1
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Pivetta de Araujo RC, Martinez L, da Silva Santos A, Ferreira Lemos E, Dias de Oliveira R, Croda M, Porto Batestin Silva D, Lemes IBG, Cunha EAT, Gonçalves TO, Pereira dos Santos PC, Oliveira da Silva B, Cavalheiro Maymone Gonçalves C, Andrews J, Croda J. Serial Mass Screening for Tuberculosis Among Incarcerated Persons in Brazil. Clin Infect Dis 2024; 78:1669-1676. [PMID: 38324908 PMCID: PMC11175667 DOI: 10.1093/cid/ciae055] [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: 05/26/2023] [Revised: 10/13/2023] [Accepted: 02/01/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND An active search for tuberculosis cases through mass screening is widely described as a tool to improve case detection in hyperendemic settings. However, its effectiveness in high-risk populations, such as incarcerated people, is debated. METHODS Between 2017 and 2021, 3 rounds of mass screening were carried out in 3 Brazilian prisons. Social and health questionnaires, chest X-rays, and Xpert MTB/RIF were performed. RESULTS More than 80% of the prison population was screened. Overall, 684 cases of pulmonary tuberculosis were diagnosed. Prevalence across screening rounds was not statistically different. Among incarcerated persons with symptoms, the overall prevalence of tuberculosis per 100 000 persons was 8497 (95% confidence interval [CI], 7346-9811), 11 115 (95% CI, 9471-13 082), and 7957 (95% CI, 6380-9882) in screening rounds 1, 2, and 3, respectively. Similar to our overall results, there were no statistical differences between screening rounds and within individual prisons. We found no statistical differences in Computer-Aided Detection for TB version 5 scores across screening rounds among people with tuberculosis-the median scores in rounds 1, 2, and 3 were 82 (interquartile range [IQR], 63-97), 77 (IQR, 60-94), and 81 (IQR, 67-92), respectively. CONCLUSIONS In this environment with hyperendemic rates of tuberculosis, 3 rounds of mass screening did not reduce the overall tuberculosis burden. In prisons, where a substantial number of tuberculosis cases is undiagnosed annually, a range of complementary interventions and more frequent tuberculosis cases screening may be required.
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Affiliation(s)
| | - Leonardo Martinez
- Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Andrea da Silva Santos
- Health Sciences Research Laboratory, Federal University of Grande Dourados, Dourados, Brazil
| | - Everton Ferreira Lemos
- School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Roberto Dias de Oliveira
- Nursing Course, State University of Mato Grosso do Sul, Dourados, Brazil
- Graduate Program in Health Sciences, Federal University of Grande Dourados, Dourados, Brazil
| | - Mariana Croda
- School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | | | | | - Eunice Atsuko Totumi Cunha
- Laboratory of Bacteriology, Central Laboratory of Mato Grosso do Sul, Campo Grande, Mato Gross do Sul, Brazil
| | - Thais Oliveira Gonçalves
- Laboratory of Bacteriology, Central Laboratory of Mato Grosso do Sul, Campo Grande, Mato Gross do Sul, Brazil
| | | | - Bruna Oliveira da Silva
- Health Sciences Research Laboratory, Federal University of Grande Dourados, Dourados, Brazil
| | | | - Jason Andrews
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Julio Croda
- School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
- Oswaldo Cruz Foundation, Campo Grande, Mato Grosso do Sul, Brazil
- Department of Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, Connecticut, USA
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2
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Blanc DC, Grundy J, Sodha SV, O'Connell TS, von Mühlenbrock HJM, Grevendonk J, Ryman T, Patel M, Olayinka F, Brooks A, Wahl B, Bar-Zeev N, Nandy R, Lindstrand A. Immunization programs to support primary health care and achieve universal health coverage. Vaccine 2024; 42 Suppl 1:S38-S42. [PMID: 36503857 DOI: 10.1016/j.vaccine.2022.09.086] [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: 05/19/2021] [Accepted: 09/28/2022] [Indexed: 12/13/2022]
Abstract
Gains in immunization coverage and delivery of primary health care service have stagnated in recent years. Remaining gaps in service coverage reflect multiple underlying reasons that may be amenable to improved health system design. Immunization systems and other primary health care services can be mutually supportive, for improved service delivery and for strengthening of Universal Health Coverage. Improvements require that dynamic and multi-faceted barriers and risks be addressed. These include workforce availability, quality data systems and use, leadership and management that is innovative, flexible, data driven and responsive to local needs. Concurrently, improvements in procurement, supply chain, logistics and delivery systems, and integrated monitoring of vaccine coverage and epidemiological disease surveillance with laboratory systems, and vaccine safety will be needed to support community engagement and drive prioritized actions and communication. Finally, political will and sustained resource commitment with transparent accountability mechanisms are required. The experience of the impact of COVID-19 pandemic on essential PHC services and the challenges of vaccine roll-out affords an opportunity to apply lessons learned in order to enhance vaccine services integrated with strong primary health care services and universal health coverage across the life course.
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Affiliation(s)
- Diana Chang Blanc
- Department of Immunizations, Vaccines & Biologicals, World Health Organization, Geneva, Switzerland
| | - John Grundy
- James Cook University, Queensland, Australia
| | - Samir V Sodha
- Department of Immunizations, Vaccines & Biologicals, World Health Organization, Geneva, Switzerland
| | - Thomas S O'Connell
- Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland
| | | | - Jan Grevendonk
- Department of Immunizations, Vaccines & Biologicals, World Health Organization, Geneva, Switzerland
| | - Tove Ryman
- Bill and Melinda Gates Foundation, Seattle WA, United States
| | - Minal Patel
- Department of Immunizations, Vaccines & Biologicals, World Health Organization, Geneva, Switzerland
| | - Folake Olayinka
- U.S. Agency for International Development, Washington, United States
| | | | - Brian Wahl
- International Vaccine Access Center, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Naor Bar-Zeev
- International Vaccine Access Center, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Robin Nandy
- Health Section, Program Division, United Nations Children's Fund, NY, United States
| | - Ann Lindstrand
- Department of Immunizations, Vaccines & Biologicals, World Health Organization, Geneva, Switzerland.
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3
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Collins TE, Akselrod S, Atun R, Bennett S, Ogbuoji O, Hanson M, Dubois G, Shakarishvili A, Kalnina I, Requejo J, Mosneaga A, Watabe A, Berlina D, Allen LN. Converging global health agendas and universal health coverage: financing whole-of-government action through UHC. Lancet Glob Health 2023; 11:e1978-e1985. [PMID: 37973345 PMCID: PMC10664822 DOI: 10.1016/s2214-109x(23)00489-8] [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: 05/31/2023] [Revised: 09/14/2023] [Accepted: 10/10/2023] [Indexed: 11/19/2023]
Abstract
UN member states have committed to universal health coverage (UHC) to ensure all individuals and communities receive the health services they need without suffering financial hardship. Although the pursuit of UHC should unify disparate global health challenges, it is too commonly seen as another standalone initiative with a singular focus on the health sector. Despite constituting the cornerstone of the health-related Sustainable Development Goals, UHC-related commitments, actions, and metrics do not engage with the major drivers and determinants of health, such as poverty, gender inequality, discriminatory laws and policies, environment, housing, education, sanitation, and employment. Given that all countries already face multiple competing health priorities, the global UHC agenda should be used to reconcile, rationalise, prioritise, and integrate investments and multisectoral actions that influence health. In this paper, we call for greater coordination and coherence using a UHC+ lens to suggest new approaches to funding that can extend beyond biomedical health services to include the cross-cutting determinants of health. The proposed intersectoral co-financing mechanisms aim to support the advancement of health for all, regardless of countries' income.
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Affiliation(s)
| | | | - Rifat Atun
- Department of Global Health and Population, T H Chan School of Public Health, Boston, MA, USA
| | - Sara Bennett
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Osondu Ogbuoji
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Mark Hanson
- Institute of Development Sciences, University of Southampton, Southampton, UK
| | | | | | - Ilze Kalnina
- Partnership for Maternal, Newborn, and Child Health, Geneva, Switzerland
| | - Jennifer Requejo
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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4
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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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Mhazo AT, Maponga CC. Retracing loss of momentum for primary health care: can renewed political interest in the context of COVID-19 be a turning point? BMJ Glob Health 2023; 8:e012668. [PMID: 37474277 PMCID: PMC10360423 DOI: 10.1136/bmjgh-2023-012668] [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: 04/24/2023] [Accepted: 06/25/2023] [Indexed: 07/22/2023] Open
Abstract
The COVID-19 pandemic has revealed major weaknesses in primary health care (PHC), and how such weaknesses pose a catastrophic threat to humanity. As a result, strengthening PHC has re-emerged as a global health priority and will take centre stage at the 2023 United Nations High Level Meeting (UNHLM) on Universal Health Coverage (UHC). In this analysis, we examine why, despite its fundamental importance and incredible promise, the momentum for PHC has been lost over the years. The portrayal of PHC itself (policy image) and the dominance of global interests has undermined the attractiveness of intended PHC reforms, leading to legacy historical policy choices (critical junctures) that have become extremely difficult to dismantle, even when it is clear that such choices were a mistake. PHC has been a subject of several political declarations, but post-declarative action has been weak. The COVID-19 provides a momentous opportunity under which the image of PHC has been reconstructed in the context of health security, breaking away from the dominant social justice paradigms. However, we posit that effective PHC investments are those that are done under calm conditions, particularly through political choices that prioritise the needs of the poor who continue to face a crisis even in non-pandemic situations. In the aftermath of the 2023 UNHLM on UHC, country commitment should be evaluated based on the technical and financial resources allocated to PHC and tangible deliverables as opposed to the formulation of documents or convening of a gathering that simply (re) endorses the concept.
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Affiliation(s)
- Alison T Mhazo
- Community Health Sciences Unit (CHSU), Ministry of Health, Lilongwe, Malawi
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6
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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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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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8
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Mwai D, Hussein S, Olago A, Kimani M, Njuguna D, Njiraini R, Wangia E, Olwanda E, Mwaura L, Rotich W. Investment case for primary health care in low- and middle-income countries: A case study of Kenya. PLoS One 2023; 18:e0283156. [PMID: 36952482 PMCID: PMC10035909 DOI: 10.1371/journal.pone.0283156] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 03/02/2023] [Indexed: 03/25/2023] Open
Abstract
Background Primary healthcare (PHC) systems attain improved health outcomes and fairness and are affordable. However, the proportion of PHC spending to Total Current Health Expenditure in Kenya reduced from 63.4% in 2016/17 to 53.9% in 2020/21 while external funding reduced from 28.3% (Ksh 69.4 billion) to 23.9% (Ksh 68.2 billion) over the same period. This reduction in PHC spending negatively affects PHC performance and the overall health system goals. Methods We conducted a cost-benefit analysis and computed costs against the economic benefits of a PHC scale-up. Activity-Based Costing (ABC) on the provider perspective was employed to estimate the incremental costs. The OneHealth Tool was used to estimate the health impact of operationalizing PHC over five years. Finally, we quantified Return on Investment (ROI) by estimating monetized DALYs based on a constant value per statistical life year (VSLY) derived from a VSL estimate. Results The total projected cost of PHC interventions in the Kenya was Ksh 1.65 trillion (USD 15,581.91 billion). Human resource was the main cost driver accounting for 75% of the total cost. PHC investments avert 64,430,316 Disability Adjusted Life-Years (DALYs) and generate cost savings of Ksh. 21.5 trillion (USD 204.4 Billion) over five years. Shifting services from high-level facilities to PHC facilities generates Ksh 198.2 billion (USD 1.9 billion) and yields a benefit-cost ratio of 16:1 in 5 years. Thus, every $1 invested in PHC interventions saves up to $16 in spending on conditions like stunting, NCDs, anaemia, TB, Malaria, and maternal and child health morbidity. Conclusions Evidence of the economic benefits of continued prioritization of funding for PHC can strengthen the advocacy argument for increased domestic and external financing of PHC in Kenya. A well-resourced and functional PHC system translates to substantial health benefits with positive economic benefits. Therefore, governments and stakeholders should increase investments in PHC to accelerate economic growth.
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Affiliation(s)
- Daniel Mwai
- Economics Department, University of Nairobi, Nairobi, Kenya
- Department of Research and Knowledge Management, Futures Health Economics and Metrics Limited, Nairobi, Kenya
- Department of Information Technology and Data, Futures Health Economics and Metrics Limited, Nairobi, Kenya
- * E-mail:
| | - Salim Hussein
- Department of Primary Health Care, Kenya Ministry of Health, Nairobi, Kenya
| | - Agatha Olago
- Department of Primary Health Care, Kenya Ministry of Health, Nairobi, Kenya
| | - Maureen Kimani
- Department of Community Health, Kenya Ministry of Health, Nairobi, Kenya
| | - David Njuguna
- Department of Planning and Health Financing, Kenya Ministry of Health, Nairobi, Kenya
| | - Rose Njiraini
- Kenya Country Office, United Nations Children’s Fund, Nairobi, Kenya
| | | | - Easter Olwanda
- Department of Research and Knowledge Management, Futures Health Economics and Metrics Limited, Nairobi, Kenya
| | - Lilian Mwaura
- Department of Research and Knowledge Management, Futures Health Economics and Metrics Limited, Nairobi, Kenya
| | - Wesley Rotich
- Department of Research and Knowledge Management, Futures Health Economics and Metrics Limited, Nairobi, Kenya
- Department of Information Technology and Data, Futures Health Economics and Metrics Limited, Nairobi, Kenya
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Holmér S, Nedlund AC, Thomas K, Krevers B. How health care professionals handle limited resources in primary care - an interview study. BMC Health Serv Res 2023; 23:6. [PMID: 36597086 PMCID: PMC9808951 DOI: 10.1186/s12913-022-08996-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 12/20/2022] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Health care systems around the world are struggling with limited resources, in relation to the prevailing health care need. An accessible primary care is an important part of the solution for how to provide affordable care for the population and reduce pressure on the overall health care system such as unnecessary hospital stays and associated costs. As primary care constitutes an important first line of healthcare, the task of prioritising and deciding what to do and for whom lies in practice, primarily with the primary care professionals. Thus, the decisions and behaviour of primary care professionals have a central role in achieving good and equal health in the population. The aim of this study is to explore how primary health care professionals handle situations with limited resources and enhance our knowledge of priorities in practice. METHODS: Semi-structured interviews with 14 health care professionals (7 nurses, 7 physicians) working in Swedish primary care were interviewed. Data were analysed inductively with content analysis. FINDINGS Three main categories were found: Influx of patients; Structural conditions; and Actions. Each category illustrates an important aspect for what primary care professionals do to achieve good and equal care. The influx of patients concerned what the professionals handled in terms of patients' healthcare needs and patient behaviour. Structural conditions consisted of policies and goals set for primary care, competence availability, technical systems, and organisational culture. To handle situations due to limited resources, professionals performed different actions: matching health care needs with professionals' competency, defining care needs to suit booking systems appointments, giving care at the inappropriate health care level, rearranging workhours, and passing on the decision making. CONCLUSION Priorities in primary care are not, "one fits all" solution. Our study shows that priorities in primary care comprise of ongoing daily processes that are adapted to the situation, context of patient influx, and structural conditions. Healthcare professional's actions for how influx of patients' is handled in relation to limited resources, are created, and shaped within this context which also sets the boundaries for their actions.
