyandou, 0950, South Africa
| | - Anthony A Adegoke
- Department of Microbiology, Faculty of Science, University of Uyo, Uyo, Nigeria.
- Department of Community Health Studies, Faculty of Health Sciences, Durban University of Technology (DUT), Durban, 4001, KwaZulu-Natal, South Africa.
| | - Afam I O Jideani
- School of Agriculture, Department of Food Science and Technology, University of Venda, Thohoyandou, 0950, South Africa
- Postharvest-Handling Group, ISEKI-Food Association, Vienna, Austria
| | - Poovendhree Reddy
- Department of Community Health Studies, Faculty of Health Sciences, Durban University of Technology (DUT), Durban, 4001, KwaZulu-Natal, South Africa
| | - Anthony I Okoh
- Department of Environmental Health Sciences, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- SAMRC Microbial Water Quality Monitoring Centre, University of For Hare, Alice, South Africa
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Xia Y, Hu Y, Tang L. Factor XIa Inhibitors as a Novel Anticoagulation Target: Recent Clinical Research Advances. Pharmaceuticals (Basel) 2023; 16:866. [PMID: 37375813 DOI: 10.3390/ph16060866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/03/2023] [Accepted: 06/04/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND While current clinically administered anticoagulant medications have demonstrated effectiveness, they have also precipitated significant risks: severe bleeding complications including, but not limited to, gastrointestinal hemorrhaging and intracranial and other life-threatening major bleedings. An ongoing effort is being made to identify the best targets for anticoagulant-targeted drugs. Coagulation factor XIa (FXIa) is emerging as an important target of current anticoagulant treatment. OBJECTIVE This review will summarize the development of anticoagulants and recent advances in clinical trials of experimental factor XI inhibitors from a clinical application perspective. RESULTS As of 1 January 2023, our search screening included 33 clinical trials. We summarized the research progress of FXIa inhibitors from seven clinical trials that evaluated their efficacy and safety. The results showed no statistically meaningful distinction in the primary efficacy between patients receiving FXIa inhibitors compared to controls (RR = 0.796; 95% CI: 0.606-1.046; I2 = 68%). The outcomes did not indicate a statistical difference in the occurrence of any bleeding between patients receiving FXIa inhibitors compared to controls (RR = 0.717; 95% CI: 0.502-1.023; I2 = 60%). A subgroup analysis found significant differences in severe bleeding and clinically relevant hemorrhaging in subjects receiving FXIa inhibitors compared to Enoxaparin (RR = 0.457; 95% CI: 0.256-0.816; I2 = 0%). CONCLUSIONS Clinical trials to date have indicated that factor XIa is a potential anticoagulation target, and factor XIa inhibitors may play an important role in the development of anticoagulants.
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Affiliation(s)
- Yunqing Xia
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan 430022, China
| | - Yu Hu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan 430022, China
- Collaborative Innovation Center of Hematology, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Liang Tang
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan 430022, China
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Da Costa S. Estimating the welfare gains from anti-retroviral therapy in Sub-Saharan Africa. JOURNAL OF HEALTH ECONOMICS 2023; 90:102777. [PMID: 37329668 DOI: 10.1016/j.jhealeco.2023.102777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 05/16/2023] [Accepted: 05/30/2023] [Indexed: 06/19/2023]
Abstract
Since the start of the century, many countries in Sub-Saharan Africa have experienced large gains in life expectancy and average consumption levels. Around the same time, an unprecedented international effort has taken place to combat HIV/AIDS mortality with the expansion of anti-retroviral therapy (ART) across many of the hardest hit countries. In this paper, I estimate the impact of ART on average welfare over time in 42 countries using the equivalent consumption approach. I decompose the change in welfare to isolate the relative contribution of ART-driven improvements in life expectancy and consumption. The results indicate that ART has accounted for around 12% of total welfare growth in SSA between 2000 and 2017. In those countries most affected by HIV/AIDS, this figure rises to around 40%. Moreover, the estimates suggest that welfare in some of the worst-hit countries would have declined over time without the ART expansion.
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Affiliation(s)
- Shaun Da Costa
- Paris School of Economics, 48 Boulevard Jourdan, 75014 Paris, France.
