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Al-Abdulla O, Sonsuz AA, Alaref M, Albakor B, Kauhanen J. The impact of humanitarian aid on financial toxicity among cancer patients in Northwest Syria. BMC Health Serv Res 2024; 24:641. [PMID: 38762456 PMCID: PMC11102167 DOI: 10.1186/s12913-024-11077-x] [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: 02/18/2024] [Accepted: 05/03/2024] [Indexed: 05/20/2024] Open
Abstract
INTRODUCTION The ongoing crisis in Syria has divided the country, leading to significant deterioration of the healthcare infrastructure and leaving millions of people struggling with poor socioeconomic conditions. Consequently, the affordability of healthcare services for the population has been compromised. Cancer patients in Northwest Syria have faced difficulties in accessing healthcare services, which increased their financial distress despite the existence of humanitarian health and aid programs. This study aimed to provide insights into how humanitarian assistance can alleviate the financial burdens associated with cancer treatment in conflict-affected regions. MATERIALS AND METHODS This research employed a quantitative, quasi-experimental design with a pre-test-post-test approach, focusing on evaluating the financial toxicity among cancer patients in Northwest Syria before and after receiving humanitarian aid. The study used purposeful sampling to select participants and included comprehensive demographic data collection. The primary tool for measuring financial toxicity was the Comprehensive Score for Financial Toxicity (FACIT-COST) tool, administered in Arabic. Data analysis was conducted using SPSS v25, employing various statistical tests to explore relationships and impacts. RESULTS A total of 99 cancer patients were recruited in the first round of data collection, out of whom 28 patients affirmed consistent receipt of humanitarian aid throughout the follow-up period. The results of the study revealed that humanitarian aid has no significant relationship with reducing the financial toxicity experienced by cancer patients in Northwest Syria. Despite the aid efforts, many patients continued to face significant financial distress. CONCLUSION The research findings indicate that current humanitarian assistance models might not sufficiently address the complex financial challenges faced by cancer patients in conflict zones. The research emphasizes the need for a more comprehensive and integrated approach in humanitarian aid programs. The study highlights the importance of addressing the economic burdens associated with cancer care in conflict settings and calls for a re-evaluation of aid delivery models to better serve the needs of chronic disease patients. The findings suggest a need for multi-sectoral collaboration and a systemic approach to improve the overall effectiveness of humanitarian assistance in such contexts.
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Affiliation(s)
- Orwa Al-Abdulla
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, The University of Eastern Finland, P.O. Box 1627, Kuopio, 70211, Finland.
- Strategic Research Center (Öz SRC), Incili Pinar MAH, Gazi Muhtar Paşa BUL, Doktorlar Sitesi, 38E, 104. Sehitkamil, 27090, Gaziantep, Türkiye.
| | - Aliye Aslı Sonsuz
- Health Science Institute, Istanbul Medipol University, Beykoz, İstanbul, Türkiye
| | - Maher Alaref
- Strategic Research Center (Öz SRC), Incili Pinar MAH, Gazi Muhtar Paşa BUL, Doktorlar Sitesi, 38E, 104. Sehitkamil, 27090, Gaziantep, Türkiye
| | - Bakor Albakor
- Health Science Institute, Istanbul Medipol University, Beykoz, İstanbul, Türkiye
| | - Jussi Kauhanen
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, The University of Eastern Finland, P.O. Box 1627, Kuopio, 70211, Finland
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Vijayasingham L, Ansbro É, Zmeter C, Abbas LA, Schmid B, Sanga L, Larsen LB, Perone SA, Perel P. Implementing and evaluating integrated care models for non-communicable diseases in fragile and humanitarian settings. J Migr Health 2024; 9:100228. [PMID: 38577626 PMCID: PMC10992697 DOI: 10.1016/j.jmh.2024.100228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 03/08/2024] [Accepted: 03/26/2024] [Indexed: 04/06/2024] Open
Abstract
In this commentary, we advocate for the wider implementation of integrated care models for NCDs within humanitarian preparedness, response, and resilience efforts. Since experience and evidence on integrated NCD care in humanitarian settings is limited, we discuss potential benefits, key lessons learned from other settings, and lessons from the integration of other conditions that may be useful for stakeholders considering an integrated model of NCD care. We also introduce our ongoing project in North Lebanon as a case example currently undergoing parallel tracks of program implementation and process evaluation that aims to strengthen the evidence base on implementing an integrated NCD care model in a crisis setting.
