1
|
Lane J, Nakambale H, Kadakia A, Dambisya Y, Stergachis A, Odoch WD. A systematic scoping review of medicine availability and affordability in Africa. BMC Health Serv Res 2024; 24:91. [PMID: 38233851 PMCID: PMC10792840 DOI: 10.1186/s12913-023-10494-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 12/18/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND The most recent World Medicines Situation Report published in 2011 found substantial medicine availability and affordability challenges across WHO regions, including Africa. Since publication of the 2011 report, medicine availability and affordability has risen on the international agenda and was included in the Sustainable Development Goals as Target 3.8. While numerous medicine availability and affordability studies have been conducted in Africa since the last World Medicines Situation Report, there has not been a systematic analysis of the methods used in these studies, measures of medicine availability and affordability, categories of medicines studied, or geographic distribution. Filling this knowledge gap can help inform future medicine availability and affordability studies, design systems to monitor progress toward Sustainable Development Goal Target 3.8 in Africa and beyond, and inform policy and program decisions to improve medicine availability and affordability. METHODS We conducted a systematic scoping review of studies assessing medicine availability or affordability conducted in the WHO Africa region published from 2009-2021. RESULTS Two hundred forty one articles met our eligibility criteria. 88% of the articles (213/241) reported descriptive studies, while 12% (28/241) reported interventional studies. Of the 198 studies measuring medicine availability, the most commonly used measure of medicine availability was whether a medicine was in stock on the date of a survey (124/198, 63%). We also identified multiple other availability methods and measures, including retrospective stock record reviews and self-reported medicine availability surveys. Of the 59 articles that included affordability measures, 32 (54%) compared the price of the medicine to the daily wage of the lowest paid government worker. Other affordability measures were patient self-reported affordability, capacity to pay measures, and comparing medicines prices with a population-level income standard (such as minimum wage, poverty line, or per capita income). The most commonly studied medicines were antiparasitic and anti-bacterial medicines. We did not identify studies in 22 out of 48 (46%) countries in the WHO Africa Region and more than half of the studies identified were conducted in Ethiopia, Kenya, Tanzania, and/or Uganda. CONCLUSION Our results revealed a wide range of medicine availability and affordability assessment methodologies and measures, including cross-sectional facility surveys, population surveys, and retrospective data analyses. Our review also indicated a need for greater focus on medicines for certain non-communicable diseases, greater geographic diversity of studies, and the need for more intervention studies to identify approaches to improve access to medicines in the region.
Collapse
Affiliation(s)
- Jeff Lane
- Department of Global Health, School of Public Health, University of Washington, Seattle, WA, USA.
| | - Hilma Nakambale
- Department of Global Health, School of Public Health, University of Washington, Seattle, WA, USA
| | - Asha Kadakia
- Department of Global Health, School of Public Health, University of Washington, Seattle, WA, USA
| | - Yoswa Dambisya
- East Central and Southern Africa Health Community, Arusha, Tanzania
| | - Andy Stergachis
- Departments of Pharmacy and Global Health, Schools of Pharmacy and Public Health, University of Washington, Seattle, WA, USA
| | - Walter Denis Odoch
- Afya Research and Development Institute, Kampala, Uganda
- World Health Organization, Harare, Zimbabwe
| |
Collapse
|
2
|
Kruk ME, Kapoor NR, Lewis TP, Arsenault C, Boutsikari EC, Breda J, Carai S, Croke K, Dayalu R, Fink G, Garcia PJ, Kassa M, Mohan S, Moshabela M, Nzinga J, Oh J, Okiro EA, Prabhakaran D, SteelFisher GK, Tarricone R, Garcia-Elorrio E. Population confidence in the health system in 15 countries: results from the first round of the People's Voice Survey. Lancet Glob Health 2024; 12:e100-e111. [PMID: 38096882 PMCID: PMC10716625 DOI: 10.1016/s2214-109x(23)00499-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 09/11/2023] [Accepted: 10/18/2023] [Indexed: 12/17/2023]
Abstract
Population confidence is essential to a well functioning health system. Using data from the People's Voice Survey-a novel population survey conducted in 15 low-income, middle-income, and high-income countries-we report health system confidence among the general population and analyse its associated factors. Across the 15 countries, fewer than half of respondents were health secure and reported being somewhat or very confident that they could get and afford good-quality care if very sick. Only a quarter of respondents endorsed their current health system, deeming it to work well with no need for major reform. The lowest support was in Peru, the UK, and Greece-countries experiencing substantial health system challenges. Wealthy, more educated, young, and female respondents were less likely to endorse the health system in many countries, portending future challenges for maintaining social solidarity for publicly financed health systems. In pooled analyses, the perceived quality of the public health system and government responsiveness to public input were strongly associated with all confidence measures. These results provide a post-COVID-19 pandemic baseline of public confidence in the health system. The survey should be repeated regularly to inform policy and improve health system accountability.
Collapse
Affiliation(s)
- Margaret E Kruk
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA.
| | - Neena R Kapoor
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Todd P Lewis
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Catherine Arsenault
- Department of Global Health, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Eleni C Boutsikari
- Division of Country Health Policies and Systems, WHO Athens Quality of Care Office, WHO Regional Office for Europe, Athens, Greece
| | - João Breda
- Division of Country Health Policies and Systems, WHO Athens Quality of Care Office, WHO Regional Office for Europe, Athens, Greece
| | - Susanne Carai
- Division of Country Health Policies and Systems, WHO Athens Quality of Care Office, WHO Regional Office for Europe, Athens, Greece
| | - Kevin Croke
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Rashmi Dayalu
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Günther Fink
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute and University of Basel, Basel, Switzerland
| | - Patricia J Garcia
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Munir Kassa
- Minister's Office, Ministry of Health, Addis Ababa, Ethiopia
| | | | - Mosa Moshabela
- College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Jacinta Nzinga
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Juhwan Oh
- Seoul National University College of Medicine, Seoul, South Korea
| | - Emelda A Okiro
- Population and Health Impact Surveillance Group, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Gillian K SteelFisher
- Department of Health Policy and Management, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Rosanna Tarricone
- Department of Social and Political Science, Bocconi University, Milan, Italy
| | - Ezequiel Garcia-Elorrio
- School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru; Health Care Quality and Patient Safety, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| |
Collapse
|
3
|
Tellioglu N, Chisholm RH, Campbell PT, Collinson S, Timothy J, Kollie K, Zayzay S, Devine A, McVernon J, Marks M, Geard N. Modelling mass drug administration strategies for reducing scabies burden in Monrovia, Liberia. Epidemiol Infect 2023; 151:e153. [PMID: 37593956 PMCID: PMC10548539 DOI: 10.1017/s0950268823001310] [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: 01/13/2023] [Revised: 05/29/2023] [Accepted: 07/28/2023] [Indexed: 08/19/2023] Open
Abstract
Scabies is a parasitic infestation with high global burden. Mass drug administrations (MDAs) are recommended for communities with a scabies prevalence of >10%. Quantitative analyses are needed to demonstrate the likely effectiveness of MDA recommendations. In this study, we developed an agent-based model of scabies transmission calibrated to demographic and epidemiological data from Monrovia. We used this model to compare the effectiveness of MDA scenarios for achieving scabies elimination and reducing scabies burden, as measured by time until recrudescence following delivery of an MDA and disability-adjusted-life-years (DALYs) averted. Our model showed that three rounds of MDA delivered at six-month intervals and reaching 80% of the population could reduce prevalence below 2% for three years following the final round, before recrudescence. When MDAs were followed by increased treatment uptake, prevalence was maintained below 2% indefinitely. Increasing the number of and coverage of MDA rounds increased the probability of achieving elimination and the number of DALYs averted. Our results suggest that acute reduction of scabies prevalence by MDA can support a transition to improved treatment access. This study demonstrates how modelling can be used to estimate the expected impact of MDAs by projecting future epidemiological dynamics and health gains under alternative scenarios.