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40
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Gerstl JVE, Yearley AG, Kilgallon JL, Lassarén P, Robertson FC, Herdell V, Wang AY, Segar DJ, Bernstock JD, Laws ER, Ranganathan K, Smith TR. A national stratification of the global macroeconomic burden of central nervous system cancer. J Neurosurg 2023; 138:1522-1530. [PMID: 36272121 DOI: 10.3171/2022.9.jns221499] [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: 06/25/2022] [Accepted: 09/08/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Country-by-country estimates of the macroeconomic disease burden of central nervous system (CNS) cancers are important when determining the allocation of resources related to neuro-oncology. Accordingly, in this study the authors investigated macroeconomic losses related to CNS cancer in 173 countries and identified pertinent epidemiological trends. METHODS Data for CNS cancer incidence, mortality, and disability-adjusted life years (DALYs) were collected from the Global Burden of Disease 2019 database. Gross domestic product data were combined with DALY data to estimate economic losses using a value of lost welfare approach. RESULTS The mortality-to-incidence ratio of CNS cancer in 2019 was 0.60 in high-income regions compared to 0.82 in Sub-Saharan Africa and 0.87 in Central Europe, Eastern Europe, and Central Asia. Welfare losses varied across both high- and low-income countries. Welfare losses attributable to CNS cancer in Japan represented 0.07% of the gross domestic product compared to 0.23% in Germany. In low- and middle-income countries, Iraq reported welfare losses of 0.20% compared to 0.04% in Angola. Globally, the DALY rate in 2019 was the same for CNS cancer as for prostate cancer at 112 per 100,000 person-years, despite a 75% lower incidence rate, equating to CNS cancer welfare losses of 182 billion US dollars. CONCLUSIONS Macroeconomic losses vary across high- and low-income settings and appear to be region specific. These differences may be explained by differences in regional access to screening and diagnosis, population-level genetic predispositions, and environmental risk factors. Mortality-to-incidence ratios are higher in low- and middle-income countries than in high-income countries, highlighting possible gaps in treatment access. Quantification of macroeconomic losses related to CNS cancer can help to justify the spending of finite resources to improve outcomes for neuro-oncological patients globally.
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Affiliation(s)
- Jakob V E Gerstl
- 1Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- 2University College London Medical School, London, United Kingdom
| | - Alexander G Yearley
- 1Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - John L Kilgallon
- 1Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Philipp Lassarén
- 1Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- 3Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
| | - Faith C Robertson
- 4Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Vendela Herdell
- 3Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
| | - Andy Y Wang
- 5Tufts University School of Medicine, Boston; and
| | - David J Segar
- 1Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joshua D Bernstock
- 1Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Edward R Laws
- 1Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kavitha Ranganathan
- 1Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- 6Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Timothy R Smith
- 1Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Ward ZJ, Atun R, King G, Sequeira Dmello B, Goldie SJ. A simulation-based comparative effectiveness analysis of policies to improve global maternal health outcomes. Nat Med 2023; 29:1262-1272. [PMID: 37081227 DOI: 10.1038/s41591-023-02311-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 03/15/2023] [Indexed: 04/22/2023]
Abstract
The Sustainable Development Goals include a target to reduce the global maternal mortality ratio (MMR) to less than 70 maternal deaths per 100,000 live births by 2030, with no individual country exceeding 140. However, on current trends the goals are unlikely to be met. We used the empirically calibrated Global Maternal Health microsimulation model, which simulates individual women in 200 countries and territories to evaluate the impact of different interventions and strategies from 2022 to 2030. Although individual interventions yielded fairly small reductions in maternal mortality, integrated strategies were more effective. A strategy to simultaneously increase facility births, improve the availability of clinical services and quality of care at facilities, and improve linkages to care would yield a projected global MMR of 72 (95% uncertainty interval (UI) = 58-87) in 2030. A comprehensive strategy adding family planning and community-based interventions would have an even larger impact, with a projected MMR of 58 (95% UI = 46-70). Although integrated strategies consisting of multiple interventions will probably be needed to achieve substantial reductions in maternal mortality, the relative priority of different interventions varies by setting. Our regional and country-level estimates can help guide priority setting in specific contexts to accelerate improvements in maternal health.
