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Perera PN, Amarasinghe SN, Fonseka SH, Abeysinghe N, Rannan-Eliya RP. Factors impacting sustained coverage in the context of donor transitions: experience from Sri Lanka. Health Policy Plan 2024; 39:i33-i49. [PMID: 38258892 PMCID: PMC10805178 DOI: 10.1093/heapol/czad099] [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: 03/13/2023] [Revised: 09/12/2023] [Accepted: 11/01/2023] [Indexed: 01/24/2024] Open
Abstract
Although not reliant on donor funding for health, the external assistance that Sri Lanka receives contributes to the improvement of the health system and health outcomes. In this study, we evaluated transition experiences of the expanded programme on immunization (EPI) that received Gavi funding to expand the vaccine portfolio and the Anti-Malaria Campaign (AMC) that received funding from the Global Fund for AIDS, Tuberculosis and Malaria to scale-up interventions to target and achieve malaria elimination. We assessed if EPI and AMC programmes were able to sustain coverage of previously donor-funded interventions post-transition and explain the facilitators and barriers that contribute to this. We used a mixed methods approach using quantitative data to assess coverage indicators and the financing mix of the health programmes and qualitative analysis guided by a framework informed by the Walt and Gilson policy triangle that brought together document review and in-depth interviews to identify facilitators and barriers to transition success. The EPI programme showed sustained coverage of Gavi-funded vaccines post-transition and the funding gap was bridged by mobilizing domestic financing facilitated by the Gavi co-financing mechanism, full integration within existing service delivery structures, well-established and favourable pharmaceutical procurement processes for the public sector and stewardship and financial advocacy by technically competent managers. Although the absence of indigenous cases of malaria since 2012 suggests overall programme success, the AMC showed mixed transition success in relation to its different programme components. Donor-supported programme components requiring mobilization of operational expenses, facilitated by early financial planning, were successfully transitioned (e.g. entomological and parasitological surveillance) given COVID-19-related constraints. Other key programme components, such as research, training, education and awareness that are dependent on non-operational expenses are lagging behind. Additionally, concerns of AMC's future financial sustainability within the current structure remain in the context of low malaria burden.
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Affiliation(s)
- Prasadini N Perera
- Institute for Health Policy (IHP), 72, Park Street, Colombo 02, Sri Lanka
- Department of Pharmacy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | | | - Sachini H Fonseka
- Institute for Health Policy (IHP), 72, Park Street, Colombo 02, Sri Lanka
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Kim S, Tadesse E, Jin Y, Cha S. Association between Development Assistance for Health and Disease Burden: A Longitudinal Analysis on Official Development Assistance for HIV/AIDS, Tuberculosis, and Malaria in 2005-2017. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14091. [PMID: 36360980 PMCID: PMC9656851 DOI: 10.3390/ijerph192114091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/23/2022] [Accepted: 10/24/2022] [Indexed: 06/16/2023]
Abstract
From the early stage of the millennium development goals campaign, HIV/AIDS, tuberculosis and malaria have received huge aid funds. With the datasets published by the Institute for Health Metrics and Evaluation, Organization for Economic Cooperation and Developments, and World Health Organization from 2005 to 2017, we analyzed the association between the total DAH or DAH per capita and the disease burden. We measured the total DAH or DAH per capita as the dependent variable, with six independent variables of disease burden for Disability Adjusted Life Year (DALY), number of infected people, number of deaths, prevalence, incidence, and mortality rate. For the trend in ODA targeting, the likelihood ratio test of the fixed effects models was used to assess any existence of slope changes in linear regression across the years. The total amount of DAH and DAH per capita was found positively related with every aspect of disease burden, with the regression coefficients increasing during 2005-2017. For instance, the slope of association between the DAH per capita and the disease burden of malaria became steeper over time (likelihood ratio, χ2 = 26.14, p < 0.001). Although the selection criteria for the recipient country have been controversial, ODA targeting has been performed based on disease burden in this research.
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Affiliation(s)
- Sumin Kim
- Department of Global Development and Entrepreneurship, Graduate School of Global Development and Entrepreneurship, Handong Global University, Pohang 37554, Korea
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul 06355, Korea
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Korea
| | - Ermias Tadesse
- Department of Human Ecology and Technology, Graduate School of Advanced Convergence, Handong Global University, Pohang 37554, Korea
| | - Yan Jin
- Department of Microbiology, Dongguk University College of Medicine, Gyeongju 38066, Korea
| | - Seungman Cha
- Department of Global Development and Entrepreneurship, Graduate School of Global Development and Entrepreneurship, Handong Global University, Pohang 37554, Korea
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Onambele L, Ortega-Leon W, Guillen-Aguinaga S, Forjaz MJ, Yoseph A, Guillen-Aguinaga L, Alas-Brun R, Arnedo-Pena A, Aguinaga-Ontoso I, Guillen-Grima F. Maternal Mortality in Africa: Regional Trends (2000-2017). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13146. [PMID: 36293727 PMCID: PMC9602585 DOI: 10.3390/ijerph192013146] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/03/2022] [Accepted: 10/09/2022] [Indexed: 05/27/2023]
Abstract
BACKGROUND United Nations Sustainable Development Goals state that by 2030, the global maternal mortality rate (MMR) should be lower than 70 per 100,000 live births. MMR is still one of Africa's leading causes of death among women. The leading causes of maternal mortality in Africa are hemorrhage and eclampsia. This research aims to study regional trends in maternal mortality (MM) in Africa. METHODS We extracted data for maternal mortality rates per 100,000 births from the United Nations Children's Fund (UNICEF) databank from 2000 to 2017, 2017 being the last date available. Joinpoint regression was used to study the trends and estimate the annual percent change (APC). RESULTS Maternal mortality has decreased in Africa over the study period by an average APC of -3.0% (95% CI -2.9; -3,2%). All regions showed significant downward trends, with the greatest decreases in the South. Only the North African region is close to the United Nations' sustainable development goals for Maternal mortality. The remaining Sub-Saharan African regions are still far from achieving the goals. CONCLUSIONS Maternal mortality has decreased in Africa, especially in the South African region. The only region close to the United Nations' target is the North African region. The remaining Sub-Saharan African regions are still far from achieving the goals. The West African region needs more extraordinary efforts to achieve the goals of the United Nations. Policies should ensure that all pregnant women have antenatal visits and give birth in a health facility staffed by specialized personnel.
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Affiliation(s)
- Luc Onambele
- School of Health Sciences, Catholic University of Central Africa, Yaoundé 1110, Cameroon
| | - Wilfrido Ortega-Leon
- Epidemiology and Public Health Program, Department of Surgery, Medical and Social Sciences, University of Alcala de Henares, 28801 Madrid, Spain
| | - Sara Guillen-Aguinaga
- Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain
- San Juan Health Center, Primary Health Care, Navarra Health Service, 31006 Pamplona, Spain
| | - Maria João Forjaz
- National Epidemiology Centre, Carlos III Health Institute, 28029 Madrid, Spain
- REDISSEC and REDIAPP, 28029 Madrid, Spain
| | - Amanuel Yoseph
- Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa P.O. Box 5, Ethiopia
| | | | - Rosa Alas-Brun
- Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain
| | - Alberto Arnedo-Pena
- Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain
- Epidemiology Division, Public Health Center, 12003 Castelló de la Plana, Spain
- Public Health and Epidemiology (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Ines Aguinaga-Ontoso
- Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain
- Department of Preventive Medicine, Clínica Universidad de Navarra, 31008 Pamplona, Spain
- Facultad de Ciencias de la Salud, Universidad Pública de Navarra (UPNA), Avda. de Baranain sn, 31008 Pamplona, Spain
| | - Francisco Guillen-Grima
- Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain
- Department of Preventive Medicine, Clínica Universidad de Navarra, 31008 Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain
- Center for Biomedical Research Network, Physiopathology of Obesity and CIBER-OBN, Instituto de Salud Carlos III, 28029 Madrid, Spain
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Fambirai T, Chimbari MJ, Ndarukwa P. Global Cross-Border Malaria Control Collaborative Initiatives: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12216. [PMID: 36231519 PMCID: PMC9566216 DOI: 10.3390/ijerph191912216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/26/2022] [Accepted: 05/26/2022] [Indexed: 06/16/2023]
Abstract
Malaria remains a global disease of public health concern. Malaria control collaborative initiatives are widely being adopted to reduce malaria burden by various countries. This review sought to describe current and past cross-border malaria control initiatives focusing on key activities, outcomes and challenges. An exhaustive search was conducted in Web of Science, PubMed, Google Scholar and EBSCOhost using the following key words: cross-border malaria control, cross-border malaria elimination, bi-national malaria control and multinational malaria control, in combination with Boolean operators "AND" and "OR". Eleven studies satisfied the inclusion criteria for this review. The majority of collaborative initiatives have been formed within regional developmental and continental bodies with support from political leadership. The studies revealed that joint vector control, cases management, epidemiological data sharing along border regions as well as resource sharing and capacity building are some of the key collaborative initiatives being implemented globally. Collaborative initiatives have led to significant reduction in malaria burden and mortality. The majority of collaborative initiatives are underfunded and rely on donor support. We concluded that cross-border malaria collaborative initiatives have the capacity to reduce malaria burden and mortality along border regions; however, inadequate internal funding and over-reliance on donor funding remain the biggest threats to the survival of collaborative initiatives.
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Affiliation(s)
- Tichaona Fambirai
- School of Nursing and Public Health, College of Health Sciences, Howard College Campus, University of KwaZulu-Natal, Durban 4001, South Africa
| | - Moses John Chimbari
- School of Nursing and Public Health, College of Health Sciences, Howard College Campus, University of KwaZulu-Natal, Durban 4001, South Africa
- Pro Vice Chancellor’s Office, Main Campus, Great Zimbabwe University, Morning Side Drive, Masvingo P.O. Box 1235, Zimbabwe
| | - Pisirai Ndarukwa
- School of Nursing and Public Health, College of Health Sciences, Howard College Campus, University of KwaZulu-Natal, Durban 4001, South Africa
- Department of Health Sciences, Faculty of Sciences and Engineering, Main Campus, Bindura University of Science Education, Chimurenga Road off Trojan Road, Bindura P.O. Box 720, Zimbabwe
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Cinaroglu S. Interaction Between Self-rated Health and Labour Force Participation: A Panel Data Probit Model with Survival Estimates. JOURNAL OF HEALTH MANAGEMENT 2021. [DOI: 10.1177/09720634211050483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aimed to reveal the relationship between health and labour in Turkey under the intervention of demographic variables. Four waves of the TurkStat Income and Living Conditions Panel Survey (2008–2011) were used. Demographic, education, self-rated health and labour force participation indicators were used to examine different generalised linear model (GLM)-like panel binomial probit model specifications using self-assessed health (SAH) status and self-reported working status (SRWS) as dependent variables. Kaplan–Meier (KM) estimates for the probability of survival in SAH and SRWS were examined using the X2 values of the log-rank and Peto–Peto–Prentice tests for equality of survivor functions by study variables. Study results reveal that the hazard of assessing good health and currently working increases for individuals who are married ( p < 0.001), highly educated ( p < 0.001), do not have any chronic disease ( p < 0.001), do not have any health restrictions ( p < 0.001) and occupy high-qualification jobs ( p < 0.001). KM estimates support the panel model results. The present study reveals that demographic, education, self-rated health and labour force participation are the driving forces in the interaction of health and labour dynamics. Reducing income inequality, increasing the minimum wage and improving working conditions, while promoting gender equality, are essentials of better management of health and labour markets.
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Pitt C, Bath D, Binyaruka P, Borghi J, Martinez-Alvarez M. Falling aid for reproductive, maternal, newborn and child health in the lead-up to the COVID-19 pandemic. BMJ Glob Health 2021; 6:e006089. [PMID: 34108147 PMCID: PMC8190982 DOI: 10.1136/bmjgh-2021-006089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 05/21/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Catherine Pitt
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - David Bath
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Peter Binyaruka
- Department of Health System, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Josephine Borghi
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Melisa Martinez-Alvarez
- Department of Global Health and Development, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Dakar, Senegal
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Parsons MA. Toward an ethics of global health (de)funding: Thoughts from a maternity hospital project in Kabul, Afghanistan. Glob Public Health 2021; 17:1136-1151. [PMID: 33977857 DOI: 10.1080/17441692.2021.1924821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Funding and defunding decisions in global health are often not subject to ethical scrutiny although they carry the potential for iatrogenic violence. The funding and defunding of a maternal health project in Kabul, Afghanistan during the 2000s reveals the post 9/11 science-politics dynamics that resulted in the emergence of maternal mortality in Afghanistan as a humanitarian object. Despite concerns raised by the Afghan Ministry of Public Health, U.S. Department of Health and Human Services subcontractors renovated one of four public maternity hospitals in Kabul, doubling the number of births per year and increasing the rate of caesarean sections. Project defunding in 2011 was due to a confluence of primarily political factors. Project actors - Afghan and internationals - expressed ethical concerns about the abrupt defunding and the particular risks to women undergoing emergency caesarean sections at the hospital. The analysis presented here has wider relevance for the global surgery movement and concerns about fluctuations in donor funding in global health. There is a need for an ethics of global health funding and defunding decisions that encompasses policies, relationships, stronger local public health systems and civic participation. Global health (de)funding must be made more of an object of ethical deliberation and negotiation.
