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Rubinstein A, Filippini F, Santoro A, Lopez Osornio AL, Bardach AL, Navarro E, Cejas C, Bauhoff S, Augustovski F, Pichon-Riviere AL, Levy Yeyati EL. Lives Versus Livelihoods: The Epidemiological, Social, And Economic Impact Of COVID-19 In Latin America And The Caribbean. Health Aff (Millwood) 2023; 42:1647-1656. [PMID: 38048507 DOI: 10.1377/hlthaff.2023.00706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
During the COVID-19 pandemic, Latin American and Caribbean countries implemented stringent public health and social measures that disrupted economic and social activities. This study used an integrated model to evaluate the epidemiological, economic, and social trade-offs in Argentina, Brazil, Jamaica, and Mexico throughout 2021. Argentina and Mexico displayed a higher gross domestic product (GDP) loss and lower deaths per million compared with Brazil. The magnitude of the trade-offs differed across countries. Reducing GDP loss at the margin by 1 percent would have increased daily deaths by 0.5 per million in Argentina but only 0.3 per million in Brazil. We observed an increase in poverty rates related to the stringency of public health and social measures but no significant income-loss differences by sex. Our results indicate that the economic impact of COVID-19 was uneven across countries as a result of different pandemic trajectories, public health and social measures, and vaccination uptake, as well as socioeconomic differences and fiscal responses. Policy makers need to be informed about the trade-offs to make strategic decisions to save lives and livelihoods.
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Affiliation(s)
- Adolfo Rubinstein
- Adolfo Rubinstein , Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Federico Filippini
- Federico Filippini, University Torcuato Di Tella, Buenos Aires, Argentina
| | - Adrian Santoro
- Adrian Santoro, Institute for Clinical Effectiveness and Health Policy
| | | | - Ariel L Bardach
- Ariel L. Bardach, Institute for Clinical Effectiveness and Health Policy
| | - Emiliano Navarro
- Emiliano Navarro, Institute for Clinical Effectiveness and Health Policy
| | - Cintia Cejas
- Cintia Cejas, Institute for Clinical Effectiveness and Health Policy
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Augustovski F, Bardach A, Santoro A, Rodriguez-Cairoli F, López-Osornio A, Argento F, Havela M, Blumenfeld A, Ballivian J, Solioz G, Capula A, López A, Cejas C, Savedoff W, Palacios A, Rubinstein A, Pichon-Riviere A. Publisher Correction: cost-effectiveness of COVID-19 vaccination in Latin America and the Caribbean: an analysis in Argentina, Brazil, Chile, Colombia, Costa Rica, Mexico, and Peru. Cost Eff Resour Alloc 2023; 21:56. [PMID: 37620882 PMCID: PMC10463684 DOI: 10.1186/s12962-023-00466-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
Affiliation(s)
- Federico Augustovski
- Departamento de Evaluación de Tecnologías Sanitarias y Economía de la Salud/Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy, Instituto de Efectividad Clínica y Sanitaria (IECS) - CONICET, Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina.
| | - Ariel Bardach
- Departamento de Evaluación de Tecnologías Sanitarias y Economía de la Salud/Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy, Instituto de Efectividad Clínica y Sanitaria (IECS) - CONICET, Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Adrián Santoro
- Departamento de Evaluación de Tecnologías Sanitarias y Economía de la Salud/Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy, Instituto de Efectividad Clínica y Sanitaria (IECS) - CONICET, Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Federico Rodriguez-Cairoli
- Departamento de Evaluación de Tecnologías Sanitarias y Economía de la Salud/Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy, Instituto de Efectividad Clínica y Sanitaria (IECS) - CONICET, Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Alejandro López-Osornio
- Centro de Implementación e Innovación en Políticas de Salud (CIIPS). Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Fernando Argento
- Departamento de Evaluación de Tecnologías Sanitarias y Economía de la Salud/Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy, Instituto de Efectividad Clínica y Sanitaria (IECS) - CONICET, Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Maissa Havela
- Centro de Implementación e Innovación en Políticas de Salud (CIIPS). Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Alejandro Blumenfeld