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Affiliation(s)
- Lavanya Vijayasingham
- NCD in Humanitarian Settings Group, Department of Epidemiology and Population Health & Centre for Global Chronic Conditions, London School of Hygiene & Tropical Medicine, United Kingdom
| | - Éimhín Ansbro
- NCD in Humanitarian Settings Group, Department of Epidemiology and Population Health & Centre for Global Chronic Conditions, London School of Hygiene & Tropical Medicine, United Kingdom
| | - Carla Zmeter
- Beirut Delegation, International Committee for the Red Cross (ICRC) Beirut, Lebanon
| | - Linda Abou Abbas
- Beirut Delegation, International Committee for the Red Cross (ICRC) Beirut, Lebanon
| | - Benjamin Schmid
- NCD in Humanitarian Settings Group, Department of Epidemiology and Population Health & Centre for Global Chronic Conditions, London School of Hygiene & Tropical Medicine, United Kingdom
| | - Leah Sanga
- NCD in Humanitarian Settings Group, Department of Epidemiology and Population Health & Centre for Global Chronic Conditions, London School of Hygiene & Tropical Medicine, United Kingdom
| | | | - Sigiriya Aebischer Perone
- International Committee for the Red Cross (ICRC), Geneva, Switzerland
- Geneva University Hospitals, Geneva, Switzerland
| | - Pablo Perel
- NCD in Humanitarian Settings Group, Department of Epidemiology and Population Health & Centre for Global Chronic Conditions, London School of Hygiene & Tropical Medicine, United Kingdom
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Tafesse W, Jemutai J, Mayora C, Margini F. Scoping Review of Health Economics Research on Refugee Health in Sub-Saharan Africa. Value Health Reg Issues 2024; 39:98-106. [PMID: 38064761 DOI: 10.1016/j.vhri.2023.10.008] [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: 02/12/2023] [Revised: 09/15/2023] [Accepted: 10/27/2023] [Indexed: 01/15/2024]
Abstract
OBJECTIVES Most refugees and internally displaced people (IDP) stay in low- and middle-income settings. A substantial proportion are hosted by countries in sub-Saharan African (SSA), which puts significant pressure on limited government healthcare budgets. As health economics may guide more optimal healthcare decision making, we scope the health economics literature on forcibly displaced populations in SSA to identify the nature and range of health economics evidence. METHODS We conducted a scoping review of peer-reviewed and gray literature in English published from 2000 to 2021. Our search terms comprised a combination of keywords related to refugees, SSA, and health economics. We followed a stepwise methodology consisting of the identification and selection of studies, extraction and charting of data. RESULTS We identified 29 health economics studies on refugees and IDPs in SSA covering different providers, interventions, and delivery platforms. Twenty-one articles studied the determinants of health, followed by 5 on the supply of healthcare and 2 concerned with economic evaluation and the demand for healthcare, respectively. We found an equal division of articles focusing on refugees and IDPs, as well as by settlement type. Mental health was the most frequently studied health area and Uganda was the most studied destination country. CONCLUSIONS The health economics literature on refugees in SSA remains limited. Our scoping review encourages future research to study a larger variety of healthcare systems and health economic topics such as economic evaluations, health financing and whole health systems to support resource allocation decisions and sustainable long-term solutions.
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Affiliation(s)
- Wiktoria Tafesse
- Centre for Health Economics, University of York, York, England, UK.