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Affiliation(s)
- Zachary J Ward
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.
| | - Rifat Atun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Gary King
- Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA
| | - Brenda Sequeira Dmello
- Maternal and Newborn Healthcare, Comprehensive Community Based Rehabilitation in Tanzania, Dar es Salaam, Tanzania
| | - Sue J Goldie
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA
- Global Health Education and Learning Incubator, Harvard University, Cambridge, MA, USA
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Schenck HE, Joackim P, Lazaro A, Wu X, Gerber LM, Stieg PE, Härtl R, Shabani H, Mangat HS. Affordability impacts therapeutic intensity of acute management of severe traumatic brain injury patients: An exploratory study in Tanzania. BRAIN & SPINE 2023; 3:101738. [PMID: 37383438 PMCID: PMC10293321 DOI: 10.1016/j.bas.2023.101738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 03/30/2023] [Accepted: 04/03/2023] [Indexed: 06/30/2023]
Abstract
Introduction Quality health care in low and middle-income countries (LMICs) is constrained by financing of care. Research question What is the effect of ability to pay on critical care management of patients with severe traumatic brain injury (sTBI)? Material and Methods Data on sTBI patients admitted to a tertiary referral hospital in Dar-es-Salaam, Tanzania, were collected between 2016 and 2018, and included payor mechanisms for hospitalization costs. Patients were grouped as those who could afford care and those who were unable to pay. Results Sixty-seven patients with sTBI were included. Of those enrolled, 44 (65.7%) were able to pay and 15 (22.3%) were unable to pay costs of care upfront. Eight (11.9%) patients did not have a documented source of payment (unknown identity or excluded from further analysis). Overall mechanical ventilation rates were 81% (n=36) in the affordable group and 100% (n=15) in the unaffordable group (p=0.08). Computed tomography (CT) rates were 71.6% (n=48) overall, 100% (n=44) and 0% respectively (p<0.01); Surgical rates were 16.4% (n=11) overall, 18.2% (n=8) vs. 13.3% (n=2) (p=0.67) respectively. Two-week mortality was 59.7% overall (n=40), 47.7% (n=21) in the affordable group and 73.3% (n=11) in the unaffordable group (p=0.09) (adjusted OR 0.4; 95% CI: 0.07-2.41, p=0.32). Discussion and Conclusion Ability to pay appears to have a strong association with the use of head CT and a weak association with mechanical ventilation in the management of sTBI. Inability to pay increases redundant or sub-optimal care, and imposes a financial burden on patients and their relatives.
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Affiliation(s)
| | - Pascal Joackim
- Department of Neurosurgery, Muhimbili Orthopedic Institute, Muhimbili National Hospital, Dar-es-Salaam, Tanzania
| | - Albert Lazaro
- Department of Neurosurgery, Muhimbili Orthopedic Institute, Muhimbili National Hospital, Dar-es-Salaam, Tanzania
| | - Xian Wu
- Department of Population Health Sciences, Weill Cornell Medicine, New York, USA
| | - Linda M. Gerber
- Department of Population Health Sciences, Weill Cornell Medicine, New York, USA
| | - Philip E. Stieg
- Department of Neurosurgery, Weill Cornell Brain & Spine Institute, USA
| | - Roger Härtl
- Department of Neurosurgery, Weill Cornell Brain & Spine Institute, USA
| | - Hamisi Shabani
- Department of Neurosurgery, Muhimbili Orthopedic Institute, Muhimbili National Hospital, Dar-es-Salaam, Tanzania
| | - Halinder S. Mangat
- Department of Neurosurgery, Weill Cornell Brain & Spine Institute, USA
- Department of Neurology, Weill Cornell Medical College, New York, NY, USA
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Saunders AC, Mutebi M, Rao TS. A Review of the Current State of Global Surgical Oncology and the Role of Surgeons Who Treat Cancer: Our Profession’s Imperative to Act Upon a Worldwide Crisis in Evolution. Ann Surg Oncol 2023; 30:3197-3205. [PMID: 36973564 PMCID: PMC10175401 DOI: 10.1245/s10434-023-13352-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 02/19/2023] [Indexed: 03/29/2023]
Abstract
AbstractWorldwide, the capacity of healthcare systems and physician workforce is woefully inadequate for the surgical treatment of cancer. With major projected increases in the global burden of neoplastic disease, this inadequacy is expected to worsen, and interventions to increase the workforce of surgeons who treat cancer and strengthen the necessary supporting infrastructure, equipment, staffing, financial and information systems are urgently called for to prevent this inadequacy from deepening. These efforts must also occur in the context of broader healthcare systems strengthening and cancer control plans, including prevention, screening, early detection, safe and effective treatment, surveillance, and palliation. The cost of these interventions should be considered a critical investment in healthcare systems strengthening that will contribute to improvement in the public and economic health of nations. Failure to act should be seen as a missed opportunity, at the cost of lives and delayed economic growth and development. Surgeons who treat cancer must engage with a diverse array of stakeholders in efforts to address this critical need and are indispensably positioned to participate in collaborative approaches to influence these efforts through research, advocacy, training, and initiatives for sustainable development and overall systems strengthening.