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Hollis SM, Amato SS, Bulger E, Mock C, Reynolds T, Stewart BT. Tracking global development assistance for trauma care: A call for advocacy and action. J Glob Health 2021; 11:04007. [PMID: 33828843 PMCID: PMC8005307 DOI: 10.7189/jogh.11.04007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background This study aimed to track development assistance for trauma care (DAH-TC), uncover funding trends and gaps, and compare DAH-TC to development assistance for other health conditions. Methods A systematic search of the OECD Creditor Reporting System (CRS) and Development Assistance Committee (DAC) databases was performed to capture projects related to trauma care. Reports from large foundations and public-private partnerships were also searched. DAH-TC was described, and comparisons were made between DAH-TC and other health conditions. Results The search yielded 1754 records; after applying exclusion criteria, 301 records were included for analysis. During the 25-year period, US$93.7M of DAH-TC was disbursed to low- and middle-income countries (LMICs) (0.02% of total DAH). Contributions were dominated by a few donors and fluctuated dramatically over time. A sizable portion of DAH-TC came in the form of investments to build infrastructure (38% of DAH-TC); information and research activities (17%); and training (16%). Nearly US$58M (62% of DAH-TC) was funneled to projects that targeted victims of war. Trauma care received US$0.04 per DALY incurred, while malaria, TB, HIV and MCH received US$9.62 per DALY, US$25.09 per DALY, US$4.05 per DALY and US$45.75 per DALY, respectively. Conclusions DAH-TC is critically underfunded, particularly compared to other health foci. To improve the DAH-TC landscape, stakeholders can better mobilize domestic resources; use advocacy more effectively by catalyzing network convergence, grafting trauma care onto related high-priority issues, and seeking broader coalitions; and develop partners within the donor and channel communities to promote strategic DAH-TC disbursements.
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Affiliation(s)
| | - Stas Salerno Amato
- Department of Surgery, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Eileen Bulger
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Charles Mock
- Department of Surgery, University of Washington, Seattle, Washington, USA.,Department Global Health, University of Washington, Seattle, Washington, USA
| | | | - Barclay T Stewart
- Department of Surgery, University of Washington, Seattle, Washington, USA.,Harborview Injury Prevention and Research Center, Seattle, W Washington A, USA
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Mutero CM, Okoyo C, Girma M, Mwangangi J, Kibe L, Ng'ang'a P, Kussa D, Diiro G, Affognon H, Mbogo CM. Evaluating the impact of larviciding with Bti and community education and mobilization as supplementary integrated vector management interventions for malaria control in Kenya and Ethiopia. Malar J 2020; 19:390. [PMID: 33143707 PMCID: PMC7607826 DOI: 10.1186/s12936-020-03464-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 10/26/2020] [Indexed: 12/04/2022] Open
Abstract
Background Malaria prevention in Africa is mainly through the use of long-lasting insecticide treated nets (LLINs). The objective of the study was to assess the effect of supplementing LLINs with either larviciding with Bacillus thuringiensis israelensis (Bti) or community education and mobilization (CEM), or with both interventions in the context of integrated vector management (IVM). Methods The study involved a factorial, cluster-randomized, controlled trial conducted in Malindi and Nyabondo sites in Kenya and Tolay site in Ethiopia, to assess the impact of the following four intervention options on mosquitoes and malaria prevalence: LLINs only (arm 1); LLINs and Bti (arm 2); LLINs and CEM (arm 3); and, LLINs combined with Bti and CEM (arm 4). Between January 2013 and December 2015, CDC light traps were used to sample adult mosquitoes during the second, third and fourth quarter of each year in 10 houses in each of 16 villages at each of the three study sites. Larvae were sampled once a fortnight from potential mosquito-breeding habitats using standard plastic dippers. Cross-sectional malaria parasite prevalence surveys were conducted involving a total of 11,846 primary school children during the 3-year period, including 4800 children in Tolay, 3000 in Malindi and 4046 in Nyabondo study sites. Results Baseline relative indoor anopheline density was 0.11, 0.05 and 0.02 mosquitoes per house per night in Malindi, Tolay and Nyabondo sites, respectively. Nyabondo had the highest recorded overall average malaria prevalence among school children at 32.4%, followed by Malindi with 5.7% and Tolay 1.7%. There was no significant reduction in adult anopheline density at each of the three sites, which could be attributed to adding of the supplementary interventions to the usage of LLINs. Malaria prevalence was significantly reduced by 50% in Tolay when using LLINs coupled with application of Bti, community education and mobilization. The two other sites did not reveal significant reduction of prevalence as a result of combining LLINs with any of the other supplementary interventions. Conclusion Combining LLINs with larviciding with Bti and CEM further reduced malaria infection in a low prevalence setting in Ethiopia, but not at sites with relatively higher prevalence in Kenya. More research is necessary at the selected sites in Kenya to periodically determine the suite of vector control interventions and broader disease management strategies, which when integrated would further reduce adult anopheline populations and malaria prevalence beyond what is achieved with LLINs.
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Affiliation(s)
- Clifford M Mutero
- International Centre of Insect Physiology and Ecology (ICIPE), P. O. Box 30772, 00100, Nairobi, Kenya. .,Institute for Sustainable Malaria Control, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa.
| | - Collins Okoyo
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Melaku Girma
- Zoological Sciences Department, Addis Ababa University, Addis Ababa, Ethiopia
| | - Joseph Mwangangi
- Centre for Geographic Medicine Research, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
| | - Lydia Kibe
- Centre for Geographic Medicine Research, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
| | - Peter Ng'ang'a
- International Centre of Insect Physiology and Ecology (ICIPE), P. O. Box 30772, 00100, Nairobi, Kenya
| | - Dereje Kussa
- International Centre of Insect Physiology and Ecology (ICIPE), Addis Ababa, Ethiopia
| | - Gracious Diiro
- International Centre of Insect Physiology and Ecology (ICIPE), P. O. Box 30772, 00100, Nairobi, Kenya
| | - Hippolyte Affognon
- West and Central Africa Council for Agricultural Research and Development, Dakar, Senegal
| | - Charles M Mbogo
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya.,Centre for Geographic Medicine Research, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
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Are Individuals Willing to Pay for Community-Based Eco-Friendly Malaria Vector Control Strategies? A Case of Mosquito Larviciding Using Plant-Based Biopesticides in Kenya. SUSTAINABILITY 2020. [DOI: 10.3390/su12208552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This study was carried out to assess individuals’ willingness to pay (WTP) for UZIMAX, a novel plant-based biopesticide developed for malaria vector control. The biopesticide is estimated to kill up to 100% of Anopheles larvae within 48 h of application and poses no risks to human health and the environment. However, scaling-up of its adoption requires clear evidence of its acceptance by individuals in malaria-prone areas. We conducted Becker-DeGroot-Marschak (BDM) revealed preference auctions with 204 participants to determine their willingness to pay (WTP) for community-based application of the biopesticide to control malaria vectors. Nearly all participants were willing to pay at the lowest bid price of the biopesticide, and the majority of them expressed great interest in pooling resources to facilitate biopesticide application. Household per capita income and building capacity of households through training significantly increased WTP. These findings imply high adoption potential of the technology and the need to devise inclusive policy tools, especially those that enhance collective action, resource mobilization and capacity building to empower both men and women and stimulate investment in eco-friendly technologies for malaria prevention. Financial and labor resource mechanisms managed by the community could potentially spur adoption of the biopesticides, and in turn, generate health, environmental and economic benefits to households in malaria-prone communities.
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Kostova D, Cassell CH, Redd JT, Williams DE, Singh T, Martel LD, Bunnell RE. Long-distance effects of epidemics: Assessing the link between the 2014 West Africa Ebola outbreak and U.S. exports and employment. HEALTH ECONOMICS 2019; 28:1248-1261. [PMID: 31464014 PMCID: PMC6852535 DOI: 10.1002/hec.3938] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 06/19/2019] [Accepted: 07/23/2019] [Indexed: 05/11/2023]
Abstract
Although the economic consequences of epidemic outbreaks to affected areas are often well documented, little is known about how these might carry over into the economies of unaffected regions. In the absence of direct pathogen transmission, global trade is one mechanism through which geographically distant epidemics could reverberate to unaffected countries. This study explores the link between global public health events and U.S. economic outcomes by evaluating the role of the 2014 West Africa Ebola outbreak in U.S. exports and exports-supported U.S. jobs, 2005-2016. Estimates were obtained using difference-in-differences models where sub-Saharan Africa countries were assigned to treatment and comparison groups based on their Ebola transmission status, with controls for observed and unobserved time-variant factors that may independently influence trends in trade. Multiple model specification checks were performed to ensure analytic robustness. The year of peak transmission, 2014, was estimated to result in $1.08 billion relative reduction in U.S. merchandise exports to Ebola-affected countries, whereas estimated losses in exports-supported U.S. jobs exceeded 1,200 in 2014 and 11,000 in 2015. These findings suggest that remote disruptions in health security might play a role in U.S. economic indicators, demonstrating the interconnectedness between global health and aspects of the global economy and informing the relevance of health security efforts.
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Affiliation(s)
- Deliana Kostova
- Division of Global Health Protection, Center for Global HealthCenters for Disease Control and PreventionAtlantaGeorgia
| | - Cynthia H. Cassell
- Division of Global Health Protection, Center for Global HealthCenters for Disease Control and PreventionAtlantaGeorgia
| | - John T. Redd
- Division of Global Health Protection, Center for Global HealthCenters for Disease Control and PreventionAtlantaGeorgia
| | - Desmond E. Williams
- Division of Global Health Protection, Center for Global HealthCenters for Disease Control and PreventionAtlantaGeorgia
| | - Tushar Singh
- Division of Global Health Protection, Center for Global HealthCenters for Disease Control and PreventionAtlantaGeorgia
| | - Lise D. Martel
- Division of Global Health Protection, Center for Global HealthCenters for Disease Control and PreventionAtlantaGeorgia
| | - Rebecca E. Bunnell
- Division of Global Health Protection, Center for Global HealthCenters for Disease Control and PreventionAtlantaGeorgia
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12
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Ikilezi G, Augusto OJ, Dieleman JL, Sherr K, Lim SS. Effect of donor funding for immunization from Gavi and other development assistance channels on vaccine coverage: Evidence from 120 low and middle income recipient countries. Vaccine 2019; 38:588-596. [PMID: 31679863 DOI: 10.1016/j.vaccine.2019.10.057] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 08/29/2019] [Accepted: 10/21/2019] [Indexed: 10/25/2022]
Abstract
Donor assistance for immunization has remained resilient with increased resource mobilization efforts in recent years to achieve current global coverage targets. As a result, more countries continue to introduce new vaccines while optimizing coverage for traditional vaccines. Gavi the Vaccine Alliance has been at the forefront of immunization support specifically among low and middle income countries, alongside other channels of development assistance which continue to play a vital role in immunization. Using available recipient country level data from 1996 to 2016, we estimate the impact of Gavi support for vaccines and health systems strengthening on vaccine coverage for 3 dose DPT, 3 dose pneumococcal conjugate vaccine, 3 dose pentavalent, 2 dose measles and 2 dose rotavirus vaccines. We investigate the same effects of total aid for immunization from other channels of development assistance. Standard time series cross sectional analysis methods are applied to investigate the effects of vaccine support controlling for country income, governance and population, with robustness tests implemented using different model specifications. Double counting was eliminated and results are presented in real 2017 US dollars. We found significant positive effects of aid particularly among the newer vaccines. Using 2016 country specific disbursements and coverage levels as baseline, we estimated that among recipient countries below the universal target, additional DAH per capita required to reach 90%, ranged from 0.01USD to 4.33USD for PCV, 0.03USD to 9.06USD for pentavalent vaccine and 0.01USD to 2.57USD for rotavirus vaccine. The estimated number of children vaccinated through 2016, attributable to Gavi support totaled 46.6million, 75.2million and 12.3million for PCV, pentavalent and rotavirus vaccines respectively. Our analysis suggests substantial success both from a historical and prospective perspective in the implementation of global immunization initiatives thus far. As more vaccines are rolled out and countries transition from donor aid, strategies for fiscal sustainability and efficiency need to be strengthened in order to achieve universal immunization coverage.