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Affiliation(s)
- Suzana Holmér
- grid.5640.70000 0001 2162 9922Department of Health, Medicine and Caring Sciences, Linköping University, Sandbäcksgatan 7, 581 83 Linköping, Sweden ,grid.5640.70000 0001 2162 9922Department of Health, Medicine and Caring Sciences, Swedish National Centre for Priority Setting in Health Care, Linköping University, Linköping, Sweden
| | - Ann- Charlotte Nedlund
- grid.5640.70000 0001 2162 9922Department of Health, Medicine and Caring Sciences, Linköping University, Sandbäcksgatan 7, 581 83 Linköping, Sweden ,grid.5640.70000 0001 2162 9922Department of Health, Medicine and Caring Sciences, Swedish National Centre for Priority Setting in Health Care, Linköping University, Linköping, Sweden
| | - Kristin Thomas
- grid.5640.70000 0001 2162 9922Department of Health, Medicine and Caring Sciences, Linköping University, Sandbäcksgatan 7, 581 83 Linköping, Sweden
| | - Barbro Krevers
- grid.5640.70000 0001 2162 9922Department of Health, Medicine and Caring Sciences, Linköping University, Sandbäcksgatan 7, 581 83 Linköping, Sweden ,grid.5640.70000 0001 2162 9922Department of Health, Medicine and Caring Sciences, Swedish National Centre for Priority Setting in Health Care, Linköping University, Linköping, Sweden
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10
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Daniels B, Shah D, Kwan AT, Das R, Das V, Puri V, Tipre P, Waghmare U, Gomare M, Keskar P, Das J, Pai M. Tuberculosis diagnosis and management in the public versus private sector: a standardised patients study in Mumbai, India. BMJ Glob Health 2022; 7:e009657. [PMID: 36261230 PMCID: PMC9582305 DOI: 10.1136/bmjgh-2022-009657] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 09/13/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND There are few rigorous studies comparing quality of tuberculosis (TB) care in public versus private sectors. METHODS We used standardised patients (SPs) to measure technical quality and patient experience in a sample of private and public facilities in Mumbai. RESULTS SPs presented a 'classic, suspected TB' scenario and a 'recurrence or drug-resistance' scenario. In the private sector, SPs completed 643 interactions. In the public sector, 164 interactions. Outcomes included indicators of correct management, medication use and client experience. Public providers used microbiological testing (typically, microscopy) more frequently, in 123 of 164 (75%; 95% CI 68% to 81%) vs 223 of 644 interactions (35%; 95% CI 31% to 38%) in the private sector. Private providers were more likely to order chest X-rays, in 556 of 639 interactions (86%; 95% CI 84% to 89%). According to national TB guidelines, we found higher proportions of correct management in the public sector (75% vs 35%; (adjusted) difference 35 percentage points (pp); 95% CI 25 to 46). If X-rays were considered acceptable for the first case but drug-susceptibility testing was required for the second case, the private sector correctly managed a slightly higher proportion of interactions (67% vs 51%; adjusted difference 16 pp; 95% CI 7 to 25). Broad-spectrum antibiotics were used in 76% (95% CI 66% to 84%) of the interactions in public hospitals, and 61% (95% CI 58% to 65%) in private facilities. Costs in the private clinics averaged rupees INR 512 (95% CI 485 to 539); public facilities charged INR 10. Private providers spent more time with patients (4.4 min vs 2.4 min; adjusted difference 2.0 min; 95% CI 1.2 to 2.9) and asked a greater share of relevant questions (29% vs 43%; adjusted difference 13.7 pp; 95% CI 8.2 to 19.3). CONCLUSIONS While the public providers did a better job of adhering to national TB guidelines (especially microbiological testing) and offered less expensive care, private sector providers did better on client experience.
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Affiliation(s)
- Benjamin Daniels
- McCourt School of Public Policy, Georgetown University, Washington, District of Columbia, USA
| | - Daksha Shah
- Public Health Department, Municipal Corporation of Greater Mumbai, Mumbai, India
| | - Ada T Kwan
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Ranendra Das
- Institute for Socio-Economic Research on Development and Democracy, Delhi, India
| | - Veena Das
- Department of Anthropology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Varsha Puri
- Public Health Department, Municipal Corporation of Greater Mumbai, Mumbai, India
| | - Pranita Tipre
- Public Health Department, Municipal Corporation of Greater Mumbai, Mumbai, India
| | - Upalimitra Waghmare
- Public Health Department, Municipal Corporation of Greater Mumbai, Mumbai, India
| | - Mangala Gomare
- Public Health Department, Municipal Corporation of Greater Mumbai, Mumbai, India
| | - Padmaja Keskar
- Public Health Department, Municipal Corporation of Greater Mumbai, Mumbai, India
| | - Jishnu Das
- McCourt School of Public Policy, Georgetown University, Washington, District of Columbia, USA
| | - Madhukar Pai
- McGill International TB Centre, McGill University, Montreal, Québec, Canada
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11
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Huffstetler HE, Bandara S, Bharali I, Kennedy McDade K, Mao W, Guo F, Zhang J, Riviere J, Becker L, Mohamadi M, Rice RL, King Z, Farooqi ZW, Zhang X, Yamey G, Ogbuoji O. The Impacts of Donor Transitions on Health Systems in Middle-Income Countries: A Scoping Review. Health Policy Plan 2022; 37:1188-1202. [PMID: 35904274 PMCID: PMC9558870 DOI: 10.1093/heapol/czac063] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 05/21/2022] [Accepted: 07/29/2022] [Indexed: 11/30/2022] Open
Abstract
As countries graduate from low-income to middle-income status, many face losses in development assistance for health and must ‘transition’ to greater domestic funding of their health response. If improperly managed, donor transitions in middle-income countries (MICs) could present significant challenges to global health progress. No prior knowledge synthesis has comprehensively surveyed how donor transitions can affect health systems in MICs. We conducted a scoping review using a structured search strategy across five academic databases and 37 global health donor and think tank websites for literature published between January 1990 and October 2018. We used the World Health Organization health system ‘building blocks’ framework to thematically synthesize and structure the analysis. Following independent screening, 89 publications out of 11 236 were included for data extraction and synthesis. Most of this evidence examines transitions related to human immunodeficiency virus/Acquired Immune Deficiency Syndrome (AIDS; n = 45, 50%) and immunization programmes (n = 14, 16%), with a focus on donors such as the Global Fund to Fight AIDS, Tuberculosis and Malaria (n = 26, 29%) and Gavi, the Vaccine Alliance (n = 15, 17%). Donor transitions are influenced by the actions of both donors and country governments, with impacts on every component of the health system. Successful transition experiences show that leadership, planning, and pre-transition investments in a country’s financial, technical, and logistical capacity are vital to ensuring smooth transition. In the absence of such measures, shortages in financial resources, medical product and supply stock-outs, service disruptions, and shortages in human resources were common, with resulting implications not only for programme continuation, but also for population health. Donor transitions can affect different components of the health system in varying and interconnected ways. More rigorous evaluation of how donor transitions can affect health systems in MICs will create an improved understanding of the risks and opportunities posed by donor exits.
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Affiliation(s)
- Hanna E Huffstetler
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill.,Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University
| | - Shashika Bandara
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University.,Faculty of Medicine and Health Sciences, McGill University
| | - Ipchita Bharali
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University
| | - Kaci Kennedy McDade
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University
| | - Wenhui Mao
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University
| | - Felicia Guo
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University
| | - Jiaqi Zhang
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University
| | - Judy Riviere
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University
| | - Liza Becker
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University
| | - Mina Mohamadi
- Department of Industrial and Systems Engineering, North Carolina State University
| | - Rebecca L Rice
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Zoe King
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University
| | - Zoha Waqar Farooqi
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University
| | - Xinqi Zhang
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University
| | - Gavin Yamey
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University
| | - Osondu Ogbuoji
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University
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12
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Pickersgill SJ, Msemburi WT, Cobb L, Ide N, Moran AE, Su Y, Xu X, Watkins DA. Modeling global 80-80-80 blood pressure targets and cardiovascular outcomes. Nat Med 2022; 28:1693-1699. [PMID: 35851877 PMCID: PMC9388375 DOI: 10.1038/s41591-022-01890-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 06/08/2022] [Indexed: 12/31/2022]
Abstract
As the leading cause of death worldwide, cardiovascular diseases (CVDs) present major challenges for health systems. In this study, we analyzed the effects of better population blood pressure control in the context of a proposed 80-80-80 target: 80% of individuals with hypertension are screened and aware of their diagnosis; 80% of those who are aware are prescribed treatment; and 80% of those on treatment have achieved guideline-specified blood pressure targets. We developed a population CVD model using country-level evidence on CVD rates, blood pressure levels and hypertension intervention coverage. Under realistic implementation conditions, most countries could achieve 80-80-80 targets by 2040, reducing all-cause mortality by 4-7% (76-130 million deaths averted over 2022-2050) and slowing the rise in CVD expected from population growth and aging (110-200 million cases averted). Although populous middle-income countries would account for most of the reduced CVD cases and deaths, low-income countries would experience the largest reductions in disease rates.
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Affiliation(s)
| | - William T Msemburi
- Division of Data, Analytics, and Delivery for Impact, World Health Organization, Geneva, Switzerland
| | - Laura Cobb
- Resolve to Save Lives, New York, NY, USA
| | - Nicole Ide
- Resolve to Save Lives, New York, NY, USA
| | - Andrew E Moran
- Resolve to Save Lives, New York, NY, USA.,Columbia University Irving Medical Center, New York, NY, USA
| | - Yanfang Su
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Xinpeng Xu
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - David A Watkins
- Department of Global Health, University of Washington, Seattle, WA, USA. .,Department of Medicine, Division of General Internal Medicine, University of Washington, Seattle, WA, USA.
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13
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Pickersgill SJ, Watkins DA, Mikkelsen B, Varghese C. A tool to identify NCD interventions to achieve the SDG target. Lancet Glob Health 2022; 10:e949-e950. [PMID: 35714640 PMCID: PMC9197247 DOI: 10.1016/s2214-109x(22)00124-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/14/2022] [Indexed: 11/04/2022]
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14
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Hanson K, Brikci N, Erlangga D, Alebachew A, De Allegri M, Balabanova D, Blecher M, Cashin C, Esperato A, Hipgrave D, Kalisa I, Kurowski C, Meng Q, Morgan D, Mtei G, Nolte E, Onoka C, Powell-Jackson T, Roland M, Sadanandan R, Stenberg K, Vega Morales J, Wang H, Wurie H. The Lancet Global Health Commission on financing primary health care: putting people at the centre. Lancet Glob Health 2022; 10:e715-e772. [PMID: 35390342 PMCID: PMC9005653 DOI: 10.1016/s2214-109x(22)00005-5] [Citation(s) in RCA: 118] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 01/18/2023]
Affiliation(s)
- Kara Hanson
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
| | - Nouria Brikci
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Darius Erlangga
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Abebe Alebachew
- Breakthrough International Consultancy, Addis Ababa, Ethiopia
| | - Manuela De Allegri
- Heidelberg Institute of Global Health, University Hospital and Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Dina Balabanova
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | - Ina Kalisa
- World Health Organization, Kigali, Rwanda
| | | | - Qingyue Meng
- China Center for Health Development Studies, Peking University, Beijing, China
| | - David Morgan
- Health Division, The Organisation for Economic Co-operation and Development, Paris, France
| | | | - Ellen Nolte
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Chima Onoka
- Department of Community Medicine, University of Nigeria, Enugu, Nigeria
| | - Timothy Powell-Jackson
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Martin Roland
- Department of Public Health and Primary Care, University of Cambridge, UK
| | | | | | | | - Hong Wang
- Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Haja Wurie
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
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15
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Watkins DA, Msemburi WT, Pickersgill SJ, Kawakatsu Y, Gheorghe A, Dain K, Johansson KA, Said S, Renshaw N, Tolla MT, Twea PD, Varghese C, Chalkidou K, Ezzati M, Norheim OF. NCD Countdown 2030: efficient pathways and strategic investments to accelerate progress towards the Sustainable Development Goal target 3.4 in low-income and middle-income countries. Lancet 2022; 399:1266-1278. [PMID: 35339227 PMCID: PMC8947779 DOI: 10.1016/s0140-6736(21)02347-3] [Citation(s) in RCA: 68] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/03/2021] [Accepted: 10/19/2021] [Indexed: 12/11/2022]
Abstract
Most countries have made little progress in achieving the Sustainable Development Goal (SDG) target 3.4, which calls for a reduction in premature mortality from non-communicable diseases (NCDs) by a third from 2015 to 2030. In this Health Policy paper, we synthesise the evidence related to interventions that can reduce premature mortality from the major NCDs over the next decade and that are feasible to implement in countries at all levels of income. Our recommendations are intended as generic guidance to help 123 low-income and middle-income countries meet SDG target 3.4; country-level applications require additional analyses and consideration of the local implementation and utilisation context. Protecting current investments and scaling up these interventions is especially crucial in the context of COVID-19-related health system disruptions. We show how cost-effectiveness data and other information can be used to define locally tailored packages of interventions to accelerate rates of decline in NCD mortality. Under realistic implementation constraints, most countries could achieve (or almost achieve) the NCD target using a combination of these interventions; the greatest gains would be for cardiovascular disease mortality. Implementing the most efficient package of interventions in each world region would require, on average, an additional US$18 billion annually over 2023-30; this investment could avert 39 million deaths and generate an average net economic benefit of $2·7 trillion, or $390 per capita. Although specific clinical intervention pathways would vary across countries and regions, policies to reduce behavioural risks, such as tobacco smoking, harmful use of alcohol, and excess sodium intake, would be relevant in nearly every country, accounting for nearly two-thirds of the health gains of any locally tailored NCD package. By 2030, ministries of health would need to contribute about 20% of their budgets to high-priority NCD interventions. Our report concludes with a discussion of financing and health system implementation considerations and reflections on the NCD agenda beyond the SDG target 3.4 and beyond the SDG period.