Collapse
Affiliation(s)
- Nefel Tellioglu
- School of Computing and Information Systems, The University of Melbourne, Melbourne, VIC, Australia
| | - Rebecca H. Chisholm
- Department of Mathematical and Physical Sciences, La Trobe University, Bundoora, VIC, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Patricia Therese Campbell
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
- Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Shelui Collinson
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Joseph Timothy
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Angela Devine
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Jodie McVernon
- Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
- Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Hospital for Tropical Diseases, University College London Hospital, London, UK
- Division of Infection and Immunity, University College London, London, UK
| | - Nicholas Geard
- School of Computing and Information Systems, The University of Melbourne, Melbourne, VIC, Australia
| |
Collapse
|
4
|
Zuhair M, Roy RB. Eliciting relative preferences for the attributes of health insurance schemes among rural consumers in India. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2022; 22:443-458. [PMID: 35394574 DOI: 10.1007/s10754-022-09327-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 03/12/2022] [Indexed: 06/14/2023]
Abstract
There is a limited understanding of the preferences of rural consumers in India for health insurance schemes. In this article, we investigate the preferences of the rural population for the attributes of a health insurance scheme by implementing a discrete choice experiment (DCE). We identified six attributes through qualitative and quantitative study: enrollment, management, benefit package, coverage, transportation facility, and monthly premium. A D-efficient design of 18 choices has been constructed, each comprising two health insurance choices. We collected the representative sample from 675 household heads of the rural population through personal interviews. The preferences for the attributes and attribute levels were estimated using the multinomial logit (MNL) and random-parameter logit (RPL) models. The analysis shows that all attribute levels significantly affect the choice behavior (P < 0.05). The relative order of preferences for attributes are; enrollment, benefit package, monthly premium, management, coverage, and transportation.
Collapse
Affiliation(s)
- Mohd Zuhair
- Department of Computer Science and Engineering, Institute of Technology, Nirma University, Ahmedabad, Gujarat, India.
| | - Ram Babu Roy
- Indian Institute of Technology Kharagpur, Kharagpur, West Bengal, India
| |
Collapse
|
5
|
Otekunrin OA, Olasehinde L, Oliobi C, Otekunrin O, Osuolale K. Exploring women's preferences for attributes of long-acting reversible contraceptive (LARC) methods: a discrete choice experiment. SCIENTIFIC AFRICAN 2022. [DOI: 10.1016/j.sciaf.2022.e01499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
|
6
|
Bowen I, Toor H, Zampella B, Doe A, King C, Miulli DE. Infrastructural Limitations in Establishing Neurosurgical Specialty Services in Liberia. Cureus 2022; 14:e29373. [PMID: 36284802 PMCID: PMC9584543 DOI: 10.7759/cureus.29373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/19/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction Liberia recently employed the first neurosurgeon in the country’s history. In a country with a population of 4.7 million people and staggering rates of cranial and spine trauma, as well as hydrocephalus and neural tube defects, neurosurgery is considered a luxury. Our study documents the experience of a team of neurosurgeons, critical care nurses, scrub technicians, nurses, and biomedical engineers who carried out a series of neurosurgical clinics and complex brain and spine surgeries in Liberia. Specifically, we aim to highlight some of the larger obstacles, beyond staff and equipment, facing the development of a neurosurgical or any other specialty practice in Liberia. Methods Our institutions, in collaboration with the Korle-Bu Neuroscience Foundation, spent 10 days in Liberia, based in Tappita, and performed 18 surgeries in addition to seeing several hundred clinic patients. This is a retrospective review of the cases performed along with outcomes to investigate obstacles in providing neurosurgical services in the country. Results Before arriving in Liberia, we evaluated, planned, and supplied staff and materials for treating complex neurosurgical patients. Sixteen patients underwent 18 surgeries at a hospital in Tappita, Liberia, in November 2018. Their ages ranged from 1 month to 72 years (average 20 years). Five patients (28%) were female. Ten patients (56%) were under the age of 18. Surgeries included ventriculoperitoneal shunting (VP-shunt), lumbar myelomeningocele repair, encephalocele repair, laminectomy, and a craniotomy for tumor resection. Ten patients (55%) underwent VP-shunting. Two patients (11%) had a craniotomy for tumor resection. Three patients (17%) had laminectomy for lumbar stenosis. Two patients (11%) had repair of lumbar myelomeningocele. Conclusion After an aggressive and in-depth approach to planning, conducting, and supplying complex neurosurgical procedures in Liberia, the greatest limiting factor to successful outcomes lie in real-time is access to health care, which is largely limited by overall infrastructure. Our study documents the experience of a team of neurosurgeons, critical care nurses, scrub technicians, nurses, and biomedical engineers who carried out a series of neurosurgical clinics and complex brain and spine surgeries in Liberia. Specifically, we aim to highlight some of the larger obstacles, beyond staff and equipment, facing the development of a neurosurgical or any other specialty procedural practice in the country of Liberia. Most notably, we focus on infrastructure factors, including power, roads, water, education, and overall health care.
Collapse
|
7
|
Lim AH, Ng SW, Teh XR, Ong SM, Sivasampu S, Lim KK. Conjoint analyses of patients’ preferences for primary care: a systematic review. BMC PRIMARY CARE 2022; 23:234. [PMID: 36085032 PMCID: PMC9463739 DOI: 10.1186/s12875-022-01822-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 08/09/2022] [Indexed: 11/10/2022]
Abstract
Abstract
Background
While patients’ preferences in primary care have been examined in numerous conjoint analyses, there has been little systematic effort to synthesise the findings. This review aimed to identify, to organise and to assess the strength of evidence for the attributes and factors associated with preference heterogeneity in conjoint analyses for primary care outpatient visits.
Methods
We searched five bibliographic databases (PubMed, Embase, PsycINFO, Econlit and Scopus) from inception until 15 December 2021, complemented by hand-searching. We included conjoint analyses for primary care outpatient visits. Two reviewers independently screened papers for inclusion and assessed the quality of all included studies using the checklist by ISPOR Task Force for Conjoint Analysis. We categorized the attributes of primary care based on Primary Care Monitoring System framework and factors based on Andersen’s Behavioural Model of Health Services Use. We then assessed the strength of evidence and direction of preference for the attributes of primary care, and factors affecting preference heterogeneity based on study quality and consistency in findings.
Results
Of 35 included studies, most (82.4%) were performed in high-income countries. Each study examined 3–8 attributes, mainly identified through literature reviews (n = 25). Only six examined visits for chronic conditions, with the rest on acute or non-specific / other conditions. Process attributes were more commonly examined than structure or outcome attributes. The three most commonly examined attributes were waiting time for appointment, out-of-pocket costs and ability to choose the providers they see. We identified 24/58 attributes with strong or moderate evidence of association with primary care uptake (e.g., various waiting times, out-of-pocket costs) and 4/43 factors with strong evidence of affecting preference heterogeneity (e.g., age, gender).
Conclusions
We found 35 conjoint analyses examining 58 attributes of primary care and 43 factors that potentially affect the preference of these attributes. The attributes and factors, stratified into evidence levels based on study quality and consistency, can guide the design of research or policies to improve patients’ uptake of primary care. We recommend future conjoint analyses to specify the types of visits and to define their attributes clearly, to facilitate consistent understanding among respondents and the design of interventions targeting them.
Word Count: 346/350 words.
Trial registration
On Open Science Framework: https://osf.io/m7ts9
Collapse
|
8
|
Jordan K, Lewis TP, Roberts B. Quality in crisis: a systematic review of the quality of health systems in humanitarian settings. Confl Health 2021; 15:7. [PMID: 33531065 PMCID: PMC7851932 DOI: 10.1186/s13031-021-00342-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 01/22/2021] [Indexed: 12/03/2022] Open
Abstract
Background There is a growing concern that the quality of health systems in humanitarian crises and the care they provide has received little attention. To help better understand current practice and research on health system quality, this paper aimed to examine the evidence on the quality of health systems in humanitarian settings. Methods This systematic review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. The context of interest was populations affected by humanitarian crisis in low- and middle- income countries (LMICs). We included studies where the intervention of interest, health services for populations affected by crisis, was provided by the formal health system. Our outcome of interest was the quality of the health system. We included primary research studies, from a combination of information sources, published in English between January 2000 and January 2019 using quantitative and qualitative methods. We used the High Quality Health Systems Framework to analyze the included studies by quality domain and sub-domain. Results We identified 2285 articles through our search, of which 163 were eligible for full-text review, and 55 articles were eligible for inclusion in our systematic review. Poor diagnosis, inadequate patient referrals, and inappropriate treatment of illness were commonly cited barriers to quality care. There was a strong focus placed on the foundations of a health system with emphasis on the workforce and tools, but a limited focus on the health impacts of health systems. The review also suggests some barriers to high quality health systems that are specific to humanitarian settings such as language barriers for refugees in their host country, discontinued care for migrant populations with chronic conditions, and fears around provider safety. Conclusion The review highlights a large gap in the measurement of quality both at the point of care and at the health system level. There is a need for further work particularly on health system measurement strategies, accountability mechanisms, and patient-centered approaches in humanitarian settings. Supplementary Information The online version contains supplementary material available at 10.1186/s13031-021-00342-z.