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Affiliation(s)
- Gloria Ikilezi
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Avenue, Suite 600, Seattle, WA 98121, USA.
| | - Orvalho J Augusto
- Department of Global Health, University of Washington, Harris Hydraulics Laboratory, Box 357965, Seattle, WA 98195, USA
| | - Joseph L Dieleman
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Avenue, Suite 600, Seattle, WA 98121, USA
| | - Kenneth Sherr
- Department of Global Health, University of Washington, Harris Hydraulics Laboratory, Box 357965, Seattle, WA 98195, USA
| | - Stephen S Lim
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Avenue, Suite 600, Seattle, WA 98121, USA
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Behera DK, Dash U. Impact of macro-fiscal determinants on health financing: empirical evidence from low-and middle-income countries. Glob Health Res Policy 2019; 4:21. [PMID: 31417961 PMCID: PMC6688340 DOI: 10.1186/s41256-019-0112-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 07/17/2019] [Indexed: 11/30/2022] Open
Abstract
Background Health financing is a major challenge in low-and middle-income counties (LMICs) for achieving Universal Health Coverage (UHC). Past studies have argued that the budgetary allocation on health financing depends on macro-fiscal policies of an economy such as sustained economic growth and higher revenue mobilization. While the global financial crisis of late 2008 observed a shortage of financial resources in richer countries and adversely affected the health sector. Therefore, this study has examined the impact of macro-fiscal policies on health financing by adopting socioeconomic factors in 85 LMICs for the period 2000 to 2013. Methods The study has employed the panel System Generalized Method of Moment model that captures the endogeneity problem in the regression estimation by adopting appropriate instrumental variables. Results The elasticity of public health expenditure (PHE) with respect to macro-fiscal factors varies across LMICs. Tax revenue shows a positive and statistically significant relationship with PHE in full sample, pre-global financial crisis, middle-income, and coefficient value varies from 0.040 to 0.141%. Fiscal deficit and debt services payment shows a negative effect on PHE in full sample, as well as sub-samples and coefficient value, varies from 0.001 to 0.032%. Aging and per capita income show an expected positive relationship with PHE in LIMI countries. Conclusions Favorable macro-fiscal policies would necessarily raise finance for the health sector development but the prioritization of health budget allocation during the crisis period depends on the nature of tax revenue mobilization and demand for health services. Therefore, the generation of health-specific revenues and effective usage of health budget would probably accelerate the progress towards the achievement of UHC. Electronic supplementary material The online version of this article (10.1186/s41256-019-0112-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Deepak Kumar Behera
- 1Indian Institute of Public Health, Public Health Foundation of India, 751013 Bhubaneswar, India
| | - Umakant Dash
- 2Department of Humanities and Social Sciences, Indian Institute of Technology Madras, 600036 Chennai, India
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Chang AY, Cowling K, Micah AE, Chapin A, Chen CS, Ikilezi G, Sadat N, Tsakalos G, Wu J, Younker T, Zhao Y, Zlavog BS, Abbafati C, Ahmed AE, Alam K, Alipour V, Aljunid SM, Almalki MJ, Alvis-Guzman N, Ammar W, Andrei CL, Anjomshoa M, Antonio CAT, Arabloo J, Aremu O, Ausloos M, Avila-Burgos L, Awasthi A, Ayanore MA, Azari S, Azzopardi-Muscat N, Bagherzadeh M, Bärnighausen TW, Baune BT, Bayati M, Belay YB, Belay YA, Belete H, Berbada DA, Berman AE, Beuran M, Bijani A, Busse R, Cahuana-Hurtado L, Cámera LA, Catalá-López F, Chauhan BG, Constantin MM, Crowe CS, Cucu A, Dalal K, De Neve JW, Deiparine S, Demeke FM, Do HP, Dubey M, El Tantawi M, Eskandarieh S, Esmaeili R, Fakhar M, Fazaeli AA, Fischer F, Foigt NA, Fukumoto T, Fullman N, Galan A, Gamkrelidze A, Gezae KE, Ghajar A, Ghashghaee A, Goginashvili K, Haakenstad A, Haghparast Bidgoli H, Hamidi S, Harb HL, Hasanpoor E, Hassen HY, Hay SI, Hendrie D, Henok A, Heredia-Pi I, Herteliu C, Hoang CL, Hole MK, Homaie Rad E, Hossain N, Hosseinzadeh M, Hostiuc S, Ilesanmi OS, Irvani SSN, Jakovljevic M, Jalali A, James SL, Jonas JB, Jürisson M, Kadel R, Karami Matin B, Kasaeian A, Kasaye HK, Kassaw MW, Kazemi Karyani A, Khabiri R, Khan J, Khan MN, Khang YH, Kisa A, Kissimova-Skarbek K, Kohler S, Koyanagi A, Krohn KJ, Leung R, Lim LL, Lorkowski S, Majeed A, Malekzadeh R, Mansourian M, Mantovani LG, Massenburg BB, McKee M, Mehta V, Meretoja A, Meretoja TJ, Milevska Kostova N, Miller TR, Mirrakhimov EM, Mohajer B, Mohammad Darwesh A, Mohammed S, Mohebi F, Mokdad AH, Morrison SD, Mousavi SM, Muthupandian S, Nagarajan AJ, Nangia V, Negoi I, Nguyen CT, Nguyen HLT, Nguyen SH, Nosratnejad S, Oladimeji O, Olgiati S, Olusanya JO, Onwujekwe OE, Otstavnov SS, Pana A, Pereira DM, Piroozi B, Prada SI, Qorbani M, Rabiee M, Rabiee N, Rafiei A, Rahim F, Rahimi-Movaghar V, Ram U, Ranabhat CL, Ranta A, Rawaf DL, Rawaf S, Rezaei S, Roro EM, Rostami A, Rubino S, Salahshoor M, Samy AM, Sanabria J, Santos JV, Santric Milicevic MM, Sao Jose BP, Savic M, Schwendicke F, Sepanlou SG, Sepehrimanesh M, Sheikh A, Shrime MG, Sisay S, Soltani S, Soofi M, Soofi M, Srinivasan V, Tabarés-Seisdedos R, Torre A, Tovani-Palone MR, Tran BX, Tran KB, Undurraga EA, Valdez PR, van Boven JFM, Vargas V, Veisani Y, Violante FS, Vladimirov SK, Vlassov V, Vollmer S, Vu GT, Wolfe CDA, Yonemoto N, Younis MZ, Yousefifard M, Zaman SB, Zangeneh A, Zegeye EA, Ziapour A, Chew A, Murray CJL, Dieleman JL. Past, present, and future of global health financing: a review of development assistance, government, out-of-pocket, and other private spending on health for 195 countries, 1995-2050. Lancet 2019; 393:2233-2260. [PMID: 31030984 PMCID: PMC6548764 DOI: 10.1016/s0140-6736(19)30841-4] [Citation(s) in RCA: 219] [Impact Index Per Article: 43.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 03/22/2019] [Accepted: 03/27/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Comprehensive and comparable estimates of health spending in each country are a key input for health policy and planning, and are necessary to support the achievement of national and international health goals. Previous studies have tracked past and projected future health spending until 2040 and shown that, with economic development, countries tend to spend more on health per capita, with a decreasing share of spending from development assistance and out-of-pocket sources. We aimed to characterise the past, present, and predicted future of global health spending, with an emphasis on equity in spending across countries. METHODS We estimated domestic health spending for 195 countries and territories from 1995 to 2016, split into three categories-government, out-of-pocket, and prepaid private health spending-and estimated development assistance for health (DAH) from 1990 to 2018. We estimated future scenarios of health spending using an ensemble of linear mixed-effects models with time series specifications to project domestic health spending from 2017 through 2050 and DAH from 2019 through 2050. Data were extracted from a broad set of sources tracking health spending and revenue, and were standardised and converted to inflation-adjusted 2018 US dollars. Incomplete or low-quality data were modelled and uncertainty was estimated, leading to a complete data series of total, government, prepaid private, and out-of-pocket health spending, and DAH. Estimates are reported in 2018 US dollars, 2018 purchasing-power parity-adjusted dollars, and as a percentage of gross domestic product. We used demographic decomposition methods to assess a set of factors associated with changes in government health spending between 1995 and 2016 and to examine evidence to support the theory of the health financing transition. We projected two alternative future scenarios based on higher government health spending to assess the potential ability of governments to generate more resources for health. FINDINGS Between 1995 and 2016, health spending grew at a rate of 4·00% (95% uncertainty interval 3·89-4·12) annually, although it grew slower in per capita terms (2·72% [2·61-2·84]) and increased by less than $1 per capita over this period in 22 of 195 countries. The highest annual growth rates in per capita health spending were observed in upper-middle-income countries (5·55% [5·18-5·95]), mainly due to growth in government health spending, and in lower-middle-income countries (3·71% [3·10-4·34]), mainly from DAH. Health spending globally reached $8·0 trillion (7·8-8·1) in 2016 (comprising 8·6% [8·4-8·7] of the global economy and $10·3 trillion [10·1-10·6] in purchasing-power parity-adjusted dollars), with a per capita spending of US$5252 (5184-5319) in high-income countries, $491 (461-524) in upper-middle-income countries, $81 (74-89) in lower-middle-income countries, and $40 (38-43) in low-income countries. In 2016, 0·4% (0·3-0·4) of health spending globally was in low-income countries, despite these countries comprising 10·0% of the global population. In 2018, the largest proportion of DAH targeted HIV/AIDS ($9·5 billion, 24·3% of total DAH), although spending on other infectious diseases (excluding tuberculosis and malaria) grew fastest from 2010 to 2018 (6·27% per year). The leading sources of DAH were the USA and private philanthropy (excluding corporate donations and the Bill & Melinda Gates Foundation). For the first time, we included estimates of China's contribution to DAH ($644·7 million in 2018). Globally, health spending is projected to increase to $15·0 trillion (14·0-16·0) by 2050 (reaching 9·4% [7·6-11·3] of the global economy and $21·3 trillion [19·8-23·1] in purchasing-power parity-adjusted dollars), but at a lower growth rate of 1·84% (1·68-2·02) annually, and with continuing disparities in spending between countries. In 2050, we estimate that 0·6% (0·6-0·7) of health spending will occur in currently low-income countries, despite these countries comprising an estimated 15·7% of the global population by 2050. The ratio between per capita health spending in high-income and low-income countries was 130·2 (122·9-136·9) in 2016 and is projected to remain at similar levels in 2050 (125·9 [113·7-138·1]). The decomposition analysis identified governments' increased prioritisation of the health sector and economic development as the strongest factors associated with increases in government health spending globally. Future government health spending scenarios suggest that, with greater prioritisation of the health sector and increased government spending, health spending per capita could more than double, with greater impacts in countries that currently have the lowest levels of government health spending. INTERPRETATION Financing for global health has increased steadily over the past two decades and is projected to continue increasing in the future, although at a slower pace of growth and with persistent disparities in per-capita health spending between countries. Out-of-pocket spending is projected to remain substantial outside of high-income countries. Many low-income countries are expected to remain dependent on development assistance, although with greater government spending, larger investments in health are feasible. In the absence of sustained new investments in health, increasing efficiency in health spending is essential to meet global health targets. FUNDING Bill & Melinda Gates Foundation.
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Waqas M, Siddiqui UT, Shamim MS. Follow-Up Bibliometric Analysis of Neurosurgical Publications from Pakistan and Institutional Comparison with other Countries Using h-Index and i-10 Index. Asian J Neurosurg 2019; 14:126-130. [PMID: 30937023 PMCID: PMC6417325 DOI: 10.4103/ajns.ajns_286_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Aim: The aim of the study was to analyze the neurosurgical research output of Pakistan and compare it with that of developed countries. Methodology: We conducted a bibliometric analysis of publically available databases for all neurosurgical publications from Pakistan. All indexed peer-reviewed publications from January 2009 to December 2014 where at least one author was affiliated with any neurosurgical departments in Pakistan and research was conducted in Pakistan were selected. Manual and electronic search was done using MeSH terms to search for articles from Pakistan. Articles were then categorized according to design, subspecialty, region, and year. Results: Our search identified 121 articles during the defined study period (mean = 20.16 ± 5.2 papers/year). A relatively constant increase was noticed for the last 6 years, i.e., 2009–2014. From the total 121 references, 100 (82.4%) publications were from one city, and on subanalysis, 80 (66.1%) were from a single institution. Three primary authors cumulatively contributed to 76 (62.8%) of these publications. Almost two-thirds (n = 76, 62.8%) of these publications were published in either regional or international journals while only 37.2% (n = 45) were published in local nonneurosurgery-specific journals. Only one study in the 6-year study period was with Level I evidence (meta-analysis). Conclusion: Neurosurgery research in Pakistan has shown modest improvement in terms of quality and quantity. Collaboration between various centers and channelizing different resources to create national data registries along with basic science laboratories is much needed.