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Affiliation(s)
| | | | - T Subramanyeshwar Rao
- Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India
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Pérez-Cruz PE, Undurraga E, Arreola-Ornelas H, Corsi O, Jiang Kwete XX, Krakauer EL, Rosa WE, Knaul FM. Bridging gaps to universal palliative care access in Chile: serious health-related suffering and the cost of expanding the package of care services. LANCET REGIONAL HEALTH. AMERICAS 2023; 19:100425. [PMID: 36950031 PMCID: PMC10025417 DOI: 10.1016/j.lana.2022.100425] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/24/2022] [Accepted: 12/15/2022] [Indexed: 01/05/2023]
Abstract
Background The Lancet Commission on Palliative Care (PC) and Pain Relief quantified the burden of serious health-related suffering (SHS), proposing an Essential Package of PC (EPPC) to narrow the global PC divide. We applied the EPPC framework to analyze PC access in Chile, identify gaps in coverage, and provide recommendations to improve PC access. Methods Total SHS and population in need of PC was estimated using official 2019 government data. We differentiated between cancer and non-cancer related SHS given guaranteed Chilean PC coverage for cancer. We calculated differences between the Chilean PC package and the Lancet Commission EPPC to estimate the cost of expanding to achieve national coverage of palliative care. Findings In 2019, nearly 105,000 decedent and non-decedent Chileans experienced SHS with a lower-bound estimate of 12.1 million days and an upper-bound estimate of 42.4 million days of SHS. Each individual experienced between 116 and 520 days of SHS per year. People living with a cancer diagnosis had PC access with financial protection, accounting for almost 42% of patients in need. People with non-cancer diagnoses-about 61 thousand patients-lacked PC coverage. Expanding coverage of the EPPC for all patients in need would cost just above $123 million USD, equivalent to 0.47% of Chilean National Health Expenditure. Interpretation Achieving universal PC access is urgent and feasible for Chile, classified as a high-income country. Expanding PC services and coverage to the EPPC standard are affordable and critical health system responses to ensuring financial protection for patients with SHS. In Chile, this requires closing large gaps in PC coverage pertaining to patients with non-cancer conditions and treatment of symptoms that go beyond pain. Our research provides an empirical approach for applying the Lancet Commission SHS framework to estimate the cost of achieving national universal PC access anchored in a package of health care services. Funding This research was partially funded by the Chilean Government through the Fondo Nacional de Ciencia y Tecnología (Fondecyt Regular) grant number 1201721, the U.S. Cancer Pain Relief Committee grant AWD-003806 awarded to the University of Miami and by the University of Miami Institute for Advanced Study of the Americas. We acknowledge NIH/NCI award P30CA008748.
