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Näher AF, Schulte-Althoff M, Kopka M, Balzer F, Pozo-Martin F. Effects of Face Mask Mandates on COVID-19 Transmission in 51 Countries: Retrospective Event Study. JMIR Public Health Surveill 2024; 10:e49307. [PMID: 38457225 PMCID: PMC10926949 DOI: 10.2196/49307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 09/20/2023] [Accepted: 12/22/2023] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND The question of the utility of face masks in preventing acute respiratory infections has received renewed attention during the COVID-19 pandemic. However, given the inconclusive evidence from existing randomized controlled trials, evidence based on real-world data with high external validity is missing. OBJECTIVE To add real-world evidence, this study aims to examine whether mask mandates in 51 countries and mask recommendations in 10 countries increased self-reported face mask use and reduced SARS-CoV-2 reproduction numbers and COVID-19 case growth rates. METHODS We applied an event study approach to data pooled from four sources: (1) country-level information on self-reported mask use was obtained from the COVID-19 Trends and Impact Survey, (2) data from the Oxford COVID-19 Government Response Tracker provided information on face mask mandates and recommendations and any other nonpharmacological interventions implemented, (3) mobility indicators from Google's Community Mobility Reports were also included, and (4) SARS-CoV-2 reproduction numbers and COVID-19 case growth rates were retrieved from the Our World in Data-COVID-19 data set. RESULTS Mandates increased mask use by 8.81 percentage points (P=.006) on average, and SARS-CoV-2 reproduction numbers declined on average by -0.31 units (P=.008). Although no significant average effect of mask mandates was observed for growth rates of COVID-19 cases (-0.98 percentage points; P=.56), the results indicate incremental effects on days 26 (-1.76 percentage points; P=.04), 27 (-1.89 percentage points; P=.05), 29 (-1.78 percentage points; P=.04), and 30 (-2.14 percentage points; P=.02) after mandate implementation. For self-reported face mask use and reproduction numbers, incremental effects are seen 6 and 13 days after mandate implementation. Both incremental effects persist for >30 days. Furthermore, mask recommendations increased self-reported mask use on average (5.84 percentage points; P<.001). However, there were no effects of recommendations on SARS-CoV-2 reproduction numbers or COVID-19 case growth rates (-0.06 units; P=.70 and -2.45 percentage points; P=.59). Single incremental effects on self-reported mask use were observed on days 11 (3.96 percentage points; P=.04), 13 (3.77 percentage points; P=.04) and 25 to 27 (4.20 percentage points; P=.048 and 5.91 percentage points; P=.01) after recommendation. Recommendations also affected reproduction numbers on days 0 (-0.07 units; P=.03) and 1 (-0.07 units; P=.03) and between days 21 (-0.09 units; P=.04) and 28 (-0.11 units; P=.05) and case growth rates between days 1 and 4 (-1.60 percentage points; P=.03 and -2.19 percentage points; P=.03) and on day 23 (-2.83 percentage points; P=.05) after publication. CONCLUSIONS Contrary to recommendations, mask mandates can be used as an effective measure to reduce SARS-CoV-2 reproduction numbers. However, mandates alone are not sufficient to reduce growth rates of COVID-19 cases. Our study adds external validity to the existing randomized controlled trials on the effectiveness of face masks to reduce the spread of SARS-CoV-2.