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Affiliation(s)
- Muhammad Waqas
- Department of Neurosurgery, The Aga Khan University Hospital, Karachi, Pakistan
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16
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Marcos-Marcos J, Olry de Labry-Lima A, Toro-Cardenas S, Lacasaña M, Degroote S, Ridde V, Bermudez-Tamayo C. Impact, economic evaluation, and sustainability of integrated vector management in urban settings to prevent vector-borne diseases: a scoping review. Infect Dis Poverty 2018; 7:83. [PMID: 30173675 PMCID: PMC6120095 DOI: 10.1186/s40249-018-0464-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 07/18/2018] [Indexed: 12/03/2022] Open
Abstract
Background The control of vector-borne diseases (VBD) is one of the greatest challenges on the global health agenda. Rapid and uncontrolled urbanization has heightened the interest in addressing these challenges through an integrated vector management (IVM) approach. The aim was to identify components related to impacts, economic evaluation, and sustainability that might contribute to this integrated approach to VBD prevention. Main body We conducted a scoping review of available literature (2000–2016) using PubMed, Web of Science, Cochrane, CINAHL, Econlit, LILACS, Global Health Database, Scopus, and Embase, as well as Tropical Diseases Bulletin, WHOLIS, WHO Pesticide Evaluation Scheme, and Google Scholar. MeSH terms and free-text terms were used. A data extraction form was used, including TIDieR and ASTAIRE. MMAT and CHEERS were used to evaluate quality. Of the 42 documents reviewed, 30 were focused on dengue, eight on malaria, and two on leishmaniasis. More than a half of the studies were conducted in the Americas. Half used a quantitative descriptive approach (n = 21), followed by cluster randomized controlled trials (n = 11). Regarding impacts, outcomes were: a) use of measures for vector control; b) vector control; c) health measures; and d) social measures. IVM reduced breeding sites, the entomology index, and parasite rates. Results were heterogeneous, with variable magnitudes, but in all cases were favourable to the intervention. Evidence of IVM impacts on health outcomes was very limited but showed reduced incidence. Social outcomes were improved abilities and capacities, empowerment, and community knowledge. Regarding economic evaluation, only four studies performed an economic analysis, and intervention benefits outweighed costs. Cost-effectiveness was dependent on illness incidence. The results provided key elements to analyze sustainability in terms of three dimensions (social, economic, and environmental), emphasizing the implementation of a community-focused eco-bio-social approach. Conclusions IVM has an impact on reducing vector breeding sites and the entomology index, but evidence of impacts on health outcomes is limited. Social outcomes are improved abilities and capacities, empowerment, and community knowledge. Economic evaluations are scarce, and cost-effectiveness is dependent on illness incidence. Community capacity building is the main component of sustainability, together with collaboration, institutionalization, and routinization of activities. Findings indicate a great heterogeneity in the interventions and highlight the need for characterizing interventions rigorously to facilitate transferability. Electronic supplementary material The online version of this article (10.1186/s40249-018-0464-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jorge Marcos-Marcos
- Public Health Research Group, University of Alicante, Alicante, Spain.,Andalusian School of Public Health, Granada, Spain
| | - Antonio Olry de Labry-Lima
- Andalusian School of Public Health, Granada, Spain.,Biomedical Research Centre Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Biomedical Research Centre (ibs.GRANADA), Granada, Spain
| | | | - Marina Lacasaña
- Andalusian School of Public Health, Granada, Spain.,Biomedical Research Centre Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Biomedical Research Centre (ibs.GRANADA), Granada, Spain
| | - Stéphanie Degroote
- Public Health Research Institute (IRSPUM), University of Montreal, Montreal, Quebec, Canada
| | - Valéry Ridde
- Public Health Research Institute (IRSPUM), University of Montreal, Montreal, Quebec, Canada.,IRD (French Institute for Research on Sustainable Development), CEPED (IRD-Université Paris Descartes), Universités Paris Sorbonne Cités, ERL INSERM SAGESUD, Paris, France
| | - Clara Bermudez-Tamayo
- Andalusian School of Public Health, Granada, Spain. .,Biomedical Research Centre Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain. .,Biomedical Research Centre (ibs.GRANADA), Granada, Spain.
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Rana RH, Alam K, Gow J. Health expenditure, child and maternal mortality nexus: a comparative global analysis. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2018; 18:29. [PMID: 30012137 PMCID: PMC6048901 DOI: 10.1186/s12914-018-0167-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 06/19/2018] [Indexed: 12/21/2022]
Abstract
Background This paper provides empirical evidence on how the relationship between health expenditure and health outcomes varies across countries at different income levels. Method Heterogeneity and cross-section dependence were controlled for in the panel data which consist of 161 countries over the period 1995–2014. Infant, under-five and maternal mortality along with life expectancy at birth were selected as health outcome measures. Cross-sectional augmented IPS unit root, panel autoregressive distributed lag, Dumitrescu-Hurlin and Toda-Yamamoto approach to Granger causality tests were used to investigate the relationship across four income groups. An impulse response function modelled the impact on health outcomes of negative shocks to health expenditure. Results The results indicate that the health expenditure and health outcome link is stronger for low-income compared to high-income countries. Moreover, rising health expenditure can reduce child mortality but has an insignificant relationship with maternal mortality at all income levels. Lower-income countries are more at risk of adverse impact on health because of negative shocks to health expenditure. Variations in child mortality are better explained by rising health expenditure than maternal mortality. However, the estimated results showed dissimilarity when different assumptions and methods were used. Conclusion The influence of health expenditure on health outcome varies significantly across different income levels except for maternal health. Policymakers should recognize that increasing spending has a minute potential to improve maternal health. Lastly, the results vary significantly due to income level, choice of assumptions (homogeneity, cross-section independence) and estimation techniques used. Therefore, findings of the cross-country panel studies should be interpreted with cautions.
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Affiliation(s)
- Rezwanul Hasan Rana
- School of Commerce, University of Southern Queensland, Toowoomba, Australia.
| | - Khorshed Alam
- School of Commerce, University of Southern Queensland, Toowoomba, Australia
| | - Jeff Gow
- School of Commerce, University of Southern Queensland, Toowoomba, Australia.,School of Accounting, Economics and Finance, University of KwaZulu-Natal, Durban, South Africa
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Lewin S, Booth A, Glenton C, Munthe-Kaas H, Rashidian A, Wainwright M, Bohren MA, Tunçalp Ö, Colvin CJ, Garside R, Carlsen B, Langlois EV, Noyes J. Applying GRADE-CERQual to qualitative evidence synthesis findings: introduction to the series. Implement Sci 2018; 13:2. [PMID: 29384079 PMCID: PMC5791040 DOI: 10.1186/s13012-017-0688-3] [Citation(s) in RCA: 489] [Impact Index Per Article: 81.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
The GRADE-CERQual ('Confidence in the Evidence from Reviews of Qualitative research') approach provides guidance for assessing how much confidence to place in findings from systematic reviews of qualitative research (or qualitative evidence syntheses). The approach has been developed to support the use of findings from qualitative evidence syntheses in decision-making, including guideline development and policy formulation. Confidence in the evidence from qualitative evidence syntheses is an assessment of the extent to which a review finding is a reasonable representation of the phenomenon of interest. CERQual provides a systematic and transparent framework for assessing confidence in individual review findings, based on consideration of four components: (1) methodological limitations, (2) coherence, (3) adequacy of data, and (4) relevance. A fifth component, dissemination (or publication) bias, may also be important and is being explored. As with the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach for effectiveness evidence, CERQual suggests summarising evidence in succinct, transparent, and informative Summary of Qualitative Findings tables. These tables are designed to communicate the review findings and the CERQual assessment of confidence in each finding. This article is the first of a seven-part series providing guidance on how to apply the CERQual approach. In this paper, we describe the rationale and conceptual basis for CERQual, the aims of the approach, how the approach was developed, and its main components. We also outline the purpose and structure of this series and discuss the growing role for qualitative evidence in decision-making. Papers 3, 4, 5, 6, and 7 in this series discuss each CERQual component, including the rationale for including the component in the approach, how the component is conceptualised, and how it should be assessed. Paper 2 discusses how to make an overall assessment of confidence in a review finding and how to create a Summary of Qualitative Findings table. The series is intended primarily for those undertaking qualitative evidence syntheses or using their findings in decision-making processes but is also relevant to guideline development agencies, primary qualitative researchers, and implementation scientists and practitioners.
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Affiliation(s)
- Simon Lewin
- Norwegian Institute of Public Health, Oslo, Norway
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Andrew Booth
- School of Health & Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | | | - Arash Rashidian
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Information, Evidence and Research Department, Eastern Mediterranean Regional Office, World Health Organization, Cairo, Egypt
| | - Megan Wainwright
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Meghan A. Bohren
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Özge Tunçalp
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Christopher J. Colvin
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Ruth Garside
- European Centre for Environment and Human Health, University of Exeter Medical School, Exeter, UK
| | | | - Etienne V. Langlois
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
| | - Jane Noyes
- School of Social Sciences, Bangor University, Bangor, UK
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Hamiduzzaman M, De Bellis A, Abigail W, Kalaitzidis E. The Social Determinants of Healthcare Access for Rural Elderly Women - A Systematic Review of Quantitative Studies. ACTA ACUST UNITED AC 2017. [DOI: 10.2174/1874944501710010244] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective:This review aimed to explore and analyze the social determinants that impact rural women’s aged 60 years and older healthcare access in low or middle income and high income countries.Methods:Major healthcare databases including MEDLINE and MEDLINE In-Process, PsycINFO, PubMed, ProQuest, Web of Science, CINAHL and ERIC were searched from April 2016 to August 2016 and a manual search was also conducted. A rigorous selection process focusing on the inclusion of rural elderly women in study population and the social determinants of their healthcare access resulted in 38 quantitative articles for inclusion. Data were extracted and summarized from these studies, and grouped into seven categories under upstream and downstream social determinants.Results:Prevailing healthcare systems in combination with personal beliefs and ideas about ageing and healthcare were identified as significant determinants. Socioeconomic and cultural determinants also had a statistically significant negative impact on the access to healthcare services, especially in developing countries.Conclusion:Potentially, improvements to healthcare access can be achieved through consideration of rural elderly women’s overall status including healthcare needs, socioeconomic determinants and cultural issues rather than simply establishing healthcare centers.
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Grépin KA, Pinkstaff CB, Shroff ZC, Ghaffar A. Donor funding health policy and systems research in low- and middle-income countries: how much, from where and to whom. Health Res Policy Syst 2017; 15:68. [PMID: 28854946 PMCID: PMC5577666 DOI: 10.1186/s12961-017-0224-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 06/26/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The need for sufficient and reliable funding to support health policy and systems research (HPSR) in low- and middle-income countries (LMICs) has been widely recognised. Currently, most resources to support such activities come from traditional development assistance for health (DAH) donors; however, few studies have examined the levels, trends, sources and national recipients of such support - a gap this research seeks to address. METHOD Using OECD's Creditor Reporting System database, we classified donor funding commitments using a keyword analysis of the project-level descriptions of donor supported projects to estimate total funding available for HPSR-related activities annually from bilateral and multilateral donors, as well as the Bill and Melinda Gates Foundation, to LMICs over the period 2000-2014. RESULTS Total commitments to HPSR-related activities have greatly increased since 2000, peaked in 2010, and have held steady since 2011. Over the entire study period (2000-2014), donors committed a total of $4 billion in funding for HPSR-related activities or an average of $266 million a year. Over the last 5 years (2010-2014), donors committed an average of $434 million a year to HPSR-related activities. Funding for HPSR is heavily concentrated, with more than 93% coming from just 10 donors and only represents approximately 2% of all donor funding for health and population projects. Countries in the sub-Saharan African region are the major recipients of HPSR funding. CONCLUSION Funding for HPSR-related activities has generally increased over the study period; however, donor support to such activities represents only a small proportion of total DAH and has not grown in recent years. Donors should consider increasing the proportion of funds they allocate to support HPSR activities in order to further build the evidence base on how to build stronger health systems.
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Affiliation(s)
- Karen Ann Grépin
- Wilfrid Laurier University, 75 University Avenue West, Waterloo, ON, N2L 3C5, Canada.
| | | | - Zubin Cyrus Shroff
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
| | - Abdul Ghaffar
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
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Bartfay WJ, Bartfay E, Wu T. Impact of the Global Economic Crisis on the Health of Unemployed Autoworkers. Can J Nurs Res 2017; 45:66-79. [DOI: 10.1177/084456211304500305] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Wagner Z, Barofsky J, Sood N. PEPFAR Funding Associated With An Increase In Employment Among Males in Ten Sub-Saharan African Countries. Health Aff (Millwood) 2016; 34:946-53. [PMID: 26056199 DOI: 10.1377/hlthaff.2014.1006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The President's Emergency Plan for AIDS Relief (PEPFAR) has provided billions of US tax dollars to expand HIV treatment, care, and prevention programs in sub-Saharan Africa. This investment has generated significant health gains, but much less is known about PEPFAR's population-level economic effects. We used a difference-in-differences approach to compare employment trends between ten countries that received a large amount of PEPFAR funding (focus countries) and eleven countries that received little or no funding (control countries). We found that PEPFAR was associated with a 13 percent differential increase in employment among males in focus countries, compared to control countries. However, we observed no change in employment among females. In addition, we found that increasing PEPFAR per capita funding by $100 was associated with a 9.1-percentage-point increase in employment among males. This rise in employment generates economic benefits equal to half of PEPFAR's cost. These findings suggest that PEPFAR's economic impact should be taken into account when making aid allocation decisions.