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16
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Jantsch AG, Burström B, Nilsson GH, Ponce de Leon A. Residency training in family medicine and its impact on coordination and continuity of care: an analysis of referrals to secondary care in Rio de Janeiro. BMJ Open 2022; 12:e051515. [PMID: 35168968 PMCID: PMC8852675 DOI: 10.1136/bmjopen-2021-051515] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To measure the effect that residency training in family medicine (RTFM) has on continuity and coordination of care. DESIGN Observational cohort study using electronic health records. SETTING Rio de Janeiro, Brazil, public primary care system. PARTICIPANTS 504 940 patients, 633 generalists (physicians without RTFM) and 204 family physicians (FP-doctors with 2 years of RTFM) from one health district between January 2015 and December 2018. INTERVENTION Two years of RTFM. MAIN OUTCOME MEASURES Relative risks of patients being referred to secondary care for outpatient consultations and diagnostics tests; and having a follow-up medical consultation in primary care within 3 and 6 months after being referred. RESULTS We examined 2 414 508 medical consultations and 284 754 referrals to secondary care. FPs were less likely to request ambulatory care services (including surgical specialties), but were more likely to request ophthalmology, physiotherapy, rehabilitationand surgical evaluations for their patients. Patients referred to secondary care by FPs were more likely to have a follow-up visit in primary care for almost every service requested. If all medical consultations were performed by FPs, a 37.6% (95% CI 32.4% to 42.4%) increased demand for rehabilitation services would be noticed. Oppositely, 1532 (95% CI 1458 to 1602) fewer requests for dermatology would happen every year. CONCLUSIONS RTFM improves coordination and continuity of care by making FPs more competent to retain those health conditions that can be properly managed in primary care and making FPs more competent to detect health conditions that require specific biomedical technologies and skills, increasing the demand for those services. Besides, it increases the chances of patients having follow-up visits in primary care. Policy-makers in low-income and middle-income countries must consider investing in RTFM to make primary care systems more comprehensive, with better coordination and continuity of care.
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Affiliation(s)
- Adelson Guaraci Jantsch
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Maracanã, Brazil
| | - Bo Burström
- Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Gunnar H Nilsson
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Karolinska Institutet, Stockholm, Sweden
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17
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Kostova DA, Moolenaar RL, Van Vliet G, Lasu A, Mahar M, Richter P. Strengthening Pandemic Preparedness Through Noncommunicable Disease Strategies. Prev Chronic Dis 2021; 18:E93. [PMID: 34672923 PMCID: PMC8588872 DOI: 10.5888/pcd18.210237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Deliana A Kostova
- Division of Global Health Protection, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30322.
| | - Ronald L Moolenaar
- Division of Global Health Protection, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, Georgia
| | | | - Ally Lasu
- RTI International, Research Triangle Park, North Carolina
| | - Michael Mahar
- Division of Global Health Protection, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, Georgia
| | - Patricia Richter
- Division of Global Health Protection, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, Georgia
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18
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Effect of health systems context on infant and child mortality in sub-Saharan Africa from 1995 to 2015, a longitudinal cohort analysis. Sci Rep 2021; 11:16263. [PMID: 34381150 PMCID: PMC8357794 DOI: 10.1038/s41598-021-95886-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 07/29/2021] [Indexed: 11/28/2022] Open
Abstract
Each year, > 3 million children die in sub-Saharan Africa before their fifth birthday. Most deaths are preventable or avoidable through interventions delivered in the primary healthcare system. However, evidence regarding the impact of health system characteristics on child survival is sparse. We assembled a retrospective cohort of > 250,000 children in seven countries in sub-Saharan Africa. We described their health service context at the subnational level using standardized surveys and employed parametric survival models to estimate the effect of three major domains of health services—quality, access, and cost—on infant and child survival, after adjusting for child, maternal, and household characteristics. Between 1995 and 2015 we observed 13,629 deaths in infants and 5149 in children. In fully-adjusted models, the largest effect sizes were related to fees for services. Immunization fees were correlated with poor child survival (HR = 1.20, 95% CI 1.12–1.28) while delivery fees were correlated with poor infant survival (HR = 1.11, 95% CI 1.01–1.21). Accessibility of facilities and greater concentrations of private facilities were associated with improved infant and child survival. The proportion of facilities with a doctor was correlated with increased risk of death in children and infants. We quantify the impact of health service environment on survival up to five years of age. Reducing health care costs and improving the accessibility of health facilities should remain a priority for improving infant and child survival. In the absence of these fundamental investments, more specialized interventions may not achieve their desired impact.
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19
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Achieving global mortality reduction targets and universal health coverage: The impact of COVID-19. PLoS Med 2021; 18:e1003675. [PMID: 34166391 PMCID: PMC8270396 DOI: 10.1371/journal.pmed.1003675] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 07/09/2021] [Indexed: 12/02/2022] Open
Abstract
Wenhui Mao and coauthors discuss possible implications of the COVID-19 pandemic for health aspirations in low- and middle-income countries.
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20
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Kostova D, Richter P, Van Vliet G, Mahar M, Moolenaar RL. The Role of Noncommunicable Diseases in the Pursuit of Global Health Security. Health Secur 2021; 19:288-301. [PMID: 33961498 PMCID: PMC8217593 DOI: 10.1089/hs.2020.0121] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Noncommunicable diseases and their risk factors are important for all aspects of outbreak preparedness and response, affecting a range of factors including host susceptibility, pathogen virulence, and health system capacity. This conceptual analysis has 2 objectives. First, we use the Haddon matrix paradigm to formulate a framework for assessing the relevance of noncommunicable diseases to health security efforts throughout all phases of the disaster life cycle: before, during, and after an event. Second, we build upon this framework to identify 6 technical action areas in global health security programs that are opportune integration points for global health security and noncommunicable disease objectives: surveillance, workforce development, laboratory systems, immunization, risk communication, and sustainable financing. We discuss approaches to integration with the goal of maximizing the reach of global health security where infectious disease threats and chronic disease burdens overlap.
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Affiliation(s)
- Deliana Kostova
- Deliana Kostova, PhD, is a Senior Economist; Patricia Richter, PhD, is Branch Chief, Global Noncommunicable Diseases Branch; Michael Mahar, PhD, is a Public Health Advisor; and Ronald L. Moolenaar, MD, is Associate Director for Science; all in the Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA. Gretchen Van Vliet, MPH, is Senior Public Health Project Director, Global Public Health Impact Center, RTI International, Research Triangle Park, NC
| | - Patricia Richter
- Deliana Kostova, PhD, is a Senior Economist; Patricia Richter, PhD, is Branch Chief, Global Noncommunicable Diseases Branch; Michael Mahar, PhD, is a Public Health Advisor; and Ronald L. Moolenaar, MD, is Associate Director for Science; all in the Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA. Gretchen Van Vliet, MPH, is Senior Public Health Project Director, Global Public Health Impact Center, RTI International, Research Triangle Park, NC
| | - Gretchen Van Vliet
- Deliana Kostova, PhD, is a Senior Economist; Patricia Richter, PhD, is Branch Chief, Global Noncommunicable Diseases Branch; Michael Mahar, PhD, is a Public Health Advisor; and Ronald L. Moolenaar, MD, is Associate Director for Science; all in the Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA. Gretchen Van Vliet, MPH, is Senior Public Health Project Director, Global Public Health Impact Center, RTI International, Research Triangle Park, NC
| | - Michael Mahar
- Deliana Kostova, PhD, is a Senior Economist; Patricia Richter, PhD, is Branch Chief, Global Noncommunicable Diseases Branch; Michael Mahar, PhD, is a Public Health Advisor; and Ronald L. Moolenaar, MD, is Associate Director for Science; all in the Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA. Gretchen Van Vliet, MPH, is Senior Public Health Project Director, Global Public Health Impact Center, RTI International, Research Triangle Park, NC
| | - Ronald L Moolenaar
- Deliana Kostova, PhD, is a Senior Economist; Patricia Richter, PhD, is Branch Chief, Global Noncommunicable Diseases Branch; Michael Mahar, PhD, is a Public Health Advisor; and Ronald L. Moolenaar, MD, is Associate Director for Science; all in the Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA. Gretchen Van Vliet, MPH, is Senior Public Health Project Director, Global Public Health Impact Center, RTI International, Research Triangle Park, NC
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21
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Cárdenas MK, Pérez-León S, Singh SB, Madede T, Munguambe S, Govo V, Jha N, Damasceno A, Miranda JJ, Beran D. Forty years after Alma-Ata: primary health-care preparedness for chronic diseases in Mozambique, Nepal and Peru. Glob Health Action 2021; 14:1975920. [PMID: 34569443 PMCID: PMC8477950 DOI: 10.1080/16549716.2021.1975920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Four decades after the Alma-Ata Declaration, strengthening primary health care (PHC) remains a priority for health systems, especially in low- and middle-income countries (LMICs). Given the prominence of chronic diseases as a global health issue, PHC must include a wide range of components in order to provide adequate care. Objective To assess PHC preparedness to provide chronic care in Mozambique, Nepal and Peru, we used, as ‘tracer conditions’, diabetes, hypertension and a country-specific neglected tropical disease with chronic sequelae in each country. Methods By implementing a health system assessment, we collected quantitative and qualitative data from primary and secondary sources, including interviews of key informants at three health-system levels (macro, meso and micro). The World Health Organization’s health-system building blocks provided the basis for content analysis. Results In total, we conducted 227 interviews. Our findings show that the ambitious policies targeting specific diseases lack the support of technical, administrative and financial resources. Data collection systems do not allow the monitoring of individual patients or provide the health system with the information it requires. Patients receive limited disease-specific information. Clinical guidelines and training are either non-existent or not adapted to local contexts. Availability of medicines and diagnostic tests at the PHC level is an issue. Although medicines available through the public health care system are affordable, some essential medicines suffer shortages or are not available to PHC providers. This need, along with a lack of clear referral procedures and available transportation, generates financial issues for individuals and affects access to health care. Conclusion PHC in these LMICs is not well prepared to provide adequate care for chronic diseases. Improving PHC to attain universal health coverage requires strengthening the identified weaknesses across health-system building blocks.
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Affiliation(s)
- Maria Kathia Cárdenas
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Silvana Pérez-León
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Tavares Madede
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Savaiva Munguambe
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Valério Govo
- Research Unit, Department of Internal Medicine, Maputo Central Hospital, Maputo, Mozambique
| | - Nilambar Jha
- B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | | | - J Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.,School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - David Beran
- Division of Tropical and Humanitarian Medicine, Faculty of Medicine, University of Geneva, Geneva University Hospitals, Geneva, Switzerland
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Proactive prevention: Act now to disrupt the impending non-communicable disease crisis in low-burden populations. PLoS One 2020; 15:e0243004. [PMID: 33259517 PMCID: PMC7707577 DOI: 10.1371/journal.pone.0243004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Non-communicable disease (NCD) prevention efforts have traditionally targeted high-risk and high-burden populations. We propose an alteration in prevention efforts to also include emphasis and focus on low-risk populations, predominantly younger individuals and low-prevalence populations. We refer to this approach as "proactive prevention." This emphasis is based on the priority to put in place policies, programs, and infrastructure that can disrupt the epidemiological transition to develop NCDs among these groups, thereby averting future NCD crises. Proactive prevention strategies can be classified, and their implementation prioritized, based on a 2-dimensional assessment: impact and feasibility. Thus, potential interventions can be categorized into a 2-by-2 matrix: high impact/high feasibility, high impact/low feasibility, low impact/high feasibility, and low impact/low feasibility. We propose that high impact/high feasibility interventions are ready to be implemented (act), while high impact/low feasibility interventions require efforts to foster buy-in first. Low impact/high feasibility interventions need to be changed to improve their impact while low impact/low feasibility might be best re-designed in the context of limited resources. Using this framework, policy makers, public health experts, and other stakeholders can more effectively prioritize and leverage limited resources in an effort to slow or prevent the evolving global NCD crisis.
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Van Schalkwyk SC, Kiguli-Malwadde E, Budak JZ, Reid MJA, de Villiers MR. Identifying research priorities for health professions education research in sub-Saharan Africa using a modified Delphi method. BMC MEDICAL EDUCATION 2020; 20:443. [PMID: 33208149 PMCID: PMC7672834 DOI: 10.1186/s12909-020-02367-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 11/09/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Recent increases in health professions education (HPE) research in sub-Saharan Africa (SSA), though substantial, have predominantly originated from single institutions and remained uncoordinated. A shared research agenda can guide the implementation of HPE practices to ultimately influence the recruitment and retention of the health workforce. Thus, the authors aimed to generate and prioritise a list of research topics for HPE research (HPER) in SSA. METHODS A modified Delphi process was designed to prioritise a shared agenda. Members of the African Forum for Research and Education in Health (AFREhealth) technical working group (TWG) were asked to first list potential research topics. Then, members of the same TWG and attendees at the annual AFREhealth academic symposium held in Lagos, Nigeria in August 2019 rated the importance of including each topic on a 3-point Likert scale, through two rounds of consensus seeking. Consensus for inclusion was predefined as ≥70% of respondents rating the topic as "must be included." RESULTS Health professions educators representing a variety of professions and 13 countries responded to the survey rounds. Twenty-three TWG members suggested 26 initial HPER topics; subsequently 90 respondents completed round one, and 51 completed round 2 of the modified Delphi. The final list of 12 research topics which met predetermined consensus criteria were grouped into three categories: (1) creating an enabling environment with sufficient resources and relevant training; (2) enhancing student learning; and (3) identifying and evaluating strategies to improve pedagogical practice. CONCLUSIONS Establishing research priorities for HPE is important to ensure efficient and appropriate allocation of resources. This study serves as a reminder of how the prevailing context within which HPE, and by implication research in the field, is undertaken will inevitably influence choices about research foci. It further points to a potential advocacy role for research that generates regionally relevant evidence.