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Affiliation(s)
- Anatol-Fiete Näher
- Digital Global Public Health, Hasso Plattner Institute, University of Potsdam, Potsdam, Germany
- Institute for Medical Informatics, Charité - Universitätsmedizin, Berlin, Germany
- Method Development, Research Infrastructure, and Information Technology, Robert Koch Institute, Berlin, Germany
| | - Matthias Schulte-Althoff
- Institute for Medical Informatics, Charité - Universitätsmedizin, Berlin, Germany
- Department of Information Systems, School of Business and Economics, Freie Universität, Berlin, Germany
| | - Marvin Kopka
- Institute for Medical Informatics, Charité - Universitätsmedizin, Berlin, Germany
- Department of Psychology and Ergonomics, Technische Universität Berlin, Berlin, Germany
| | - Felix Balzer
- Institute for Medical Informatics, Charité - Universitätsmedizin, Berlin, Germany
| | - Francisco Pozo-Martin
- Evidence-based Public Health Unit, Center for International Health Protection, Robert Koch Institute, Berlin, Germany
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Röbl K, Fischer HT, Delamou A, Mbawah AK, Geurts B, Feddern L, Baldé H, Kaba I, Pozo-Martin F, Weishaar H, Menelik-Obbarius S, Burger G, Diaconu V, Dörre A, El Bcheraoui C. Caregiver acceptance of malaria vaccination for children under 5 years of age and associated factors: cross-sectional household survey, Guinea and Sierra Leone, 2022. Malar J 2023; 22:355. [PMID: 37986067 PMCID: PMC10662512 DOI: 10.1186/s12936-023-04783-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/04/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Malaria is a leading cause of death and reduced life span in Guinea and Sierra Leone, where plans for rolling out the malaria vaccine for children are being made. There is little evidence about caregiver acceptance rates to guide roll-out policies. To inform future vaccine implementation planning, this analysis aimed to assess potential malaria vaccine acceptance by caregivers and identify factors associated with acceptance in Guinea and Sierra Leone. METHODS A cross-sectional household survey using lot quality assurance sampling was conducted in three regions per country between May 2022 and August 2022. The first survey respondent in each household provided sociodemographic information. A household member responsible for childcare shared their likelihood of accepting a malaria vaccine for their children under 5 years and details about children's health. The prevalence of caregiver vaccine acceptance was calculated and associated factors were explored using multivariable logistic regression modelling calculating adjusted odds ratios (aOR) with 95% confidence intervals (CI). RESULTS Caregivers in 76% of 702 sampled households in Guinea and 81% of 575 households in Sierra Leone were accepting of a potential vaccine for their children. In both countries, acceptance was lower in remote areas than in urban areas (Guinea: aOR 0.22 [95%CI 0.09-0.50], Sierra Leone: 0.17 [0.06-0.47]). In Guinea, acceptance was lower among caregivers living in the richest households compared to the poorest households (0.10 [0.04-0.24]), among those whose children were tested for malaria when febrile (0.54 [0.34-0.85]) and in households adopting more preventative measures against malaria (0.39 [0.25-0.62]). Better knowledge of the cause of malaria infection was associated with increased acceptance (3.46 [1.01-11.87]). In Sierra Leone, vaccine acceptance was higher among caregivers living in households where the first respondent had higher levels of education as compared to lower levels (2.32 [1.05-5.11]). CONCLUSION In both countries, malaria vaccine acceptance seems promising for future vaccine roll-out programmes. Policy makers might consider regional differences, sociodemographic factors, and levels of knowledge about malaria for optimization of implementation strategies. Raising awareness about the benefits of comprehensive malaria control efforts, including vaccination and other preventive measures, requires attention in upcoming campaigns.
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Affiliation(s)
- Klara Röbl
- Department of Infectious Disease Epidemiology, Robert Koch-Institute, Seestraße 10, 13353, Berlin, Germany
- Postgraduate Training for Applied Epidemiology (PAE), Robert Koch-Institute, Seestraße 10, 13353, Berlin, Germany
- ECDC Fellowship Programme, Field Epidemiology Path (EPIET), European Centre for Disease Prevention and Control (ECDC), Gustav III:S Boulevard 40, 16973, Solna, Sweden
| | - Hanna-Tina Fischer
- Evidence-Based Public Health, Centre for International Health Protection, Robert Koch-Institute, Nordufer 20, 13353, Berlin, Germany
- Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Alexandre Delamou
- Centre d'Excellence Africain pour la Prévention et le Contrôle des Maladies Transmissibles (CEA-PCMT), Université Gamal Abdel Nasser de Conakry (UGANC), Dixinn, PoBox 1017, Conakry, Guinea
- Faculté des sciences techniques de la santé (FSTS), Université Gamal Abdel Nasser de Conakry (UGANC), Conakry, Guinea
| | - Abdul Karim Mbawah
- College of Medicine and Allied Health Sciences (COMAHS), University of Sierra Leone, Connaught Hospital, Freetown, Sierra Leone
| | - Brogan Geurts
