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Rao C, Bundhamcharoen K, Kelly M, Tangcharoensathien V. Mortality estimates for WHO SEAR countries: problems and prospects. BMJ Glob Health 2021; 6:bmjgh-2021-007177. [PMID: 34728480 PMCID: PMC8568533 DOI: 10.1136/bmjgh-2021-007177] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 09/30/2021] [Indexed: 12/11/2022] Open
Abstract
Cause-specific mortality estimates for 11 countries located in the WHO’s South East Asia Region (WHO SEAR) are generated periodically by the Global Burden of Disease (GBD) and the WHO Global Health Estimates (GHE) analyses. A comparison of GBD and GHE estimates for 2019 for 11 specific causes of epidemiological importance to South East Asia was undertaken. An index of relative difference (RD) between the estimated numbers of deaths by sex for each cause from the two sources for each country was calculated, and categorised as marginal (RD=±0%–9%), moderate (RD=±10%–19%), high (RD=±20%–39%) and extreme (RD>±40%). The comparison identified that the RD was >10% in two-thirds of all instances. The RD was ‘high’ or ‘extreme’ for deaths from tuberculosis, diarrhoea, road injuries and suicide for most SEAR countries, and for deaths from most of the 11 causes in Bangladesh, DPR Korea, Myanmar, Nepal and Sri Lanka. For all WHO SEAR countries, mortality estimates from both sources are based on statistical models developed from an international historical cause-specific mortality data series that included very limited empirical data from the region. Also, there is no scientific rationale available to justify the reliability of one set of estimates over the other. The characteristics of national mortality statistics systems for each WHO SEAR country were analysed, to understand the reasons for weaknesses in empirical data. The systems analysis identified specific limitations in structure, organisation and implementation that affect data completeness, validity of causes of death and vital statistics production, which vary across countries. Therefore, customised national strategies are required to strengthen mortality statistics systems to meet immediate and long-term data needs for health policy and research, and reduce dependence on current unreliable modelled estimates.
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Affiliation(s)
- Chalapati Rao
- Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | | | - Matthew Kelly
- Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
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Aftab W, Siddiqui FJ, Tasic H, Perveen S, Siddiqi S, Bhutta ZA. Implementation of health and health-related sustainable development goals: progress, challenges and opportunities - a systematic literature review. BMJ Glob Health 2021; 5:bmjgh-2019-002273. [PMID: 32847825 PMCID: PMC7451474 DOI: 10.1136/bmjgh-2019-002273] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 06/03/2020] [Accepted: 06/15/2020] [Indexed: 12/12/2022] Open
Abstract
Introduction While health is one of the Sustainable Development Goals (SDGs), many other ‘health-related’ goals comprise determinants of health. Integrated implementation across SDGs is needed for the achievement of Agenda 2030. While existing literature is rich in normative recommendations about potentially useful approaches, evidence of implementation strategies being adopted by countries is limited. Methods We conducted a systematic review with qualitative synthesis of findings using peer reviewed and grey literature from key databases. We included publications examining implementation of health and health-related SDGs (HHSDGs) at national or subnational level published between June 2013 and July 2019. Results Of the 32 included publications, 24 provided information at the national level while eight provided information for multiple countries or regions. Our findings indicate that high-level political commitment is evident in most countries and HHSDGs are being aligned with existing national development strategies and plans. A multisectoral, integrated approach is being adopted in institutional setups but evidence on effectiveness of these approaches is limited. Funding constraints are a major challenge for many countries. HHSDGs are generally being financed from within existing funded plans and, in some instances, through SDG-specific budgeting and tracking; additional funding is being mobilised by increasing domestic taxation and subsidisation, and by collaborating with development partners and private sector. Equity is being promoted by improving health service access through universal health coverage and social insurance schemes, especially for disadvantaged populations. Governments are collaborating with development partners and UN agencies for support in planning, institutional development and capacity building. However, evidence on equity promotion, capacity building initiatives and implementation approaches at subnational level is limited. Lack of coordination among various levels of government emerges as a key challenge. Conclusion strengthening implementation of multisectoral work, capacity building, financial sustainability and data availability are key considerations to accelerate implementation of HHSDGs.