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Affiliation(s)
- Susan C. Van Schalkwyk
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Elsie Kiguli-Malwadde
- Health Workforce, African Centre for Global Health and Social Transformation (ACHEST), Kampala, Uganda
| | - Jehan Z. Budak
- Division of Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington USA
| | - Michael J. A. Reid
- Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, USA
| | - Marietjie R. de Villiers
- Division of Family Medicine and Primary Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
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24
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Watkins DA. Cardiovascular health and COVID-19: time to reinvent our systems and rethink our research priorities. Heart 2020; 106:1870-1872. [PMID: 33144390 DOI: 10.1136/heartjnl-2020-318323] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- David A Watkins
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA .,Department of Global Health, University of Washington, Seattle, Washington, USA
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25
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Rasanathan K, Evans TG. Primary health care, the Declaration of Astana and COVID-19. Bull World Health Organ 2020; 98:801-808. [PMID: 33177777 PMCID: PMC7607474 DOI: 10.2471/blt.20.252932] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 07/30/2020] [Accepted: 07/31/2020] [Indexed: 12/01/2022] Open
Abstract
Four decades after the Declaration of Alma-Ata, its vision of health for all and strategy of primary health care are still an inspiration to many people. In this article we evaluate the current status of primary health care in the era of the Declaration of Astana, the sustainable development goals, universal health coverage and the coronavirus disease 2019 pandemic. We consider how best to guide greater application of the primary health care strategy, reflecting on tensions that remain between the political vision of primary health care and its implementation in countries. We also consider what is required to support countries to realize the aspirations of primary health care, arguing that national needs and action must dominate over global preoccupations. Changing contexts and realities need to be accommodated. A clear distinction is needed between primary health care as an inspirational vision and set of values for health development, and primary health care as policy and implementation space. To achieve this vision, political action is required. Stakeholders beyond the health sector will often need to lead, which is challenging because the concept of primary health care is poorly understood by other sectors. Efforts on primary health care as policy and implementation space might focus explicitly on primary care and the frontline of service delivery with clear links and support to complementary work on social determinants and building healthy societies. Such efforts can be partial but important implementation solutions to contribute to the much bigger political vision of primary health care.
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Affiliation(s)
| | - Tim G Evans
- School of Population and Global Health, McGill University, Montreal, Canada
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26
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Beaton A, Kamalembo FB, Dale J, Kado JH, Karthikeyan G, Kazi DS, Longenecker CT, Mwangi J, Okello E, Ribeiro ALP, Taubert KA, Watkins DA, Wyber R, Zimmerman M, Carapetis J. The American Heart Association's Call to Action for Reducing the Global Burden of Rheumatic Heart Disease: A Policy Statement From the American Heart Association. Circulation 2020; 142:e358-e368. [PMID: 33070654 DOI: 10.1161/cir.0000000000000922] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Rheumatic heart disease (RHD) affects ≈40 million people and claims nearly 300 000 lives each year. The historic passing of a World Health Assembly resolution on RHD in 2018 now mandates a coordinated global response. The American Heart Association is committed to serving as a global champion and leader in RHD care and prevention. Here, we pledge support in 5 key areas: (1) professional healthcare worker education and training, (2) technical support for the implementation of evidence-based strategies for rheumatic fever/RHD prevention, (3) access to essential medications and technologies, (4) research, and (5) advocacy to increase global awareness, resources, and capacity for RHD control. In bolstering the efforts of the American Heart Association to combat RHD, we hope to inspire others to collaborate, communicate, and contribute.
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Bukhman G, Mocumbi AO, Atun R, Becker AE, Bhutta Z, Binagwaho A, Clinton C, Coates MM, Dain K, Ezzati M, Gottlieb G, Gupta I, Gupta N, Hyder AA, Jain Y, Kruk ME, Makani J, Marx A, Miranda JJ, Norheim OF, Nugent R, Roy N, Stefan C, Wallis L, Mayosi B. The Lancet NCDI Poverty Commission: bridging a gap in universal health coverage for the poorest billion. Lancet 2020; 396:991-1044. [PMID: 32941823 PMCID: PMC7489932 DOI: 10.1016/s0140-6736(20)31907-3] [Citation(s) in RCA: 155] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 05/29/2020] [Accepted: 08/25/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Gene Bukhman
- Department of Global Health and Social Medicine, Harvard University, Boston, MA, USA; Program in Global NCDs and Social Change, Harvard University, Boston, MA, USA; Partners In Health, Boston, MA, USA; Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
| | - Ana O Mocumbi
- Universidade Eduardo Mondlane, Maputo, Mozambique; Instituto Nacional de Saúde, Maputo, Mozambique
| | - Rifat Atun
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Anne E Becker
- Department of Global Health and Social Medicine, Harvard University, Boston, MA, USA
| | - Zulfiqar Bhutta
- Center for Global Child Health, Hospital for Sick Kids, Toronto, ON, Canada; Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan; Institute for Global Health & Development, Aga Khan University, South-Central Asia, East Africa, and UK
| | | | - Chelsea Clinton
- Clinton Foundation, New York, NY, USA; Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Matthew M Coates
- Department of Global Health and Social Medicine, Harvard University, Boston, MA, USA; Program in Global NCDs and Social Change, Harvard University, Boston, MA, USA; Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Majid Ezzati
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Gary Gottlieb
- Department of Psychiatry, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Indrani Gupta
- Health Policy Research Unit, Institute of Economic Growth, Delhi, India
| | - Neil Gupta
- Department of Global Health and Social Medicine, Harvard University, Boston, MA, USA; Program in Global NCDs and Social Change, Harvard University, Boston, MA, USA; Partners In Health, Boston, MA, USA; Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Adnan A Hyder
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Yogesh Jain
- Jan Swasthya Sahyog, Bilaspur, Chhattisgarh, India
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Julie Makani
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Andrew Marx
- Department of Global Health and Social Medicine, Harvard University, Boston, MA, USA; Program in Global NCDs and Social Change, Harvard University, Boston, MA, USA
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ole F Norheim
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA; Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Rachel Nugent
- Research Triangle Institute International, Seattle, WA, USA
| | - Nobhojit Roy
- WHO Collaborating Centre for Research on Surgical Care Delivery in LMICs, Department of Surgery, BARC Hospital, HBNI University, Government of India, Mumbai, India; Field Health Systems Laboratory, Bihar Technical Support Programme, CARE India, Madhubani, Bihar, India
| | - Cristina Stefan
- SingHealth Duke-NUS Global Health Institute (SDGHI), Duke-NUS Medical School, Singapore; African Medical Research and Innovation Institute, Cape Town, South Africa
| | - Lee Wallis
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - Bongani Mayosi
- Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Yamey G, Jamison D, Hanssen O, Soucat A. Financing Global Common Goods for Health: When the World is a Country. Health Syst Reform 2020; 5:334-349. [PMID: 31860402 DOI: 10.1080/23288604.2019.1663118] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
"Global functions" of health cooperation refer to those activities that go beyond the boundaries of individual nations to address transnational issues. This paper begins by presenting a taxonomy of global functions and laying out the key value propositions of investing in such functions. Next, it examines the current funding flows to global functions and the estimated price tag, which is large. Given that existing financing mechanisms have not closed the gap, it then proposes a suite of options for directing additional funding to global functions and discusses the governance of this additional funding. These options are organized into resource mobilization mechanisms, pooling approaches, and strategic purchasing of global functions. Given its legitimacy, convening power, and role in setting global norms and standards, the World Health Organization (WHO) is uniquely placed among global health organizations to provide the overarching governance of global functions. Therefore, the paper includes an assessment of WHO's financial situation. Finally, the paper concludes with reflections on the future of aid for health and its role in supporting global functions. The concluding section also summarizes a set of key priorities in financing global functions for health.
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Affiliation(s)
- Gavin Yamey
- The 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, CA, USA
| | | | - Agnès Soucat
- Health Systems, Governance and Financing, World Health Organization, Geneva, Switzerland
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29
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Watkins DA, Qi J, Kawakatsu Y, Pickersgill SJ, Horton SE, Jamison DT. Resource requirements for essential universal health coverage: a modelling study based on findings from Disease Control Priorities, 3rd edition. Lancet Glob Health 2020; 8:e829-e839. [PMID: 32446348 PMCID: PMC7248571 DOI: 10.1016/s2214-109x(20)30121-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 03/12/2020] [Accepted: 03/23/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Disease Control Priorities, 3rd edition (DCP3), published two model health benefits packages (HBPs). This study estimates the overall costs and individual component costs of these packages in low-income countries (LICs) and lower-middle-income countries (lower-MICs). METHODS This study reports on our Disease Control Priorities Cost Model (DCP-CM), developed as part of the DCP3 project to determine the overall costs of the 218 health sector interventions recommended in the model HBP termed essential universal health coverage (EUHC). Model inputs included data on intervention unit costs, demographic and epidemiological data to quantify the populations in need of specific interventions, baseline coverage indicators, and estimates of required health system costs to support direct service delivery. The DCP-CM was informed primarily by published estimates of economic costs of interventions measured from the health system perspective. We estimated counterfactual annual costs for the year 2015. We disaggregated costs according to intervention characteristics (delivery platform, delivery timing, and health system objective) and did one-way and probabilistic sensitivity analyses with determination of 95% credible intervals (Crls). FINDINGS At 80% population coverage, the annual cost of EUHC would be US$79 (95% Crl 60-110) per capita (in 2016 US dollars) in LICs and US$130 (100-180) per capita in lower-MICs. As a share of 2015 gross national income (GNI), additional investments would require 8·0% (95% Crl 5·7-11·3) in LICs and 4·2% (2·9-5·9) in lower-MICs. A highest priority subpackage comprising 115 of the EUHC interventions would cost approximately half of these amounts (3·7% [2·6-5·3] of 2015 GNI in LICs and 2·0% [1·4-2·8] in lower-MICs). Mortality-reducing interventions would require around two-thirds of the overall package costs, with interventions to reduce mortality at age 5-69 years from non-communicable disease and injury comprising the highest share of total EUHC costs in both income groups (37·6% [37·2-37·9] in LICs and 43·0% [42·6-43·4] in lower-MICs). Interventions addressing chronic health conditions (requiring 45·5% [44·8-46·4] 2015 GNI for LICs and lower-MICs combined) and interventions delivered in health centres (requiring 49·8% [49·5-50·2] 2015 GNI for LICs and lower-MICs combined) would each comprise the plurality of costs. INTERPRETATION Implementation of EUHC would require costly investment, especially in LICs. DCP-CM is available as an online tool that can inform local HBP deliberation and support efficient investment in UHC, especially as countries pivot towards non-communicable disease and injury care. FUNDING Bill & Melinda Gates Foundation, Trond Mohn Foundation, and Norwegian Agency for Development Cooperation.
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Affiliation(s)
- David A Watkins
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA; Department of Global Health, University of Washington, Seattle, WA, USA.
| | - Jinyuan Qi
- Office of Population Research, Princeton University, Princeton, NJ, USA
| | - Yoshito Kawakatsu
- Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Susan E Horton
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Dean T Jamison
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
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30
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Bandara S, Chapman N, Chowdhary V, Doubell A, Hynen A, Rugarabamu G, Gunn A, Yamey G. Analysis of the health product pipeline for poverty-related and neglected diseases using the Portfolio-to-Impact (P2I) modeling tool. F1000Res 2020; 9:416. [PMID: 35634166 PMCID: PMC9120931 DOI: 10.12688/f1000research.24015.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/18/2020] [Indexed: 11/20/2022] Open
Abstract
Background: To estimate how much additional funding is needed for poverty-related and neglected disease (PRND) product development and to target new resources effectively, policymakers need updated information on the development pipeline and estimated costs to fill pipeline gaps. Methods: We previously conducted a pipeline review to identify candidates for 35 neglected diseases as of August 31, 2017 (“2017 pipeline”). We used the Portfolio-to-Impact (P2I) tool to estimate costs to move these candidates through the pipeline, likely launches, and additional costs to develop “missing products.” We repeated this analysis, reviewing the pipeline to August 31, 2019 to get a time trend. We made a direct comparison based on the same 35 diseases (“2019 direct comparison pipeline”), then a comparison based on an expanded list of 45 diseases (“2019 complete pipeline”). Results: In the 2017 pipeline, 538 product candidates met inclusion criteria for input into the model; it would cost $16.3 billion (B) to move these through the pipeline, yielding 128 launches. In the 2019 direct comparison pipeline, we identified 690 candidates, an increase of 152 candidates from 2017; the largest increase was for Ebola. The direct comparison 2019 pipeline yields 196 launches, costing $19.9B. In the 2019 complete pipeline, there were 754 candidates, an increase of 216 candidates from 2017, of which 152 reflected pipeline changes and 64 reflected changes in scope. The complete pipeline 2019 yields 207 launches, costing $21.0B. There would still be 16 “missing products” based on the complete 2019 pipeline; it would cost $5.5B-$14.2B (depending on product complexity) to develop these products. Conclusion: The PRNDs product development pipeline has grown by over a quarter in two years. The number of expected new product launches based on the 2019 pipeline increased by half compared to 2017; the cost of advancing the pipeline increased by a quarter.