Collapse
Affiliation(s)
- Keely Jordan
- Department of Health Policy, New York University School of Global Public Health, 665 Broadway, New York, NY, 10012, USA.
| | - Todd P Lewis
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Bayard Roberts
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
9
|
Olugasa BO, Jomah ND, Dogba JB, Ishola OO, Olarinmoye AO, Adeola OA, Ojo JF, Aldosari AA. Improving dog bite victim survey and estimation of annual human deaths due to suspected rabies cases in three selected Liberian cities and environs, 2008-2017. PLoS Negl Trop Dis 2020; 14:e0008957. [PMID: 33370268 PMCID: PMC7833524 DOI: 10.1371/journal.pntd.0008957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 01/25/2021] [Accepted: 11/06/2020] [Indexed: 12/17/2022] Open
Abstract
Rabies remains a public health challenge of unknown magnitude in Liberia in spite of the goal of ensuring that no human in the country dies of rabies by 2030. The annual prevalence of Dog Bite Victims (DBVs) and true load of Annual Human Deaths (AHDs) due to rabies were not known. We investigated three selected cities of Liberia for annual prevalence of DBVs and true load of AHD due to suspected rabies, using 10-year retrospective record, 2008-2017 obtained from Buchanan, Gbarnga, and Voinjama, three socio-economically important cities in post-conflict Liberia. Data were sourced at County Reference Hospitals and at the Liberia National Institute of Health for these cities and their local environs. In addition, household questionnaire survey was used to identify and audit data quality for unreported DBVs, and treatment received from traditional caregivers. The proportion was used to audit the 10-year data on unreported DBVs in the cities. Descriptive statistics was used to summarize annual DBVs over the 10-year period in the three cities, respectively. A standardized clinical decision tree model was used to estimate AHDs due to suspected rabies. Based on questionnaire survey, 140/365, 148/375 and 146/350 DBVs did not visit any orthodox health facility in Buchanan, Gbarnga and Voinjama cities, respectively in 2014. An estimated total of 559 DBVs died of suspected rabies in the three cities and their environs during the 10-year period. Mean yearly prevalence of DBVs was 179±106.82, 393±257.85 and 76.9±38.11 per 100,000 population, while mean AHDs due to suspected rabies was 14.3±8.47, 35.5±23.25, and 6.1±3.21 per 100,000 population in Buchanan, Gbarnga, and Voinjama cities, respectively. The present findings provide annual prevalence of suspected rabies cases, corrected for under-reporting in three selected cities of Liberia. The findings would be useful in planning for stepwise actions towards rabies elimination, ensuring that no human dies of rabies in Liberia by 2030.
Collapse
Affiliation(s)
- Babasola Oluseyi Olugasa
- Centre for Control and Prevention of Zoonoses (CCPZ), University of Ibadan, Ibadan, Oyo State, Nigeria
- Department of Veterinary Public Health and Preventive Medicine, Faculty of Veterinary Medicine, University of Ibadan, Ibadan, Nigeria
| | - Nykoi Dormon Jomah
- Centre for Control and Prevention of Zoonoses (CCPZ), University of Ibadan, Ibadan, Oyo State, Nigeria
- Department of Veterinary Public Health and Preventive Medicine, Faculty of Veterinary Medicine, University of Ibadan, Ibadan, Nigeria
- Central Agricultural Research Institute (CARI), Suakoko, Bong County, Liberia
| | - John Bobo Dogba
- Centre for Control and Prevention of Zoonoses (CCPZ), University of Ibadan, Ibadan, Oyo State, Nigeria
- Department of Veterinary Public Health and Preventive Medicine, Faculty of Veterinary Medicine, University of Ibadan, Ibadan, Nigeria
- National Public Health Institute (NPHI), Monrovia, Montserrado County, Liberia
| | - Olayinka Olabisi Ishola
- Department of Veterinary Public Health and Preventive Medicine, Faculty of Veterinary Medicine, University of Ibadan, Ibadan, Nigeria
| | - Ayodeji Oluwadare Olarinmoye
- Centre for Control and Prevention of Zoonoses (CCPZ), University of Ibadan, Ibadan, Oyo State, Nigeria
- Department of Veterinary Public Health and Preventive Medicine, Faculty of Veterinary Medicine, University of Ibadan, Ibadan, Nigeria
- Eng. Abdullah Bugshan Research Chair for Dental and Oral Rehabilitation (DOR), College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Oluwagbenga Adebayo Adeola
- Centre for Control and Prevention of Zoonoses (CCPZ), University of Ibadan, Ibadan, Oyo State, Nigeria
- Department of Medical Microbiology and Parasitology, College of Medicine and Health Sciences, Bingham University, Karu, via Abuja, Nigeria
| | - Johnson Funminiyi Ojo
- Centre for Control and Prevention of Zoonoses (CCPZ), University of Ibadan, Ibadan, Oyo State, Nigeria
- Department of Statistics, Faculty of Science, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Ali Abdullah Aldosari
- Department of Geography, College of Arts, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
10
|
Lau R, Crump RT, Brousseau DC, Panepinto JA, Nicholson M, Engel J, Lagatta J. Parent Preferences Regarding Home Oxygen Use for Infants with Bronchopulmonary Dysplasia. J Pediatr 2019; 213:30-37.e3. [PMID: 31256913 PMCID: PMC6765432 DOI: 10.1016/j.jpeds.2019.05.069] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 05/07/2019] [Accepted: 05/29/2019] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To determine parent preferences for discharge with home oxygen in infants with bronchopulmonary dysplasia. STUDY DESIGN This was a prospective study of parents of infants born at <32 weeks' gestation with established bronchopulmonary dysplasia and approaching neonatal intensive care unit (NICU) discharge. Parents were presented a hypothetical scenario of an infant who failed weaning to room air and 2 options: discharge with home oxygen or try longer to wean oxygen. The initial scenario risks reflected a 1.5-week difference in NICU length of stay and no differences in other outcomes. Length of stay and readmission outcomes were increased or decreased until the parent switched preference. Three months after discharge, parents were asked to reconsider their preference. Differences were analyzed by χ2 or Kruskal-Wallis tests. RESULTS Of 125 parents, 50% preferred home oxygen. For parents preferring home oxygen, the most important reason was comfort at home (79%). Forty percent switched preference when the length of stay difference decreased by 1 week; 35% switched when readmission increased by 5%. For parents preferring to stay in NICU, the most important reason was fear of taking care of the child at home (73%). Thirty-two percent switched preference when the length of stay difference increased by 1 week; 31% switched when readmission decreased by 5%. One hundred ten parents completed the 3-month follow-up; 80 were discharged with home oxygen. Seventy-eight percent would prefer home oxygen (97% who initially preferred home oxygen and 60% who initially preferred to stay in the NICU). CONCLUSIONS Parents weigh differences in NICU length of stay and readmission risk similarly. After discharge, most prefer earlier discharge with home oxygen. Earlier education to increase comfort with home technology may facilitate NICU discharge planning.