- Centro de Implementación e Innovación en Políticas de Salud (CIIPS). Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Jamile Ballivian
- Departamento de Evaluación de Tecnologías Sanitarias y Economía de la Salud/Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy, Instituto de Efectividad Clínica y Sanitaria (IECS) - CONICET, Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Germán Solioz
- Departamento de Evaluación de Tecnologías Sanitarias y Economía de la Salud/Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy, Instituto de Efectividad Clínica y Sanitaria (IECS) - CONICET, Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Analía Capula
- Centro de Implementación e Innovación en Políticas de Salud (CIIPS). Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Analía López
- Centro de Implementación e Innovación en Políticas de Salud (CIIPS). Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Cintia Cejas
- Centro de Implementación e Innovación en Políticas de Salud (CIIPS). Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | | | - Alfredo Palacios
- Departamento de Evaluación de Tecnologías Sanitarias y Economía de la Salud/Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy, Instituto de Efectividad Clínica y Sanitaria (IECS) - CONICET, Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Adolfo Rubinstein
- Centro de Implementación e Innovación en Políticas de Salud (CIIPS). Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Andrés Pichon-Riviere
- Departamento de Evaluación de Tecnologías Sanitarias y Economía de la Salud/Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy, Instituto de Efectividad Clínica y Sanitaria (IECS) - CONICET, Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
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Augustovski F, Bardach A, Santoro A, Rodriguez-Cairoli F, López-Osornio A, Argento F, Havela M, Blumenfeld A, Ballivian J, Solioz G, Capula A, López A, Cejas C, Savedoff W, Palacios A, Rubinstein A, Pichon-Riviere A. Cost-effectiveness of COVID-19 vaccination in Latin America and the Caribbean: an analysis in Argentina, Brazil, Chile, Colombia, Costa Rica, Mexico, and Peru. Cost Eff Resour Alloc 2023; 21:21. [PMID: 37005606 PMCID: PMC10066967 DOI: 10.1186/s12962-023-00430-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 03/08/2023] [Indexed: 04/04/2023] Open
Abstract
OBJECTIVE Our study analyzes the cost-effectiveness of the COVID-19 vaccination campaigns in Argentina, Brazil, Chile, Colombia, Costa Rica, Mexico, and Peru. METHODS Using a previously published SVEIR model, we analyzed the impact of a vaccination campaign (2021) from a national healthcare perspective. The primary outcomes were quality adjusted life years (QALYs) lost and total costs. Other outcomes included COVID-19 cases, hospitalizations, deaths, and life years. We applied a discount rate of 3% for health outcomes. We modeled a realistic vaccination campaign in each country (the realistic country-specific campaign). Additionally, we assessed a standard campaign (similar, "typical" for all countries), and an optimized campaign (similar in all countries with higher but plausible population coverage). One-way deterministic sensitivity analyses were performed. FINDINGS Vaccination was health improving as well as cost-saving in almost all countries and scenarios. Our analysis shows that vaccination in this group of countries prevented 573,141 deaths (508,826 standard; 685,442 optimized) and gained 5.07 million QALYs (4.53 standard; 6.03 optimized). Despite the incremental costs of vaccination campaigns, they had a total net cost saving to the health system of US$16.29 billion (US$16.47 standard; US$18.58 optimized). The realistic (base case) vaccination campaign in Chile was the only scenario, which was not cost saving, but it was still highly cost-effective with an ICER of US$22 per QALY gained. Main findings were robust in the sensitivity analyses. INTERPRETATION The COVID-19 vaccination campaign in seven Latin American and Caribbean countries -that comprise nearly 80% of the region- was beneficial for population health and was also cost-saving or highly cost-effective.
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Affiliation(s)
- Federico Augustovski
- Departamento de Evaluación de Tecnologías Sanitarias y Economía de la Salud/Health Technology Assessment and Health Economics Department/ Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina.