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Affiliation(s)
- Zachary Wagner
- Zachary Wagner is a doctoral student in health economics at the University of California, Berkeley
| | - Jeremy Barofsky
- Jeremy Barofsky is the Okun-Model Fellow at the Brookings Institution, in Washington, D.C
| | - Neeraj Sood
- Neeraj Sood is an associate professor of health economics and director of research at the Leonard D. Schaeffer Center for Health Policy and Economics at the University of Southern California, in Los Angeles
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Gutnik L, Yamey G, Riviello R, Meara JG, Dare AJ, Shrime MG. Financial contributions to global surgery: an analysis of 160 international charitable organizations. SPRINGERPLUS 2016; 5:1558. [PMID: 27652131 PMCID: PMC5021658 DOI: 10.1186/s40064-016-3046-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 08/11/2016] [Indexed: 11/23/2022]
Abstract
Background The non-profit and volunteer sector has made notable contributions to delivering surgical services in low-and middle-income countries (LMICs). As an estimated 55 % of surgical care delivered in some LMICs is via charitable organizations; the financial contributions of this sector provides valuable insight into understanding financing priorities in global surgery. Methods Databases of registered charitable organizations in five high-income nations (United States, United Kingdom, Canada, Australia, and New Zealand) were searched to identify organizations committed exclusively to surgery in LMICs and their financial data. For each organization, we categorized the surgical specialty and calculated revenues and expenditures. All foreign currency was converted to U.S. dollars based on historical yearly average conversion rates. All dollars were adjusted for inflation by converting to 2014 U.S. dollars. Results
One hundred sixty organizations representing 15 specialties were identified. Adjusting for inflation, in 2014 U.S. dollars (US$), total aggregated revenue over the years 2008–2013 was $3·4 billion and total aggregated expenses were $3·1 billion. Twenty-eight ophthalmology organizations accounted for 45 % of revenue and 49 % of expenses. Fifteen cleft lip/palate organizations totaled 26 % of both revenue and expenses. The remaining 117 organizations, representing a variety of specialties, accounted for 29 % of revenue and 25 % of expenses. In comparison, from 2008 to 2013, charitable organizations provided nearly $27 billion for global health, meaning an estimated 11.5 % went towards surgery. Conclusion Charitable organizations that exclusively provide surgery in LMICs primarily focus on elective surgeries, which cover many subspecialties, and often fill deep gaps in care. The largest funding flows are directed at ophthalmology, followed by cleft lip and palate surgery. Despite the number of contributing organizations, there is a clear need for improvement and increased transparency in tracking of funds to global surgery via charitable organizations.
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Affiliation(s)
- Lily Gutnik
- Department of Surgery, University of Utah, Salt Lake City, UT USA ; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA USA ; Tidziwe Center, UNC Project Malawi, Privae Bag A-104, Lilongwe, Malawi
| | - Gavin Yamey
- Duke Global Health Institute, Duke University, Durham, NC USA
| | - Robert Riviello
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA USA ; Department of Surgery, Brigham and Women's Hospital, Boston, MA USA
| | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA ; Department of Plastic Surgery, Boston Children's Hospital, Boston, MA USA
| | - Anna J Dare
- King's Centre for Global Health, King's Health Partners, King's College London, London, England, UK
| | - Mark G Shrime
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA ; Harvard University Interfaculty Initiative in Health Policy, Boston, MA USA ; Office of Global Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA USA ; Department of Otology and Laryngology, Harvard Medical School, Boston, MA USA
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24
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Addressing unwarranted variations in colorectal cancer outcomes: a conceptual approach. Nat Rev Clin Oncol 2016; 13:706-712. [PMID: 27349194 DOI: 10.1038/nrclinonc.2016.94] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
In the clinical setting, the term 'unwarranted variation' refers to variations in patient outcomes that cannot be explained by the patient's underlying illness or medical needs, or the dictates of evidence-based medicine. These types of variations persist even after adjusting for patient-specific factors. Unwarranted variation depends on a complex mix of disparities, including inequalities in access to appropriate care in a wide variety of geographical and cultural settings, in the uptake and application of clinical knowledge, in the prioritization and allocation of resources, and differences in organizational and professional culture. Nevertheless, unwarranted variation has been inexorably linked with clinical practice. Thus, awareness of the antecedents of unwarranted variations in clinical practice is strategically important. In this Perspective, we discuss these antecedents in colorectal cancer clinical care pathways with an emphasis upon the multidisciplinary team (MDT), and suggest pragmatic steps that could be taken to address latent unwarranted variation.
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Dieleman JL, Schneider MT, Haakenstad A, Singh L, Sadat N, Birger M, Reynolds A, Templin T, Hamavid H, Chapin A, Murray CJL. Development assistance for health: past trends, associations, and the future of international financial flows for health. Lancet 2016; 387:2536-44. [PMID: 27086170 DOI: 10.1016/s0140-6736(16)30168-4] [Citation(s) in RCA: 138] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Disbursements of development assistance for health (DAH) have risen substantially during the past several decades. More recently, the international community's attention has turned to other international challenges, introducing uncertainty about the future of disbursements for DAH. METHODS We collected audited budget statements, annual reports, and project-level records from the main international agencies that disbursed DAH from 1990 to the end of 2015. We standardised and combined records to provide a comprehensive set of annual disbursements. We tracked each dollar of DAH back to the source and forward to the recipient. We removed transfers between agencies to avoid double-counting and adjusted for inflation. We classified assistance into nine primary health focus areas: HIV/AIDS, tuberculosis, malaria, maternal health, newborn and child health, other infectious diseases, non-communicable diseases, Ebola, and sector-wide approaches and health system strengthening. For our statistical analysis, we grouped these health focus areas into two categories: MDG-related focus areas (HIV/AIDS, tuberculosis, malaria, child and newborn health, and maternal health) and non-MDG-related focus areas (other infectious diseases, non-communicable diseases, sector-wide approaches, and other). We used linear regression to test for structural shifts in disbursement patterns at the onset of the Millennium Development Goals (MDGs; ie, from 2000) and the global financial crisis (impact estimated to occur in 2010). We built on past trends and associations with an ensemble model to estimate DAH through the end of 2040. FINDINGS In 2015, US$36·4 billion of DAH was disbursed, marking the fifth consecutive year of little change in the amount of resources provided by global health development partners. Between 2000 and 2009, DAH increased at 11·3% per year, whereas between 2010 and 2015, annual growth was just 1·2%. In 2015, 29·7% of DAH was for HIV/AIDS, 17·9% was for child and newborn health, and 9·8% was for maternal health. Linear regression identifies three distinct periods of growth in DAH. Between 2000 and 2009, MDG-related DAH increased by $290·4 million (95% uncertainty interval [UI] 174·3 million to 406·5 million) per year. These increases were significantly greater than were increases in non-MDG DAH during the same period (p=0·009), and were also significantly greater than increases in the previous period (p<0·0001). Between 2000 and 2009, growth in DAH was highest for HIV/AIDS, malaria, and tuberculosis. Since 2010, DAH for maternal health and newborn and child health has continued to climb, although DAH for HIV/AIDS and most other health focus areas has remained flat or decreased. Our estimates of future DAH based on past trends and associations present a wide range of potential futures, although our mean estimate of $64·1 billion (95% UI $30·4 billion to $161·8 billion) shows an increase between now and 2040, although with a large uncertainty interval. INTERPRETATION Our results provide evidence of two substantial shifts in DAH growth during the past 26 years. DAH disbursements increased faster in the first decade of the 2000s than in the 1990s, but DAH associated with the MDGs increased the most out of all focus areas. Since 2010, limited growth has characterised DAH and we expect this pattern to persist. Despite the fact that DAH is still growing, albeit minimally, DAH is shifting among the major health focus areas, with relatively little growth for HIV/AIDS, malaria, and tuberculosis. These changes in the growth and focus of DAH will have critical effects on health services in some low-income countries. Coordination and collaboration between donors and domestic governments is more important than ever because they have a great opportunity and responsibility to ensure robust health systems and service provision for those most in need. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
| | | | | | - Lavanya Singh
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Nafis Sadat
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Maxwell Birger
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Alex Reynolds
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Tara Templin
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Hannah Hamavid
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Abigail Chapin
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
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Fan VY, Grépin KA, Shen GC, Chen L. Tracking the flow of health aid from BRICS countries. Bull World Health Organ 2016; 92:457-8. [PMID: 24940022 DOI: 10.2471/blt.13.132472] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 03/24/2014] [Accepted: 03/26/2014] [Indexed: 11/27/2022] Open
Affiliation(s)
- Victoria Y Fan
- Center for Global Development, Washington, United States of America (USA)
| | - Karen A Grépin
- Robert F Wagner Graduate School of Public Service, New York University, 295 Lafayette Street, New York, NY 10012-9604, USA
| | - Gordon C Shen
- School of Public Health, Yale University, New Haven, USA
| | - Lucy Chen
- Institute for Global Health, Peking University, Beijing, China
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Houben RMGJ, Lalli M, Sumner T, Hamilton M, Pedrazzoli D, Bonsu F, Hippner P, Pillay Y, Kimerling M, Ahmedov S, Pretorius C, White RG. TIME Impact - a new user-friendly tuberculosis (TB) model to inform TB policy decisions. BMC Med 2016; 14:56. [PMID: 27012808 PMCID: PMC4806495 DOI: 10.1186/s12916-016-0608-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 03/22/2016] [Indexed: 02/01/2023] Open
Abstract
Tuberculosis (TB) is the leading cause of death from infectious disease worldwide, predominantly affecting low- and middle-income countries (LMICs), where resources are limited. As such, countries need to be able to choose the most efficient interventions for their respective setting. Mathematical models can be valuable tools to inform rational policy decisions and improve resource allocation, but are often unavailable or inaccessible for LMICs, particularly in TB. We developed TIME Impact, a user-friendly TB model that enables local capacity building and strengthens country-specific policy discussions to inform support funding applications at the (sub-)national level (e.g. Ministry of Finance) or to international donors (e.g. the Global Fund to Fight AIDS, Tuberculosis and Malaria).TIME Impact is an epidemiological transmission model nested in TIME, a set of TB modelling tools available for free download within the widely-used Spectrum software. The TIME Impact model reflects key aspects of the natural history of TB, with additional structure for HIV/ART, drug resistance, treatment history and age. TIME Impact enables national TB programmes (NTPs) and other TB policymakers to better understand their own TB epidemic, plan their response, apply for funding and evaluate the implementation of the response.The explicit aim of TIME Impact's user-friendly interface is to enable training of local and international TB experts towards independent use. During application of TIME Impact, close involvement of the NTPs and other local partners also builds critical understanding of the modelling methods, assumptions and limitations inherent to modelling. This is essential to generate broad country-level ownership of the modelling data inputs and results. In turn, it stimulates discussions and a review of the current evidence and assumptions, strengthening the decision-making process in general.TIME Impact has been effectively applied in a variety of settings. In South Africa, it informed the first South African HIV and TB Investment Cases and successfully leveraged additional resources from the National Treasury at a time of austerity. In Ghana, a long-term TIME model-centred interaction with the NTP provided new insights into the local epidemiology and guided resource allocation decisions to improve impact.
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Affiliation(s)
- R M G J Houben
- TB Modelling Group, TB Centre, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, UK. .,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
| | - M Lalli
- TB Modelling Group, TB Centre, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, UK.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - T Sumner
- TB Modelling Group, TB Centre, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, UK.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | | | - D Pedrazzoli
- TB Modelling Group, TB Centre, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, UK.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - F Bonsu
- National Tuberculosis Control Programme, Ghana Health Service, Accra, Ghana
| | - P Hippner
- Aurum Institute, Johannesburg, South Africa
| | - Y Pillay
- National Department of Health, Pretoria, South Africa
| | - M Kimerling
- KNCV Tuberculosis Foundation, The Hague, The Netherlands
| | | | | | - R G White
- TB Modelling Group, TB Centre, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, UK.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Bachireddy C, Weisberg DF, Altice FL. Balancing access and safety in prescribing opioid agonist therapy to prevent HIV transmission. Addiction 2015; 110:1869-71. [PMID: 26464200 DOI: 10.1111/add.13055] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 07/11/2015] [Accepted: 07/13/2015] [Indexed: 12/31/2022]
Affiliation(s)
| | - Daniel F Weisberg
- Brigham and Women's Hospital, Department of Medicine, Boston, MA, USA.
| | - Frederick L Altice
- Yale University School of Medicine, Department of Medicine, Division of Infectious Diseases, AIDS Program, New Haven, CT, USA. .,Yale University School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven, CT, USA. .,Centre of Excellence in Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia.
