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Hehakaya C, Frederix G, van der Voort van Zyp J, Grobbee D, Verkooijen H. Realizing the value of complex medical technology: Demonstrating cost-effectiveness is not enough. Clin Transl Radiat Oncol 2023; 41:100644. [PMID: 37304169 PMCID: PMC10248500 DOI: 10.1016/j.ctro.2023.100644] [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: 05/18/2023] [Accepted: 05/29/2023] [Indexed: 06/13/2023] Open
Abstract
The main factors driving the value of medical treatments are proven effectiveness and cost-effectiveness. This is different for complex medical technologies that combine scientific disciplines, functions or tools in a single solution-oriented method. This short communication provides three recommendations to realize the value of complex medical technologies. It is important to engage stakeholders before technology implementation to promote its relevance from multiple perspectives, to explore opportunities for professional development and collaboration, and to demonstrate the societal effects over the entire life-cycle.
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Affiliation(s)
- C. Hehakaya
- Global Public Health & Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - G.W.J. Frederix
- Health Economic Evaluation, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - D.E. Grobbee
- Global Public Health & Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Division of Imaging & Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - H.M. Verkooijen
- Division of Imaging & Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
- Utrecht University, The Netherlands
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Teshome GB, Whiting SJ, Green TJ, Mulualem D, Henry CJ. Scaled-up nutrition education on pulse-cereal complementary food practice in Ethiopia: a cluster-randomized trial. BMC Public Health 2020; 20:1437. [PMID: 32962685 PMCID: PMC7507676 DOI: 10.1186/s12889-020-09262-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 07/14/2020] [Indexed: 11/13/2022] Open
Abstract
Background Improving children’s weight status through nutrition education (NE) for mothers about using pulses in complementary feeding has been demonstrated in pilot studies, but no effect on stunting was reported. The aim of the study was to assess the impact of a 9-month pulse-nutrition education program on improving mothers’ knowledge, attitude, and practices (KAP) towards pulses, as well as its effect on children’s diet diversity, and nutritional status. The NE was delivered by Health Extension Workers (HEWs). Methods A cluster randomized study was employed for the community-based interventional study. Twelve randomly selected villages in Sidama Zone, Southern Ethiopia were included in the study. A total of 772 mother-child pairs involved in the study; where 386 mother-child pairs in the intervention group received additional messages about pulse-cereal complementary food, and 386 pairs (the control) received only routine health education for 9 months. A survey on mothers’ KAP and anthropometric measurements of the children were taken at baseline, midpoint, and end point. ANOVA and descriptive statistics were used to analyzed data. Results At baseline and end point, maternal KAP and the dietary diversity score of the children (mean age at end point 18.8 ± 2.9 mo) were assessed. Intervention mothers’ KAP improved (p < 0.001) at midpoint and end point compared to that of the control group, as did frequency of pulse consumption and Dietary Diversity Score (DDS) among children. At 9 months, the prevalence of stunting, wasting, and underweight was significantly reduced in the intervention group compared to the control group (p = 0.001). Conclusions NE delivered by HEWs improved KAP of mothers regarding pulse consumption and dietary diversity of children led to improved nutritional status of the children. Training HEWs on the use of pulses for complementary food may be an effective way to improve the health of children in Ethiopian communities. Trial registration Clinicaltrials.gov #NCT02638571. Date of registration: 12/18/2015. Prospectively registered.
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Affiliation(s)
| | - Susan J Whiting
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada
| | | | - Demmelash Mulualem
- School of Nutrition, Food Science and Technology, Hawassa University, Hawassa, Ethiopia
| | - Carol J Henry
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada
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Clark LF. Policy conflicts in global food assistance strategies: balancing local procurement and harmonization. Food Secur 2018. [DOI: 10.1007/s12571-017-0758-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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McDermott J, Wyatt AJ. The role of pulses in sustainable and healthy food systems. Ann N Y Acad Sci 2017; 1392:30-42. [DOI: 10.1111/nyas.13319] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 01/13/2017] [Accepted: 01/19/2017] [Indexed: 12/21/2022]
Affiliation(s)
- John McDermott
- International Food Policy Research Institute (IFPRI); Washington DC
| | - Amanda J. Wyatt
- International Food Policy Research Institute (IFPRI); Washington DC
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McDermott J, Johnson N, Kadiyala S, Kennedy G, Wyatt AJ. Agricultural research for nutrition outcomes – rethinking the agenda. Food Secur 2015. [DOI: 10.1007/s12571-015-0462-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Dubé L, Webb P, Arora NK, Pingali P. Agriculture, health, and wealth convergence: bridging traditional food systems and modern agribusiness solutions. Ann N Y Acad Sci 2015; 1331:1-14. [PMID: 25514864 DOI: 10.1111/nyas.12602] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The causes of many vexing challenges facing 21st-century society are at the nexus of systems involved in agriculture, health and wealth production, consumption, and distribution. Using food as a test bed, and on the basis of emerging roadmaps that set achievable objectives over a 1- to 3-year horizon, we introduce this special feature with convergence thinking and practice at its core. Specifically, we discuss academic papers structured around four themes: (1) evidence for a need for convergence and underlying mechanisms at the individual and societal levels; (2) strategy for mainstreaming convergence as a driver of business engagement and innovation; (3) convergence in policy and governance; (4) convergence in metrics and methods. Academic papers under each theme are accompanied by a roadmap paper reporting on the current status of concrete transformative convergence-building projects associated with that theme. We believe that the insights provided by these papers have the potential to enable all actors throughout society to singly and collectively work to build supply and demand for nutritious food, in both traditional and modern food systems, while placing the burdens of malnutrition and ill health on their core strategic agendas.