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Affiliation(s)
- Shashika Bandara
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University, Durham, NC, 27708, USA
| | - Nick Chapman
- Policy Cures Research, Sydney, NSW, 2010, Australia
| | | | - Anna Doubell
- Policy Cures Research, Sydney, NSW, 2010, Australia
| | - Amelia Hynen
- Policy Cures Research, Sydney, NSW, 2010, Australia
| | | | - Alexander Gunn
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University, Durham, NC, 27708, USA
| | - Gavin Yamey
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University, Durham, NC, 27708, USA
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Chalkidou K, Claxton K, Silverman R, Yadav P. Value-based tiered pricing for universal health coverage: an idea worth revisiting. Gates Open Res 2020; 4:16. [PMID: 32185365 PMCID: PMC7059551 DOI: 10.12688/gatesopenres.13110.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2020] [Indexed: 10/03/2023] Open
Abstract
The pricing of medicines and health products ranks among the most hotly debated topics in health policy, generating controversy in richer and poorer markets alike. Creating the right pricing structure for pharmaceuticals and other healthcare products is particularly important for low- and middle-income countries, where pharmaceuticals account for a significant portion of total health expenditure; high medicine prices therefore threaten the feasibility and sustainability of nascent schemes for universal health coverage (UHC). We argue that a strategic system of value-based tiered pricing (VBTP), wherein each country would pay a price for each health product commensurate with the local value it provides, could improve access, enhance efficiency, and empower countries to negotiate with product manufacturers. This paper attempts to further understanding on the potential value of tiered pricing, barriers to its implementation, and potential strategies to overcome those.
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Affiliation(s)
- Kalipso Chalkidou
- Global Health Policy, Center for Global Development, London, UK
- Medicine, School of Public Health, Imperial College London, London, UK
| | - Karl Claxton
- Department of Economics, University of York, UK, York, UK
| | | | - Prashant Yadav
- Global Health Policy, Center for Global Development, London, UK
- Technology and Operations Management, INSEAD, Fontainebleau, France
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32
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Chalkidou K, Claxton K, Silverman R, Yadav P. Value-based tiered pricing for universal health coverage: an idea worth revisiting. Gates Open Res 2020; 4:16. [PMID: 32185365 PMCID: PMC7059551 DOI: 10.12688/gatesopenres.13110.3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2020] [Indexed: 01/29/2023] Open
Abstract
The pricing of medicines and health products ranks among the most hotly debated topics in health policy, generating controversy in richer and poorer markets alike. Creating the right pricing structure for pharmaceuticals and other healthcare products is particularly important for low- and middle-income countries, where pharmaceuticals account for a significant portion of total health expenditure; high medicine prices therefore threaten the feasibility and sustainability of nascent schemes for universal health coverage (UHC). We argue that a strategic system of value-based tiered pricing (VBTP), wherein each country would pay a price for each health product commensurate with the local value it provides, could improve access, enhance efficiency, and empower countries to negotiate with product manufacturers. This paper attempts to further understanding on the potential value of tiered pricing, barriers to its implementation, and potential strategies to overcome those.
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Affiliation(s)
- Kalipso Chalkidou
- Global Health Policy, Center for Global Development, London, UK.,Medicine, School of Public Health, Imperial College London, London, UK
| | - Karl Claxton
- Department of Economics, University of York, UK, York, UK
| | | | - Prashant Yadav
- Global Health Policy, Center for Global Development, London, UK.,Technology and Operations Management, INSEAD, Fontainebleau, France
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33
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Jimenez Carrillo M, León García M, Vidal N, Bermúdez K, De Vos P. Comprehensive primary health care and non-communicable diseases management: a case study of El Salvador. Int J Equity Health 2020; 19:50. [PMID: 32252764 PMCID: PMC7132977 DOI: 10.1186/s12939-020-1140-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 02/07/2020] [Indexed: 01/12/2023] Open
Abstract
Background One of today’s greatest challenges in public health worldwide - and especially its key management from Primary Health Care (PHC) - is the growing burden of non-communicable diseases (NCDs). In El Salvador, since 2009 the Minister of Health (MoH) has scaled up a national public health system based on a comprehensive PHC approach. A national multi-sectorial strategic plan for a comprehensive approach to NCDs has also been developed. This analysis explores stakeholders’ perceptions related to the management of NCDs in PHC and, in particular, the role of social participation. Methods A case-study was developed consisting of semi structured interviews and official document reviews. Semi-structured interviews were developed with chronic patients (14) and PHC professionals working in different levels within PHC (12). Purposive sampling was used to recruit participants. A non-pure, deductive approach was implemented for coding. After grouping codes into potential themes, a thematic framework was elaborated through a reflexive approach and the triangulation of the data. The research was conducted between March and August of 2018 in three different departments of El Salvador. Results The structure and the functioning of the Salvadoran PHC system and its intersectoral approach is firstly described. The interdisciplinary PHC-team brings holistic health care closer to the communities in which health promoters play a key role. The findings reflect the generally positive perception of the PHC system in terms of accessibility, quality and continuity of care by chronic patients. Community engagement and the National Health Forum are ensuring accountability through social controllership mechanisms. However, certain challenges were also noted during the interviews related to the shortage of medication and workforce; coordination between the levels of care and the importance of prevention and health promotion programmes for NCDs. Conclusions The Salvadoran PHC and its comprehensive approach to NCDs with an emphasis on intersectoral participation has been positively perceived by the range of stakeholders interviewed. Social engagement and the NHF works as a driving force to ensure accountability as well as in the promotion of a preventive culture. The challenges identified provide keys to amplify knowledge for addressing inequalities in health by strengthening PHC and its NCDs management.
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Affiliation(s)
| | - Montserrat León García
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK.,Biomedical Research Institute Sant Pau (IIBSant Pau), Iberoamerican Cochrane Centre, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Nicole Vidal
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
| | - Keven Bermúdez
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
| | - Pol De Vos
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
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34
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Chalkidou K, Claxton K, Silverman R, Yadav P. Value-based tiered pricing for universal health coverage: an idea worth revisiting. Gates Open Res 2020; 4:16. [DOI: 10.12688/gatesopenres.13110.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2020] [Indexed: 11/20/2022] Open
Abstract
The pricing of medicines and health products ranks among the most hotly debated topics in health policy, generating controversy in richer and poorer markets alike. Creating the right pricing structure for pharmaceuticals and other healthcare products is particularly important for low- and middle-income countries, where pharmaceuticals account for a significant portion of total health expenditure; high medicine prices therefore threaten the feasibility and sustainability of nascent schemes for universal health coverage (UHC). We argue that a strategic system of value-based tiered pricing (VBTP), wherein each country would pay a price for each health product commensurate with the local value it provides, could improve access, enhance efficiency, and empower countries to negotiate with product manufacturers. This paper attempts to further understanding on the potential value of tiered pricing, barriers to its implementation, and potential strategies to overcome those.
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Russo G, Cassenote AJF, Guilloux AGA, Scheffer MC. The role of private education in the selection of primary care careers in low and middle-income countries. Findings from a representative survey of medical residents in Brazil. HUMAN RESOURCES FOR HEALTH 2020; 18:11. [PMID: 32066457 PMCID: PMC7027019 DOI: 10.1186/s12960-020-0456-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 02/06/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Primary health care (PHC) doctors' numbers are dwindling in high- as well as low-income countries, which is feared to hamper the achievement of Universal Health Coverage goals. As a large proportion of doctors are privately educated and private medical schools are becoming increasingly common in middle-income settings, there is a debate on whether private education represents a suitable mean to increase the supply of PHC physicians. We analyse the intentions to practice of medical residents in Brazil to understand whether these differ for public and private schools. METHODS Drawing from the literature on the selection of medical specialties, we constructed a model for the determinants of medical students' intentions to practice in PHC, and used secondary data from a nationally representative sample of 4601 medical residents in Brazil to populate it. Multivariate analysis and multilevel cluster models were employed to explore the association between perspective physicians' choice of practice and types of schools attended, socio-economic characteristics, and their values and opinions on the profession. RESULTS Only 3.7% of residents in our sample declared an intention to practice in PHC, with no significant association with the public or private nature of the medical schools attended. Instead, having attended a state secondary school (p = 0.028), having trained outside Brazil's wealthy South East (p < 0.001), not coming from an affluent family (p = 0.037), and not having a high valuation of career development opportunities (p < 0.001) were predictors of willingness to practice in PHC. A low consideration for quality of life, for opportunities for treating patients, and for the liberal aspects of the profession were also associated with future physicians' intentions to work in primary care (all p < 0.001). CONCLUSIONS In Brazil, training in public or private medical schools does not influence the intention to practice in PHC. But students from affluent backgrounds, with private secondary education, and graduating in the rich South East were found to be overrepresented in both types of training institutions, and this is what appears to negatively impact the selection of PHC careers. With a view to increasing the supply of PHC practitioners in middle-income countries, policies should focus on opening medical schools in rural areas and improving access for students from disadvantaged backgrounds.
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Affiliation(s)
- Giuliano Russo
- Institute of Population Health Sciences, Queen Mary University of London, 58 Turner street, E1 2AB, London, United Kingdom.
| | - Alex J Flores Cassenote
- Departamento da Medicina Preventiva, Faculdade de Medicina da Universidade de São Paulo, CEP:01246-903, Av. Dr Arnaldo, 455, São Paulo, Brazil
| | - Aline G Alves Guilloux
- Departamento da Medicina Preventiva, Faculdade de Medicina da Universidade de São Paulo, CEP:01246-903, Av. Dr Arnaldo, 455, São Paulo, Brazil
| | - Mário César Scheffer
- Departamento da Medicina Preventiva, Faculdade de Medicina da Universidade de São Paulo, CEP:01246-903, Av. Dr Arnaldo, 455, São Paulo, Brazil
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Martinez-Alvarez M, Federspiel F, Singh NS, Schäferhoff M, Lewis Sabin M, Onoka C, Mounier-Jack S, Borghi J, Pitt C. Equity of resource flows for reproductive, maternal, newborn, and child health: are those most in need being left behind? BMJ 2020; 368:m305. [PMID: 32015053 PMCID: PMC7461904 DOI: 10.1136/bmj.m305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Although equity has improved in recent years, donors and country governments still need to improve the amount and targeting of funding for reproductive, maternal, and child health, say Melisa Martinez-Alvarez and colleagues
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Affiliation(s)
- Melisa Martinez-Alvarez
- MRC Unit in The Gambia at the London School of Hygiene and Tropical Medicine, TheGambia
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London UK
| | - Frederik Federspiel
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London UK
| | - Neha S Singh
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London UK
| | | | | | - Chima Onoka
- Department of Community Medicine, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - Sandra Mounier-Jack
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London UK
| | - Josephine Borghi
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London UK
| | - Catherine Pitt
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London UK
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Gostin LO, Meier BM, Thomas R, Magar V, Ghebreyesus TA. 70 years of human rights in global health: drawing on a contentious past to secure a hopeful future. Lancet 2019; 392:2731-2735. [PMID: 30541664 PMCID: PMC7137746 DOI: 10.1016/s0140-6736(18)32997-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 11/15/2018] [Accepted: 11/15/2018] [Indexed: 01/28/2023]
Affiliation(s)
- Lawrence O Gostin
- O'Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC, USA.
| | - Benjamin M Meier
- Department of Public Policy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rebekah Thomas
- Gender, Equity and Human Rights team, Geneva, Switzerland
| | - Veronica Magar
- Gender, Equity and Human Rights team, Geneva, Switzerland
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Abstract
In many African countries, hundreds of health-related NGOs are fed by a chaotic tangle of donor funding streams. The case of Mozambique illustrates how this NGO model impedes Universal Health Coverage. In the 1990s, NGOs multiplied across post-war Mozambique: the country’s structural adjustment program constrained public and foreign aid expenditures on the public health system, while donors favored private contractors and NGOs. In the 2000s, funding for HIV/AIDS and other vertical aid from many donors increased dramatically. In 2004, the United States introduced PEPFAR in Mozambique at nearly 500 million USD per year, roughly equivalent to the entire budget of the Ministry of Health. To be sure, PEPFAR funding has helped thousands access antiretroviral treatment, but over 90% of resources flow “off-budget” to NGO “implementing partners,” with little left for the public health system. After a decade of this major donor funding to NGOs, public sector health system coverage had barely changed. In 2014, the workforce/ population ratio was still among the five worst in the world at 71/10000; the health facility/per capita ratio worsened since 2009 to only 1 per 16,795. Achieving UHC will require rejection of austerity constraints on public sector health systems, and rechanneling of aid to public systems building rather than to NGOs.
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Affiliation(s)
- James Pfeiffer
- Department of Global Health, Department of Anthropology, University of Washington, Box 357965, Seattle, WA, 98195-7965, USA.
| | - Rachel R Chapman
- Department of Anthropology, University of Washington, Box 353100, Seattle, WA, 98195-3100, USA
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Signorelli C, Odone A, Oradini-Alacreu A, Pelissero G. Universal Health Coverage in Italy: lights and shades of the Italian National Health Service which celebrated its 40th anniversary. Health Policy 2019; 124:69-74. [PMID: 31812325 DOI: 10.1016/j.healthpol.2019.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 10/09/2019] [Accepted: 11/05/2019] [Indexed: 01/13/2023]
Abstract
The Italian National Health Service (I-NHS) was established in 1978 to guarantee universal access to healthcare. Prominent in international reports, the I-NHS has reached a satisfactory level of efficiency and excellent standards of care in many regions, in forty years. Along the years, I-NHS has developed a structural public-private partnership in health services delivery that in some regions contributes to the achievement of very high standards of healthcare quality. However, the I-NHS is currently facing some major challenges: (a) Italy is experiencing a remarkable aging of its population with increasing health needs; (b) the recent and constant cuts to public expenditures are reducing the budget for welfare. It is of utmost importance to ensure that on-going efforts to contain health system costs do not subsume health care quality. In addition, monitoring of the essential levels of care (Livelli Essenziali di Assistenza, LEA) highlights significant differences in healthcare delivery among Italian regions that, in turns, contribute to the burdensome migration of patients to best-performing regions. Therefore, a more consolidated and ambitious approach to quality monitoring and healthcare improvement at a system level is needed to guarantee its sustainability in the future.