| | | | - Chrispus Mayora
- Department of Health Policy Planning and Management, School of Public Health, Makerere University, Central Region, Kampala, Uganda
| | - Federica Margini
- UNICEF Tanzania Country Office, Kinondoni, Dar es Salaam, Tanzania
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Antonio Buendía J, Patiño DG. Fluticasone furoate plus vilanterol in patients with moderate persistent asthma: a cost-utility analysis. J Asthma 2023; 60:377-384. [PMID: 35261332 DOI: 10.1080/02770903.2022.2051547] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND In recent years, the combination of fluticasone furoate and vilanterol (FF/VI) has emerged as an alternative therapy, since it is administered every 24 h, in contrast to other ICS/LABAs such as fluticasone propionate plus salmeterol (FP/Salm), which requires administration every 12 h. Concerns have arisen over whether the benefit generated by FF/VI justifies the additional costs it involves over FP/Salm. This study aimed at assessing the health and economic consequences of FF/VI in patients with moderate-severe persistent asthma. METHODS A probabilistic Markov model was created to estimate the cost and quality-adjusted life-years (QALYs) of patients with persistent asthma. Total costs and QALYs for FF/VI and FP/Salm were calculated over a lifetime horizon. Multiple sensitivity analyses were conducted. Cost-effectiveness was evaluated at a willingness-to-pay value of $19,000. RESULTS We estimated a gain of 16.8 and 10.7 QALYs per patient per year on FF/VI and FP/Salm, respectively. At the same time, we observed a difference of US$216 in total discounted cost per person-year on FF/VI with respect to FP/Salm. The incremental cost-effectiveness ratio (ICER) of FF/VI was USD $70 per QALY with respect to FP/Salm. In the deterministic and probabilistic sensitivity analyses, our base-case results were robust to variations in all assumptions and parameters. CONCLUSION FF/VI is more cost-effective than FP/Salm. The evidence supports using FF/VI therapy in Colombia, and the study should be replicated in other middle-income countries.
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Affiliation(s)
- Jefferson Antonio Buendía
- Research Group in Pharmacology and Toxicology "INFARTO", Department of Pharmacology and Toxicology, University of Antioquia, Medellín, Colombia
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Kehlenbrink S, Ansbro É, Besançon S, Hassan S, Roberts B, Jobanputra K. Strengthening Diabetes Care in Humanitarian Crises in Low- and Middle-income Settings. J Clin Endocrinol Metab 2022; 107:e3553-e3561. [PMID: 35639997 DOI: 10.1210/clinem/dgac331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Indexed: 11/19/2022]
Abstract
Amid the growing global diabetes epidemic, the scale of forced displacement resulting from armed conflict and humanitarian crises is at record-high levels. More than 80% of the displaced population lives in lower- and middle-income countries, which also host 81% of the global population living with diabetes. Most crises are protracted, often lasting decades, and humanitarian aid organizations are providing long-term primary care to both the local and displaced populations. Humanitarian crises are extremely varied in nature and occur in contexts that are diverse and dynamic. The scope of providing diabetes care varies depending on the phase of the crisis. This paper describes key challenges and possible solutions to improving diabetes care in crisis settings. It focuses on (1) ensuring a reliable supply of life preserving medications and diagnostics, (2) restoring and maintaining access to health care, and (3) adapting service design to the context. These challenges are illustrated through case studies in Ukraine, Mali, the Central African Republic, and Jordan.
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Affiliation(s)
- Sylvia Kehlenbrink
- Brigham and Women's Hospital, Boston, MA 02115, USA
- Harvard Humanitarian Initiative, Cambridge, MA 02138, USA
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Éimhín Ansbro
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, WC1H 9SH, UK
| | | | - Saria Hassan
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, 30322,USA
- Emory Rollins School of Public Health, Atlanta, GA, 30322, USA
| | - Bayard Roberts
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, WC1H 9SH, UK
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Biddle L, Wahedi K, Bozorgmehr K. Comparable worth of life for all? Conducting and disseminating health economic evaluations for refugees in Germany. Global Health 2022; 18:48. [PMID: 35550577 PMCID: PMC9096763 DOI: 10.1186/s12992-022-00845-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 05/04/2022] [Indexed: 11/25/2022] Open
Abstract
Comparative health economic evaluation is based on premise of being able to compare the worth of a year of life lived in full quality across different patients, population groups, settings and interventions. Given the rising numbers of forcibly displaced people, the nexus of economics, migration and health has emerged as a central theme in recent conceptual and empirical approaches. However, some of the assumptions made in conventional economic approaches do not hold true in the decision-making context of migration and the health of forcibly displaced populations. Using the experience of conducting and disseminating economic analyses to support decision-making on health screening policies for refugees in Germany, we show that in particular the assumptions of individual utility with no positive externalities, equity-blind utilitarian ethical stances and stable budgets are challenged. The further development of methods to address these challenges are required to support decision-makers in this contentious and politically fraught context and continue to make choices and decisions transparent.