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Mutero CM, Mbogo C, Mwangangi J, Imbahale S, Kibe L, Orindi B, Girma M, Njui A, Lwande W, Affognon H, Gichuki C, Mukabana WR. An Assessment of Participatory Integrated Vector Management for Malaria Control in Kenya. ENVIRONMENTAL HEALTH PERSPECTIVES 2015; 123:1145-51. [PMID: 25859686 PMCID: PMC4629737 DOI: 10.1289/ehp.1408748] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 04/07/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND The World Health Organization (WHO) recommends integrated vector management (IVM) as a strategy to improve and sustain malaria vector control. However, this approach has not been widely adopted. OBJECTIVES We comprehensively assessed experiences and findings on IVM in Kenya with a view to sharing lessons that might promote its wider application. METHODS The assessment used information from a qualitative external evaluation of two malaria IVM projects implemented between 2006 and 2011 and an analysis of their accumulated entomological and malaria case data. The project sites were Malindi and Nyabondo, located in coastal and western Kenya, respectively. The assessment focused on implementation of five key elements of IVM: integration of vector control methods, evidence-based decision making, intersectoral collaboration, advocacy and social mobilization, and capacity building. RESULTS IVM was more successfully implemented in Malindi than in Nyabondo owing to greater community participation and multistakeholder engagement. There was a significant decline in the proportion of malaria cases among children admitted to Malindi Hospital, from 23.7% in 2006 to 10.47% in 2011 (p < 0.001). However, the projects' operational research methodology did not allow statistical attribution of the decline in malaria and malaria vectors to specific IVM interventions or other factors. CONCLUSIONS Sustaining IVM is likely to require strong participation and support from multiple actors, including community-based groups, non-governmental organizations, international and national research institutes, and various government ministries. A cluster-randomized controlled trial would be essential to quantify the effectiveness and impact of specific IVM interventions, alone or in combination. CITATION Mutero CM, Mbogo C, Mwangangi J, Imbahale S, Kibe L, Orindi B, Girma M, Njui A, Lwande W, Affognon H, Gichuki C, Mukabana WR. 2015. An assessment of participatory integrated vector management for malaria control in Kenya. Environ Health Perspect 123:1145-1151; http://dx.doi.org/10.1289/ehp.1408748.
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Vermund SH, Sheldon EK, Sidat M. Southern Africa: the Highest Priority Region for HIV Prevention and Care Interventions. Curr HIV/AIDS Rep 2015; 12:191-5. [PMID: 25869940 PMCID: PMC4536916 DOI: 10.1007/s11904-015-0270-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The global HIV pandemic began to expand rapidly in southern Africa a decade later than was noted in central Africa, Europe, the Caribbean, and North America. Multiple factors played a role in this rapid expansion which led Southern Africa to become the most heavily afflicted region for HIV/AIDS globally. In this issue of Current HIV/AIDS Reports, investigators with active research interests in the region have reviewed key elements of the causes of and responses to the epidemic. Putative causes of the high HIV prevalence in the region are discussed, including host and viral biology, human behavior, politics and policy, structural factors, health services, health workforce, migration, traditional healers' role, and other issues. Regional epidemiological trends are described and forecasted. Issues related to the continuum of HIV care and treatment are highlighted. We hope that the reviews will prove useful to those policymakers, health care workers, and scientists who are striving to reduce the burden of HIV in the southern African region, as well as prove insightful for key issues of broader global relevance.
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Affiliation(s)
- Sten H Vermund
- Vanderbilt Institute of Global Health, Vanderbilt University School of Medicine, 2525 West End Ave., Suite 750, Nashville, TN, 37203, USA,
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Raeburn T, Hungerford C, Sayers J, Escott P, Lopez V, Cleary M. Leading a Recovery-oriented Social Enterprise. Issues Ment Health Nurs 2015; 36:362-9. [PMID: 26090553 DOI: 10.3109/01612840.2015.1011760] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Recovery-oriented mental health services promote the principles of recovery, such as hope and optimism, and are characterized by a personalized approach to developing consumer self-determination. Nurse leaders are increasingly developing such services as social enterprises, but there is limited research on the leadership of these programs. Leading a recovery-oriented mental health nurse social enterprise requires visionary leadership, collaboration with consumers and local health providers, financial viability, and commitment to recovery-focused practice. This article describes the framework of an Australian mental health nursing social enterprise, including the service attributes and leadership lessons that have been learned from developing program sustainability.
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Affiliation(s)
- Toby Raeburn
- University of Sydney, Sydney Nursing School, Camperdown , Sydney, New South Wales , Australia
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Duber HC, Dansereau E, Masters SH, Achan J, Burstein R, DeCenso B, Gasasira A, Ikilezi G, Kisia C, Masiye F, Njuguna P, Odeny T, Okiro E, Roberts DA, Gakidou E. Uptake of WHO recommendations for first-line antiretroviral therapy in Kenya, Uganda, and Zambia. PLoS One 2015; 10:e0120350. [PMID: 25807553 PMCID: PMC4373941 DOI: 10.1371/journal.pone.0120350] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 02/06/2015] [Indexed: 11/24/2022] Open
Abstract
Introduction Antiretroviral therapy (ART) guidelines were significantly changed by the World Health Organization in 2010. It is largely unknown to what extent these guidelines were adopted into clinical practice. Methods This was a retrospective observational analysis of first-line ART regimens in a sample of health facilities providing ART in Kenya, Uganda, and Zambia between 2007-2008 and 2011-2012. Data were analyzed for changes in regimen over time and assessed for key patient- and facility-level determinants of tenofovir (TDF) utilization in Kenya and Uganda using a mixed effects model. Results Data were obtained from 29,507 patients from 146 facilities. The overall percentage of patients initiated on TDF-based therapy increased between 2007-2008 and 2011-2012 from 3% to 37% in Kenya, 2% to 34% in Uganda, and 64% to 87% in Zambia. A simultaneous decrease in stavudine (d4T) utilization was also noted, but its use was not eliminated, and there remained significant variation in facility prescribing patterns. For patients initiating ART in 2011-2012, we found increased odds of TDF use with more advanced disease at initiation in both Kenya (odds ratio [OR]: 2.78; 95% confidence interval [CI]: 1.73-4.48) and Uganda (OR: 2.15; 95% CI: 1.46-3.17). Having a CD4 test performed at initiation was also a significant predictor in Uganda (OR: 1.43; 95% CI: 1.16-1.76). No facility-level determinants of TDF utilization were seen in Kenya, but private facilities (OR: 2.86; 95% CI: 1.45-5.66) and those employing a doctor (OR: 2.86; 95% CI: 1.48-5.51) were more likely to initiate patients on TDF in Uganda. Discussion d4T-based ART has largely been phased out over the study period. However, significant in-country and cross-country variation exists. Among the most recently initiated patients, those with more advanced disease at initiation were most likely to start TDF-based treatment. No facility-level determinants were consistent across countries to explain the observed facility-level variation.
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Affiliation(s)
- Herbert C. Duber
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States of America
- * E-mail:
| | - Emily Dansereau
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States of America
| | - Samuel H. Masters
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States of America
| | - Jane Achan
- Infectious Disease Research Collaboration, Makerere University, Kampala, Uganda
| | - Roy Burstein
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States of America
| | - Brendan DeCenso
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States of America
| | - Anne Gasasira
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States of America
| | - Gloria Ikilezi
- Infectious Disease Research Collaboration, Makerere University, Kampala, Uganda
| | | | - Felix Masiye
- Department of Economics, University of Zambia, Lusaka, Zambia
| | | | - Thomas Odeny
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States of America
| | - Emelda Okiro
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States of America
| | - D. Allen Roberts
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States of America
| | - Emmanuela Gakidou
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States of America
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Graves CM, Haakenstad A, Dieleman JL. Tracking development assistance for health to fragile states: 2005-2011. Global Health 2015; 11:12. [PMID: 25886046 PMCID: PMC4381367 DOI: 10.1186/s12992-015-0097-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 02/23/2015] [Indexed: 11/10/2022] Open
Abstract
Background Development assistance for health (DAH) has grown substantially, totaling more than $31.3 billion in 2013. However, the degree that countries with high concentrations of armed conflict, ethnic violence, inequality, debt, and corruption have received this health aid and how that assistance might be different from the funding provided to other countries has not been assessed. Methods We combine DAH estimates and a multidimensional fragile states index for 2005 through 2011. We disaggregate and compare total DAH disbursed for fragile states versus stable states. Results Between 2005 and 2011, DAH per person in fragile countries increased at an annualized rate of 5.4%. In 2011 DAH to fragile countries totaled $6.2 billion, which is $5.05 per person. This is 43% of total DAH that is traced to a country. Comparing low-income countries, funding channeled to fragile countries was $7.22 per person while stable countries received $11.15 per person. Relative to stable countries, donors preferred to provide more funding to low-income fragile countries that have refugees or ongoing external intervention but tended to avoid providing funding to countries with political gridlock, flawed elections, or economic decline. In 2011, Ethiopia received the most health aid of all fragile countries, while the United States provided the most funds to fragile countries. Conclusions In 2011, 1.2 billion people lived in fragile countries. DAH can bolster health systems and might be especially valuable in providing long-term stability in fragile environments. While external health funding to these countries has increased since 2005, it is, in per person terms, almost half as much as the DAH provided to stable countries of comparable income levels. Electronic supplementary material The online version of this article (doi:10.1186/s12992-015-0097-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Casey M Graves
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Avenue, Suite 600, Seattle, WA, 98121, USA.
| | - Annie Haakenstad
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Avenue, Suite 600, Seattle, WA, 98121, USA.
| | - Joseph L Dieleman
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Avenue, Suite 600, Seattle, WA, 98121, USA.
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Maruthappu M, Da Zhou C, Williams C, Zeltner T, Atun R. Unemployment, public-sector health care expenditure and HIV mortality: An analysis of 74 countries, 1981-2009. J Glob Health 2015; 5:010403. [PMID: 25734005 PMCID: PMC4337148 DOI: 10.7189/jogh.05.010403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background The global economic downturn has been associated with increased unemployment and reduced public–sector expenditure on health care (PSEH). We determined the association between unemployment, PSEH and HIV mortality. Methods Data were obtained from the World Bank and the World Health Organisation (1981–2009). Multivariate regression analysis was implemented, controlling for country–specific demographics and infrastructure. Time–lag analyses and robustness–checks were performed. Findings Data were available for 74 countries (unemployment analysis) and 75 countries (PSEH analysis), equating to 2.19 billion and 2.22 billion people, respectively, as of 2009. A 1% increase in unemployment was associated with a significant increase in HIV mortality (men: 0.1861, 95% CI: 0.0977 to 0.2744, P = 0.0000, women: 0.0383, 95% CI: 0.0108 to 0.0657, P = 0.0064). A 1% increase in PSEH was associated with a significant decrease in HIV mortality (men: –0.5015, 95% CI: –0.7432 to –0.2598, P = 0.0001; women: –0.1562, 95% CI: –0.2404 to –0.0720, P = 0.0003). Time–lag analysis showed that significant changes in HIV mortality continued for up to 5 years following variations in both unemployment and PSEH. Interpretation Unemployment increases were associated with significant HIV mortality increases. PSEH increases were associated with reduced HIV mortality. The facilitation of access–to–care for the unemployed and policy interventions which aim to protect PSEH could contribute to improved HIV outcomes.
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Affiliation(s)
- Mahiben Maruthappu
- Imperial College London, London, UK ; Faculty of Arts and Sciences, Harvard University, Cambridge, MA, USA
| | | | - Callum Williams
- The Economist, London, UK ; Faculty of History, University of Oxford, Oxford, UK
| | - Thomas Zeltner
- Special Envoy for Financing to the Director General of the World Health Organization, Geneva, Switzerland ; University of Bern, Bern, Switzerland
| | - Rifat Atun
- Harvard School of Public Health, Boston, MA, USA
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Abstract
Global trends in HIV incidence are estimated typically by serial prevalence surveys in selected sentinel populations or less often in representative population samples. Incidence estimates are often modeled because cohorts are costly to maintain and are rarely representative of larger populations. From global trends, we can see reason for cautious optimism. Downward trends in generalized epidemics in Africa, concentrated epidemics in persons who inject drugs (PWID), some female sex worker cohorts, and among older men who have sex with men (MSM) have been noted. However, younger MSM and those from minority populations, as with black MSM in the United States, show continued transmission at high rates. Among the many HIV prevention strategies, current efforts to expand testing, linkage to effective care, and adherence to antiretroviral therapy are known as "treatment as prevention" (TasP). A concept first forged for the prevention of mother to child transmission, TasP generates high hopes that persons treated early will derive considerable clinical benefits and that lower infectiousness will reduce transmission in communities. With the global successes of risk reduction for PWID, we have learned that reducing marginalization of the at-risk population, implementation of nonjudgmental and pragmatic sterile needle and syringe exchange programs, and offering of opiate substitution therapy to help persons eschew needle use altogether can work to reduce the HIV epidemic. Never has the urgency of stigma reduction and guarantees of human rights been more urgent; a public health approach to at-risk populations requires that to avail themselves of prevention services and they must feel welcomed.