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Affiliation(s)
- C Signorelli
- School of Public Health, Faculty of Medicine, University Vita-Salute San Raffaele, Milan, Italy; Department of Medicine and Surgery, University of Parma, Italy.
| | - A Odone
- School of Public Health, Faculty of Medicine, University Vita-Salute San Raffaele, Milan, Italy
| | - A Oradini-Alacreu
- School of Public Health, Faculty of Medicine, University Vita-Salute San Raffaele, Milan, Italy
| | - G Pelissero
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
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Schäferhoff M, Chodavadia P, Martinez S, McDade KK, Fewer S, Silva S, Jamison D, Yamey G. International Funding for Global Common Goods for Health: An Analysis Using the Creditor Reporting System and G-FINDER Databases. Health Syst Reform 2019; 5:350-365. [PMID: 31710516 DOI: 10.1080/23288604.2019.1663646] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
West Africa's Ebola epidemic of 2014-2016 exposed, among other problems, the under-funding of transnational global health activities known as global common goods for health (CGH), global functions such as pandemic preparedness and research and development (R&D) for neglected diseases. To mobilize sustainable funding for global CGH, it is critical first to understand existing financing flowing to different types of global CGH. In this study, we estimate trends in international spending for global CGH in 2013, 2015, and 2017, encompassing the era before and after the Ebola epidemic. We use a measure of international funding that combines official development assistance (ODA) for health with additional international spending on R&D for diseases of poverty, a measure called ODA+. We classify ODA+ into funding for three global functions-provision of global public goods, management of cross-border externalities, and fostering of global health leadership and stewardship-and country-specific aid. International funding for global functions increased between 2013 and 2015 by $1.4 billion to a total of $7.3 billion in 2015. It then declined to $7.0 billion in 2017, accounting for 24% of all ODA+ in 2017. These findings provide empirical evidence of the reactive nature of international funders for global CGH. While international funders increased funding for global functions in response to the Ebola outbreak, they failed to sustain that funding. To meet future global health challenges proactively, international funders should allocate more funding for global functions.
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Affiliation(s)
| | | | | | | | - Sara Fewer
- Institute for Global Health Sciences, University of California, San Francisco, CA, USA
| | - Sachin Silva
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Dean Jamison
- Institute for Global Health Sciences, University of California, San Francisco, CA, USA
| | - Gavin Yamey
- Duke Global Health Institute, Duke University, Durham, NC, USA
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Barbosa ACS, Luiz FS, Friedrich DBDC, Püschel VADA, Farah BF, Carbogim FDC. Profile of nursing graduates: competencies and professional insertion. Rev Lat Am Enfermagem 2019; 27:e3205. [PMID: 31664413 PMCID: PMC6818661 DOI: 10.1590/1518-8345.3222.3205] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 07/02/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE evaluate the profile of the graduates of Nursing a public college from the perception of skills developed during graduation and the process of professional insertion. METHOD quantitative, exploratory and descriptive study. The sample was composed of 216 graduates. The data was collected by a validated questionnaire and sent to a population of 470 egresses via electronic mail. For the analysis of the data, frequencies, mean and standard deviation were applied and, for the correlation, the chi-square test. RESULTS the majority of the participants were female (88%) and the mean age was 29.62 years. The majority (65%) had an employment relationship, 14% worked in a single institution and 48% started working six months after graduation. Regarding the form of work, 56% work in care, with an average of 4.5 minimum wages and a weekly workload between 37 and 44 hours. The majority reported competence acquisition to practice the profession, assisting the patient in his integrality with ethics and applying technical and scientific concepts in care. CONCLUSION the study made it possible to describe the singularities of nurses' education, their insertion in the world of work and the impact on the educational institution, as well as the presentation of specific competences from the perspective of the graduates themselves.
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Affiliation(s)
| | - Franciane Silva Luiz
- Universidade Federal de Juiz de Fora, Programa de Pós-Graduação em Enfermagem, Juiz de Fora, MG, Brazil
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Reid M, Roberts G, Goosby E, Wesson P. Monitoring Universal Health Coverage (UHC) in high Tuberculosis burden countries: Tuberculosis mortality an important tracer of UHC service coverage. PLoS One 2019; 14:e0223559. [PMID: 31665144 PMCID: PMC6821027 DOI: 10.1371/journal.pone.0223559] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 09/23/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There is a paucity of empiric data evaluating whether Tuberculosis (TB) is a useful surrogate measure for Universal Health Coverage (UHC), despite recognition of the importance of TB control efforts as part of the broader UHC agenda. We hypothesized that indicators of TB burden and coverage are sensitive tracers of UHC, when compared to other disease-specific indicators of service provision. METHODS Linear regression models were used to determine the extent to which variability in UHC Service Coverage Index (SCI) was accounted for by (1) TB incidence rates and (2) TB mortality rates across 183 countries. Dominance analyses, stratifying countries by World Bank income criteria and TB burden, were used to determine the importance of TB treatment coverage in predicting UHC SCI scores, relative to other disease-specific indicators of service provision. RESULTS Across 183 countries, TB incidence rate and TB mortality rate were negatively correlated, with UHC SCI score, (r = -0.67 and r = -0.74, respectively). In linear regression models including all 183 countries, TB incidence rates explained 45% of the variability in SCI scores; TB mortality rate explained 55% of variability. Restricting models to the 30 highest TB burden countries, both incidence and mortality explained less of the variability in SCI score (16% and 36%, respectively). In dominance analysis, comparing 13 disease-specific indicators of service provision, TB effective treatment coverage, ranked ninth overall. In dominance analysis stratified by TB burden, the TB treatment coverage estimate was ranked ninth in the 30 high burden countries and sixth in the 153 non-high burden countries. In separate analyses stratified by world bank income status, TB coverage ranked as third most important variable in LICs and fifth in LMICs and UMICs, but was less important in analysis restricted HICs (ranked seventh). CONCLUSIONS Compared to other disease-specific indicators of service provision, TB coverage was an important indicator of overall UHC service coverage, especially in low-income countries. These findings highlight that national-level inequities in TB-coverage may be an important tracer of universal health coverage.
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Affiliation(s)
- Michael Reid
- University of California, San Francisco, School of Medicine, San Francisco, California, United States of America
- University of California, San Francisco, Institute for Global Health Sciences, San Francisco, California, United States of America
- * E-mail:
| | - Glenna Roberts
- University of California, San Francisco, Institute for Global Health Sciences, San Francisco, California, United States of America
| | - Eric Goosby
- University of California, San Francisco, School of Medicine, San Francisco, California, United States of America
- University of California, San Francisco, Institute for Global Health Sciences, San Francisco, California, United States of America
| | - Paul Wesson
- University of California, San Francisco, School of Medicine, San Francisco, California, United States of America
- University of California, San Francisco, Center of AIDS Prevention Studies, San Francisco, California, United States of America
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43
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Marks GB, Nguyen NV, Nguyen PTB, Nguyen TA, Nguyen HB, Tran KH, Nguyen SV, Luu KB, Tran DTT, Vo QTN, Le OTT, Nguyen YH, Do VQ, Mason PH, Nguyen VAT, Ho J, Sintchenko V, Nguyen LN, Britton WJ, Fox GJ. Community-wide Screening for Tuberculosis in a High-Prevalence Setting. N Engl J Med 2019; 381:1347-1357. [PMID: 31577876 DOI: 10.1056/nejmoa1902129] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The World Health Organization has set ambitious targets for the global elimination of tuberculosis. However, these targets will not be achieved at the current rate of progress. METHODS We performed a cluster-randomized, controlled trial in Ca Mau Province, Vietnam, to evaluate the effectiveness of active community-wide screening, as compared with standard passive case detection alone, for reducing the prevalence of tuberculosis. Persons 15 years of age or older who resided in 60 intervention clusters (subcommunes) were screened for pulmonary tuberculosis, regardless of symptoms, annually for 3 years, beginning in 2014, by means of rapid nucleic acid amplification testing of spontaneously expectorated sputum samples. Active screening was not performed in the 60 control clusters in the first 3 years. The primary outcome, measured in the fourth year, was the prevalence of microbiologically confirmed pulmonary tuberculosis among persons 15 years of age or older. The secondary outcome was the prevalence of tuberculosis infection, as assessed by an interferon gamma release assay in the fourth year, among children born in 2012. RESULTS In the fourth-year prevalence survey, we tested 42,150 participants in the intervention group and 41,680 participants in the control group. A total of 53 participants in the intervention group (126 per 100,000 population) and 94 participants in the control group (226 per 100,000) had pulmonary tuberculosis, as confirmed by a positive nucleic acid amplification test for Mycobacterium tuberculosis (prevalence ratio, 0.56; 95% confidence interval [CI], 0.40 to 0.78; P<0.001). The prevalence of tuberculosis infection in children born in 2012 was 3.3% in the intervention group and 2.6% in the control group (prevalence ratio, 1.29; 95% CI, 0.70 to 2.36; P = 0.42). CONCLUSIONS Three years of community-wide screening in persons 15 years of age or older who resided in Ca Mau Province, Vietnam, resulted in a lower prevalence of pulmonary tuberculosis in the fourth year than standard passive case detection alone. (Funded by the Australian National Health and Medical Research Council; ACT3 Australian New Zealand Clinical Trials Registry number, ACTRN12614000372684.).
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Affiliation(s)
- Guy B Marks
- From the Woolcock Institute of Medical Research (G.B.M., P.T.B.N., T.-A.N., K.B.L., D.T.T.T., Q.T.N.V., O.T.T.L., Y.H.N., P.H.M., J.H., G.J.F.), the National Lung Hospital (N.V.N., H.B.N.), the National Institute of Hygiene and Epidemiology (V.-A.T.N..), and the National Tuberculosis Control Program (N.V.N., H.B.N., K.H.T., S.V.N.), Hanoi, and the Center for Social Disease Control, Ca Mau (K.H.T., S.V.N.) - all in Vietnam; the South Western Sydney Clinical School, University of New South Wales (G.B.M., J.H.), and the Faculty of Medicine and Health (G.B.M., N.V.N., T.-A.N., V.Q.D., P.H.M., V.S., W.J.B., G.J.F.) and the Centenary Institute (W.J.B.), University of Sydney, Sydney, the School of Social Sciences, Monash, Clayton, VIC (P.H.M.), and the Department of Anthropology, Macquarie University, North Ryde, NSW (P.H.M.) - all in Australia; the Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris (H.B.N.); and the Global Tuberculosis Program, World Health Organization, Geneva (L.N.N.)
| | - Nhung V Nguyen
- From the Woolcock Institute of Medical Research (G.B.M., P.T.B.N., T.-A.N., K.B.L., D.T.T.T., Q.T.N.V., O.T.T.L., Y.H.N., P.H.M., J.H., G.J.F.), the National Lung Hospital (N.V.N., H.B.N.), the National Institute of Hygiene and Epidemiology (V.-A.T.N..), and the National Tuberculosis Control Program (N.V.N., H.B.N., K.H.T., S.V.N.), Hanoi, and the Center for Social Disease Control, Ca Mau (K.H.T., S.V.N.) - all in Vietnam; the South Western Sydney Clinical School, University of New South Wales (G.B.M., J.H.), and the Faculty of Medicine and Health (G.B.M., N.V.N., T.-A.N., V.Q.D., P.H.M., V.S., W.J.B., G.J.F.) and the Centenary Institute (W.J.B.), University of Sydney, Sydney, the School of Social Sciences, Monash, Clayton, VIC (P.H.M.), and the Department of Anthropology, Macquarie University, North Ryde, NSW (P.H.M.) - all in Australia; the Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris (H.B.N.); and the Global Tuberculosis Program, World Health Organization, Geneva (L.N.N.)
| | - Phuong T B Nguyen
- From the Woolcock Institute of Medical Research (G.B.M., P.T.B.N., T.-A.N., K.B.L., D.T.T.T., Q.T.N.V., O.T.T.L., Y.H.N., P.H.M., J.H., G.J.F.), the National Lung Hospital (N.V.N., H.B.N.), the National Institute of Hygiene and Epidemiology (V.-A.T.N..), and the National Tuberculosis Control Program (N.V.N., H.B.N., K.H.T., S.V.N.), Hanoi, and the Center for Social Disease Control, Ca Mau (K.H.T., S.V.N.) - all in Vietnam; the South Western Sydney Clinical School, University of New South Wales (G.B.M., J.H.), and the Faculty of Medicine and Health (G.B.M., N.V.N., T.-A.N., V.Q.D., P.H.M., V.S., W.J.B., G.J.F.) and the Centenary Institute (W.J.B.), University of Sydney, Sydney, the School of Social Sciences, Monash, Clayton, VIC (P.H.M.), and the Department of Anthropology, Macquarie University, North Ryde, NSW (P.H.M.) - all in Australia; the Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris (H.B.N.); and the Global Tuberculosis Program, World Health Organization, Geneva (L.N.N.)
| | - Thu-Anh Nguyen
- From the Woolcock Institute of Medical Research (G.B.M., P.T.B.N., T.-A.N., K.B.L., D.T.T.T., Q.T.N.V., O.T.T.L., Y.H.N., P.H.M., J.H., G.J.F.), the National Lung Hospital (N.V.N., H.B.N.), the National Institute of Hygiene and Epidemiology (V.-A.T.N..), and the National Tuberculosis Control Program (N.V.N., H.B.N., K.H.T., S.V.N.), Hanoi, and the Center for Social Disease Control, Ca Mau (K.H.T., S.V.N.) - all in Vietnam; the South Western Sydney Clinical School, University of New South Wales (G.B.M., J.H.), and the Faculty of Medicine and Health (G.B.M., N.V.N., T.-A.N., V.Q.D., P.H.M., V.S., W.J.B., G.J.F.) and the Centenary Institute (W.J.B.), University of Sydney, Sydney, the School of Social Sciences, Monash, Clayton, VIC (P.H.M.), and the Department of Anthropology, Macquarie University, North Ryde, NSW (P.H.M.) - all in Australia; the Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris (H.B.N.); and the Global Tuberculosis Program, World Health Organization, Geneva (L.N.N.)