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Affiliation(s)
- Louise Biddle
- Section for Health Equity Studies and Migration, Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany.,Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Katharina Wahedi
- Section for Health Equity Studies and Migration, Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Kayvan Bozorgmehr
- Section for Health Equity Studies and Migration, Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany. .,Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany.
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Baek Y, Ademi Z, Paudel S, Fisher J, Tran T, Romero L, Owen A. Economic Evaluations of Child Nutrition Interventions in Low- and Middle-Income Countries: Systematic Review and Quality Appraisal. Adv Nutr 2021; 13:282-317. [PMID: 34510178 PMCID: PMC8803532 DOI: 10.1093/advances/nmab097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 05/24/2021] [Accepted: 07/27/2021] [Indexed: 11/12/2022] Open
Abstract
Economic evaluation is crucial for cost-effective resource allocation to improve child nutrition in low and middle-income countries (LMICs). However, the quality of published economic evaluations in these settings is not well understood. This systematic review aimed to assess the quality of existing economic evaluations of child nutrition interventions in LMICs and synthesize the study characteristics and economic evidence. We searched 9 electronic databases, including MEDLINE, with the following concepts: economic evaluation, children, nutrition, and LMICs. All types of interventions addressing malnutrition, including stunting, wasting, micronutrient deficiency, and overweight, were identified. We included economic evaluations that examined both costs and effects published in English peer-reviewed journals and used the Drummond checklist for quality appraisal. We present findings through a narrative synthesis. Sixty-nine studies with diverse settings, perspectives, time horizons, and outcome measures were included. Most studies used data from sub-Saharan Africa and South Asia and addressed undernutrition. The mortality rate, intervention effect, intervention coverage, cost, and discount rate were reported as predictors among studies that performed sensitivity analyses. Despite the heterogeneity of included studies and the possibility of publication bias, 81% of included studies concluded that nutrition interventions were cost-effective or cost-beneficial, mostly based on a country's cost-effectiveness thresholds. Regarding quality assessment, the studies published after 2016 met more criteria than studies published before 2016. Most studies had well-stated research questions, forms of economic evaluation, interventions, and conclusions. However, reporting the perspective of the analyses, justification of discount rates, and describing the role of funders and ethics approval were identified as areas needing improvement. The gaps in the quality of reporting could be improved by consolidated guidance on the publication of economic evaluations and the use of appropriate quality appraisal checklists. Strengthening the evidence base for child malnutrition across different regions is necessary to inform cost-effective investment in LMICs. Trial registration: PROSPERO CRD42020194445.
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Affiliation(s)
- Yeji Baek
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Zanfina Ademi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Susan Paudel
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jane Fisher
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Thach Tran
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Ansbro É, Garry S, Karir V, Reddy A, Jobanputra K, Fardous T, Sadique Z. Delivering a primary-level non-communicable disease programme for Syrian refugees and the host population in Jordan: a descriptive costing study. Health Policy Plan 2021; 35:931-940. [PMID: 32621490 PMCID: PMC8312704 DOI: 10.1093/heapol/czaa050] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The Syrian conflict has caused enormous displacement of a population with a high
non-communicable disease (NCD) burden into surrounding countries, overwhelming health
systems’ NCD care capacity. Médecins sans Frontières (MSF) developed a primary-level NCD
programme, serving Syrian refugees and the host population in Irbid, Jordan, to assist the
response. Cost data, which are currently lacking, may support programme adaptation and
system scale up of such NCD services. This descriptive costing study from the provider
perspective explored financial costs of the MSF NCD programme. We estimated annual total,
per patient and per consultation costs for 2015–17 using a combined ingredients-based and
step-down allocation approach. Data were collected via programme budgets, facility
records, direct observation and informal interviews. Scenario analyses explored the impact
of varying procurement processes, consultation frequency and task sharing. Total annual
programme cost ranged from 4 to 6 million International Dollars (INT$), increasing
annually from INT$4 206 481 (2015) to INT$6 739 438 (2017), with costs driven mainly by
human resources and drugs. Per patient per year cost increased 23% from INT$1424 (2015) to
1751 (2016), and by 9% to 1904 (2017), while cost per consultation increased from INT$209
to 253 (2015–17). Annual cost increases reflected growing patient load and increasing
service complexity throughout 2015–17. A scenario importing all medications cut total
costs by 31%, while negotiating importation of high-cost items offered 13% savings.