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Affiliation(s)
- Pedro E. Pérez-Cruz
- Programa Medicina Paliativa y Cuidados Continuos, Facultad de Medicina, Pontificia Universidad Católica de Chile (PUC), Santiago, Chile
- Sección Medicina Paliativa, Facultad de Medicina, Pontificia Universidad Católica de Chile (PUC), Santiago, Chile
- Corresponding author. Programa Medicina Paliativa y Cuidados Continuos, Departamento Medicina Interna, Facultad de Medicina, Pontificia Universidad Católica de Chile. Diagonal Paraguay 362, Oficina 523, Santiago, 8330077, Chile.
| | - Eduardo Undurraga
- Escuela de Gobierno, Pontificia Universidad Católica de Chile (PUC), Santiago, Chile
- CIFAR Azrieli Global Scholars Program, CIFAR, Toronto, ON, Canada
- Research Center for Integrated Disaster Risk Management (CIGIDEN), Chile
| | - Hector Arreola-Ornelas
- Institute for Obesity Research, Tecnológico de Monterrey, México
- Escuela de Gobierno y Transformación Pública, Tecnológico de Monterrey, México
- Tómatelo a Pecho, AC, México
- Fundación Mexicana para la Salud, México
| | - Oscar Corsi
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile (PUC), Santiago, Chile
| | | | - Eric L. Krakauer
- Department of Global Health & Social Medicine, Harvard Medical School, Boston, MA, USA
| | - William E. Rosa
- Institute for Advanced Study of the Americas, University of Miami, Miami, FL, USA
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Felicia M. Knaul
- Tómatelo a Pecho, AC, México
- Institute for Advanced Study of the Americas, University of Miami, Miami, FL, USA
- Miller School of Medicine, University of Miami, Miami, FL, USA
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Masiano SP, Kawende B, Ravelomanana NLR, Green TL, Dahman B, Thirumurthy H, Kimmel AD, Yotebieng M. Economic costs and cost-effectiveness of conditional cash transfers for the uptake of services for the prevention of vertical HIV transmissions in a resource-limited setting. Soc Sci Med 2023; 320:115684. [PMID: 36696797 PMCID: PMC9975037 DOI: 10.1016/j.socscimed.2023.115684] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 12/06/2022] [Accepted: 01/13/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND Prevention of mother-to-child transmission (PMTCT) is critical for halting the HIV epidemic. However, innovative approaches to improve PMTCT uptake may be resource-intensive. We examined the economic costs and cost-effectiveness of conditional cash transfers (CCTs) for the uptake of PMTCT services in the Democratic Republic of Congo. METHODS We leveraged data from a randomized controlled trial of CCTs (n = 216) versus standard PMTCT care alone (standard of care (SOC), n = 217). Economic cost data came from multiple sources, with costs analyzed from the societal perspective and reported in 2016 international dollars (I$). Effectiveness outcomes included PMTCT uptake (i.e., accepting all PMTCT visits and services) and retention (i.e., in HIV care at six weeks post-partum). Generalized estimating equations estimated effectiveness (relative risk) and incremental costs, with incremental effectiveness reported as the number of women needing CCTs for an additional PMTCT uptake or retention. We evaluated the cost-effectiveness of the CCTs at various levels of willingness-to-pay and assessed uncertainty using deterministic sensitivity analysis and cost-effectiveness acceptability curves. RESULTS Mean costs per participant were I$516 (CCTs) and I$431 (SOC), representing an incremental cost of I$85 (95% CI: 59, 111). PMTCT uptake was more likely for CCTs vs SOC (68% vs 53%, p < 0.05), with seven women needing CCTs for each additional PMTCT service uptake; twelve women needed CCTs for an additional PMTCT retention. The incremental cost-effectiveness of CCTs vs SOC was I$595 (95% CI: I$550, I$638) for PMTCT uptake and I$1028 (95% CI: I$931, I$1125) for PMTCT retention. CCTs would be an efficient use of resources if society's willingness-to-pay for an additional woman who takes up PMTCT services is at least I$640. In the worst-case scenario, the findings remained relatively robust. CONCLUSIONS Given the relatively low cost of the CCTs, policies supporting CCTs may decrease onward HIV transmission and expedite progress toward ending the epidemic.