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Affiliation(s)
- Sten H Vermund
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA,
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Mamka Anyona R, de Courten M. An Analysis of the Policy Environment Surrounding Noncommunicable Diseases Risk Factor Surveillance in Kenya. AIMS Public Health 2014; 1:256-274. [PMID: 29546090 PMCID: PMC5690257 DOI: 10.3934/publichealth.2014.4.256] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 10/27/2014] [Indexed: 11/24/2022] Open
Abstract
Kenya is a developing country in sub-Saharan Africa, facing a triple disease burden, with an increase in non-communicable diseases (NCDs); uncontained infectious diseases; coupled with significant morbidity and mortality from environmental causes such as droughts and flooding. The limelight has been on infectious diseases, leaving few resources for NCDs. As NCDs start to gain attention, it is becoming apparent that essential information on their epidemiology and risk factor trends-key in evidence-based decision-making-is lacking. As a consequence, policies have long relied on information derived from unreliable data sources such as vital registries and facility-level data, and unrepresentative data from small-scale clinical and academic research. This study analyzed the health policy aspects of NCD risk factor surveillance in Kenya, describing barriers to the successful design and implementation of an NCD risk factor surveillance system, and suggests a strategy best suited for the Kenyan situation. A review of policy documents and publications was augmented by a field-study consisting of interviews of key informants identified as stakeholders. Findings were analyzed using the Walt and Gilson policy analysis triangle. Findings attest that no population baseline NCD burden or risk factor data was available, with a failed WHO STEPs survey in 2005, to be undertaken in 2013. Despite the continued mention of NCD surveillance and the highlighting of its importance in various policy documents, a related strategy is yet to be established. Hurdles ranged from a lack of political attention for NCDs and competing public interests, to the lack of an evidence-based decision making culture and the impact of aid dependency of health programs. Progress in recognition of NCDs was noted and the international community and civil society's contribution to these achievements documented. While a positive outlook on the future of NCD surveillance were encountered, it is noteworthy that overcoming policy and structural hurdles for continued success is imperative.
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Affiliation(s)
| | - Maximilian de Courten
- Centre for Chronic Disease, College of Health & Biomedicine, Victoria University, Melbourne, Australia
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Panovska-Griffiths J, Vassall A, Prudden HJ, Lépine A, Boily MC, Chandrashekar S, Mitchell KM, Beattie TS, Alary M, Martin NK, Vickerman P. Optimal allocation of resources in female sex worker targeted HIV prevention interventions: model insights from Avahan in South India. PLoS One 2014; 9:e107066. [PMID: 25271808 PMCID: PMC4182672 DOI: 10.1371/journal.pone.0107066] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 08/04/2014] [Indexed: 12/03/2022] Open
Abstract
Background The Avahan programme has provided HIV prevention activities, including condom promotion, to female sex workers (FSWs) in southern India since 2004. Evidence suggests Avahan averted 202,000 HIV infections over 4 years. For replicating this intervention elsewhere, it is essential to understand how the intervention’s impact could have been optimised for different budget levels. Methods Behavioural data were used to determine how condom use varied for FSWs with different levels of intervention intensity. Cost data from 64 Avahan districts quantified how district-level costs related to intervention scale and intensity. A deterministic model for HIV transmission amongst FSWs and clients projected the impact and cost of intervention strategies for different scale and intensity, and identified the optimal strategies that maximise impact for different budget levels. Results As budget levels increase, the optimal intervention strategy is to first increase intervention intensity which achieves little impact, then scale-up coverage to high levels for large increases in impact, and lastly increase intensity further for small additional gains. The cost-effectiveness of these optimal strategies generally improves with increasing resources, while straying from these strategies can triple costs for the same impact. Projections suggest Avahan was close to being optimal, and moderate budget reductions (≥20%) would have reduced impact considerably (>40%). Discussion Our analysis suggests that tailoring the design of HIV prevention programmes for FSWs can improve impact, and that a certain level of resources are required to achieve demonstrable impact. These insights are critical for optimising the use of limited resources for preventing HIV.
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Affiliation(s)
- Jasmina Panovska-Griffiths
- Social and Mathematical Epidemiology Group, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom; Department of Mathematics, University College London, London, United Kingdom
| | - Anna Vassall
- Social and Mathematical Epidemiology Group, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Holly J Prudden
- Social and Mathematical Epidemiology Group, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Aurélia Lépine
- Social and Mathematical Epidemiology Group, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Marie-Claude Boily
- School of Public Health, Imperial College, London, United Kingdom; Centre de recherche du CHU de Québec, Québec, Canada
| | - Sudha Chandrashekar
- Social and Mathematical Epidemiology Group, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom; St. John's Research Institute, Bangalore, India
| | - Kate M Mitchell
- Social and Mathematical Epidemiology Group, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Tara S Beattie
- Social and Mathematical Epidemiology Group, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Michel Alary
- Centre de recherche du CHU de Québec, Québec, Canada; Département de médecine sociale et préventive, Université Laval, Québec, Canada
| | - Natasha K Martin
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Peter Vickerman
- Social and Mathematical Epidemiology Group, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom; School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
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Mutero CM, Kramer RA, Paul C, Lesser A, Miranda ML, Mboera LEG, Kiptui R, Kabatereine N, Ameneshewa B. Factors influencing malaria control policy-making in Kenya, Uganda and Tanzania. Malar J 2014; 13:305. [PMID: 25107509 PMCID: PMC4249611 DOI: 10.1186/1475-2875-13-305] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 08/04/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Policy decisions for malaria control are often difficult to make as decision-makers have to carefully consider an array of options and respond to the needs of a large number of stakeholders. This study assessed the factors and specific objectives that influence malaria control policy decisions, as a crucial first step towards developing an inclusive malaria decision analysis support tool (MDAST). METHODS Country-specific stakeholder engagement activities using structured questionnaires were carried out in Kenya, Uganda and Tanzania. The survey respondents were drawn from a non-random purposeful sample of stakeholders, targeting individuals in ministries and non-governmental organizations whose policy decisions and actions are likely to have an impact on the status of malaria. Summary statistics across the three countries are presented in aggregate. RESULTS Important findings aggregated across countries included a belief that donor preferences and agendas were exerting too much influence on malaria policies in the countries. Respondents on average also thought that some relevant objectives such as engaging members of parliament by the agency responsible for malaria control in a particular country were not being given enough consideration in malaria decision-making. Factors found to influence decisions regarding specific malaria control strategies included donor agendas, costs, effectiveness of interventions, health and environmental impacts, compliance and/acceptance, financial sustainability, and vector resistance to insecticides. CONCLUSION Malaria control decision-makers in Kenya, Uganda and Tanzania take into account health and environmental impacts as well as cost implications of different intervention strategies. Further engagement of government legislators and other policy makers is needed in order to increase funding from domestic sources, reduce donor dependence, sustain interventions and consolidate current gains in malaria.
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Affiliation(s)
- Clifford M Mutero
- Centre for Sustainable Malaria Control and School of Health Systems and Public Health, University of Pretoria, Private Bag 323, Pretoria, 0001, South Africa.
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Decision-making on intra-household allocation of bed nets in Uganda: do households prioritize the most vulnerable members? Malar J 2014; 13:183. [PMID: 24885653 PMCID: PMC4030011 DOI: 10.1186/1475-2875-13-183] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 05/07/2014] [Indexed: 11/10/2022] Open
Abstract
Background Access to insecticide-treated bed nets has increased substantially in recent years, but ownership and use remain well below 100% in many malaria endemic areas. Understanding decision-making around net allocation in households with too few nets is essential to ensuring protection of the most vulnerable. This study explores household net allocation preferences and practices across four districts in Uganda. Methods Data collection consisted of eight focus group discussions, twelve in-depth interviews, and a structured questionnaire to inventory 107 sleeping spaces in 28 households. Results In focus group discussions and in-depth interviews, participants almost unanimously stated that pregnant women, infants, and young children should be prioritized when allocating nets. However, sleeping space surveys reveal that heads of household sometimes receive priority over children less than five years of age when households have too few nets to cover all members. Conclusions When asked directly, most net owners highlight the importance of allocating nets to the most biologically vulnerable household members. This is consistent with malaria behaviour change and health education messages. In actual allocation, however, factors other than biological vulnerability may influence who does and does not receive a net.
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Dieleman JL, Graves CM, Templin T, Johnson E, Baral R, Leach-Kemon K, Haakenstad AM, Murray CJ. Global Health Development Assistance Remained Steady In 2013 But Did Not Align With Recipients’ Disease Burden. Health Aff (Millwood) 2014; 33:878-86. [DOI: 10.1377/hlthaff.2013.1432] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Joseph L. Dieleman
- Joseph L. Dieleman ( ) is an acting assistant professor at the Institute for Health Metrics and Evaluation (IHME), University of Washington, in Seattle
| | | | - Tara Templin
- Tara Templin is a postbachelor fellow at the IHME
| | | | - Ranju Baral
- Ranju Baral is a postgraduate fellow at the IHME
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Shigayeva A, Coker RJ. Communicable disease control programmes and health systems: an analytical approach to sustainability. Health Policy Plan 2014; 30:368-85. [PMID: 24561988 DOI: 10.1093/heapol/czu005] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
There is renewed concern over the sustainability of disease control programmes, and re-emergence of policy recommendations to integrate programmes with general health systems. However, the conceptualization of this issue has remarkably received little critical attention. Additionally, the study of programmatic sustainability presents methodological challenges. In this article, we propose a conceptual framework to support analyses of sustainability of communicable disease programmes. Through this work, we also aim to clarify a link between notions of integration and sustainability. As a part of development of the conceptual framework, we conducted a systematic literature review of peer-reviewed literature on concepts, definitions, analytical approaches and empirical studies on sustainability in health systems. Identified conceptual proposals for analysis of sustainability in health systems lack an explicit conceptualization of what a health system is. Drawing upon theoretical concepts originating in sustainability sciences and our review here, we conceptualize a communicable disease programme as a component of a health system which is viewed as a complex adaptive system. We propose five programmatic characteristics that may explain a potential for sustainability: leadership, capacity, interactions (notions of integration), flexibility/adaptability and performance. Though integration of elements of a programme with other system components is important, its role in sustainability is context specific and difficult to predict. The proposed framework might serve as a basis for further empirical evaluations in understanding complex interplay between programmes and broader health systems in the development of sustainable responses to communicable diseases.
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Affiliation(s)
- Altynay Shigayeva
- Communicable Diseases Policy Research Group, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Richard J Coker
- Communicable Diseases Policy Research Group, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Dieleman JL, Hanlon M. Measuring the displacement and replacement of government health expenditure. HEALTH ECONOMICS 2014; 23:129-40. [PMID: 24327240 PMCID: PMC4229065 DOI: 10.1002/hec.3016] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 10/31/2013] [Accepted: 11/08/2013] [Indexed: 05/19/2023]
Abstract
Research assessing the relationship between government health expenditure and development assistance for health channeled to governments (DAHG) has not considered that this relationship may depend on whether DAHG is increasing or decreasing. We explore this issue using general method of moments estimation and a panel of financial flows data spanning 119 countries and 16 years. Our primary concern is how DAHG affects government health expenditure as source (GHES). We disaggregate the average effect of DAHG and separately identify the effects of increases versus decreases in DAHG. We find that a $1 year-over-year increase in DAHG leads to a $0.62 (90% confidence interval (CI): 0.15, 1.09) decrease in GHES, whereas a $1 year-over-year decrease in DAHG does not have an effect on GHES that is statistically different from zero (CI: -0.67, 1.17). Simulation shows that the displacement of GHES between 1995 and 2010 reduced total government health expenditure by $152.8 billion (CI: 46.9, 277.6). Moreover, the irregular disbursement of DAHG reduced total government expenditure by $96.9 billion (CI: 0.5, 212.4). Thus, this research shows that health aid is fungible and highlights the cost of displacement and erratic aid disbursement.