- Evidence-Based Public Health, Centre for International Health Protection, Robert Koch-Institute, Nordufer 20, 13353, Berlin, Germany
| | - Lukas Feddern
- Evidence-Based Public Health, Centre for International Health Protection, Robert Koch-Institute, Nordufer 20, 13353, Berlin, Germany
| | - Habibata Baldé
- Centre d'Excellence Africain pour la Prévention et le Contrôle des Maladies Transmissibles (CEA-PCMT), Université Gamal Abdel Nasser de Conakry (UGANC), Dixinn, PoBox 1017, Conakry, Guinea
- Faculté des sciences techniques de la santé (FSTS), Université Gamal Abdel Nasser de Conakry (UGANC), Conakry, Guinea
| | - Ibrahima Kaba
- Centre d'Excellence Africain pour la Prévention et le Contrôle des Maladies Transmissibles (CEA-PCMT), Université Gamal Abdel Nasser de Conakry (UGANC), Dixinn, PoBox 1017, Conakry, Guinea
- Faculté des sciences techniques de la santé (FSTS), Université Gamal Abdel Nasser de Conakry (UGANC), Conakry, Guinea
| | - Francisco Pozo-Martin
- Evidence-Based Public Health, Centre for International Health Protection, Robert Koch-Institute, Nordufer 20, 13353, Berlin, Germany
| | - Heide Weishaar
- Evidence-Based Public Health, Centre for International Health Protection, Robert Koch-Institute, Nordufer 20, 13353, Berlin, Germany
| | - Sara Menelik-Obbarius
- Evidence-Based Public Health, Centre for International Health Protection, Robert Koch-Institute, Nordufer 20, 13353, Berlin, Germany
| | - Gerrit Burger
- Evidence-Based Public Health, Centre for International Health Protection, Robert Koch-Institute, Nordufer 20, 13353, Berlin, Germany
| | - Viorela Diaconu
- Evidence-Based Public Health, Centre for International Health Protection, Robert Koch-Institute, Nordufer 20, 13353, Berlin, Germany
| | - Achim Dörre
- Department of Infectious Disease Epidemiology, Robert Koch-Institute, Seestraße 10, 13353, Berlin, Germany
| | - Charbel El Bcheraoui
- Evidence-Based Public Health, Centre for International Health Protection, Robert Koch-Institute, Nordufer 20, 13353, Berlin, Germany.
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Pozo-Martin F, Beltran Sanchez MA, Müller SA, Diaconu V, Weil K, El Bcheraoui C. Comparative effectiveness of contact tracing interventions in the context of the COVID-19 pandemic: a systematic review. Eur J Epidemiol 2023; 38:243-266. [PMID: 36795349 PMCID: PMC9932408 DOI: 10.1007/s10654-023-00963-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 12/31/2022] [Indexed: 02/17/2023]
Abstract
Contact tracing is a non-pharmaceutical intervention (NPI) widely used in the control of the COVID-19 pandemic. Its effectiveness may depend on a number of factors including the proportion of contacts traced, delays in tracing, the mode of contact tracing (e.g. forward, backward or bidirectional contact training), the types of contacts who are traced (e.g. contacts of index cases or contacts of contacts of index cases), or the setting where contacts are traced (e.g. the household or the workplace). We performed a systematic review of the evidence regarding the comparative effectiveness of contact tracing interventions. 78 studies were included in the review, 12 observational (ten ecological studies, one retrospective cohort study and one pre-post study with two patient cohorts) and 66 mathematical modelling studies. Based on the results from six of the 12 observational studies, contact tracing can be effective at controlling COVID-19. Two high quality ecological studies showed the incremental effectiveness of adding digital contact tracing to manual contact tracing. One ecological study of intermediate quality showed that increases in contact tracing were associated with a drop in COVID-19 mortality, and a pre-post study of acceptable quality showed that prompt contact tracing of contacts of COVID-19 case clusters / symptomatic individuals led to a reduction in the reproduction number R. Within the seven observational studies exploring the effectiveness of contact tracing in the context of the implementation of other non-pharmaceutical interventions, contact tracing was found to have an effect on COVID-19 epidemic control in two studies and not in the remaining five studies. However, a limitation in many of these studies is the lack of description of the extent of implementation of contact tracing interventions. Based on the results from the mathematical modelling studies, we identified the following highly effective policies: (1) manual contact tracing with high tracing coverage and either medium-term immunity, highly efficacious isolation/quarantine and/ or physical distancing (2) hybrid manual and digital contact tracing with high app adoption with highly effective isolation/ quarantine and social distancing, (3) secondary contact tracing, (4) eliminating contact tracing delays, (5) bidirectional contact tracing, (6) contact tracing with high coverage in reopening educational institutions. We also highlighted the role of social distancing to enhance the effectiveness of some of these interventions in the context of 2020 lockdown reopening. While limited, the evidence from observational studies shows a role for manual and digital contact tracing in controlling the COVID-19 epidemic. More empirical studies accounting for the extent of contact tracing implementation are required.
