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Vatandoost V, Tabatabaee SS, Okhovati M, Barooni M. Explaining the challenges of resources management and its underlying factors in COVID-19 era in Iran: a qualitative study. BMC Public Health 2023; 23:2118. [PMID: 37891547 PMCID: PMC10612242 DOI: 10.1186/s12889-023-17045-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 10/22/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Identifying factors affecting health costs can contribute to formulating the best policies for controlling and managing health costs. To this end, the present study aimed to analyze resource wastage and identify the factors underlying it in COVID-19 management in Iran's health sector. METHOD This qualitative content analysis study was conducted in Iran's health sector. The participants were 23 senior, middle, and operational managers in the health sector. The data were collected through semistructured interviews with the managers. The participants were selected using purposive, quota, and snowball sampling techniques. The interviews continued until the data were saturated. The collected data were analyzed using MAXQDA software (version 10). RESULTS Following the data analysis, the factors affecting the wastage of health resources were divided into 4 themes and 13 main themes. Vaccines, diagnostic kits, medicines, and human resources were the main factors underlying resource wastage. The identified main themes were open and unused vials, nonuse of distributed vaccines and their expiration, excess supply and decreased demand for vaccines, expiration of diagnostic and laboratory kits and their quantitative and qualitative defects, and the large number of tests. Inefficiency and the expiration of COVID-19 drugs, poor drug supply and consumption chain management, inaccuracy in inventory control and expiration dates, disorganization and inconsistency in the distribution of healthcare staff, low productivity of the staff, and failure to match the staff's skills with assigned tasks in selected centers were identified as the most important causes of resource wastage. CONCLUSION Given the limited health funds and the increased healthcare costs, effective preparation and planning and making reasonable decisions for unexpected events can minimize unnecessary costs and resource wastage, which requires some revisions in attitudes toward COVID-19 management in the healthcare sector.
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Affiliation(s)
- Vahid Vatandoost
- Department of Health Management, Policy and Economics, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Seyed Saeed Tabatabaee
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Health Economics and Management Sciences, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Okhovati
- Department of Library and Medical Information, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohsen Barooni
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
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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: 109] [Impact Index Per Article: 54.5] [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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3
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Chaitkin M, McCormick S, Alvarez-Sala Torreano J, Amongin I, Gaya S, Hanssen ON, Johnston R, Slaymaker T, Chase C, Hutton G, Montgomery M. Estimating the cost of achieving basic water, sanitation, hygiene, and waste management services in public health-care facilities in the 46 UN designated least-developed countries: a modelling study. Lancet Glob Health 2022; 10:e840-e849. [PMID: 35397226 PMCID: PMC9090898 DOI: 10.1016/s2214-109x(22)00099-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 02/28/2022] [Accepted: 03/02/2022] [Indexed: 12/21/2022]
Abstract
Background An alarming number of public health-care facilities in low-income and middle-income countries lack basic water, sanitation, hygiene (WASH), and waste management services. This study estimates the costs of achieving full coverage of basic WASH and waste services in existing public health facilities in the 46 UN designated least-developed countries (LDCs). Methods In this modelling study, in-need facilities were quantified by combining published counts of public facilities with estimated basic WASH and waste service coverage. Country-specific per-facility capital and recurrent costs to deliver basic services were collected via survey of country WASH experts and officials between Sept 24 and Dec 24, 2020. Baseline cost estimates were modelled and discounted by 5% per year. Key assumptions were adjusted to produce lower and upper estimates, including adjusting the discount rate to 8% and 3% per year, respectively. Findings An estimated US$6·5 billion to $9·6 billion from 2021 to 2030 is needed to achieve full coverage of basic WASH and waste services in public health facilities in LDCs. Capital costs are $2·9 billion to $4·8 billion and recurrent costs are $3·6 billion to $4·8 billion over this time period. A mean of $0·24–0·40 per capita in capital investment is needed each year, and annual operations and maintenance costs are expected to increase from $0·10 in 2021 to $0·39–0·60 in 2030. Waste management accounts for the greatest share of costs, requiring $3·7 billion (46·6% of the total) in the baseline estimates, followed by $1·8 billion (23·1%) for sanitation, $1·5 billion (19·5%) for water, and $845 million (10·7%) for hygiene. Needs are greatest for non-hospital facilities ($7·4 billion [94%] of $7·9 billion) and for facilities in rural areas ($5·3 billion [68%]). Interpretation Investment will need to increase to reach full coverage of basic WASH and waste services in public health facilities. Financial needs are modest compared with current overall health and WASH spending, and better service coverage will yield substantial health benefits. To sustain services and prevent degradation and early replacement, countries will need to routinely budget for operations and maintenance of WASH and waste management assets. Funding WHO (including underlying grants from the governments of Japan, the Netherlands, and the UK), World Bank (including an underlying grant from the Global Water Security and Sanitation Partnership), and UNICEF. Translations For the Arabic, French and Portuguese translations of the abstract see Supplementary Materials section.