Collapse
Affiliation(s)
- Ryan Lau
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee WI
| | | | | | | | - Mateo Nicholson
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee WI
| | | | - Joanne Lagatta
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI.
| |
Collapse
|
11
|
Larson E, Gage AD, Mbaruku GM, Mbatia R, Haneuse S, Kruk ME. Effect of a maternal and newborn health system quality improvement project on the use of facilities for childbirth: a cluster-randomised study in rural Tanzania. Trop Med Int Health 2019; 24:636-646. [PMID: 30767422 PMCID: PMC6499631 DOI: 10.1111/tmi.13220] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objectives Reduction in maternal and newborn mortality requires that women deliver in high quality health facilities. However, many facilities provide sub‐optimal quality of care, which may be a reason for less than universal facility utilisation. We assessed the impact of a quality improvement project on facility utilisation for childbirth. Methods In this cluster‐randomised experiment in four rural districts in Tanzania, 12 primary care clinics and their catchment areas received a quality improvement intervention consisting of in‐service training, mentoring and supportive supervision, infrastructure support, and peer outreach, while 12 facilities and their catchment areas functioned as controls. We conducted a census of all deliveries within the catchment area and used difference‐in‐differences analysis to determine the intervention's effect on facility utilisation for childbirth. We conducted a secondary analysis of utilisation among women whose prior delivery was at home. We further investigated mechanisms for increased facility utilisation. Results The intervention led to an increase in facility births of 6.7 percentage points from a baseline of 72% (95% Confidence Interval: 0.6, 12.8). The intervention increased facility delivery among women with past home deliveries by 18.3 percentage points (95% CI: 10.1, 26.6). Antenatal quality increased in intervention facilities with providers performing an additional 0.5 actions across the full population and 0.8 actions for the home delivery subgroup. Conclusions We attribute the increased use of facilities to better antenatal quality. This increased utilisation would lead to lower maternal mortality only in the presence of improvement in care quality.
Collapse
Affiliation(s)
- Elysia Larson
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Anna D Gage
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | | | - Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| |
Collapse
|
12
|
Wang W, Maitland E, Nicholas S, Haggerty J. Determinants of Overall Satisfaction with Public Clinics in Rural China: Interpersonal Care Quality and Treatment Outcome. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16050697. [PMID: 30818750 PMCID: PMC6427360 DOI: 10.3390/ijerph16050697] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 02/08/2019] [Accepted: 02/22/2019] [Indexed: 01/17/2023]
Abstract
The primary health care quality factors determining patient satisfaction will shape patient-centered health reform in China. While rural public clinics performed better than hospitals and private clinics in terms of patient perceived quality of primary care in China, there is little information about which quality care aspects drove patients’ satisfaction. Using a World Health Organization database on 1014 rural public clinic users from eight provinces in China, our multiple linear regression model estimated the association between patient perceived quality aspects, one treatment outcome, and overall primary health care satisfaction. Our results show that treatment outcome was the strongest predictor of overall satisfaction (β = 0.338 (95% CI: 0.284 to 0.392); p < 0.001), followed by two interpersonal care quality aspects, Dignity (being treated respectfully) (β = 0.219 (95% CI: 0.117 to 0.320); p < 0.001) and Communication (clear explanation by the physician) (β = 0.103 (95% CI: 0.003 to 0.203); p = 0.043). Prompt attention (waiting time before seeing the doctor) and Confidentiality (talking privately to the provider) were not correlated with overall satisfaction. The treatment outcome focus, and weak interpersonal primary care aspects, in overall patient satisfaction, pose barriers towards a patient-centered transformation of China’s primary care rural clinics, but support the focus of improving the clinical competency of rural primary care workers.
Collapse
Affiliation(s)
- Wenhua Wang
- Department of Family Medicine, McGill University, Montreal, QC H3T 1M5, Canada.
| | - Elizabeth Maitland
- University of Liverpool Management School, University of Liverpool, Liverpool L697ZH, UK.
| | - Stephen Nicholas
- School of Management and School of Commerce, Tianjin Normal University, Tianjin 300074, China.
- Guangdong Research Institute for International Strategies, Guangdong University of Foreign Studies, Guangzhou 510420, China.
- TOP Education Institute, Sydney, NSW 2015, Australia.
- University of Newcastle Business School, Newcastle, NSW 2308, Australia.
| | - Jeannie Haggerty
- Department of Family Medicine, McGill University, Montreal, QC H3T 1M5, Canada.
| |
Collapse
|
13
|
Sydavong T, Goto D, Kawata K, Kaneko S, Ichihashi M. Potential demand for voluntary community-based health insurance improvement in rural Lao People's Democratic Republic: A randomized conjoint experiment. PLoS One 2019; 14:e0210355. [PMID: 30620771 PMCID: PMC6324784 DOI: 10.1371/journal.pone.0210355] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 12/20/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION In Lao People's Democratic Republic (PDR), community-based health insurance (CBHI) is the only voluntary insurance scheme; it typically targets self-employed people, most of whom reside in rural areas and are dependent on agricultural activities for subsistence. However, until very recently, the enrollment rate has fallen short and failed to reach a large percentage of the target group. To promote the CBHI scheme and increase demand, some supporting components should be considered for inclusion together with the health infrastructure component. OBJECTIVES This paper provides empirical evidence that the benefit package components of hypothetical CBHI schemes have causal effects on enrollment probabilities. Furthermore, we examine the distribution of willingness to pay (WTP) in response to policy changes based on a sample of 5,800 observations. METHODS A randomized conjoint experiment is conducted in rural villages in Savannakhet Province, Lao PDR, to elicit stated preference data. Each respondent ranks three options-two hypothetical alternatives and the CBHI status quo scheme. The levels of seven attributes-insurance coverage for medical consultations, hospitalizations, traffic accidents, pharmaceuticals and transportation; premiums; and prepaid discounts-are randomly and simultaneously assigned to the two alternatives. RESULTS The findings suggest that the average WTP is at least as large as 10.9% of the per capita income of those who live in rural areas, which is higher than the WTP for health insurance averaged across low- and middle-income countries (LMICs) in the literature. The component of round-trip transportation insurance coverage has a significant effect on WTP distribution, particularly increasing the share of the highest bin. CONCLUSION Therefore, the low CBHI scheme enrollment rate in Lao PDR does not necessarily imply low demand among the targeted population, as the finding from the WTP analysis illustrates potential demand for the CBHI scheme. Specifically, if transportation is addressed, enrollment is likely to significantly increase.
Collapse
Affiliation(s)
- Thiptaiya Sydavong
- Graduate School for International Development and Cooperation, Hiroshima University, Higashi-hiroshima, Hiroshima, Japan
- Department of Planning and Investment, Savannakhet Provincial Government, Savannakhet, Lao People’s Democratic Republic
| | - Daisaku Goto
- Graduate School for International Development and Cooperation, Hiroshima University, Higashi-hiroshima, Hiroshima, Japan
| | - Keisuke Kawata
- Institute of Social Science, University of Tokyo, Tokyo, Japan
| | - Shinji Kaneko
- Graduate School for International Development and Cooperation, Hiroshima University, Higashi-hiroshima, Hiroshima, Japan
| | - Masaru Ichihashi
- Graduate School for International Development and Cooperation, Hiroshima University, Higashi-hiroshima, Hiroshima, Japan
| |
Collapse
|
14
|
Černauskas V, Angeli F, Jaiswal AK, Pavlova M. Underlying determinants of health provider choice in urban slums: results from a discrete choice experiment in Ahmedabad, India. BMC Health Serv Res 2018; 18:473. [PMID: 29921260 PMCID: PMC6006661 DOI: 10.1186/s12913-018-3264-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 05/31/2018] [Indexed: 01/08/2023] Open
Abstract
Background Severe underutilization of healthcare facilities and lack of timely, affordable and effective access to healthcare services in resource-constrained, bottom of pyramid (BoP) settings are well-known issues, which foster a negative cycle of poor health outcomes, catastrophic health expenditures and poverty. Understanding BoP patients’ healthcare choices is vital to inform policymakers’ effective resource allocation and improve population health and livelihood in these areas. This paper examines the factors affecting the choice of health care provider in low-income settings, specifically the urban slums in India. Method A discrete choice experiment was carried out to elicit stated preferences of BoP populations. A total of 100 respondents were sampled using a multi-stage systemic random sampling of urban slums. Attributes were selected based on previous studies in developing countries, findings of a previous exploratory study in the study setting and qualitative interviews. Provider type and cost, distance to the facility, attitude of doctor and staff, appropriateness of care and familiarity with doctor were the attributes included in the study. A random effects logit regression was used to perform the analysis. Interaction effects were included to control for individual characteristics. Results The relatively most valued attribute is appropriateness of care (β=3.4213, p = 0.00), followed by familiarity with the doctor (β=2.8497, p = 0.00) and attitude of the doctor and staff towards the patient (β=1.8132, p = 0.00). As expected, respondents prefer shorter distance (β= − 0.0722, p = 0.00) but the relatively low importance of the attribute distance to the facility indicate that respondents are willing to travel longer if any of the other statistically significant attributes are present. Also, significant socioeconomic differences in preferences were observed, especially with regard to the type of provider. Conclusion The analyses did not reveal universal preferences for a provider type, but overall the traditional provider type is not well accepted. It also became evident that respondents valued appropriateness of care above other attributes. Despite the study limitations, the results have broader policy implications in the context of Indian government’s attempts to reduce high healthcare out-of-pocket expenditures and provide universal health coverage for its population. The government’s attempt to emphasize the focus on traditional providers should be carefully reconsidered.