| | - Hoa B Nguyen
- From the Woolcock Institute of Medical Research (G.B.M., P.T.B.N., T.-A.N., K.B.L., D.T.T.T., Q.T.N.V., O.T.T.L., Y.H.N., P.H.M., J.H., G.J.F.), the National Lung Hospital (N.V.N., H.B.N.), the National Institute of Hygiene and Epidemiology (V.-A.T.N..), and the National Tuberculosis Control Program (N.V.N., H.B.N., K.H.T., S.V.N.), Hanoi, and the Center for Social Disease Control, Ca Mau (K.H.T., S.V.N.) - all in Vietnam; the South Western Sydney Clinical School, University of New South Wales (G.B.M., J.H.), and the Faculty of Medicine and Health (G.B.M., N.V.N., T.-A.N., V.Q.D., P.H.M., V.S., W.J.B., G.J.F.) and the Centenary Institute (W.J.B.), University of Sydney, Sydney, the School of Social Sciences, Monash, Clayton, VIC (P.H.M.), and the Department of Anthropology, Macquarie University, North Ryde, NSW (P.H.M.) - all in Australia; the Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris (H.B.N.); and the Global Tuberculosis Program, World Health Organization, Geneva (L.N.N.)
| | - Khoa H Tran
- From the Woolcock Institute of Medical Research (G.B.M., P.T.B.N., T.-A.N., K.B.L., D.T.T.T., Q.T.N.V., O.T.T.L., Y.H.N., P.H.M., J.H., G.J.F.), the National Lung Hospital (N.V.N., H.B.N.), the National Institute of Hygiene and Epidemiology (V.-A.T.N..), and the National Tuberculosis Control Program (N.V.N., H.B.N., K.H.T., S.V.N.), Hanoi, and the Center for Social Disease Control, Ca Mau (K.H.T., S.V.N.) - all in Vietnam; the South Western Sydney Clinical School, University of New South Wales (G.B.M., J.H.), and the Faculty of Medicine and Health (G.B.M., N.V.N., T.-A.N., V.Q.D., P.H.M., V.S., W.J.B., G.J.F.) and the Centenary Institute (W.J.B.), University of Sydney, Sydney, the School of Social Sciences, Monash, Clayton, VIC (P.H.M.), and the Department of Anthropology, Macquarie University, North Ryde, NSW (P.H.M.) - all in Australia; the Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris (H.B.N.); and the Global Tuberculosis Program, World Health Organization, Geneva (L.N.N.)
| | - Son V Nguyen
- From the Woolcock Institute of Medical Research (G.B.M., P.T.B.N., T.-A.N., K.B.L., D.T.T.T., Q.T.N.V., O.T.T.L., Y.H.N., P.H.M., J.H., G.J.F.), the National Lung Hospital (N.V.N., H.B.N.), the National Institute of Hygiene and Epidemiology (V.-A.T.N..), and the National Tuberculosis Control Program (N.V.N., H.B.N., K.H.T., S.V.N.), Hanoi, and the Center for Social Disease Control, Ca Mau (K.H.T., S.V.N.) - all in Vietnam; the South Western Sydney Clinical School, University of New South Wales (G.B.M., J.H.), and the Faculty of Medicine and Health (G.B.M., N.V.N., T.-A.N., V.Q.D., P.H.M., V.S., W.J.B., G.J.F.) and the Centenary Institute (W.J.B.), University of Sydney, Sydney, the School of Social Sciences, Monash, Clayton, VIC (P.H.M.), and the Department of Anthropology, Macquarie University, North Ryde, NSW (P.H.M.) - all in Australia; the Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris (H.B.N.); and the Global Tuberculosis Program, World Health Organization, Geneva (L.N.N.)
| | - Khanh B Luu
- From the Woolcock Institute of Medical Research (G.B.M., P.T.B.N., T.-A.N., K.B.L., D.T.T.T., Q.T.N.V., O.T.T.L., Y.H.N., P.H.M., J.H., G.J.F.), the National Lung Hospital (N.V.N., H.B.N.), the National Institute of Hygiene and Epidemiology (V.-A.T.N..), and the National Tuberculosis Control Program (N.V.N., H.B.N., K.H.T., S.V.N.), Hanoi, and the Center for Social Disease Control, Ca Mau (K.H.T., S.V.N.) - all in Vietnam; the South Western Sydney Clinical School, University of New South Wales (G.B.M., J.H.), and the Faculty of Medicine and Health (G.B.M., N.V.N., T.-A.N., V.Q.D., P.H.M., V.S., W.J.B., G.J.F.) and the Centenary Institute (W.J.B.), University of Sydney, Sydney, the School of Social Sciences, Monash, Clayton, VIC (P.H.M.), and the Department of Anthropology, Macquarie University, North Ryde, NSW (P.H.M.) - all in Australia; the Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris (H.B.N.); and the Global Tuberculosis Program, World Health Organization, Geneva (L.N.N.)
| | - Duc T T Tran
- From the Woolcock Institute of Medical Research (G.B.M., P.T.B.N., T.-A.N., K.B.L., D.T.T.T., Q.T.N.V., O.T.T.L., Y.H.N., P.H.M., J.H., G.J.F.), the National Lung Hospital (N.V.N., H.B.N.), the National Institute of Hygiene and Epidemiology (V.-A.T.N..), and the National Tuberculosis Control Program (N.V.N., H.B.N., K.H.T., S.V.N.), Hanoi, and the Center for Social Disease Control, Ca Mau (K.H.T., S.V.N.) - all in Vietnam; the South Western Sydney Clinical School, University of New South Wales (G.B.M., J.H.), and the Faculty of Medicine and Health (G.B.M., N.V.N., T.-A.N., V.Q.D., P.H.M., V.S., W.J.B., G.J.F.) and the Centenary Institute (W.J.B.), University of Sydney, Sydney, the School of Social Sciences, Monash, Clayton, VIC (P.H.M.), and the Department of Anthropology, Macquarie University, North Ryde, NSW (P.H.M.) - all in Australia; the Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris (H.B.N.); and the Global Tuberculosis Program, World Health Organization, Geneva (L.N.N.)
| | - Qui T N Vo
- From the Woolcock Institute of Medical Research (G.B.M., P.T.B.N., T.-A.N., K.B.L., D.T.T.T., Q.T.N.V., O.T.T.L., Y.H.N., P.H.M., J.H., G.J.F.), the National Lung Hospital (N.V.N., H.B.N.), the National Institute of Hygiene and Epidemiology (V.-A.T.N..), and the National Tuberculosis Control Program (N.V.N., H.B.N., K.H.T., S.V.N.), Hanoi, and the Center for Social Disease Control, Ca Mau (K.H.T., S.V.N.) - all in Vietnam; the South Western Sydney Clinical School, University of New South Wales (G.B.M., J.H.), and the Faculty of Medicine and Health (G.B.M., N.V.N., T.-A.N., V.Q.D., P.H.M., V.S., W.J.B., G.J.F.) and the Centenary Institute (W.J.B.), University of Sydney, Sydney, the School of Social Sciences, Monash, Clayton, VIC (P.H.M.), and the Department of Anthropology, Macquarie University, North Ryde, NSW (P.H.M.) - all in Australia; the Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris (H.B.N.); and the Global Tuberculosis Program, World Health Organization, Geneva (L.N.N.)
| | - Oanh T T Le
- From the Woolcock Institute of Medical Research (G.B.M., P.T.B.N., T.-A.N., K.B.L., D.T.T.T., Q.T.N.V., O.T.T.L., Y.H.N., P.H.M., J.H., G.J.F.), the National Lung Hospital (N.V.N., H.B.N.), the National Institute of Hygiene and Epidemiology (V.-A.T.N..), and the National Tuberculosis Control Program (N.V.N., H.B.N., K.H.T., S.V.N.), Hanoi, and the Center for Social Disease Control, Ca Mau (K.H.T., S.V.N.) - all in Vietnam; the South Western Sydney Clinical School, University of New South Wales (G.B.M., J.H.), and the Faculty of Medicine and Health (G.B.M., N.V.N., T.-A.N., V.Q.D., P.H.M., V.S., W.J.B., G.J.F.) and the Centenary Institute (W.J.B.), University of Sydney, Sydney, the School of Social Sciences, Monash, Clayton, VIC (P.H.M.), and the Department of Anthropology, Macquarie University, North Ryde, NSW (P.H.M.) - all in Australia; the Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris (H.B.N.); and the Global Tuberculosis Program, World Health Organization, Geneva (L.N.N.)
| | - Yen H Nguyen
- From the Woolcock Institute of Medical Research (G.B.M., P.T.B.N., T.-A.N., K.B.L., D.T.T.T., Q.T.N.V., O.T.T.L., Y.H.N., P.H.M., J.H., G.J.F.), the National Lung Hospital (N.V.N., H.B.N.), the National Institute of Hygiene and Epidemiology (V.-A.T.N..), and the National Tuberculosis Control Program (N.V.N., H.B.N., K.H.T., S.V.N.), Hanoi, and the Center for Social Disease Control, Ca Mau (K.H.T., S.V.N.) - all in Vietnam; the South Western Sydney Clinical School, University of New South Wales (G.B.M., J.H.), and the Faculty of Medicine and Health (G.B.M., N.V.N., T.-A.N., V.Q.D., P.H.M., V.S., W.J.B., G.J.F.) and the Centenary Institute (W.J.B.), University of Sydney, Sydney, the School of Social Sciences, Monash, Clayton, VIC (P.H.M.), and the Department of Anthropology, Macquarie University, North Ryde, NSW (P.H.M.) - all in Australia; the Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris (H.B.N.); and the Global Tuberculosis Program, World Health Organization, Geneva (L.N.N.)
| | - Vu Q Do
- From the Woolcock Institute of Medical Research (G.B.M., P.T.B.N., T.-A.N., K.B.L., D.T.T.T., Q.T.N.V., O.T.T.L., Y.H.N., P.H.M., J.H., G.J.F.), the National Lung Hospital (N.V.N., H.B.N.), the National Institute of Hygiene and Epidemiology (V.-A.T.N..), and the National Tuberculosis Control Program (N.V.N., H.B.N., K.H.T., S.V.N.), Hanoi, and the Center for Social Disease Control, Ca Mau (K.H.T., S.V.N.) - all in Vietnam; the South Western Sydney Clinical School, University of New South Wales (G.B.M., J.H.), and the Faculty of Medicine and Health (G.B.M., N.V.N., T.-A.N., V.Q.D., P.H.M., V.S., W.J.B., G.J.F.) and the Centenary Institute (W.J.B.), University of Sydney, Sydney, the School of Social Sciences, Monash, Clayton, VIC (P.H.M.), and the Department of Anthropology, Macquarie University, North Ryde, NSW (P.H.M.) - all in Australia; the Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris (H.B.N.); and the Global Tuberculosis Program, World Health Organization, Geneva (L.N.N.)
| | - Paul H Mason
- From the Woolcock Institute of Medical Research (G.B.M., P.T.B.N., T.-A.N., K.B.L., D.T.T.T., Q.T.N.V., O.T.T.L., Y.H.N., P.H.M., J.H., G.J.F.), the National Lung Hospital (N.V.N., H.B.N.), the National Institute of Hygiene and Epidemiology (V.-A.T.N..), and the National Tuberculosis Control Program (N.V.N., H.B.N., K.H.T., S.V.N.), Hanoi, and the Center for Social Disease Control, Ca Mau (K.H.T., S.V.N.) - all in Vietnam; the South Western Sydney Clinical School, University of New South Wales (G.B.M., J.H.), and the Faculty of Medicine and Health (G.B.M., N.V.N., T.-A.N., V.Q.D., P.H.M., V.S., W.J.B., G.J.F.) and the Centenary Institute (W.J.B.), University of Sydney, Sydney, the School of Social Sciences, Monash, Clayton, VIC (P.H.M.), and the Department of Anthropology, Macquarie University, North Ryde, NSW (P.H.M.) - all in Australia; the Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris (H.B.N.); and the Global Tuberculosis Program, World Health Organization, Geneva (L.N.N.)
| | - Van-Anh T Nguyen
- From the Woolcock Institute of Medical Research (G.B.M., P.T.B.N., T.-A.N., K.B.L., D.T.T.T., Q.T.N.V., O.T.T.L., Y.H.N., P.H.M., J.H., G.J.F.), the National Lung Hospital (N.V.N., H.B.N.), the National Institute of Hygiene and Epidemiology (V.-A.T.N..), and the National Tuberculosis Control Program (N.V.N., H.B.N., K.H.T., S.V.N.), Hanoi, and the Center for Social Disease Control, Ca Mau (K.H.T., S.V.N.) - all in Vietnam; the South Western Sydney Clinical School, University of New South Wales (G.B.M., J.H.), and the Faculty of Medicine and Health (G.B.M., N.V.N., T.-A.N., V.Q.D., P.H.M., V.S., W.J.B., G.J.F.) and the Centenary Institute (W.J.B.), University of Sydney, Sydney, the School of Social Sciences, Monash, Clayton, VIC (P.H.M.), and the Department of Anthropology, Macquarie University, North Ryde, NSW (P.H.M.) - all in Australia; the Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris (H.B.N.); and the Global Tuberculosis Program, World Health Organization, Geneva (L.N.N.)
| | - Jennifer Ho
- From the Woolcock Institute of Medical Research (G.B.M., P.T.B.N., T.-A.N., K.B.L., D.T.T.T., Q.T.N.V., O.T.T.L., Y.H.N., P.H.M., J.H., G.J.F.), the National Lung Hospital (N.V.N., H.B.N.), the National Institute of Hygiene and Epidemiology (V.-A.T.N..), and the National Tuberculosis Control Program (N.V.N., H.B.N., K.H.T., S.V.N.), Hanoi, and the Center for Social Disease Control, Ca Mau (K.H.T., S.V.N.) - all in Vietnam; the South Western Sydney Clinical School, University of New South Wales (G.B.M., J.H.), and the Faculty of Medicine and Health (G.B.M., N.V.N., T.-A.N., V.Q.D., P.H.M., V.S., W.J.B., G.J.F.) and the Centenary Institute (W.J.B.), University of Sydney, Sydney, the School of Social Sciences, Monash, Clayton, VIC (P.H.M.), and the Department of Anthropology, Macquarie University, North Ryde, NSW (P.H.M.) - all in Australia; the Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris (H.B.N.); and the Global Tuberculosis Program, World Health Organization, Geneva (L.N.N.)