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Affiliation(s)
- Francisco Pozo-Martin
- Evidence-based Public Health Unit, Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany.
| | | | - Sophie Alice Müller
- Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany
| | - Viorela Diaconu
- Evidence-based Public Health Unit, Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany
| | - Kilian Weil
- Evidence-based Public Health Unit, Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany
| | - Charbel El Bcheraoui
- Evidence-based Public Health Unit, Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany
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Geurts B, Weishaar H, Mari Saez A, Cristea F, Rocha C, Aminu K, Tan MMJ, Salim Camara B, Barry L, Thea P, Boucsein J, Bahr T, Al-Awlaqi S, Pozo-Martin F, Boklage E, Delamou A, Jegede AS, Legido-Quigley H, El Bcheraoui C. Communicating risk during early phases of COVID-19: Comparing governing structures for emergency risk communication across four contexts. Front Public Health 2023; 11:1038989. [PMID: 36778563 PMCID: PMC9911432 DOI: 10.3389/fpubh.2023.1038989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 01/10/2023] [Indexed: 01/28/2023] Open
Abstract
Background Emergency risk communication (ERC) is key to achieving compliance with public health measures during pandemics. Yet, the factors that facilitated ERC during COVID-19 have not been analyzed. We compare ERC in the early stages of the pandemic across four socio-economic settings to identify how risk communication can be improved in public health emergencies (PHE). Methods To map and assess the content, process, actors, and context of ERC in Germany, Guinea, Nigeria, and Singapore, we performed a qualitative document review, and thematically analyzed semi-structured key informant interviews with 155 stakeholders involved in ERC at national and sub-national levels. We applied Walt and Gilson's health policy triangle as a framework to structure the results. Results We identified distinct ERC strategies in each of the four countries. Various actors, including governmental leads, experts, and organizations with close contact to the public, collaborated closely to implement ERC strategies. Early integration of ERC into preparedness and response plans, lessons from previous experiences, existing structures and networks, and clear leadership were identified as crucial for ensuring message clarity, consistency, relevance, and an efficient use of resources. Areas of improvement primarily included two-way communication, community engagement, and monitoring and evaluation. Countries with recurrent experiences of pandemics appeared to be more prepared and equipped to implement ERC strategies. Conclusion We found that considerable potential exists for countries to improve communication during public health emergencies, particularly in the areas of bilateral communication and community engagement as well as monitoring and evaluation. Building adaptive structures and maintaining long-term relationships with at-risk communities reportedly facilitated suitable communication. The findings suggest considerable potential and transferable learning opportunities exist between countries in the global north and countries in the global south with experience of managing outbreaks.
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Affiliation(s)
- Brogan Geurts
- Evidence-Based Public Health Unit, Center for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Heide Weishaar
- Evidence-Based Public Health Unit, Center for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Almudena Mari Saez
- Center for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Florin Cristea
- Evidence-Based Public Health Unit, Center for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Carlos Rocha
- Center for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Kafayat Aminu
- Department of Sociology, Faculty of the Social Sciences, University of Ibadan, Ibadan, Nigeria
| | - Melisa Mei Jin Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Bienvenu Salim Camara
- African Center of Excellence for the Prevention and Control of Communicable Diseases, Conakry, Guinea,Centre de Formation et de Recherche en Santé Rurale de Maferinyah, Département de Recherche, Unité de Socio-Anthropologie, Conakry, Guinea
| | - Lansana Barry
- African Center of Excellence for the Prevention and Control of Communicable Diseases, Conakry, Guinea
| | - Paul Thea
- African Center of Excellence for the Prevention and Control of Communicable Diseases, Conakry, Guinea
| | - Johannes Boucsein
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany,Postgraduate Training for Applied Epidemiology, Robert Koch Institute, Berlin, Germany,European Programme for Intervention Epidemiology Training, European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Thurid Bahr
- Evidence-Based Public Health Unit, Center for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Sameh Al-Awlaqi
- Evidence-Based Public Health Unit, Center for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Francisco Pozo-Martin
- Evidence-Based Public Health Unit, Center for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Evgeniya Boklage
- Information Center for International Health, Center for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Alexandre Delamou
- African Center of Excellence for the Prevention and Control of Communicable Diseases, Conakry, Guinea,Centre de Formation et de Recherche en Santé Rurale de Maferinyah, Département de Recherche, Unité de Socio-Anthropologie, Conakry, Guinea