| | - Ariel Bardach
- Departamento de Evaluación de Tecnologías Sanitarias y Economía de la Salud/Health Technology Assessment and Health Economics Department/ Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Adrián Santoro
- Centro de Implementación e Innovación en Políticas de Salud (CIIPS). Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Federico Rodriguez-Cairoli
- Departamento de Evaluación de Tecnologías Sanitarias y Economía de la Salud/Health Technology Assessment and Health Economics Department/ Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Alejandro López-Osornio
- Centro de Implementación e Innovación en Políticas de Salud (CIIPS). Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Fernando Argento
- Departamento de Evaluación de Tecnologías Sanitarias y Economía de la Salud/Health Technology Assessment and Health Economics Department/ Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Maissa Havela
- Centro de Implementación e Innovación en Políticas de Salud (CIIPS). Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Alejandro Blumenfeld
- Centro de Implementación e Innovación en Políticas de Salud (CIIPS). Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Jamile Ballivian
- Departamento de Evaluación de Tecnologías Sanitarias y Economía de la Salud/Health Technology Assessment and Health Economics Department/ Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Germán Solioz
- Departamento de Evaluación de Tecnologías Sanitarias y Economía de la Salud/Health Technology Assessment and Health Economics Department/ Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Analía Capula
- Centro de Implementación e Innovación en Políticas de Salud (CIIPS). Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Analía López
- Centro de Implementación e Innovación en Políticas de Salud (CIIPS). Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Cintia Cejas
- Centro de Implementación e Innovación en Políticas de Salud (CIIPS). Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | | | - Alfredo Palacios
- Departamento de Evaluación de Tecnologías Sanitarias y Economía de la Salud/Health Technology Assessment and Health Economics Department/ Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Adolfo Rubinstein
- Centro de Implementación e Innovación en Políticas de Salud (CIIPS). Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Andrés Pichon-Riviere
- Departamento de Evaluación de Tecnologías Sanitarias y Economía de la Salud/Health Technology Assessment and Health Economics Department/ Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
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Santoro A, López Osornio A, Williams I, Wachs M, Cejas C, Havela M, Bardach A, López A, Augustovski F, Pichón Riviere A, Rubinstein A. Development and application of a dynamic transmission model of health systems' preparedness and response to COVID-19 in twenty-six Latin American and Caribbean countries. PLOS Glob Public Health 2022; 2:e0000186. [PMID: 36962316 PMCID: PMC10021760 DOI: 10.1371/journal.pgph.0000186] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 01/09/2022] [Indexed: 11/19/2022]
Abstract
The global impact of COVID-19 has challenged health systems across the world. This situation highlighted the need to develop policies based on scientific evidence to prepare the health systems and mitigate the pandemic. In this scenario, governments were urged to predict the impact of the measures they were implementing, how they related to the population's behavior, and the capacity of health systems to respond to the pandemic. The overarching aim of this research was to develop a customizable and open-source tool to predict the impact of the expansion of COVID-19 on the level of preparedness of the health systems of different Latin American and the Caribbean countries, with two main objectives. Firstly, to estimate the transmission dynamics of COVID-19 and the preparedness and response capacity of health systems in those countries, based on different scenarios and public policies implemented to control, mitigate, or suppress the spread of the epidemic. Secondly, to facilitate policy makers' decisions by allowing the model to adjust its parameters according to the specific pandemic trajectory and policy context. How many infections and deaths are estimated per day?; When are the peaks of cases and deaths expected, according to the different scenarios?; Which occupancy rate will ICU services have along the epidemiological curve?; When is the optimal time increase restrictions in order to prevent saturation of ICU beds?, are some of the key questions that the model can respond, and is publicly accessible through the following link: http://shinyapps.iecs.org.ar/modelo-covid19/. This open-access and open code tool is based on a SEIR model (Susceptible, Exposed, Infected and Recovered). Using a deterministic epidemiological model, it allows to frame potential scenarios for long periods, providing valuable information on the dynamics of transmission and how it could impact on health systems through multiple customized configurations adapted to specific characteristics of each country.
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Affiliation(s)
- Adrián Santoro
- Center for Implementation and Innovation in Health Policies, Institute for Clinical Effectiveness and Health Policy, Autonomous City of Buenos Aires, Argentina
| | - Alejandro López Osornio
- Center for Implementation and Innovation in Health Policies, Institute for Clinical Effectiveness and Health Policy, Autonomous City of Buenos Aires, Argentina
| | - Ivan Williams
- Faculty of Economics, University of Buenos Aires, Autonomous City of Buenos Aires, Argentina
| | - Martín Wachs
- Center for Implementation and Innovation in Health Policies, Institute for Clinical Effectiveness and Health Policy, Autonomous City of Buenos Aires, Argentina
| | - Cintia Cejas
- Center for Implementation and Innovation in Health Policies, Institute for Clinical Effectiveness and Health Policy, Autonomous City of Buenos Aires, Argentina
| | - Maisa Havela
- Center for Implementation and Innovation in Health Policies, Institute for Clinical Effectiveness and Health Policy, Autonomous City of Buenos Aires, Argentina
| | - Ariel Bardach