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Affiliation(s)
- Joseph L Dieleman
- *Correspondence to: Institute for Health Metrics and Evaluation, 2301 5 Avenue, #600, Seattle, WA 98121, USA. E-mail:
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Roessner V. Research in child and adolescent psychiatry: a multi-disciplinary, many-faceted endeavor. Eur Child Adolesc Psychiatry 2014; 23:1-2. [PMID: 24384625 DOI: 10.1007/s00787-013-0506-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Veit Roessner
- Department of Child and Adolescent Psychiatry, University of Dresden Medical School, Fetscherstrasse 74, 01307, Dresden, Germany,
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Dereli T, Coşkun Y, Kolker E, Güner O, Ağırbaşlı M, Ozdemir V. Big data and ethics review for health systems research in LMICs: understanding risk, uncertainty and ignorance -- and catching the black swans? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2014; 14:48-50. [PMID: 24521341 DOI: 10.1080/15265161.2013.868955] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Vassall A, Remme M, Watts C, Hallett T, Siapka M, Vickerman P, Terris-Prestholt F, Haacker M, Heise L, Haines A, Atun R, Piot P. Financing essential HIV services: a new economic agenda. PLoS Med 2013; 10:e1001567. [PMID: 24358028 PMCID: PMC3866083 DOI: 10.1371/journal.pmed.1001567] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Anna Vassall and colleagues discuss the need for, and challenges facing, innovative and sustainable financing of the HIV response. Please see later in the article for the Editors' Summary
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Affiliation(s)
- Anna Vassall
- SAME Modelling and Economics, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Michelle Remme
- SAME Modelling and Economics, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Charlotte Watts
- SAME Modelling and Economics, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Mariana Siapka
- SAME Modelling and Economics, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Peter Vickerman
- SAME Modelling and Economics, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Fern Terris-Prestholt
- SAME Modelling and Economics, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Markus Haacker
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Lori Heise
- SAME Modelling and Economics, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Andy Haines
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Rifat Atun
- Imperial College, London, United Kingdom
- Harvard School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| | - Peter Piot
- London School of Hygiene & Tropical Medicine, London, United Kingdom
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Vu A, Duber HC, Sasser SM, Hansoti B, Lynch C, Khan A, Johnson T, Modi P, Clattenburg EJ, Hargarten S. Emergency care research funding in the global health context: trends, priorities, and future directions. Acad Emerg Med 2013; 20:1259-63. [PMID: 24341581 DOI: 10.1111/acem.12267] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 08/13/2013] [Accepted: 08/13/2013] [Indexed: 11/30/2022]
Abstract
Over the past few decades there has been a steady growth in funding for global health, yet generally little is known about funding for global health research. As part of the 2013 Academic Emergency Medicine consensus conference, a session was convened to discuss emergency care research funding in the global health context. Overall, the authors found a lack of evidence available to determine funding priorities or quantify current funding for acute care research in global health. This article summarizes the initial preparatory research and reports on the results of the consensus conference focused on identifying challenges and strategies to improve funding for global emergency care research. The consensus conference meeting led to the creation of near- and long-term goals to strengthen global emergency care research funding and the development of important research questions. The research questions represent a consensus view of important outstanding questions that will assist emergency care researchers to better understand the current funding landscape and bring evidence to the debate on funding priorities of global health and emergency care. The four key areas of focus for researchers are: 1) quantifying funding for global health and emergency care research, 2) understanding current research funding priorities, 3) identifying barriers to emergency care research funding, and 4) using existing data to quantify the need for emergency services and acute care research. This research agenda will enable emergency health care scientists to use evidence when advocating for more funding for emergency care research.
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Affiliation(s)
- Alexander Vu
- The Department of Emergency Medicine; Johns Hopkins University; Baltimore MD
| | - Herbert C. Duber
- The Division of Emergency Medicine; Department of Medicine; University of Washington; Seattle WA
- Institute for Health Metrics and Evaluation; University of Washington; Seattle WA
| | - Scott M. Sasser
- The Department of Emergency Medicine; Emory University; Atlanta GA
| | - Bhakti Hansoti
- The Department of Emergency Medicine; Johns Hopkins University; Baltimore MD
| | - Catherine Lynch
- The Division of Emergency Medicine; Department of Surgery; Duke University; Durham NC
| | - Ayesha Khan
- The Division of Emergency Medicine; Department of Surgery; Stanford University; Stanford CA
| | - Tara Johnson
- The Department of Emergency Medicine; Maricopa Integrated Health System; Phoenix AZ
| | - Payal Modi
- The Department of Emergency Medicine; Warren Alpert Medical School of Brown University; Providence RI
| | | | - Stephen Hargarten
- The Department of Emergency Medicine; Medical College of Wisconsin; Milwaukee WI
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Loll DK, Berthe S, Faye SL, Wone I, Koenker H, Arnold B, Weber R. User-determined end of net life in Senegal: a qualitative assessment of decision-making related to the retirement of expired nets. Malar J 2013; 12:337. [PMID: 24053789 PMCID: PMC3856457 DOI: 10.1186/1475-2875-12-337] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 09/17/2013] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Procurement and distribution of long-lasting insecticidal nets (LLINs) in the African region has decreased from 145 million in 2010 to 66 million nets in 2012. As resources for LLIN distribution appear to stagnate, it is important to understand the users' perception of the life span of a net and at what point and why they stop using it. In order to get the most value out of distributed nets and to ensure that they are used for as long as possible, programmes must communicate to users about how to assess useful net life and how to extend it. METHODS Data were collected from 114 respondents who participated in 56 in-depth interviews (IDIs) and eight focus group discussions (FGDs) in August 2012 in eight regions in Senegal. Households were eligible for the study if they owned at least one net and had an available household member over the age of 18. Data were coded by a team of four coders in ATLAS.ti using a primarily deductive approach. RESULTS Respondents reported assessing useful net life using the following criteria: the age of net, the number and size of holes and the presence of mosquitoes in the net at night. If they had the means to do so, many respondents preferred the acquisition of a new net rather than the continued use of a very torn net. However, respondents would preferentially use newer nets, saving older, but useable nets for the future or sharing them with family or friends. Participants reported observing alternative uses of nets, primarily for nets that were considered expired. CONCLUSIONS The results indicate that decisions regarding the end of net life vary among community members in Senegal, but are primarily related to net integrity. Additional research is needed into user-determined end of net life as well as care and repair behaviours, which could extend useful net life. The results from this study and from future research on this topic should be used to understand current behaviours and develop communication programmes to prolong the useful life of nets.
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Affiliation(s)
- Dana K Loll
- Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sara Berthe
- Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Issa Wone
- Department of Public Health, University Cheikh Anta DIOP, Dakar, Senegal
| | - Hannah Koenker
- Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bethany Arnold
- Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rachel Weber
- Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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de Jongh TE, Harnmeijer JH, Atun R, Korenromp EL, Zhao J, Puvimanasinghe J, Baltussen R. Health impact of external funding for HIV, tuberculosis and malaria: systematic review. Health Policy Plan 2013; 29:650-62. [PMID: 23921987 PMCID: PMC4124244 DOI: 10.1093/heapol/czt051] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Since 2002, development assistance for health has substantially increased, especially investments for HIV, tuberculosis (TB) and malaria control. We undertook a systematic review to assess and synthesize the existing evidence in the scientific literature on the health impacts of these investments. METHODS AND FINDINGS We systematically searched databases for peer-reviewed and grey literature, using tailored search strategies. We screened studies for study design and relevance, using predefined inclusion criteria, and selected those that enabled us to link health outcomes or impact to increased external funding. For all included studies, we recorded dataset and study characteristics, health outcomes and impacts. We analysed the data using a causal-chain framework to develop a narrative summary of the published evidence. Thirteen articles, representing 11 individual studies set in Africa and Asia reporting impacts on HIV, tuberculosis and malaria, met the inclusion criteria. Only two of these studies documented the entire causal-chain spanning from funding to programme scale-up, to outputs, outcomes and impacts. Nonetheless, overall we find a positive correlation between consecutive steps in the causal chain, suggesting that external funds for HIV, tuberculosis and malaria programmes contributed to improved health outcomes and impact. CONCLUSIONS Despite the large number of supported programmes worldwide and despite an abundance of published studies on HIV, TB and malaria control, we identified very few eligible studies that adequately demonstrated the full process by which external funding has been translated to health impact. Most of these studies did not move beyond demonstrating statistical association, as opposed to contribution or causation. We thus recommend that funding organizations and researchers increase the emphasis on ensuring data capture along the causal pathway to demonstrate effect and contribution of external financing. The findings of these comprehensive and rigorously conducted impact evaluations should also be made publicly accessible.
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Affiliation(s)
- Thyra E de Jongh
- Gephyra IHC, Laing's Nekstraat 39-1, 1092 GT, Amsterdam, The Netherlands, ETC Crystal, PO Box 64, 3830 AB, Leusden, The Netherlands, Imperial College Business School, Imperial College London, London, UK, Department of Public Health, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China, The Global Fund to Fight Against AIDS, Tuberculosis and Malaria, Geneva, Switzerland and Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Joanne H Harnmeijer
- Gephyra IHC, Laing's Nekstraat 39-1, 1092 GT, Amsterdam, The Netherlands, ETC Crystal, PO Box 64, 3830 AB, Leusden, The Netherlands, Imperial College Business School, Imperial College London, London, UK, Department of Public Health, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China, The Global Fund to Fight Against AIDS, Tuberculosis and Malaria, Geneva, Switzerland and Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Rifat Atun
- Gephyra IHC, Laing's Nekstraat 39-1, 1092 GT, Amsterdam, The Netherlands, ETC Crystal, PO Box 64, 3830 AB, Leusden, The Netherlands, Imperial College Business School, Imperial College London, London, UK, Department of Public Health, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China, The Global Fund to Fight Against AIDS, Tuberculosis and Malaria, Geneva, Switzerland and Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Eline L Korenromp
- Gephyra IHC, Laing's Nekstraat 39-1, 1092 GT, Amsterdam, The Netherlands, ETC Crystal, PO Box 64, 3830 AB, Leusden, The Netherlands, Imperial College Business School, Imperial College London, London, UK, Department of Public Health, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China, The Global Fund to Fight Against AIDS, Tuberculosis and Malaria, Geneva, Switzerland and Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Jinkou Zhao
- Gephyra IHC, Laing's Nekstraat 39-1, 1092 GT, Amsterdam, The Netherlands, ETC Crystal, PO Box 64, 3830 AB, Leusden, The Netherlands, Imperial College Business School, Imperial College London, London, UK, Department of Public Health, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China, The Global Fund to Fight Against AIDS, Tuberculosis and Malaria, Geneva, Switzerland and Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - John Puvimanasinghe
- Gephyra IHC, Laing's Nekstraat 39-1, 1092 GT, Amsterdam, The Netherlands, ETC Crystal, PO Box 64, 3830 AB, Leusden, The Netherlands, Imperial College Business School, Imperial College London, London, UK, Department of Public Health, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China, The Global Fund to Fight Against AIDS, Tuberculosis and Malaria, Geneva, Switzerland and Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Rob Baltussen
- Gephyra IHC, Laing's Nekstraat 39-1, 1092 GT, Amsterdam, The Netherlands, ETC Crystal, PO Box 64, 3830 AB, Leusden, The Netherlands, Imperial College Business School, Imperial College London, London, UK, Department of Public Health, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China, The Global Fund to Fight Against AIDS, Tuberculosis and Malaria, Geneva, Switzerland and Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Hornberger J. Assigning value to medical algorithms: implications for personalized medicine. Per Med 2013; 10:577-588. [PMID: 29776198 DOI: 10.2217/pme.13.55] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Genomic algorithms are typically multiple variable, mathematical equations that assign a score or probability to an event of clinical interest. Debate about the valuation of multianalyte algorithm assays highlights the gaps in best practices for valuing technologies. Decisions about valuation are partly about resolving scientific uncertainty, but also involve issues of social norms and political processes. More transparent discussion and understanding of beliefs about the valuation of algorithms would help reduce uncertainty and drive optimal investment in development and adoption of algorithms that improve social welfare; that is, affordably improving population health. Techniques have been evolving for greater public participation and engagement in such deliberations, which are to be encouraged in determining the valuation of genomic algorithms.
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Affiliation(s)
- John Hornberger
- Cedar Associates, 3715 Haven Avenue, Menlo Park, CA 94025, USA and Department of Medicine, School of Medicine, Stanford University, Stanford, CA 94305, USA.
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50
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Feigl AB, Ding EL. Evidenced Formal Coverage Index and universal healthcare enactment: A prospective longitudinal study of economic, social, and political predictors of 194 countries. Health Policy 2013; 113:50-60. [PMID: 23906506 DOI: 10.1016/j.healthpol.2013.06.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Revised: 05/20/2013] [Accepted: 06/15/2013] [Indexed: 01/09/2023]
Abstract
Determinants of universal healthcare (UHC) are poorly empirically understood. We undertook a comprehensive study of UHC development using a novel Evidenced Formal Coverage (EFC) index that combines three key UHC elements: legal framework, population coverage, and accessibility. Applying the EFC index measures (legislation, ≥90% skilled birth attendance, ≥85% formal coverage) to 194 countries, aggregating time-varying data from 1880-2008, this study investigates which macro-economic, political, and social indicators are major longitudinal predictors of developing EFC globally, and in middle-income countries. Overall, 75 of 194 countries implemented legal-text UHC legislation, of which 51 achieved EFC. In a country-year prospective longitudinal analysis of EFC prediction, higher GDP-per-capita (per GDP-per-capita doubling, relative risk [RR]=1.77, 95% CI: 1.49-2.10), higher primary school completion (per +20% completion, RR=2.30, 1.65-3.21), and higher adult literacy were significantly associated with achieving EFC. Results also identify a GDP-per-capita of I$5000 as a minimum level for development of EFC. GDP-per-capita and education were each robust predictors in middle-income countries, and education remained significant even controlling for time-varying GDP growth. For income-inequality, the GINI coefficient was suggestive in its role in predicting EFC (p=0.024). For social and political indicators, a greater degree of ethnic fractionalization (per +25%, RR=0.51, 0.38-0.70), proportional electoral system (RR=2.80, 1.22-6.40), and dictatorships (RR=0.10, 0.05-0.27) were further associated with EFC. The novel EFC index and this longitudinal prospective study together indicate that investment in both economic growth and education should be seen of equal importance for development of UHC. Our findings help in understanding the social and political drivers of universal healthcare, especially for transitioning countries.
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Affiliation(s)
- Andrea B Feigl
- Harvard School of Public Health, Department of Global Health and Population, Boston, MA, USA.
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