Collapse
Affiliation(s)
- Vilius Černauskas
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, P.O. Box 6200 MD, Maastricht, the Netherlands
| | - Federica Angeli
- Department of Organization Studies, School of Social and Behavioural Sciences, Tilburg University, P.O. Box 90153, Warandelaan 2, Tilburg, 5000 LE, The Netherlands.
| | - Anand Kumar Jaiswal
- Indian Institute of Management Ahmedabad, Vastrapur, Ahmedabad, 380015, India
| | - Milena Pavlova
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, P.O. Box 6200 MD, Maastricht, the Netherlands
| |
Collapse
|
15
|
Developing attributes and levels for a discrete choice experiment on basic health insurance in Iran. Med J Islam Repub Iran 2018; 32:26. [PMID: 30159277 PMCID: PMC6108276 DOI: 10.14196/mjiri.32.26] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Indexed: 11/18/2022] Open
Abstract
Background: Nonmarket stated preferences valuation, especially discrete choice experiments (DCEs), is one of the commonly used techniques in the health sector. The primary purpose of this approach is to help select attributes and attributes-levels that are able to properly describe health care products or services. This study aimed at developing attributes and attributes-levels for basic health insurance system in Iran.
Methods: This study was conducted in 3 phases. First, narrative review was performed to identify related attributes. Also, 9 experts were interviewed to identify relevant attributes of health insurance in context. Other 36 experts rated the attributes and levels. Then, the research team decided on the inclusion of attributes and levels in the final design. The design was constructed using generic and Defficient method with SAS 9.1. The design was divided into 3 blocks, each having 8 choice sets. Finally, the choice set was piloted with 45 participants.
Results: Public hospitals, and private hospitals benefits, dental insurance coverage, inpatient benefits, rehabilitation therapy, and paraclinical benefits, long-term care, medical devices benefits (Ortez, Protez, etc.), and monthly premium were identified and included in the final attribute design (D-efficiency = 98.16). The pilot study revealed that participants could easily understand and answer all the choice sets.
Conclusion: The results of our study indicated that health insurance service benefit packages and premium were among the most important attributes that need to be included in the final attribute design for Iranians. The policymakers and health insurance organizations should emphasize these attributes in the benefit packages to make improvements. The emphasis on these attributes can help elicit people’s preferences and willingness to pay for attributes.
Collapse
|
16
|
Lungu EA, Guda Obse A, Darker C, Biesma R. What influences where they seek care? Caregivers' preferences for under-five child healthcare services in urban slums of Malawi: A discrete choice experiment. PLoS One 2018; 13:e0189940. [PMID: 29351299 PMCID: PMC5774690 DOI: 10.1371/journal.pone.0189940] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 12/05/2017] [Indexed: 11/24/2022] Open
Abstract
Access to and utilisation of quality healthcare promotes positive child health outcomes. However, to be optimally utilised, the healthcare system needs to be responsive to the expectations of the population it serves. Health systems in many sub-Saharan African countries, including Malawi, have historically focused on promoting access to health services by the rural poor. However, in the context of increasing urbanisation and consequent proliferation of urban slums, promoting health of children under five years of age in these settings is a public health imperative. We conducted a discrete choice experiment to determine the relative importance of health facility factors in seeking healthcare for childhood illnesses in urban slums of Malawi. Caregivers of children under five years of age were presented with choice cards that depicted two hypothetical health facilities using six health facility attributes: availability of medicines and supplies, thoroughness of physical examination of the child, attitude of health workers, cost, distance, and waiting time. Caregivers were asked to indicate the health facility they would prefer to use. A mixed logit model was used to estimate the relative importance of and willingness to pay (WTP) for health facility attributes. Attributes with greatest influence on choice were: availability of medicines and supplies (β = 0.842, p<0.001) and thorough examination of the child (β = 0.479, p <0.001) with WTP of MK3698.32 ($11) (95% CI: $8–$13) and MK2049.13 ($6) (95% CI: $3–$9) respectively. Respondents were willing to pay 1.8 and 2.4 times more for medicine availability over thorough examination and positive attitude of health workers respectively. Therefore, strengthening health service delivery system through investment in sustained availability of essential medicines and supplies, sufficient and competent health workforce with positive attitude and clinical discipline to undertake thorough examination, and reductions in waiting times have the potential to improve child healthcare utilization in the urban slums.
Collapse
Affiliation(s)
| | - Amarech Guda Obse
- Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Catherine Darker
- Department of Public Health & Primary Care, Trinity College Dublin, Dublin, Ireland
| | - Regien Biesma
- Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| |
Collapse
|
17
|
Brown L, Lee TH, De Allegri M, Rao K, Bridges JF. Applying stated-preference methods to improve health systems in sub-Saharan Africa: a systematic review. Expert Rev Pharmacoecon Outcomes Res 2017; 17:441-458. [PMID: 28875767 DOI: 10.1080/14737167.2017.1375854] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Sub-Saharan African health systems must balance shifting disease burdens with desires for robust institutions. Stated-preference methods have been applied extensively to elicit health care workers' preferences and priorities for rural practice. This systematic review characterizes the range of their applications to African health systems problems. Areas covered: A PRISMA protocol was submitted to PROSPERO. Six databases were queried for peer-reviewed articles using quantitative stated-preference methods to evaluate a health systems-related trade-off. Quality was assessed using the PREFS checklist. Seventy-seven articles published between 1996 and 2017 met review criteria. Methods were primarily choice-based: discrete-choice experiments (n = 46), ranking/allocation techniques (n = 21), conjoint analyses (n = 7), and best-worst scaling (n = 3). Trade-offs fell into six 'building blocks': service features (n = 27), workforce incentives (n = 17), product features (n = 14), system priorities (n = 14), insurance features (n = 4), and research priorities (n = 1). Five countries dominated: South Africa (n = 11), Ghana (n = 9), Malawi (n = 9), Uganda (n = 9), and Tanzania (n = 8). Discrete-choice experiments were of highest quality (mean score: 3.36/5). Expert commentary: Stated-preference methods have been applied to many health systems contexts throughout sub-Saharan Africa. Studies examined established strategic areas, especially primary health care for women, prevention and treatment of infectious diseases, and workforce development. Studies have neglected the emerging areas of non-communicable diseases.
Collapse
Affiliation(s)
- Lauren Brown
- a Department of International Health , The Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Ting-Hsuan Lee
- b Department of International Health/Department of Health Policy and Management , The Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Manuela De Allegri
- c Institute of Public Health, Faculty of Medicine , Heidelberg University , Heidelberg , Germany
| | - Krishna Rao
- a Department of International Health , The Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - John Fp Bridges
- b Department of International Health/Department of Health Policy and Management , The Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| |
Collapse
|
18
|
Olarinmoye AO, Ojo JF, Fasunla AJ, Ishola OO, Dakinah FG, Mulbah CK, Al-Hezaimi K, Olugasa BO. Time series analysis and mortality model of dog bite victims presented for treatment at a referral clinic for rabies exposure in Monrovia, Liberia, 2010-2013. Spat Spatiotemporal Epidemiol 2017; 22:1-13. [PMID: 28760263 DOI: 10.1016/j.sste.2017.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 03/24/2017] [Accepted: 04/07/2017] [Indexed: 11/26/2022]
Abstract
We developed time trend model, determined treatment outcome and estimated annual human deaths among dog bite victims (DBVs) from 2010 to 2013 in Monrovia, Liberia. Data obtained from clinic records included victim's age, gender and site of bite marks, site name of residence of rabies-exposed patients, promptness of care sought, initial treatment and post-exposure-prophylaxis (PEP) compliance. We computed DBV time-trend plot, seasonal index and year 2014 case forecast. Associated annual human death (AHD) was estimated using a standardized decision tree model. Of the 775 DBVs enlisted, care seeking time was within 24h of injury in 328 (42.32%) DBVs. Victim's residential location, site of bite mark, and time dependent variables were significantly associated with treatment outcome (p< 0.05). The equation X^t=28.278-0.365t models the trend of DBVs. The high (n=705, 90.97%) defaulted PEP and average 155 AHD from rabies implied urgent need for policy formulation on national programme for rabies prevention in Liberia.