- Department of Health Technology Assesments (HTA) and Health Economics, Institute for Clinical Effectivenessand Health Policy, Autonomous City of Buenos Aires, Argentina
| | - Analía López
- Center for Implementation and Innovation in Health Policies, Institute for Clinical Effectiveness and Health Policy, Autonomous City of Buenos Aires, Argentina
| | - Federico Augustovski
- Department of Health Technology Assesments (HTA) and Health Economics, Institute for Clinical Effectivenessand Health Policy, Autonomous City of Buenos Aires, Argentina
| | - Andrés Pichón Riviere
- Department of Health Technology Assesments (HTA) and Health Economics, Institute for Clinical Effectivenessand Health Policy, Autonomous City of Buenos Aires, Argentina
| | - Adolfo Rubinstein
- Center for Implementation and Innovation in Health Policies, Institute for Clinical Effectiveness and Health Policy, Autonomous City of Buenos Aires, Argentina
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Ratcliffe HL, Schwarz D, Hirschhorn LR, Cejas C, Diallo A, Garcia-Elorrio E, Fifield J, Gashumba D, Hartshorn L, Leydon N, Mohamed M, Nakamura Y, Ndiaye Y, Novignon J, Ofosu A, Roder-DeWan S, Rwiyereka A, Secci F, Veillard JH, Bitton A. PHC Progression Model: a novel mixed-methods tool for measuring primary health care system capacity. BMJ Glob Health 2019; 4:e001822. [PMID: 31565420 PMCID: PMC6748065 DOI: 10.1136/bmjgh-2019-001822] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 08/20/2019] [Accepted: 08/25/2019] [Indexed: 11/18/2022] Open
Abstract
High-performing primary health care (PHC) is essential for achieving universal health coverage. However, in many countries, PHC is weak and unable to deliver on its potential. Improvement is often limited by a lack of actionable data to inform policies and set priorities. To address this gap, the Primary Health Care Performance Initiative (PHCPI) was formed to strengthen measurement of PHC in low-income and middle-income countries in order to accelerate improvement. PHCPI’s Vital Signs Profile was designed to provide a comprehensive snapshot of the performance of a country’s PHC system, yet quantitative information about PHC systems’ capacity to deliver high-quality, effective care was limited by the scarcity of existing data sources and metrics. To systematically measure the capacity of PHC systems, PHCPI developed the PHC Progression Model, a rubric-based mixed-methods assessment tool. The PHC Progression Model is completed through a participatory process by in-country teams and subsequently reviewed by PHCPI to validate results and ensure consistency across countries. In 2018, PHCPI partnered with five countries to pilot the tool and found that it was feasible to implement with fidelity, produced valid results, and was highly acceptable and useful to stakeholders. Pilot results showed that both the participatory assessment process and resulting findings yielded novel and actionable insights into PHC strengths and weaknesses. Based on these positive early results, PHCPI will support expansion of the PHC Progression Model to additional countries to systematically and comprehensively measure PHC system capacity in order to identify and prioritise targeted improvement efforts.
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Affiliation(s)
- Hannah L Ratcliffe
- Ariadne Labs, Brigham and Women's Hospital & Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Dan Schwarz
- Ariadne Labs, Brigham and Women's Hospital & Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Lisa R Hirschhorn
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Cintia Cejas
- Secretaria de Gobierno de Salud, Ministerio de Salud y Desarrollo Social, Buenos Aires, Argentina
| | - Abdoulaye Diallo
- Directorate of Planning, Research and Statistics, Ministry of Health and Social Action, Dakar, Senegal
| | | | - Jocelyn Fifield
- Ariadne Labs, Brigham and Women's Hospital & Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Lucy Hartshorn
- Ariadne Labs, Brigham and Women's Hospital & Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Mohamed Mohamed
- Ministry of Health, Community Development, Gender, Elderly, and Children, Dodoma, United Republic of Tanzania
| | - Yoriko Nakamura
- Results for Development, Washington, District of Columbia, USA
| | - Youssoupha Ndiaye
- Directorate of Planning, Research and Statistics, Ministry of Health and Social Action, Dakar, Senegal
| | - Jacob Novignon
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Anthony Ofosu
- Division of Policy, Planning, Monitoring and Evaluation, Ghana Health Service, Accra, Ghana
| | - Sanam Roder-DeWan
- Health Section, UNICEF Tanzania, Dar es Salaam, United Republic of Tanzania
| | | | - Federica Secci
- Health, Nutrition and Population Global Practice, World Bank Group, Washington, District of Columbia, USA
| | - Jeremy H Veillard
- Health, Nutrition and Population Global Practice, World Bank Group, Washington, District of Columbia, USA
| | - Asaf Bitton
- Ariadne Labs, Brigham and Women's Hospital & Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Abstract
The reform of a health care system requires attention to specific components but also to the creation of an environment that supports change. Argentina has achieved nominal universal health coverage (UHC) but it still needs to work on achieving effective universal health coverage, especially with regard to quality and equity. Nominal coverage means that everyone has been enrolled and has the right to access, and effective coverage means that people have actually received prioritized health care services. In this article, we present our proposals to advance UHC in Argentina. The article includes an overview of Argentina's health system, then introduces the driving forces for reform, and finally analyzes four key issues where we provide our action plan to implement health reform for moving Argentina forward. Overall, our ultimate goal is to provide actual UHC and not aspirational UHC in Argentina by strengthening provincial health systems through enforcing public insurance schemes; utilizing an explicit priority-setting approach to make decisions on health coverage; reducing health disparities in coverage and outcomes, at least on prioritized health problems; and building a primary care-oriented health care system.