| | - Ayodele Samuel Jegede
- Department of Sociology, Faculty of the Social Sciences, University of Ibadan, Ibadan, Nigeria
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Charbel El Bcheraoui
- Evidence-Based Public Health Unit, Center for International Health Protection, Robert Koch Institute, Berlin, Germany,*Correspondence: Charbel El Bcheraoui ✉
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Cristea F, Weishaar H, Geurts B, Delamou A, Tan MMJ, Legido-Quigley H, Aminu K, Mari-Sáez A, Rocha C, Camara B, Barry L, Thea P, Boucsein J, Bahr T, Al-Awlaqi S, Pozo-Martin F, Boklage E, Jegede AS, Bcheraoui CE. A comparative analysis of experienced uncertainties in relation to risk communication during COVID19: a four-country study. Global Health 2022; 18:66. [PMID: 35761365 PMCID: PMC9235152 DOI: 10.1186/s12992-022-00857-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/10/2022] [Indexed: 11/25/2022] Open
Abstract
Background During outbreaks, uncertainties experienced by affected communities can influence their compliance to government guidance on public health. Communicators and authorities are, hence, encouraged to acknowledge and address such uncertainties. However, in the midst of public health crises, it can become difficult to define and identify uncertainties that are most relevant to address. We analyzed data on COVID-19-related uncertainties from four socio-economic contexts to explore how uncertainties can influence people’s perception of, and response to Risk Communication and Community Engagement (RCCE) strategies. Results This qualitative study, which adopts an interpretative approach, is based on data from a documentary review, key informant interviews (KII), and focus group discussions (FGD) with members of the general public and people with barriers to information from Germany, Guinea, Nigeria, and Singapore. Transcripts from the KII and FGD were coded and analyzed thematically. We interviewed a total of 155 KIs and conducted 73 FGD. Our analysis uncovered a divergence between uncertainties deemed relevant by stakeholders involved in policy making and uncertainties that people reportedly had to navigate in their everyday lives and which they considered relevant during the pandemic. We identified four types of uncertainties that seemed to have influenced people’s assessment of the disease risk and their trust in the pandemic control strategies including RCCE efforts: epidemiological uncertainties (related to the nature and severity of the virus), information uncertainties (related to access to reliable information), social uncertainties (related to social behavior in times of heightened risk), and economic uncertainties (related to financial insecurities). Conclusion We suggest that in future outbreaks, communicators and policy makers could improve the way in which affected communities assess their risk, and increase the trust of these communities in response efforts by addressing non-epidemiological uncertainties in RCCE strategies.
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Affiliation(s)
- Florin Cristea
- Evidence-Based Public Health Unit, Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany
| | - Heide Weishaar
- Evidence-Based Public Health Unit, Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany
| | - Brogan Geurts
- Evidence-Based Public Health Unit, Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany
| | - Alexandre Delamou
- African Center of Excellence for the Prevention and Control of Communicable Diseases & Centre de Formation et de Recherche en Santé Rurale de Maferinyah, PoBox 1017, Dixinn, Conakry, Guinea
| | - Melisa Mei Jin Tan
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Kafayat Aminu
- Department of Sociology, Faculty of the Social Sciences, University of Ibadan, 1, Oyo Road, Agbowo, Ibadan, Nigeria
| | - Almudena Mari-Sáez
- Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany
| | - Carlos Rocha
- Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany
| | - Bienvenu Camara
- Centre de Formation et de Recherche en Santé Rurale de Maferinyah, Département de Recherche, Unité de Socio-Anthropologie, Conakry, Guinea
| | - Lansana Barry
- African Center of Excellence for the Prevention and Control of Communicable Diseases, PoBox 1017, Dixinn, Conakry, Guinea
| | - Paul Thea
- African Center of Excellence for the Prevention and Control of Communicable Diseases, PoBox 1017, Dixinn, Conakry, Guinea
| | - Johannes Boucsein
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany.,Postgraduate Training for Applied Epidemiology (PAE), Robert Koch Institute, Berlin, Germany.,European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Thurid Bahr
- Evidence-Based Public Health Unit, Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany
| | - Sameh Al-Awlaqi
- Evidence-Based Public Health Unit, Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany
| | - Francisco Pozo-Martin
- Evidence-Based Public Health Unit, Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany
| | - Evgeniya Boklage
- Health Information Centre for International Health Protection unit, Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany
| | - Ayodele Samuel Jegede
- Department of Sociology, Faculty of the Social Sciences, University of Ibadan, 1, Oyo Road, Agbowo, Ibadan, Nigeria
| | - Charbel El Bcheraoui
- Evidence-Based Public Health Unit, Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany.