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Affiliation(s)
- Wafa Aftab
- Department of Community Health Sciences, Aga Khan University, Karachi, Sindh, Pakistan
| | - Fahad Javaid Siddiqui
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada.,The Academia, Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Hana Tasic
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Shagufta Perveen
- Department of Community Health Sciences, Aga Khan University, Karachi, Sindh, Pakistan
| | - Sameen Siddiqi
- Department of Community Health Sciences, Aga Khan University, Karachi, Sindh, Pakistan
| | - Zulfiqar Ahmed Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada .,Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Sindh, Pakistan
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Rao C, Kelly M. Empiricism in non-communicable disease mortality measurement for the Asia-Pacific: lost in translation. BMJ Glob Health 2021; 5:bmjgh-2020-003626. [PMID: 33199279 PMCID: PMC7670854 DOI: 10.1136/bmjgh-2020-003626] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/09/2020] [Accepted: 10/13/2020] [Indexed: 11/25/2022] Open
Abstract
Control of non-communicable diseases (NCDs) is a key target for the United Nations Sustainable Development Goals (SDGs) for 2030. Available information indicates that countries in the Asia-Pacific Region accounted for 63% of the global NCD mortality burden in 2016. The United Nations Economic and Social Commission for the Asia Pacific (UNESCAP) Regional SDG progress report for 2020 included estimates of trends in NCD mortality rates from 2000 to 2016, which showed considerable variation in national NCD mortality by sex and location. However, while the UNESCAP report states that there was sufficient primary data to derive these NCD mortality estimates for all countries, the critical gaps in availability of national data on causes of death in the Asia-Pacific region are well known. A closer review identified that the UNESCAP obtained these estimates from the United Nations Statistics Division, which in turn obtained the same estimates from WHO. Further analysis revealed that these organisations used varying and often inconsistent terms to describe estimation methodology as well as primary data availability for different countries, with substantial potential for misinterpretation. The analysis also found that for countries without primary data, WHO reported NCD mortality estimates were based on complex epidemiological models developed for the Global Burden of Disease (GBD) Study, and this contradicts the UNESCAP rating of primary data sufficiency. The GBD Study also derives modelled cause of death estimates for countries with national data, but these were different from WHO estimates for these countries. This article discusses prevailing international practices in using modelled estimates as a substitute for empirical data, and the implications of these practices for health policy. In conclusion, a strategic approach to strengthen national mortality statistics programmes in data deficient countries is presented, to improve NCD mortality measurement in the Asia-Pacific Region.
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Affiliation(s)
- Chalapati Rao
- Department of Global Health, Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Matthew Kelly
- Department of Global Health, Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
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Assessment of Progress towards Achieving Sustainable Development Goals of the “Agenda 2030” by Using the CoCoSo and the Shannon Entropy Methods: The Case of the EU Countries. SUSTAINABILITY 2020. [DOI: 10.3390/su12145717] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The United Nations Member States adopted the “Agenda 2030” which contains 17 sustainable development goals (SDG) that involve a certain number of targets and indicators. Although the indicators are helpful in defining the position of the current country relative to the goals’ achievement, it is very complex to determine its position relative to other countries, because this requires an extensive analysis. Therefore, in this paper, the application of the multiple-criteria decision-making approach (MCDM) in defining the position of the EU (Europe Union) countries relative to the SDGs is proposed. The MCDM model is based on the Combined Compromise Solution (CoCoSo) and the Shannon Entropy methods. The final results highlight Sweden as the country that best implemented the set SD goals and has the best outputs relative to them, while Romania is in last place. The main reason for these kinds of results could be that the countries on the bottom of the list are relatively new EU members and have not been made to properly implement SDGs yet. The conclusion is that the obtained results are fully objective and rational, and that the applied model is applicable for performing this kind of analysis.