Leveraging pooled procurement for local purchasing could save 20%. Staff costs were more
sensitive to reducing clinical review frequency than to task sharing review to nurses.
Over 1000 extra patients could be enrolled without additional staffing cost if care
delivery was restructured. Total costs significantly exceeded costs reported for NCD care
in low-income humanitarian contexts. Efficiencies gained by revising procurement and/or
restructuring consultation models could confer cost savings or facilitate cohort
expansion. Cost effectiveness studies of adapted models are recommended.
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Affiliation(s)
- Éimhín Ansbro
- Centre for Global Chronic Conditions, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Sylvia Garry
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Veena Karir
- Médecins sans Frontières, Plantage Middenlaan 14 1018 DD Amsterdam, The Netherlands
| | - Amulya Reddy
- Médecins Sans Frontières, Lower Ground Floor, Chancery Exchange, 10 Furnival Street, London EC4A 1AB, UK
| | - Kiran Jobanputra
- Médecins Sans Frontières, Lower Ground Floor, Chancery Exchange, 10 Furnival Street, London EC4A 1AB, UK
| | - Taissir Fardous
- Health Economy Directorate, Ministry of Health, Pr. Hamzah St., Amman, Jordan
| | - Zia Sadique
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
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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.
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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
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Garry S, Abdelmagid N, Baxter L, Roberts N, le Polain de Waroux O, Ismail S, Ratnayake R, Favas C, Lewis E, Checchi F. Considerations for planning COVID-19 treatment services in humanitarian responses. Confl Health 2020; 14:80. [PMID: 33250932 PMCID: PMC7686825 DOI: 10.1186/s13031-020-00325-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 11/10/2020] [Indexed: 12/20/2022] Open
Abstract
The COVID-19 pandemic has the potential to cause high morbidity and mortality in crisis-affected populations. Delivering COVID-19 treatment services in crisis settings will likely entail complex trade-offs between offering services of clinical benefit and minimising risks of nosocomial infection, while allocating resources appropriately and safeguarding other essential services. This paper outlines considerations for humanitarian actors planning COVID-19 treatment services where vaccination is not yet widely available. We suggest key decision-making considerations: allocation of resources to COVID-19 treatment services and the design of clinical services should be based on community preferences, likely opportunity costs, and a clearly articulated package of care across different health system levels. Moreover, appropriate service planning requires information on the expected COVID-19 burden and the resilience of the health system. We explore COVID-19 treatment service options at the patient level (diagnosis, management, location and level of treatment) and measures to reduce nosocomial transmission (cohorting patients, protecting healthcare workers). Lastly, we propose key indicators for monitoring COVID-19 health services.
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Affiliation(s)
- Sylvia Garry
- Health in Humanitarian Crises Centre, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Nada Abdelmagid
- Health in Humanitarian Crises Centre, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Louisa Baxter
- Save the Children UK, 1 St John's Ln, Farringdon, London, EC1M 4AR UK
| | - Natalie Roberts
- Centre de réflexion sur l'action et les savoirs humanitaires (CRASH), Fondation MSF (Médecins Sans Frontières), 13-34 avenue Jean Jaurès, 75019 Paris, France
| | - Olivier le Polain de Waroux
- Health in Humanitarian Crises Centre, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK.,UK Public Health Rapid Support Team (UK-PHRST), London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Sharif Ismail
- Department of Global Health and Development, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Ruwan Ratnayake
- Health in Humanitarian Crises Centre, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Caroline Favas
- Health in Humanitarian Crises Centre, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Elizabeth Lewis
- Health in Humanitarian Crises Centre, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Francesco Checchi
- Health in Humanitarian Crises Centre, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
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