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Pozo-Martin F, Akazili J, Der R, Laar A, Adler AJ, Lamptey P, Griffiths UK, Vassall A. Cost-effectiveness of a Community-based Hypertension Improvement Project (ComHIP) in Ghana: results from a modelling study. BMJ Open 2021; 11:e039594. [PMID: 34475137 PMCID: PMC8413878 DOI: 10.1136/bmjopen-2020-039594] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To undertake a cost-effectiveness analysis of a Community-based Hypertension Improvement Project (ComHIP) compared with standard hypertension care in Ghana. DESIGN Cost-effectiveness analysis using a Markov model. SETTING Lower Manya Krobo, Eastern Region, Ghana. INTERVENTION We evaluated ComHIP, an intervention with multiple components, including: community-based education on cardiovascular disease (CVD) risk factors and healthy lifestyles; community-based screening and monitoring of blood pressure by licensed chemical sellers and CVD nurses; community-based diagnosis, treatment, counselling, follow-up and referral of hypertension patients by CVD nurses; telemedicine consultation by CVD nurses and referral of patients with severe hypertension and/or organ damage to a physician; information and communication technologies messages for healthy lifestyles, treatment adherence support and treatment refill reminders for hypertension patients; Commcare, a cloud-based health records system linked to short-message service (SMS)/voice messaging for treatment adherence, reminders and health messaging. ComHIP was evaluated under two scale-up scenarios: (1) ComHIP as currently implemented with support from international partners and (2) ComHIP under full local implementation. MAIN OUTCOME MEASURES Incremental cost per disability-adjusted life-year (DALY) averted from a societal perspective over a time horizon of 10 years. RESULTS ComHIP is unlikely to be a cost-effective intervention, with current ComHIP implementation and ComHIP under full local implementation costing on average US$12 189 and US$6530 per DALY averted, respectively. Results were robust to uncertainty analyses around model parameters. CONCLUSIONS High overhead costs and high patient costs in ComHIP suggest that the societal costs of ensuring appropriate hypertension care are high and may not produce sufficient impact to achieve cost-effective implementation. However, these results are limited by the evidence quality of the effectiveness estimates, which comes from observational data rather than from randomised controlled study design.
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Affiliation(s)
- Francisco Pozo-Martin
- Independent Consultant, Berlin, Germany
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - James Akazili
- Ghana Health Service Research and Development Division, Accra, Ghana
- Navrongo Health Research Centre, Navrongo, Ghana
| | - Reina Der
- Vision for a Nation, Accra, Ghana
- Family Health International, Accra, Ghana
| | - Amos Laar
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Ghana
| | - Alma J Adler
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Peter Lamptey
- Family Health International, Accra, Ghana
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Ulla K Griffiths
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
- Health Section, UNICEF, New York City, New York, USA
| | - Anna Vassall
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
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Treskova M, Pozo-Martin F, Scholz S, Schönfeld V, Wichmann O, Harder T. Assessment of the Effects of Active Immunisation against Respiratory Syncytial Virus (RSV) using Decision-Analytic Models: A Systematic Review with a Focus on Vaccination Strategies, Modelling Methods and Input Data. Pharmacoeconomics 2021; 39:287-315. [PMID: 33462760 PMCID: PMC7813556 DOI: 10.1007/s40273-020-00991-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/20/2020] [Indexed: 05/16/2023]
Abstract
BACKGROUND Several vaccine and antibody candidates are currently in development for the prevention of lower respiratory tract infections caused by the respiratory syncytial virus (RSV). METHODS We searched MEDLINE, