1
|
Boyce MR, Attal-Juncqua A, Lin J, McKay S, Katz R. Global Fund contributions to health security in ten countries, 2014-20: mapping synergies between vertical disease programmes and capacities for preventing, detecting, and responding to public health emergencies. LANCET GLOBAL HEALTH 2021; 9:e181-e188. [PMID: 33482139 PMCID: PMC8448292 DOI: 10.1016/s2214-109x(20)30420-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 09/16/2020] [Accepted: 09/17/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND The Global Fund to Fight AIDS, Tuberculosis and Malaria is a robust vertical global health programme. The extent to which vertical programmes financially support health security has not been investigated. We, therefore, endeavoured to quantify the extent to which the budgets of this vertical programme support health security. We believe this is a crucial area of work as the global community works to combine resources for COVID-19 response and future pandemic preparedness. METHODS We examined budgets for work in Kenya, Uganda, Vietnam, Democratic Republic of the Congo, Guatemala, Guinea, India, Indonesia, Nigeria, and Sierra Leone from January, 2014 to December, 2020. These ten countries were selected because of the robustness of investments and the availability of data. Using the International Health Regulations Joint External Evaluation (JEE) tool as a framework, we mapped budget line items to health security capacities. Two researchers independently reviewed each budget and mapped items to the JEE. Budgets were then jointly reviewed until a consensus was reached regarding if an item supported health security directly, indirectly, or not at all. The budgets for the study countries were inputted into a single Microsoft Excel spreadsheet and line items that mapped to JEE indicators were scaled up to their respective JEE capacity. Descriptive analyses were then done to determine the total amount of money budgeted for activities that support health security, how much was budgeted for each JEE capacity, and how much of the support was direct or indirect. FINDINGS The research team reviewed 37 budgets. Budgets totalled US$6 927 284 966, and $2 562 063 054 (37·0%) of this mapped to JEE capacities. $1 330 942 712 (19·2%) mapped directly to JEE capacities and $1 231 120 342 (17·8%) mapped indirectly to JEE capacities. Laboratory systems, antimicrobial resistance, and the deployment of medical countermeasures and personnel received the most overall budgetary support; laboratory systems, antimicrobial resistance, and workforce development received the greatest amount of direct budgetary support. INTERPRETATION Over one-third of the Global Fund's work also supports health security and the organisation has budgeted more than $2 500 000 000 for activities that support health security in ten countries since 2014. Although these funds were not budgeted specifically for health security purposes, recognising how vertical programmes can synergistically support other global health efforts has important implications for policy related to health systems strengthening. FUNDING Resolve to Save Lives: An Initiative of Vital Strategies.
Collapse
Affiliation(s)
- Matthew R Boyce
- Center for Global Health Science & Security, Georgetown University Medical Center, Georgetown University, Washington, DC, USA
| | - Aurelia Attal-Juncqua
- Center for Global Health Science & Security, Georgetown University Medical Center, Georgetown University, Washington, DC, USA
| | - Jessica Lin
- Center for Global Health Science & Security, Georgetown University Medical Center, Georgetown University, Washington, DC, USA
| | - Stephanie McKay
- Center for Global Health Science & Security, Georgetown University Medical Center, Georgetown University, Washington, DC, USA
| | - Rebecca Katz
- Center for Global Health Science & Security, Georgetown University Medical Center, Georgetown University, Washington, DC, USA.
| |
Collapse
|
3
|
Bello AK, Levin A, Lunney M, Osman MA, Ye F, Ashuntantang GE, Bellorin-Font E, Benghanem Gharbi M, Davison SN, Ghnaimat M, Harden P, Htay H, Jha V, Kalantar-Zadeh K, Kerr PG, Klarenbach S, Kovesdy CP, Luyckx VA, Neuen BL, O'Donoghue D, Ossareh S, Perl J, Rashid HU, Rondeau E, See E, Saad S, Sola L, Tchokhonelidze I, Tesar V, Tungsanga K, Turan Kazancioglu R, Wang AYM, Wiebe N, Yang CW, Zemchenkov A, Zhao MH, Jager KJ, Caskey F, Perkovic V, Jindal KK, Okpechi IG, Tonelli M, Feehally J, Harris DC, Johnson DW. Status of care for end stage kidney disease in countries and regions worldwide: international cross sectional survey. BMJ 2019; 367:l5873. [PMID: 31672760 DOI: 10.1136/bmj.l5873] [Citation(s) in RCA: 123] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To determine the global capacity (availability, accessibility, quality, and affordability) to deliver kidney replacement therapy (dialysis and transplantation) and conservative kidney management. DESIGN International cross sectional survey. SETTING International Society of Nephrology (ISN) survey of 182 countries from July to September 2018. PARTICIPANTS Key stakeholders identified by ISN's national and regional leaders. MAIN OUTCOME MEASURES Markers of national capacity to deliver core components of kidney replacement therapy and conservative kidney management. RESULTS Responses were received from 160 (87.9%) of 182 countries, comprising 97.8% (7338.5 million of 7501.3 million) of the world's population. A wide variation was found in capacity and structures for kidney replacement therapy and conservative kidney management-namely, funding mechanisms, health workforce, service delivery, and available technologies. Information on the prevalence of treated end stage kidney disease was available in 91 (42%) of 218 countries worldwide. Estimates varied more than 800-fold from 4 to 3392 per million population. Rwanda was the only low income country to report data on the prevalence of treated disease; 5 (<10%) of 53 African countries reported these data. Of 159 countries, 102 (64%) provided public funding for kidney replacement therapy. Sixty eight (43%) of 159 countries charged no fees at the point of care delivery and 34 (21%) made some charge. Haemodialysis was reported as available in 156 (100%) of 156 countries, peritoneal dialysis in 119 (76%) of 156 countries, and kidney transplantation in 114 (74%) of 155 countries. Dialysis and kidney transplantation were available to more than 50% of patients in only 108 (70%) and 45 (29%) of 154 countries that offered these services, respectively. Conservative kidney management was available in 124 (81%) of 154 countries. Worldwide, the median number of nephrologists was 9.96 per million population, which varied with income level. CONCLUSIONS These comprehensive data show the capacity of countries (including low income countries) to provide optimal care for patients with end stage kidney disease. They demonstrate substantial variability in the burden of such disease and capacity for kidney replacement therapy and conservative kidney management, which have implications for policy.