| | - Vitali Sintchenko
- From the Woolcock Institute of Medical Research (G.B.M., P.T.B.N., T.-A.N., K.B.L., D.T.T.T., Q.T.N.V., O.T.T.L., Y.H.N., P.H.M., J.H., G.J.F.), the National Lung Hospital (N.V.N., H.B.N.), the National Institute of Hygiene and Epidemiology (V.-A.T.N..), and the National Tuberculosis Control Program (N.V.N., H.B.N., K.H.T., S.V.N.), Hanoi, and the Center for Social Disease Control, Ca Mau (K.H.T., S.V.N.) - all in Vietnam; the South Western Sydney Clinical School, University of New South Wales (G.B.M., J.H.), and the Faculty of Medicine and Health (G.B.M., N.V.N., T.-A.N., V.Q.D., P.H.M., V.S., W.J.B., G.J.F.) and the Centenary Institute (W.J.B.), University of Sydney, Sydney, the School of Social Sciences, Monash, Clayton, VIC (P.H.M.), and the Department of Anthropology, Macquarie University, North Ryde, NSW (P.H.M.) - all in Australia; the Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris (H.B.N.); and the Global Tuberculosis Program, World Health Organization, Geneva (L.N.N.)
| | - Linh N Nguyen
- From the Woolcock Institute of Medical Research (G.B.M., P.T.B.N., T.-A.N., K.B.L., D.T.T.T., Q.T.N.V., O.T.T.L., Y.H.N., P.H.M., J.H., G.J.F.), the National Lung Hospital (N.V.N., H.B.N.), the National Institute of Hygiene and Epidemiology (V.-A.T.N..), and the National Tuberculosis Control Program (N.V.N., H.B.N., K.H.T., S.V.N.), Hanoi, and the Center for Social Disease Control, Ca Mau (K.H.T., S.V.N.) - all in Vietnam; the South Western Sydney Clinical School, University of New South Wales (G.B.M., J.H.), and the Faculty of Medicine and Health (G.B.M., N.V.N., T.-A.N., V.Q.D., P.H.M., V.S., W.J.B., G.J.F.) and the Centenary Institute (W.J.B.), University of Sydney, Sydney, the School of Social Sciences, Monash, Clayton, VIC (P.H.M.), and the Department of Anthropology, Macquarie University, North Ryde, NSW (P.H.M.) - all in Australia; the Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris (H.B.N.); and the Global Tuberculosis Program, World Health Organization, Geneva (L.N.N.)
| | - Warwick J Britton
- From the Woolcock Institute of Medical Research (G.B.M., P.T.B.N., T.-A.N., K.B.L., D.T.T.T., Q.T.N.V., O.T.T.L., Y.H.N., P.H.M., J.H., G.J.F.), the National Lung Hospital (N.V.N., H.B.N.), the National Institute of Hygiene and Epidemiology (V.-A.T.N..), and the National Tuberculosis Control Program (N.V.N., H.B.N., K.H.T., S.V.N.), Hanoi, and the Center for Social Disease Control, Ca Mau (K.H.T., S.V.N.) - all in Vietnam; the South Western Sydney Clinical School, University of New South Wales (G.B.M., J.H.), and the Faculty of Medicine and Health (G.B.M., N.V.N., T.-A.N., V.Q.D., P.H.M., V.S., W.J.B., G.J.F.) and the Centenary Institute (W.J.B.), University of Sydney, Sydney, the School of Social Sciences, Monash, Clayton, VIC (P.H.M.), and the Department of Anthropology, Macquarie University, North Ryde, NSW (P.H.M.) - all in Australia; the Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris (H.B.N.); and the Global Tuberculosis Program, World Health Organization, Geneva (L.N.N.)
| | - Greg J Fox
- From the Woolcock Institute of Medical Research (G.B.M., P.T.B.N., T.-A.N., K.B.L., D.T.T.T., Q.T.N.V., O.T.T.L., Y.H.N., P.H.M., J.H., G.J.F.), the National Lung Hospital (N.V.N., H.B.N.), the National Institute of Hygiene and Epidemiology (V.-A.T.N..), and the National Tuberculosis Control Program (N.V.N., H.B.N., K.H.T., S.V.N.), Hanoi, and the Center for Social Disease Control, Ca Mau (K.H.T., S.V.N.) - all in Vietnam; the South Western Sydney Clinical School, University of New South Wales (G.B.M., J.H.), and the Faculty of Medicine and Health (G.B.M., N.V.N., T.-A.N., V.Q.D., P.H.M., V.S., W.J.B., G.J.F.) and the Centenary Institute (W.J.B.), University of Sydney, Sydney, the School of Social Sciences, Monash, Clayton, VIC (P.H.M.), and the Department of Anthropology, Macquarie University, North Ryde, NSW (P.H.M.) - all in Australia; the Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris (H.B.N.); and the Global Tuberculosis Program, World Health Organization, Geneva (L.N.N.)
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Stenberg K, Hanssen O, Bertram M, Brindley C, Meshreky A, Barkley S, Tan-Torres Edejer T. Guide posts for investment in primary health care and projected resource needs in 67 low-income and middle-income countries: a modelling study. LANCET GLOBAL HEALTH 2019; 7:e1500-e1510. [PMID: 31564629 PMCID: PMC7024989 DOI: 10.1016/s2214-109x(19)30416-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 09/11/2019] [Accepted: 09/18/2019] [Indexed: 12/13/2022]
Abstract
Background Primary health care (PHC) is a driving force for advancing towards universal health coverage (UHC). PHC-oriented health systems bring enormous benefits but require substantial financial investments. Here, we aim to present measures for PHC investments and project the associated resource needs. Methods This modelling study analysed data from 67 low-income and middle-income countries (LMICs). Recognising the variation in PHC services among countries, we propose three measures for PHC, with different scope for included interventions and system strengthening. Measure 1 is centred on public health interventions and outpatient care; measure 2 adds general inpatient care; and measure 3 further adds cross-sectoral activities. Cost components included in each measure were based on the Declaration of Astana, informed by work delineating PHC within health accounts, and finalised through an expert and country validation meeting. We extracted the subset of PHC costs for each measure from WHO's Sustainable Development Goal (SDG) price tag for the 67 LMICs, and projected the associated health impact. Estimates of financial resource need, health workforce, and outpatient visits are presented as PHC investment guide posts for LMICs. Findings An estimated additional US$200–328 billion per year is required for the various measures of PHC from 2020 to 2030. For measure 1, an additional $32 is needed per capita across the countries. Needs are greatest in low-income countries where PHC spending per capita needs to increase from $25 to $65. Overall health workforces would need to increase from 5·6 workers per 1000 population to 6·7 per 1000 population, delivering an average of 5·9 outpatient visits per capita per year. Increasing coverage of PHC interventions would avert an estimated 60·1 million deaths and increase average life expectancy by 3·7 years. By 2030, these incremental PHC costs would be about 3·3% of projected gross domestic product (GDP; median 1·7%, range 0·1–20·2). In a business-as-usual financing scenario, 25 of 67 countries will have funding gaps in 2030. If funding for PHC was increased by 1–2% of GDP across all countries, as few as 16 countries would see a funding gap by 2030. Interpretation The resources required to strengthen PHC vary across countries, depending on demographic trends, disease burden, and health system capacity. The proposed PHC investment guide posts advance discussions around the budgetary implications of strengthening PHC, including relevant system investment needs and achievable health outcomes. Preliminary findings suggest that low-income and lower-middle-income countries would need to at least double current spending on PHC to strengthen their systems and universally provide essential PHC services. Investing in PHC will bring substantial health benefits and build human capital. At country level, PHC interventions need to be explicitly identified, and plans should be made for how to most appropriately reorient the health system towards PHC as a key lever towards achieving UHC and the health-related SDGs. Funding The Bill & Melinda Gates Foundation.
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Affiliation(s)
- Karin Stenberg
- Department of Health Systems Governance and Financing, WHO, Geneva, Switzerland; Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
| | - Odd Hanssen
- Department of Health Systems Governance and Financing, WHO, Geneva, Switzerland
| | - Melanie Bertram
- Department of Health Systems Governance and Financing, WHO, Geneva, Switzerland
| | - Callum Brindley
- Department of Health Systems Governance and Financing, WHO, Geneva, Switzerland
| | | | - Shannon Barkley
- Department of Integrated Health Services, WHO, Geneva, Switzerland
| | - Tessa Tan-Torres Edejer
- Department of Health Systems Governance and Financing, WHO, Geneva, Switzerland; Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
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Collins TE, Nugent R, Webb D, Placella E, Evans T, Akinnawo A. Time to align: development cooperation for the prevention and control of non-communicable diseases. BMJ 2019; 366:l4499. [PMID: 31366599 PMCID: PMC6667969 DOI: 10.1136/bmj.l4499] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Téa Collins and colleagues call for coordinated global action to catalyse effective national responses to non-communicable diseases
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Affiliation(s)
- Téa E Collins
- Global Coordination Mechanism on the Prevention and Control of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - Rachel Nugent
- Global Noncommunicable Diseases, RTI International, North Carolina, USA
| | - Douglas Webb
- HIV, Health and Development, UN Development Programme, New York, USA
| | - Erika Placella
- Global Programme Health, Swiss Agency for Development and Cooperation, Bern, Switzerland
| | - Tim Evans
- Health, Nutrition and Population Global Practice, World Bank, Washington, DC, USA
| | - Ayodele Akinnawo
- Global Coordination Mechanism on the Prevention and Control of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
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Do Communities Really "Direct" in Community-Directed Interventions? A Qualitative Assessment of Beneficiaries' Perceptions at 20 Years of Community Directed Treatment with Ivermectin in Cameroon. Trop Med Infect Dis 2019; 4:tropicalmed4030105. [PMID: 31311093 PMCID: PMC6789878 DOI: 10.3390/tropicalmed4030105] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/11/2019] [Accepted: 07/13/2019] [Indexed: 11/21/2022] Open
Abstract
Recent studies in Cameroon after 20 years of implementation of the Community Directed Treatment with ivermectin (CDTI) strategy, revealed mixed results as regards community ownership. This brings into question the feasibility of Community Directed Interventions (CDI) in the country. We carried out qualitative surveys in 3 health districts of Cameroon, consisting of 11 individual interviews and 10 Focus Group Discussions (FGDs) with specific community members. The main topic discussed during individual interviews and FGDs was about community participation in health. We found an implementation gap in CDTI between the process theory in the 3 health districts. Despite this gap, community eagerness for health information and massive personal and financial adhesion to interventions that were perceived important, were indicators of CDI feasibility. The concept of CDI is culturally feasible in rural and semi-urban settlements, but many challenges hinder its actual implementation. In the view of community participation as a process rather than an intervention, these challenges include real dialogue with communities as partners, dialogue and advocacy with operational level health staff, and macroeconomic and political reforms in health, finance and other associated sectors.
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Affiliation(s)
- David Watkins
- Division of General Internal Medicine, University of Washington, 325 9th Ave Box 359780 Seattle, 98104 WA, United States of America
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Yamey G, Ogbuoji O, Nonvignon J. Middle-income countries graduating from health aid: Transforming daunting challenges into smooth transitions. PLoS Med 2019; 16:e1002837. [PMID: 31237872 PMCID: PMC6592502 DOI: 10.1371/journal.pmed.1002837] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Gavin Yamey and co-authors discuss approaches to providing support for middle-income countries transitioning away from health aid.
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Affiliation(s)
- Gavin Yamey
- The Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Osondu Ogbuoji
- The Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
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Abstract
Low income countries are still unable to fund a basic package of health services
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Affiliation(s)
| | | | - Osondu Ogbuoji
- Center for Policy Impact in Global Health at Duke University, Durham, NC, USA
| | | | - Gavin Yamey
- Center for Policy Impact in Global Health at Duke University, Durham, NC, USA
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Kaur H, Singh J, Narasimhan B. Indole hybridized diazenyl derivatives: synthesis, antimicrobial activity, cytotoxicity evaluation and docking studies. BMC Chem 2019; 13:65. [PMID: 31384812 PMCID: PMC6661771 DOI: 10.1186/s13065-019-0580-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 05/02/2019] [Indexed: 02/07/2023] Open
Abstract
Background In search of effective antimicrobial and cytotoxic agents, a series of indole hybridized diazenyl derivatives (DS-1 to DS-21) was efficiently prepared by condensation of diazotized p-aminoacetophenone with indole or nitroindole followed by reaction with different aromatic/heteroaromatic amines of biological significance. The synthesized derivatives were characterized by various spectroscopic techniques. Methodology The antimicrobial evaluation of DS-1 to DS-23 was done by tube dilution method against various pathogenic bacterial and fungal strains. The active antimicrobial derivatives were further evaluated for cytotoxicity against human lung carcinoma cell line (HCT-116), breast cancer cell line (MDAMB231), leukemic cancer cell line (K562), and normal cell line (HEK293) by MTT assay using doxorubicin as the standard drug. The test derivatives were additionally docked for the B-subunit of enzyme DNA gyrase from E. coli at the ATPase binding site to study the molecular interactions using Schrodinger maestro v11.5 software. Results and discussion Most of the synthesized derivatives have shown high activity against Gram-negative bacteria particularly E. coli and K. pneumonia with MIC ranging from 1.95 to 7.81 μg/ml. The derivatives have demonstrated very less activity against tested Gram positive bacterial and fungal strains. The derivatives DS-14 and DS-20 have been found to active against breast cancer cell line and human colon carcinoma cell line having IC50 in the range of 19–65 µg/ml. All the derivatives were found to less potent against leukemic cancer cell line. The synthesized derivatives have revealed their safety by exhibiting very less cytotoxicity against the normal cell line (HEK-293) with IC50 > 100 µg/ml. Most of the active derivatives have shown good docking scores in comparison to the standard drugs against DNA gyrase from E. coli. Further ADME predictions by Qikprop module of the Schrodinger confirmed these molecules have drug like properties. Conclusion The derivatives DS-14 and DS-20 have shown potential against Gram-negative bacteria and breast cancer cell line and can be used as a lead for rational drug designing of the antimicrobial and cytotoxic agents. .
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Affiliation(s)
- Harmeet Kaur
- 1Faculty of Pharmaceutical Sciences, Maharshi Dayanand University, Rohtak, 124001 India
| | - Jasbir Singh
- 2College of Pharmacy, Postgraduate Institute of Medical Sciences, Rohtak, 124001 India
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