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AbouZahr C, Boerma T, Byass P. Bridging the data gaps: do we have the right balance between country data and global estimates? Glob Health Action 2018; 10:1299978. [PMID: 28532310 PMCID: PMC5645668 DOI: 10.1080/16549716.2017.1299978] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
| | - Ties Boerma
- b Department of Information, Evidence and Research , WHO , Geneva , Switzerland.,c Department of Community Health Sciences , University of Manitoba , Winnipeg , Canada
| | - Peter Byass
- d Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden.,e School of Public Health , University of the Witwatersrand , Johannesburg , South Africa.,f Institute of Applied Health Sciences , University of Aberdeen , Aberdeen , UK
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Manyazewal T. Using the World Health Organization health system building blocks through survey of healthcare professionals to determine the performance of public healthcare facilities. ACTA ACUST UNITED AC 2017; 75:50. [PMID: 29075485 PMCID: PMC5651704 DOI: 10.1186/s13690-017-0221-9] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 07/12/2017] [Indexed: 01/01/2023]
Abstract
Background Acknowledging the health system strengthening agenda, the World Health Organization (WHO) has formulated a health systems framework that describes health systems in terms of six building blocks. This study aimed to determine the current status of the six WHO health system building blocks in public healthcare facilities in Ethiopia. Methods A quantitative, cross-sectional study was conducted in five public hospitals in central Ethiopia which were in a post-reform period. A self-administered, structured questionnaire which covered the WHO’s six health system building blocks was used to collect data on healthcare professionals who consented. Data was analyzed using IBM SPSS version 20. Results The overall performance of the public hospitals was 60% when weighed against the WHO building blocks which, in this procedure, needed a minimum of 80% score. For each building block, performance scores were: information 53%, health workforce 55%, medical products and technologies 58%, leadership and governance 61%, healthcare financing 62%, and service delivery 69%. There existed a significant difference in performance among the hospitals (p < .001). Conclusion The study proved that the WHO’s health system building blocks are useful for assessing the process of strengthening health systems in Ethiopia. The six blocks allow identifying different improvement opportunities in each one of the hospitals. There was no contradiction between the indicators of the WHO building blocks and the health sustainable development goal (SDG) objectives. However, such SDG objectives should not be a substitute for strategies to strengthen health systems.
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Affiliation(s)
- Tsegahun Manyazewal
- Department of Health Studies, College of Human Science, University of South Africa, Pretoria, P.O. BOX 392 South Africa
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AbouZahr C, Boerma T, Hogan D. Global estimates of country health indicators: useful, unnecessary, inevitable? Glob Health Action 2017; 10:1290370. [PMID: 28532307 PMCID: PMC5645718 DOI: 10.1080/16549716.2017.1290370] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 01/12/2017] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The MDG era relied on global health estimates to fill data gaps and ensure temporal and cross-country comparability in reporting progress. Monitoring the Sustainable Development Goals will present new challenges, requiring enhanced capacities to generate, analyse, interpret and use country produced data. OBJECTIVE To summarize the development of global health estimates and discuss their utility and limitations from global and country perspectives. DESIGN Descriptive paper based on findings of intercountry workshops, reviews of literatureon and synthesis of experiences. RESULTS Producers of global health estimates focus on the technical soundness of estimation methods and comparability of the results across countries and over time. By contrast, country users are more concerned about the extent of their involvement in the estimation process and hesitate to buy into estimates derived using methods their technical staff cannot explain and that differ from national data sources. Quantitative summaries of uncertainty may be of limited practical use in policy discussions where decisions need to be made about what to do next. CONCLUSIONS Greater transparency and involvement of country partners in the development of global estimates will help improve ownership, strengthen country capacities for data production and use, and reduce reliance on externally produced estimates.
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Affiliation(s)
| | - Ties Boerma
- Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland
| | - Daniel Hogan
- Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland
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