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Affiliation(s)
| | - María Clara Zerbino
- b Advisor General Coordination Unit, Ministry of Health , Buenos Aires , Argentina
| | - Cintia Cejas
- c Undersecretary for Public Health Coverage, Ministry of Health , Buenos Aires , Argentina
| | - Analía López
- d Chief of Staff, Ministry of Health , Buenos Aires , Argentina
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Cavassa E, Tordjman M, Ferreiro A, Dabaj I, Malfatti E, Benezit A, Monges S, Bonne G, Vazquez G, Taratuto A, Laforet P, Cejas C, Metay C, Romero N, Carlier R, Quijano-Roy S. Interest of whole-body muscle MRI for the diagnosis of Pompe disease in rigid spine syndrome and differential diagnosis. Neuromuscul Disord 2016. [DOI: 10.1016/j.nmd.2016.06.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Cejas C, Rollán C, Michelin G, Nogués M. High resolution neurography of the brachial plexus by 3 Tesla magnetic resonance imaging. Radiologia 2016; 58:88-100. [PMID: 26860655 DOI: 10.1016/j.rx.2015.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 09/23/2015] [Accepted: 12/16/2015] [Indexed: 12/23/2022]
Abstract
The study of the structures that make up the brachial plexus has benefited particularly from the high resolution images provided by 3T magnetic resonance scanners. The brachial plexus can have mononeuropathies or polyneuropathies. The mononeuropathies include traumatic injuries and trapping, such as occurs in thoracic outlet syndrome due to cervical ribs, prominent transverse apophyses, or tumors. The polyneuropathies include inflammatory processes, in particular chronic inflammatory demyelinating polyneuropathy, Parsonage-Turner syndrome, granulomatous diseases, and radiation neuropathy. Vascular processes affecting the brachial plexus include diabetic polyneuropathy and the vasculitides. This article reviews the anatomy of the brachial plexus and describes the technique for magnetic resonance neurography and the most common pathologic conditions that can affect the brachial plexus.
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Affiliation(s)
- C Cejas
- Departamento de Imágenes, Fundación para la lucha de las enfermedades neurológicas de la infancia Dr. Raúl Carrea (FLENI), Buenos Aires, Argentina.
| | - C Rollán
- Departamento de Imágenes, Fundación para la lucha de las enfermedades neurológicas de la infancia Dr. Raúl Carrea (FLENI), Buenos Aires, Argentina
| | - G Michelin
- Departamento de Imágenes, Fundación para la lucha de las enfermedades neurológicas de la infancia Dr. Raúl Carrea (FLENI), Buenos Aires, Argentina
| | - M Nogués
- Departamento de Neurología, Fundación para la lucha de las enfermedades neurológicas de la infancia Dr. Raúl Carrea (FLENI), Buenos Aires, Argentina
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Cejas C, Escobar I, Serra M, Barroso F. High resolution neurography of the lumbosacral plexus on 3T magnetic resonance imaging. Radiología (English Edition) 2015. [DOI: 10.1016/j.rxeng.2014.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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10
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Cejas C, Escobar I, Serra M, Barroso F. Neurografía de alta resolución del plexo lumbosacro en resonancia magnética 3T. Radiología 2015; 57:22-34. [DOI: 10.1016/j.rx.2014.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 07/03/2014] [Accepted: 07/21/2014] [Indexed: 01/08/2023]
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11
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Pineda D, Barroso F, Cháves H, Cejas C. Neurografía de alta resolución del nervio peroneo en resonancia magnética 3T. Radiología 2014; 56:107-17. [DOI: 10.1016/j.rx.2013.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Revised: 10/26/2013] [Accepted: 11/02/2013] [Indexed: 01/30/2023]
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