Collapse
Affiliation(s)
- Ayodeji O Olarinmoye
- Department of Agriculture and Industrial Technology (Animal Science Unit), Faculty of Science and Technology, Babcock University, Ilisan-Remo, Ogun State, Nigeria; Centre for Control and Prevention of Zoonoses, University of Ibadan, Ibadan, Nigeria; Engineer Abdullah Bugshan Research Chair for Growth Factors and Bone Regeneration, King Saud University, Saudi Arabia
| | - Johnson F Ojo
- Centre for Control and Prevention of Zoonoses, University of Ibadan, Ibadan, Nigeria; Department of Statistics, Faculty of Science, University of Ibadan, Ibadan, Nigeria
| | - Ayotunde J Fasunla
- Centre for Control and Prevention of Zoonoses, University of Ibadan, Ibadan, Nigeria; Department of Otorhinolaryngology, College of Medicine, University of Ibadan, Nigeria
| | - Olayinka O Ishola
- Centre for Control and Prevention of Zoonoses, University of Ibadan, Ibadan, Nigeria; Department of Veterinary Public Health and Preventive Medicine, University of Ibadan, Ibadan, Nigeria
| | - Fahnboah G Dakinah
- Dog bite and Rabies Referral Clinic, 16th Street Sinkor, Barclay Avenue, Monrovia, Liberia
| | - Charles K Mulbah
- College of Agriculture and Sustainable Development, Cuttington University, Liberia
| | - Khalid Al-Hezaimi
- Engineer Abdullah Bugshan Research Chair for Growth Factors and Bone Regeneration, King Saud University, Saudi Arabia
| | - Babasola O Olugasa
- Centre for Control and Prevention of Zoonoses, University of Ibadan, Ibadan, Nigeria; Department of Veterinary Public Health and Preventive Medicine, University of Ibadan, Ibadan, Nigeria.
| |
Collapse
|
19
|
Shrime MG, Sekidde S, Linden A, Cohen JL, Weinstein MC, Salomon JA. Sustainable Development in Surgery: The Health, Poverty, and Equity Impacts of Charitable Surgery in Uganda. PLoS One 2016; 11:e0168867. [PMID: 28036357 PMCID: PMC5201287 DOI: 10.1371/journal.pone.0168867] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 12/06/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The recently adopted Sustainable Development Goals call for the end of poverty and the equitable provision of healthcare. These goals are often at odds, however: health seeking can lead to catastrophic spending, an outcome for which cancer patients and the poor in resource-limited settings are at particularly high risk. How various health policies affect the additional aims of financial wellbeing and equity is poorly understood. This paper evaluates the health, financial, and equity impacts of governmental and charitable policies for surgical oncology in a resource-limited setting. METHODS Three charitable platforms for surgical oncology delivery in Uganda were compared to six governmental policies aimed at improving healthcare access. An extended cost-effectiveness analysis using an agent-based simulation model examined the numbers of lives saved, catastrophic expenditure averted, impoverishment averted, costs, and the distribution of benefits across the wealth spectrum. FINDINGS Of the nine policies and platforms evaluated, two were able to provide simultaneous health and financial benefits efficiently and equitably: mobile surgical units and governmental policies that simultaneously address surgical scaleup, the cost of surgery, and the cost of transportation. Policies that only remove user fees are dominated, as is the commonly employed short-term "surgical mission trip". These results are robust to scenario and sensitivity analyses. INTERPRETATION The most common platforms for increasing access to surgical care appear unable to provide health and financial risk protection equitably. On the other hand, mobile surgical units, to date an underutilized delivery platform, are able to deliver surgical oncology in a manner that meets sustainable development goals by improving health, financial solvency, and equity. These platforms compare favorably with policies that holistically address surgical delivery and should be considered as countries strengthen health systems.
Collapse
Affiliation(s)
- Mark G. Shrime
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America
- Office of Global Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, United States of America
| | - Serufusa Sekidde
- Aspen Global Health and Development, Aspen Institute, Aspen, CO, United States of America
| | - Allison Linden
- Division of Pediatric Surgery, Children’s Hospital Los Angeles, Los Angeles, CA, United States of America
| | - Jessica L. Cohen
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Milton C. Weinstein
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Joshua A. Salomon
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| |
Collapse
|
20
|
Firestone R, Moorsmith R, James S, Urey M, Greifinger R, Lloyd D, Hartenberger-Toby L, Gausman J, Sanoe M. Intensive Group Learning and On-Site Services to Improve Sexual and Reproductive Health Among Young Adults in Liberia: A Randomized Evaluation of HealthyActions. GLOBAL HEALTH: SCIENCE AND PRACTICE 2016; 4:435-51. [PMID: 27688717 PMCID: PMC5042699 DOI: 10.9745/ghsp-d-16-00074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 06/30/2016] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Young Liberians, particularly undereducated young adults, face substantial sexual and reproductive health (SRH) challenges, with low uptake of contraceptive methods, high rates of unintended pregnancy, and low levels of knowledge about HIV status. The purpose of this study was to assess the impact of a 6-day intensive group learning intervention combined with on-site SRH services (called HealthyActions) among out-of-school young adults, implemented through an existing alternative education program, on uptake of contraception and HIV testing and counseling (HTC). METHODS The intervention was implemented among young women and men ages 15-35 who were enrolled in alternative basic education learning sites in 5 counties of Liberia. We conducted a randomized evaluation to assess program impact. Baseline data were collected in January-March 2014, and endline data in June-July 2014. Key outcomes of condom use, contraceptive use, and HTC were estimated with difference-in-difference models using fixed effects. All analyses were conducted in Stata 13. RESULTS We assessed outcomes for 1,157 learners at baseline and 1,052 learners at endline, across 29 treatment and 26 control sites. After adjusting for potential confounders, learners in the HealthyActions intervention group were 12% less likely to report never using a condom with a regular partner over the last month compared with the control group (P = .02). Female learners who received HealthyActions were 13% more likely to use any form of modern contraception compared with learners in control sites (P<.001), with the greatest increase in the use of contraceptive implants. Learners in HealthyActions sites were 45% more likely to have received HTC (P<.001). CONCLUSION Providing intensive group learning in a supportive environment coupled with on-site health services improved SRH outcomes among participating learners. The focus of HealthyActions on participatory learning for low-literacy populations presents an adaptable solution for health programming across Liberia and the region.
Collapse
Affiliation(s)
| | | | - Simon James
- Education Development Center, Inc., Washington, DC, USA
| | - Marilyn Urey
- Population Services International, Monrovia, Liberia
| | | | | | | | - Jewel Gausman
- Independent Consultant, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Musa Sanoe
- Education Development Center, Inc., Advancing Youth Project, Monrovia, Liberia
| |
Collapse
|
21
|
Larson E, Vail D, Mbaruku GM, Kimweri A, Freedman LP, Kruk ME. Moving Toward Patient-Centered Care in Africa: A Discrete Choice Experiment of Preferences for Delivery Care among 3,003 Tanzanian Women. PLoS One 2015; 10:e0135621. [PMID: 26262840 PMCID: PMC4532509 DOI: 10.1371/journal.pone.0135621] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 07/24/2015] [Indexed: 11/18/2022] Open
Abstract
Objective In order to develop patient-centered care we need to know what patients want and how changing socio-demographic factors shape their preferences. Methods We fielded a structured questionnaire that included a discrete choice experiment to investigate women’s preferences for place of delivery care in four rural districts of Pwani Region, Tanzania. The discrete choice experiment consisted of six attributes: kind treatment by the health worker, health worker medical knowledge, modern equipment and medicines, facility privacy, facility cleanliness, and cost of visit. Each woman received eight choice questions. The influence of potential supply- and demand- side factors on patient preferences was evaluated using mixed logit models. Results 3,003 women participated in the discrete choice experiment (93% response rate) completing 23,947 choice tasks. The greatest predictor of health facility preference was kind treatment by doctor (β = 1.13, p<0.001), followed by having a doctor with excellent medical knowledge (β = 0.89 p<0.001) and modern medical equipment and drugs (β = 0.66 p<0.001). Preferences for all attributes except kindness and cost were changed with changes to education, primiparity, media exposure and distance to nearest hospital. Conclusions Care quality, both technical and interpersonal, was more important than clinic inputs such as equipment and cleanliness. These results suggest that while basic clinic infrastructure is necessary, it is not sufficient for provision of high quality, patient-centered care. There is an urgent need to build an adequate, competent, and kind health workforce to raise facility delivery and promote patient-centered care.