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Affiliation(s)
- Steven P Masiano
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, 23219, USA; Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, 44195, USA.
| | - Bienvenu Kawende
- The University of Kinshasa, School of Public Health, Kinshasa, Democratic Republic of the Congo, The
| | - Noro Lantoniaina Rosa Ravelomanana
- The University of Kinshasa, School of Public Health, Kinshasa, Democratic Republic of the Congo, The; Albert Einstein College of Medicine, Department of Medicine, Division of General Internal Medicine, 3300 Kossuth Ave, Bronx, NY, 10467, USA
| | - Tiffany L Green
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, 23219, USA; Departments of Population Health Sciences and Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Bassam Dahman
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, 23219, USA
| | - Harsha Thirumurthy
- Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, USA; Center for Health Incentives and Behavioral Economics, University of Pennsylvania, USA
| | - April D Kimmel
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, 23219, USA.
| | - Marcel Yotebieng
- The University of Kinshasa, School of Public Health, Kinshasa, Democratic Republic of the Congo, The; Albert Einstein College of Medicine, Department of Medicine, Division of General Internal Medicine, 3300 Kossuth Ave, Bronx, NY, 10467, USA
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Silva S, Goosby E, Reid MJA. Assessing the impact of one million COVID-19 deaths in America: economic and life expectancy losses. Sci Rep 2023; 13:3065. [PMID: 36813824 PMCID: PMC9947095 DOI: 10.1038/s41598-023-30077-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 02/15/2023] [Indexed: 02/24/2023] Open
Abstract
Between February 2020 and May 2022, one million Americans have died of COVID-19. To determine the contribution of those deaths to all-cause mortality in terms of life expectancy reductions and the resulting economic welfare losses, we calculated their combined impact on national income growth and the added value of lives lost. We estimated that US life expectancy at birth dropped by 3.08 years due to the million COVID-19 deaths. Economic welfare losses estimated in terms of national income growth supplemented by the value of lives lost, was in the order of US$3.57 trillion. US$2.20 trillion of these losses were in in the non-Hispanic White population (56.50%), US$698.24 billion (19.54%) in the Hispanic population, and US$579.93 billion (16.23%) in the non-Hispanic Black population. The scale of life expectancy and welfare losses underscores the pressing need to invest in health in the US to prevent further economic shocks from future pandemic threats.
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Affiliation(s)
- Sachin Silva
- grid.38142.3c000000041936754XHarvard TH Chan School of Public Health, Harvard University, 677 Huntington Avenue, Boston, MA 02115 USA ,grid.266102.10000 0001 2297 6811Institute for Global Health Sciences, University of California, San Francisco, 550 16th Street, Third Floor, San Francisco, CA 94158 USA
| | - Eric Goosby
- grid.266102.10000 0001 2297 6811Institute for Global Health Sciences, University of California, San Francisco, 550 16th Street, Third Floor, San Francisco, CA 94158 USA ,grid.266102.10000 0001 2297 6811School of Medicine, University of California, San Francisco, 513 Parnassus Avenue, San Francisco, CA 94143-0410 USA
| | - Michael J. A. Reid
- grid.266102.10000 0001 2297 6811Institute for Global Health Sciences, University of California, San Francisco, 550 16th Street, Third Floor, San Francisco, CA 94158 USA ,grid.266102.10000 0001 2297 6811School of Medicine, University of California, San Francisco, 513 Parnassus Avenue, San Francisco, CA 94143-0410 USA
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Mladovsky P. Mental health coverage for forced migrants: Managing failure as everyday governance in the public and NGO sectors in England. Soc Sci Med 2023; 319:115385. [PMID: 36175262 DOI: 10.1016/j.socscimed.2022.115385] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 08/24/2022] [Accepted: 09/16/2022] [Indexed: 11/16/2022]
Abstract
High-income countries (HICs) which are said to have "reached" universal health coverage (UHC) typically still have coverage gaps, due to both formal policies and informal barriers which result in "hypothetical access". In England, a user fee exemption has in principle made access to treatment for post-traumatic stress disorder (PTSD) and other mental health conditions thought to be caused by certain forms of violence universal, regardless of immigration status. This study explores the everyday governance of this mental health coverage for forced migrants in the English National Health Service (NHS) and NGO sector. Fieldwork was conducted in two waves, in 2015-2016 and 2019-2021, including six months of participant observation in an NGO and 21 semi-structured interviews with psy professionals across 16 NHS and NGO service providers. Further interviews were conducted with mental health commissioners and policymakers, as well as analysis of grey literature. Despite being formally covered for certain types of mental health care, in practice asylum seekers and undocumented migrants were often excluded by NHS providers. Undocumented migrants were also often excluded by NGO providers. Several rationalities linked discursive fields to practices developed by psy professionals and other street-level bureaucrats to govern coverage, in a process of "managing failure". These rationalities are presented under three paired themes which draw attention to tensions and resistance in the governance of coverage: medicalisation and biolegitimacy; austerity and ethico-politics; and differential racialisation and decolonisation. Rationalities were associated with strategies and tactics such as social triage, clinical advocacy, obfuscation, evidence-based advocacy and silencing critique. The concept of "health coverage assemblage" is introduced to explain the complex, unstable, contingent and fragmented nature of UHC policies and programmes. Misrecognition and underestimation of the everyday work of health professionals in promoting, resisting and reproducing diverse rationalities within the assemblage may lead to missed opportunities for reform.