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Affiliation(s)
| | | | | | - Irene Amongin
- Division of Water, Sanitation and Hygiene, UNICEF, New York, NY, USA
| | - Silvia Gaya
- Division of Water, Sanitation and Hygiene, UNICEF, New York, NY, USA
| | - Odd N Hanssen
- Center for Economic and Policy Research, Washington, DC, USA
| | - Richard Johnston
- Water, Sanitation, Hygiene and Health Unit, WHO, Geneva, Switzerland
| | - Tom Slaymaker
- Division of Data, Analytics, Planning and Monitoring, UNICEF, New York, NY, USA
| | - Claire Chase
- Water Global Practice, The World Bank, Washington, DC, USA
| | - Guy Hutton
- Division of Water, Sanitation and Hygiene, UNICEF, New York, NY, USA
| | - Maggie Montgomery
- Water, Sanitation, Hygiene and Health Unit, WHO, Geneva, Switzerland
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Kwon S, Kim E. Sustainable Health Financing for COVID‐19 Preparedness and Response in Asia and the Pacific. ASIAN ECONOMIC POLICY REVIEW 2022; 17. [PMCID: PMC8441797 DOI: 10.1111/aepr.12360] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
To make health systems more resilient to shocks and crises, it is critical for governments to invest in core health system functions such as financing, service delivery, and governance. Ensuring sufficient resources for health is necessary for basic infrastructure including vaccines; the overall level of health expenditure and the public sources of funding are important. Funding for public health services, including infection prevention and control, surveillance, and information systems, is fundamental to ensure health systems are prepared for and respond to health emergencies. Funding should be made available for a quick and effective response to emergencies, requiring a supportive flexible public financial management system. Moreover, it is essential to mitigate the potential risks of health system collapses through innovative ways, for example, telemedicine, and mobilizing private sector providers. Vulnerable groups who are even more impacted during crises need special attention. Multisectoral cooperation is paramount to health system resilience during pandemic response.
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Affiliation(s)
- Soonman Kwon
- Seoul National University and Korea Health Industry Development Institute (KHIDI)
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de Vries L, Koopmans M, Morton A, van Baal P. The economics of improving global infectious disease surveillance. BMJ Glob Health 2021; 6:bmjgh-2021-006597. [PMID: 34475025 PMCID: PMC8413876 DOI: 10.1136/bmjgh-2021-006597] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/19/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Linda de Vries
- Department of Health Economics, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Marion Koopmans
- Department of Viroscience, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Alec Morton
- Department of Management Science, Strathclyde Business School, University of Strathclyde, Glasgow, UK
| | - Pieter van Baal
- Department of Health Economics, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Sparkes SP, Eozenou PHV, Evans D, Kurowski C, Kutzin J, Tandon A. Will the Quest for UHC be Derailed? Health Syst Reform 2021; 7:e1929796. [PMID: 34402407 DOI: 10.1080/23288604.2021.1929796] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
COVID-19 has shocked all countries' economic and health systems. The combined direct health impact and the current macro-fiscal picture present real and present risks to health financing that facilitate progress toward universal health coverage (UHC). This paper lays out the health financing mechanisms through which the UHC objectives of service coverage and financial protection may be impacted. Macroeconomic, fiscal capacity, and poverty indicators and trends are analyzed in conjunction with health financing indicators to present spending scenarios. The analysis shows that falling or reduced economic growth, combined with rising poverty, is likely to lead to a fall in service use and coverage, while any observed reductions in out-of-pocket spending have to be analyzed carefully to make sure they reflect improved financial protection and not just decreased utilization of services. Potential decreases in out-of-pocket spending will likely be drive by households' financial constraints that lead to less service use. In this way, it is critical to measure and monitor both the service coverage and financial protection indicators of UHC to have a complete picture of downstream effects. The analysis of historical data, including available evidence since the start of the COVID-19 pandemic, lay the foundation for health financing-related policy options that can effectively safeguard UHC progress particularly for the poor and most vulnerable. These targeted policy options are based on documented evidence of effective country responses to previous crises as well as the overall evidence base around health financing for UHC.