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Affiliation(s)
- Laurette Dubé
- Desautels Faculty of Management.,McGill Centre for the Convergence of Health and Economics (MMCHE), McGill University, Montréal, Québec, Canada
| | - Patrick Webb
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Narendra K Arora
- Clinical Epidemiology, The INCLEN Trust International, New Delhi, India
| | - Prabhu Pingali
- Charles H. Dyson School of Applied Economics and Management, Cornell University, Ithaca, New York
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Dubé L, Jha S, Faber A, Struben J, London T, Mohapatra A, Drager N, Lannon C, Joshi PK, McDermott J. Convergent innovation for sustainable economic growth and affordable universal health care: innovating the way we innovate. Ann N Y Acad Sci 2014; 1331:119-141. [PMID: 25294668 DOI: 10.1111/nyas.12548] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This paper introduces convergent innovation (CI) as a form of meta-innovation-an innovation in the way we innovate. CI integrates human and economic development outcomes, through behavioral and ecosystem transformation at scale, for sustainable prosperity and affordable universal health care within a whole-of-society paradigm. To this end, CI combines technological and social innovation (including organizational, social process, financial, and institutional), with a special focus on the most underserved populations. CI takes a modular approach that convenes around roadmaps for real world change-a portfolio of loosely coupled complementary partners from the business community, civil society, and the public sector. Roadmaps serve as collaborative platforms for focused, achievable, and time-bound projects to provide scalable, sustainable, and resilient solutions to complex challenges, with benefits both to participating partners and to society. In this paper, we first briefly review the literature on technological innovation that sets the foundations of CI and motivates its feasibility. We then describe CI, its building blocks, and enabling conditions for deployment and scaling up, illustrating its operational forms through examples of existing CI-sensitive innovation.
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Affiliation(s)
- Laurette Dubé
- Desautels Faculty of Management, McGill University, Montréal, Québec, Canada.,McGill Centre for the Convergence of Health and Economics (MCCHE), McGill University, Montréal, Québec, Canada
| | - Srivardhini Jha
- McGill Centre for the Convergence of Health and Economics (MCCHE), McGill University, Montréal, Québec, Canada.,International Food Policy Research Institute (IFPRI), Washington, DC
| | - Aida Faber
- Desautels Faculty of Management, McGill University, Montréal, Québec, Canada.,McGill Centre for the Convergence of Health and Economics (MCCHE), McGill University, Montréal, Québec, Canada
| | - Jeroen Struben
- Desautels Faculty of Management, McGill University, Montréal, Québec, Canada
| | - Ted London
- William Davidson Institute and Ross School of Business, University of Michigan, Ann Arbor, Michigan
| | | | - Nick Drager
- McGill Centre for the Convergence of Health and Economics (MCCHE), McGill University, Montréal, Québec, Canada.,Public Policy and Global Health Diplomacy, McGill University, Montréal, Québec, Canada.,London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Chris Lannon
- McGill Centre for the Convergence of Health and Economics (MCCHE), McGill University, Montréal, Québec, Canada
| | - P K Joshi
- International Food Policy and Research Institute (IFPRI), New Delhi, India
| | - John McDermott
- International Food Policy and Research Institute (IFPRI), New Delhi, India.,Consultative Group on International Agricultural Research (CGIAR), Research Program on Agriculture for Nutrition and Health, Washington, D.C
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Addy NA, Poirier A, Blouin C, Drager N, Dubé L. Whole-of-society approach for public health policymaking: a case study of polycentric governance from Quebec, Canada. Ann N Y Acad Sci 2014; 1331:216-229. [PMID: 25118135 DOI: 10.1111/nyas.12503] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Revised: 07/08/2014] [Accepted: 07/09/2014] [Indexed: 11/28/2022]
Abstract
In adopting a whole-of-society (WoS) approach that engages multiple stakeholders in public health policies across contexts, the authors propose that effective governance presents a challenge. The purpose of this paper is to highlight a case for how polycentric governance underlying the WoS approach is already functioning, while outlining an agenda to enable adaptive learning for improving such governance processes. Drawing upon a case study from Quebec, Canada, we employ empirically developed concepts from extensive, decades-long work of the 2009 Nobel laureate Elinor Ostrom in the governance of policy in nonhealth domains to analyze early efforts at polycentric governance in policies around overnutrition, highlighting interactions between international, domestic, state and nonstate actors and processes. Using information from primary and secondary sources, we analyze the emergence of the broader policy context of Quebec's public health system in the 20th century. We present a microsituational analysis of the WoS approach for Quebec's 21st century policies on healthy lifestyles, emphasizing the role of governance at the community level. We argue for rethinking prescriptive policy analysis of the 20th century, proposing an agenda for diagnostic policy analysis, which explicates the multiple sets of actors and interacting variables shaping polycentric governance for operationalizing the WoS approach to policymaking in specific contexts.
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Affiliation(s)
- Nii A Addy
- McGill Centre for the Convergence of Health and Economics (MCCHE) and the Desautels Faculty of Management, McGill University, Montréal, Québec, Canada
| | - Alain Poirier
- Institut national de santé publique du Québec, Montréal, Québec, Canada
| | - Chantal Blouin
- Agri-food and health, Institut national de santé publique du Québec, Québec City, Québec, Canada
| | - Nick Drager
- McGill Centre for the Convergence of Health and Economics (MCCHE) and the Desautels Faculty of Management, McGill University, Montréal, Québec, Canada.,London School of Hygiene and Tropical Medicine, London, England
| | - Laurette Dubé
- McGill Centre for the Convergence of Health and Economics (MCCHE) and the Desautels Faculty of Management, McGill University, Montréal, Québec, Canada
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