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Affiliation(s)
- Philipa Mladovsky
- Department of International Development, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK.
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48
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Alwan A, Majdzadeh R, Yamey G, Blanchet K, Hailu A, Jama M, Johansson KA, Musa MYA, Mwalim O, Norheim OF, Safi N, Siddiqi S, Zaidi R. Country readiness and prerequisites for successful design and transition to implementation of essential packages of health services: experience from six countries. BMJ Glob Health 2023; 8:bmjgh-2022-010720. [PMID: 36657808 PMCID: PMC9853149 DOI: 10.1136/bmjgh-2022-010720] [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: 09/16/2022] [Accepted: 12/10/2022] [Indexed: 01/20/2023] Open
Abstract
This paper reviews the experience of six low-income and lower middle-income countries in setting their own essential packages of health services (EPHS), with the purpose of identifying the key requirements for the successful design and transition to implementation of the packages in the context of accelerating progress towards universal health coverage (UHC). The analysis is based on input from three meetings of a knowledge network established by the Disease Control Priorities 3 Country Translation Project and working groups, supplemented by a survey of participating countries.All countries endorsed the Sustainable Development Goals target 3.8 on UHC for achievement by 2030. The assessment of country experiences found that health system strengthening and mobilising and sustaining health financing are major challenges. EPHS implementation is more likely when health system gaps are addressed and when there are realistic and sustainable financing prospects. However, health system assessments were inadequate and the government planning and finance sectors were not consistently engaged in setting the EPHS in most of the countries studied. There was also a need for greater engagement with community and civil society representatives, academia and the private sector in package design. Leadership and reinforcement of technical and managerial capacity are critical in the transition from EPHS design to sustained implementation, as are strong human resources and country ownership of the process. Political commitment beyond the health sector is key, particularly commitment from parliamentarians and policymakers in the planning and finance sectors. National ownership, institutionalisation of technical and managerial capacity and reinforcing human resources are critical for success.The review concludes that four prerequisites are crucial for a successful EPHS: (1) sustained high-level commitment, (2) sustainable financing, (3) health system readiness, and (4) institutionalisation.
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Affiliation(s)
- Ala Alwan
- DCP3 Country Translation Project, London School of Hygiene & Tropical Medicine, London, UK
| | - Reza Majdzadeh
- School of Health and Social Care, University of Essex, Colchester, Essex, UK
| | - Gavin Yamey
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Karl Blanchet
- Geneva Centre of Humanitarian Studies, University of Geneva, Geneva, Switzerland
| | - Alemayehu Hailu
- Bergen Center for Ethics and Priority Setting, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway,Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Mohamed Jama
- Ministry of Health, Federal Government of Somalia, Mogadishu, Somalia
| | - Kjell Arne Johansson
- Bergen Center for Ethics and Priority Setting, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | | | - Omar Mwalim
- Bergen Center for Ethics and Priority Setting, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Ole Frithjof Norheim
- Bergen Center for Ethics and Priority Setting, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | | | - Sameen Siddiqi
- Department of Community Health Sciences, Aga Khan University Medical College Pakistan, Karachi, Sindh, Pakistan
| | - Raza Zaidi
- Pakistan Ministry of National Health Services, Regulations, and Coordination, Islamabad, Pakistan
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Biddlecom A, Sully EA, Kantorová V, Wheldon MC, Lince-Deroche N, Riley T. Setting Health Targets Using Information from Probabilistic Projections: A Research Brief on an Application to Contraceptive Coverage. POPULATION RESEARCH AND POLICY REVIEW 2023; 42:13. [PMID: 36789331 PMCID: PMC9913024 DOI: 10.1007/s11113-023-09766-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/14/2022] [Indexed: 02/12/2023]
Abstract