Collapse
Affiliation(s)
- Elysia Larson
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, United States of America
- * E-mail:
| | - Daniel Vail
- Epidemiology Department, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | | | - Angela Kimweri
- Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania
| | - Lynn P. Freedman
- Averting Maternal Death and Disability Program, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Margaret E. Kruk
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, United States of America
| |
Collapse
|
22
|
Zickafoose JS, DeCamp LR, Prosser LA. Parents' preferences for enhanced access in the pediatric medical home: a discrete choice experiment. JAMA Pediatr 2015; 169:358-64. [PMID: 25643000 PMCID: PMC4545238 DOI: 10.1001/jamapediatrics.2014.3534] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Efforts to transform primary care through the medical home model may have limited effectiveness if they do not incorporate families' preferences for different primary care services. OBJECTIVE To assess parents' relative preferences for different categories of enhanced access services in primary care. DESIGN, SETTING, AND PARTICIPANTS Internet-based survey that took place with a national online panel from December 8, 2011, to December 22, 2011. Participants included 820 parents of children aged 0 to 17 years. Hispanic and black non-Hispanic parents were each oversampled to 20% of the sample. The survey included a discrete choice experiment with questions that asked parents to choose between hypothetical primary care practices with different levels of enhanced access and other primary care services. MAIN OUTCOMES AND MEASURES We estimated parents' relative preferences for different enhanced access services using travel time to the practice as a trade-off and parents' marginal willingness to travel in minutes for practices with different levels of services. RESULTS The response rate of parents who participated in the study was 41.2%. Parents were most likely to choose primary care offices that guaranteed same-day sick visits (coefficient, 0.57 [SE, 0.05]; P < .001) followed by those with higher professional continuity (coefficient, 0.36 [SE, 0.03]; P < .001). Parents were also significantly more likely to choose practices with 24-hour telephone advice plus nonurgent email advice (0.08 [0.04]; P < .05), evening hours 4 or more times a week (0.14 [0.04]; P < .001), and at least some hours on weekends. Parents were significantly less likely to choose practices that were closed during some weekday daytime hours or had wait times longer than 4 weeks for preventive care visits. There was very little variation in preferences among parents with different sociodemographic characteristics. Parents' marginal willingness to travel was 14 minutes (95% CI, 11-16 minutes) for guaranteed same-day sick visits and 44 minutes (95% CI, 37-51 minutes) for an office with idealized levels of all services. CONCLUSIONS AND RELEVANCE As primary care practices for children implement aspects of the medical home model, those that emphasize same-day sick care and professional continuity are more likely to meet parents' preferences for enhanced access. Practices should seek to engage families in prioritizing changes in practice services as part of medical home implementation.
Collapse
Affiliation(s)
- Joseph S. Zickafoose
- Mathematica Policy Research, Ann Arbor, Michigan3Child Health Evaluation and Research (CHEAR) Unit, Division of General Pediatrics, University of Michigan, Ann Arbor
| | - Lisa R. DeCamp
- Division of General Pediatrics, Johns Hopkins University, Baltimore, Maryland
| | - Lisa A. Prosser
- Child Health Evaluation and Research (CHEAR) Unit, Division of General Pediatrics, University of Michigan, Ann Arbor
| |
Collapse
|
23
|
Abiiro GA, Torbica A, Kwalamasa K, De Allegri M. Eliciting community preferences for complementary micro health insurance: a discrete choice experiment in rural Malawi. Soc Sci Med 2014; 120:160-8. [PMID: 25243642 DOI: 10.1016/j.socscimed.2014.09.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 08/23/2014] [Accepted: 09/09/2014] [Indexed: 10/24/2022]
Abstract
There is a limited understanding of preferences for micro health insurance (MHI) as a strategy for moving towards universal health coverage. Using a discrete choice experiment (DCE), we explored community preferences for the attributes and attribute-levels of a prospective MHI scheme, aimed at filling health coverage gaps in Malawi. Through a qualitative study informed by a literature review, we identified six MHI attributes (and attribute-levels): unit of enrollment, management structure, health service benefit package, copayment levels, transportation coverage, and monthly premium per person. Qualitative data was collected from 12 focus group discussions and 8 interviews in August-September, 2012. We constructed a D-efficient design of eighteen choice-sets, each comprising two MHI choice alternatives and an opt-out. Using pictorial images, trained interviewers administered the DCE in March-May, 2013, to 814 household heads and/or their spouse(s) in two rural districts. We estimated preferences for attribute-levels and relative importance of attributes using conditional and nested logit models. The results showed that all attribute-levels except management by external NGO significantly influenced respondents' choice behavior (P<0.05). These included: enrollment as core nuclear family (odds ratio (OR)=1.1574), extended family (OR=1.1132), compared to individual; management by community committee (OR=0.9494) compared to local micro finance institution; comprehensive health service package (OR=1.4621), medium service package (OR=1.2761), compared to basic service package; no copayment (OR=1.1347), 25% copayment (OR=1.1090), compared to 50% copayment; coverage of all transport (OR=1.5841), referral and emergency transport (OR=1.2610), compared to no transport; and premium (OR=0.9994). The relative importance of attributes is ordered as: transport, health services benefits, enrollment unit, premium, copayment, and management. To maximize consumer utility and encourage community acceptance of MHI, potential MHI schemes should cover transport costs, offer a comprehensive benefit package, define the core family as the unit of enrollment, avoid high copayments, and be managed by a competent financial institution.
Collapse
Affiliation(s)
- Gilbert Abotisem Abiiro
- Institute of Public Health, Medical Faculty, University of Heidelberg, Heidelberg, Germany; Department of Planning and Management, University for Development Studies, Wa, Ghana.
| | - Aleksandra Torbica
- Centre for Research on Health and Social Care Management - CERGAS, Department of Policy Analysis and Public Management, Bocconi University, Italy
| | - Kassim Kwalamasa
- Research for Equity and Community Health Trust (REACH Trust), Malawi
| | - Manuela De Allegri
- Institute of Public Health, Medical Faculty, University of Heidelberg, Heidelberg, Germany
| |
Collapse
|
24
|
Abiiro GA, Leppert G, Mbera GB, Robyn PJ, De Allegri M. Developing attributes and attribute-levels for a discrete choice experiment on micro health insurance in rural Malawi. BMC Health Serv Res 2014; 14:235. [PMID: 24884920 PMCID: PMC4032866 DOI: 10.1186/1472-6963-14-235] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 05/06/2014] [Indexed: 12/03/2022] Open
Abstract
Background Discrete choice experiments (DCEs) are attribute-driven experimental techniques used to elicit stakeholders’ preferences to support the design and implementation of policy interventions. The validity of a DCE, therefore, depends on the appropriate specification of the attributes and their levels. There have been recent calls for greater rigor in implementing and reporting on the processes of developing attributes and attribute-levels for discrete choice experiments (DCEs). This paper responds to such calls by carefully reporting a systematic process of developing micro health insurance attributes and attribute-levels for the design of a DCE in rural Malawi. Methods Conceptual attributes and attribute-levels were initially derived from a literature review which informed the design of qualitative data collection tools to identify context specific attributes and attribute-levels. Qualitative data was collected in August-September 2012 from 12 focus group discussions with community residents and 8 in-depth interviews with health workers. All participants were selected according to stratified purposive sampling. The material was tape-recorded, fully transcribed, and coded by three researchers to identify context-specific attributes and attribute-levels. Expert opinion was used to scale down the attributes and levels. A pilot study confirmed the appropriateness of the selected attributes and levels for a DCE. Results First, a consensus, emerging from an individual level analysis of the qualitative transcripts, identified 10 candidate attributes. Levels were assigned to all attributes based on data from transcripts and knowledge of the Malawian context, derived from literature. Second, through further discussions with experts, four attributes were discarded based on multiple criteria. The 6 remaining attributes were: premium level, unit of enrollment, management structure, health service benefit package, transportation coverage and copayment levels. A final step of revision and piloting confirmed that the retained attributes satisfied the credibility criteria of DCE attributes. Conclusion This detailed description makes our attribute development process transparent, and provides the reader with a basis to assess the rigor of this stage of constructing the DCE. This paper contributes empirical evidence to the limited methodological literature on attributes and levels development for DCE, thereby providing further empirical guidance on the matter, specifically within rural communities of low- and middle-income countries.