Collapse
Affiliation(s)
- Aminu K Bello
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, AB T6B 2B7, Canada
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Meaghan Lunney
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | | | - Feng Ye
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, AB T6B 2B7, Canada
| | - Gloria E Ashuntantang
- Faculty of Medicine and Biomedical Sciences, Yaounde General Hospital, University of Yaounde I, Yaounde, Cameroon
| | - Ezequiel Bellorin-Font
- Division of Nephology and Hypertension, Department of Medicine, Saint Louis University, Saint Louis, MO, USA
| | - Mohammed Benghanem Gharbi
- Urinary Tract Diseases Department, Faculty of Medicine and Pharmacy of Casablanca, University Hassan II of Casablanca, Casablanca, Morocco
| | - Sara N Davison
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, AB T6B 2B7, Canada
| | - Mohammad Ghnaimat
- Nephrology Division, Department of Internal Medicine, The Specialty Hospital, Amman, Jordan
| | - Paul Harden
- Oxford Kidney Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Htay Htay
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Vivekanand Jha
- George Institute for Global Health, UNSW, New Delhi, India
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, CA, USA
- UCLA Fielding School of Public Health in Irvine and Los Angeles, CA, USA
| | - Peter G Kerr
- Department of Nephrology, Monash Medical Centre, Monash Health, Clayton, VIC, Australia
- Department of Medicine, Monash University, Clayton, VIC, Australia
| | - Scott Klarenbach
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, AB T6B 2B7, Canada
| | - Csaba P Kovesdy
- Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
- Memphis VA Medical Center, Memphis, TN, USA
| | - Valerie A Luyckx
- Institute of Biomedical Ethics and the History of Medicine, University of Zurich, Zurich, Switzerland
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Donal O'Donoghue
- Salford Royal NHS Foundation Trust, Salford, UK
- University of Manchester, Manchester, UK
| | - Shahrzad Ossareh
- Division of Nephrology, Department of Medicine, Hasheminejad Kidney Center, Iran University of Medical Sciences, Tehran, Iran
| | - Jeffrey Perl
- Division of Nephrology, St Michael's Hospital and the Keenan Research Centre in the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
- Division of Nephrology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Harun Ur Rashid
- Department of Nephrology, Kidney Foundation Hospital and Research Institute, Dhaka, Bangladesh
| | - Eric Rondeau
- Intensive Care Nephrology and Transplantation Department, Hopital Tenon, Assistance Publique-Hopitaux de Paris, Paris, France
- Sorbonne Université, Paris, France
| | - Emily See
- Department of Intensive Care, Austin Health, Melbourne, VIC, Australia
- School of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Syed Saad
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, AB T6B 2B7, Canada
| | - Laura Sola
- Dialysis Unit, CASMU-IAMPP, Montevideo, Uruguay
| | - Irma Tchokhonelidze
- Nephrology Development Clinical Center, Tbilisi State Medical University, Tbilisi, Georgia
| | - Vladimir Tesar
- Department of Nephrology, General University Hospital, Charles University, Prague, Czech Republic
| | - Kriang Tungsanga
- Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
- Bhumirajanagarindra Kidney Institute, Bangkok, Thailand
| | | | | | - Natasha Wiebe
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, AB T6B 2B7, Canada
| | - Chih-Wei Yang
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Alexander Zemchenkov
- Department of Internal Disease and Nephrology, North-Western State Medical University named after I I Mechnikov, Saint Petersburg, Russia
- Department of Nephrology and Dialysis, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia
| | - Ming-Hui Zhao
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Key Lab of Renal Disease, Ministry of Health of China, Beijing, China
- Key Lab of Chronic Kidney Disease Prevention and Treatment, Ministry of Education of China; Beijing, China
- Peking-Tsinghua Center for Life Sciences, Beijing, China
| | - Kitty J Jager
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, Netherlands
| | - Fergus Caskey
- Population Health Sciences, University of Bristol, Bristol, UK
- Richard Bright Renal Unit, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Vlado Perkovic
- George Institute for Global Health, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Kailash K Jindal
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, AB T6B 2B7, Canada
| | - Ikechi G Okpechi
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
- Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, AB, Canada
- Pan-American Health Organization/World Health Organization's Collaborating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, AB, Canada
| | | | - David C Harris
- Centre for Transplantation and Renal Research, Westmead Institute for Medical Research, University of Sydney, Sydney, NSW, Australia
| | - David W Johnson
- Centre for Kidney Disease Research, University of Queensland, Brisbane, QLD, Australia
- Translational Research Institute, Brisbane, QLD, Australia
- Metro South and Ipswich Nephrology and Transplant Services, Princess Alexandra Hospital, Brisbane, QLD, Australia
| |
Collapse
|