Broad and aspirational targets to meet health service needs are useful for advocacy, but setting measurable, time-defined targets for accelerated yet feasible progress is necessary for national monitoring and planning purposes. Information from probabilistic projections of health outcomes and service coverage can be used to set country-specific targets that reflect different starting points and rates of change. We show the utility of this approach in an application to contraceptive coverage in 131 low- and middle-income countries (LMICs) and the related cost and impact of different coverage scenarios. We use the sustainable development goal (SDG) indicator of the proportion of women who have their need for family planning satisfied with modern contraception. The results show that accelerated progress targets would collectively result in 83% of the need satisfied in 2030 for LMICs, which is 5% points higher than the projected level based on the current pace of progress. This translated into 41 million fewer women with an unmet need for modern methods and 14 million fewer unintended pregnancies. Annual direct costs would be $480 million more in 2030 to support contraceptive services compared with costs in 2030 based on the current pace of progress. As governments plan and budget for expanded health service coverage, information from probabilistic projections can guide them in setting measurable, ambitious yet realistic targets that are relevant to their particular contexts. Supplementary Information The online version contains supplementary material available at 10.1007/s11113-023-09766-2.
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Affiliation(s)
| | | | - Vladimíra Kantorová
- Population Division, Department of Economic and Social Affairs, United Nations, New York, NY USA
| | - Mark C. Wheldon
- Population Division, Department of Economic and Social Affairs, United Nations, New York, NY USA
| | | | - Taylor Riley
- Department of Epidemiology, University of Washington, Seattle, WA USA
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50
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Belardi P, Corazza I, Bonciani M, Manenti F, Vainieri M. Evaluating Healthcare Performance in Low- and Middle-Income Countries: A Pilot Study on Selected Settings in Ethiopia, Tanzania, and Uganda. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:41. [PMID: 36612364 PMCID: PMC9819807 DOI: 10.3390/ijerph20010041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/13/2022] [Accepted: 12/15/2022] [Indexed: 06/17/2023]
Abstract
The literature reports some experiences regarding the design of integrated healthcare Performance Evaluation Systems (PES) applied in Low- and Middle-income Countries (LMIC). This study describes the design of an integrated and bottom-up PES aimed at evaluating healthcare services delivery in rural settings. The analysis involved four hospitals and their relative health districts in Ethiopia, Tanzania, and Uganda. The evaluation process was undertaken for those indicators that could be evaluated using the same reference standard. The evaluation scores were determined through the international standards identified in the literature or through benchmarking assessment. Both administrative and health data were extracted from the hospitals' registers and District Health Information Systems (DHIS) from 2017 to 2020. We defined 128 indicators: 88 were calculated at the hospital level and 40 at the health district level. The evaluation process was undertaken for 48 indicators. The evaluated indicators are represented using effective graphical tools. In settings characterised by multiple healthcare providers, this framework may contribute to achieving good governance through performance evaluation, benchmarking, and accountability. It may promote evidence-based decision-making in the planning and allocation of resources, thus ultimately fostering quality improvement processes and practices, both at the hospital and health district level.
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Affiliation(s)
- Paolo Belardi
- Doctors with Africa CUAMM, Via San Francesco, 126, 35121 Padua, Italy
| | - Ilaria Corazza
- Health and Management Laboratory, Institute of Management, Sant’Anna School of Advanced Studies, Piazza Martiri della Libertà, 33, 56127 Pisa, Italy
| | - Manila Bonciani
- Meyer Children’s University Hospital, Viale Gaetano Pieraccini, 24, 50139 Florence, Italy
| | - Fabio Manenti
- Doctors with Africa CUAMM, Via San Francesco, 126, 35121 Padua, Italy
| | - Milena Vainieri
- Health and Management Laboratory, Institute of Management, Sant’Anna School of Advanced Studies, Piazza Martiri della Libertà, 33, 56127 Pisa, Italy
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