Collapse
|
25
|
Lagarde M, Pagaiya N, Tangcharoensathian V, Blaauw D. One size does not fit all: investigating doctors' stated preference heterogeneity for job incentives to inform policy in Thailand. HEALTH ECONOMICS 2013; 22:1452-69. [PMID: 23349119 DOI: 10.1002/hec.2897] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 10/29/2012] [Accepted: 11/29/2012] [Indexed: 05/26/2023]
Abstract
This study investigates heterogeneity in Thai doctors' job preferences at the beginning of their career, with a view to inform the design of effective policies to retain them in rural areas. A discrete choice experiment was designed and administered to 198 young doctors. We analysed the data using several specifications of a random parameter model to account for various sources of preference heterogeneity. By modelling preference heterogeneity, we showed how sensitivity to different incentives varied in different sections of the population. In particular, doctors from rural backgrounds were more sensitive than others to a 45% salary increase and having a post near their home province, but they were less sensitive to a reduction in the number of on-call nights. On the basis of the model results, the effects of two types of interventions were simulated: introducing various incentives and modifying the population structure. The results of the simulations provide multiple elements for consideration for policy-makers interested in designing effective interventions. They also underline the interest of modelling preference heterogeneity carefully.
Collapse
Affiliation(s)
- Mylene Lagarde
- London School of Hygiene and Tropical Medicine, Department of Global Health and Development, London, UK
| | | | | | | |
Collapse
|
26
|
Petit D, Sondorp E, Mayhew S, Roura M, Roberts B. Implementing a Basic Package of Health Services in post-conflict Liberia: Perceptions of key stakeholders. Soc Sci Med 2013; 78:42-9. [DOI: 10.1016/j.socscimed.2012.11.026] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2012] [Revised: 10/09/2012] [Accepted: 11/23/2012] [Indexed: 10/27/2022]
|
27
|
Depressive symptoms and posttraumatic stress disorder as determinants of preference weights for attributes of obstetric care among Ethiopian women. PLoS One 2012; 7:e46788. [PMID: 23071637 PMCID: PMC3468585 DOI: 10.1371/journal.pone.0046788] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 09/06/2012] [Indexed: 11/16/2022] Open
Abstract
Background Mental health, specifically mood/anxiety disorders, may be associated with value for health care attributes, but the association remains unclear. Examining the relation between mental health and attributes in a context where quality of care is low and exposure to suboptimal health conditions is increased, such as in Sub Saharan Africa (SSA), may elucidate the association. Methodology/Principal Findings We assessed whether preference weights for obstetric care attributes varied by mental health among 1006 women from Jimma Zone, Ethiopia, using estimates obtained through a discrete choice experiment (DCE), a method used to elicit preferences. Facilities were described by several attributes including provider attitude and performance and drug/equipment availability. Mental health measures included depressive symptoms and posttraumatic stress disorder (PTSD). We used Bayesian models to estimate preference weights for attributes and linear models to investigate whether these weights were associated with mental health. We found that women with high depressive symptoms valued a positive provider attitude [β = −0.43 (95% CI: −0.66, −0.21)] and drug/equipment availability [β = −0.43 (95% CI: −0.78, −0.07)] less compared to women without high depressive symptoms. Similar results were obtained for PTSD. Upon adjusting for both conditions, value for drug/equipment availability was lower only among women with both conditions [β = −0.89 (95% CI −1.4, −0.42)]. Conclusions/Significance We found that women with psychopathology had lower preference weights for positive provider attitude and drug/equipment availability. Further work investigating why value for obstetric care attributes might vary by psychopathology in SSA is needed.
Collapse
|
28
|
Lee PT, Kruse GR, Chan BT, Massaquoi MBF, Panjabi RR, Dahn BT, Gwenigale WT. An analysis of Liberia's 2007 national health policy: lessons for health systems strengthening and chronic disease care in poor, post-conflict countries. Global Health 2011; 7:37. [PMID: 21985150 PMCID: PMC3201890 DOI: 10.1186/1744-8603-7-37] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 10/10/2011] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Globally, chronic diseases are responsible for an enormous burden of deaths, disability, and economic loss, yet little is known about the optimal health sector response to chronic diseases in poor, post-conflict countries. Liberia's experience in strengthening health systems and health financing overall, and addressing HIV/AIDS and mental health in particular, provides a relevant case study for international stakeholders and policymakers in other poor, post-conflict countries seeking to understand and prioritize the global response to chronic diseases. METHODS We conducted a historical review of Liberia's post-conflict policies and their impact on general economic and health indicators, as well as on health systems strengthening and chronic disease care and treatment. Key sources included primary documents from Liberia's Ministry of Health and Social Welfare, published and gray literature, and personal communications from key stakeholders engaged in Liberia's Health Sector Reform. In this case study, we examine the early reconstruction of Liberia's health care system from the end of conflict in 2003 to the present time, highlight challenges and lessons learned from this initial experience, and describe future directions for health systems strengthening and chronic disease care and treatment in Liberia. RESULTS Six key lessons emerge from this analysis: (i) the 2007 National Health Policy's 'one size fits all' approach met aggregate planning targets but resulted in significant gaps and inefficiencies throughout the system; (ii) the innovative Health Sector Pool Fund proved to be an effective financing mechanism to recruit and align health actors with the 2007 National Health Policy; (iii) a substantial rural health delivery gap remains, but it could be bridged with a robust cadre of community health workers integrated into the primary health care system; (iv) effective strategies for HIV/AIDS care in other settings should be validated in Liberia and adapted for use in other chronic diseases; (v) mental health disorders are extremely prevalent in Liberia and should remain a top chronic disease priority; and (vi) better information systems and data management are needed at all levels of the health system. CONCLUSIONS The way forward for chronic diseases in Liberia will require an increased emphasis on quality over quantity, better data management to inform rational health sector planning, corrective mechanisms to more efficiently align health infrastructure and personnel with existing needs, and innovative methods to improve long-term retention in care and bridge the rural health delivery gap.
Collapse
Affiliation(s)
- Patrick T Lee
- Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, USA
- Harvard Medical School, 25 Shattuck Street, Boston, Massachusetts, USA
- Tiyatien Health, Hospital Road, Zwedru, Grand Gedeh County, Liberia
| | - Gina R Kruse
- Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, USA
- Harvard Medical School, 25 Shattuck Street, Boston, Massachusetts, USA
- Tiyatien Health, Hospital Road, Zwedru, Grand Gedeh County, Liberia
| | - Brian T Chan
- Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, USA
- Harvard Medical School, 25 Shattuck Street, Boston, Massachusetts, USA
- Tiyatien Health, Hospital Road, Zwedru, Grand Gedeh County, Liberia
| | - Moses BF Massaquoi
- Clinton Health Access Initiative, 383 Dorchester Avenue, Suite 400, Boston, Massachusetts, USA
- Ministry of Health and Social Welfare, Capital Bypass, Monrovia, Liberia
| | - Rajesh R Panjabi
- Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, USA
- Harvard Medical School, 25 Shattuck Street, Boston, Massachusetts, USA
- Tiyatien Health, Hospital Road, Zwedru, Grand Gedeh County, Liberia
| | - Bernice T Dahn
- Ministry of Health and Social Welfare, Capital Bypass, Monrovia, Liberia
| | - Walter T Gwenigale
- Ministry of Health and Social Welfare, Capital Bypass, Monrovia, Liberia
| |
Collapse
|