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Affiliation(s)
- Susan P Sparkes
- Health Financing, World Health Organization, Geneva, Switzerland
| | | | - David Evans
- Health, Nutrition and Population, World Bank Group, Washington, DC, USA
| | | | - Joseph Kutzin
- Health Financing, World Health Organization, Geneva, Switzerland
| | - Ajay Tandon
- Health, Nutrition and Population, World Bank Group, Washington, DC, USA
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West H, Lawton A, Hossain S, Mustafa AHMG, Razzaque A, Kuhn R. COVID-19 Vaccine Hesitancy among Temporary Foreign Workers from Bangladesh. Health Syst Reform 2021; 7:e1991550. [PMID: 34780314 DOI: 10.1080/23288604.2021.1991550] [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] [Indexed: 10/19/2022] Open
Abstract
The COVID-19 pandemic poses an extraordinary threat to the health, safety, and freedom of temporary foreign workers (TFWs). Highly effective vaccines against COVID-19 may hold an outsized benefit for TFWs, particularly those living in congregate settings where protective measures such as social distancing are not possible. While some studies of migrant destination countries have included migrants, no study to date has sought to understand variations in vaccine hesitancy among individuals in a single migrant source population across different destinations. Such a design is critical for understanding how the context of immigration affects levels of hesitancy among migrants from similar conditions of origin. This observational study leverages longitudinal data from an ongoing monthly rapid-response survey of TFWs from Bangladesh (n = 360). Overall vaccine hesitancy was 25%, with significant variation by host country. Multivariate analyses confirmed that immigration system factors and threat perception are the strongest predictors of COVID-19 vaccine hesitancy for TFWs. The predicted probability of hesitancy for an undocumented TFW was 0.405, while the predicted probability for those with valid visas was 0.207 (p < .01). The probability of being hesitant for TFWs who were worried about getting COVID-19 was 0.129 compared to 0.305 (p < .01) for those who were not worried. Results reveal low vaccine hesitancy among TFWs from Bangladesh with differences in location, undocumented status, COVID-19 threat perception, and level of worry about side effects. There could be relatively high returns for targeting vaccine access and distribution to TFWs because of their high levels of vaccine acceptance.
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Affiliation(s)
- Heidi West
- Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA
| | - Alexander Lawton
- Department of Community Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA
| | - Shamim Hossain
- Department of Community Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA
| | - A H M Golam Mustafa
- Health and Population Surveillance Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Abdur Razzaque
- Health and Population Surveillance Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Randall Kuhn
- Department of Community Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA
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Soucat A. Financing Common Goods for Health: Fundamental for Health, the Foundation for UHC. Health Syst Reform 2020; 5:263-267. [PMID: 31860401 DOI: 10.1080/23288604.2019.1671125] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Agnès Soucat
- Health Systems, Governance and Financing, World Health Organization, Geneva, Switzerland
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9
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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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Abstract
This paper presents the rationale and motivation for countries and the global development community to tackle a critical set of functions in the health sector that appear to be under-prioritized and underfunded. The recent eruptions of Ebola outbreaks in Africa and other communicable diseases like Zika and SARS elsewhere led scientific and medical commissions to call for global action. The calls for action motivated the World Health Organization (WHO) to respond by defining a new construct within the health sector: Common Good for Health (CGH). While the starting point for developing the CGH construct was the re-emergence of communicable diseases, it extends to additional outcomes resulting from failures to act and finance within and outside the health sector. This paper summarizes global evidence on failures to address CGHs effectively, identifies potential reasons for the public and private sectors' failures to respond, and lays out the first phase of the WHO program as represented by the papers in this special issue of Health Systems & Reform.
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Affiliation(s)
- Abdo S Yazbeck
- Department of International Health, Johns Hopkins University, Baltimore, MD, USA
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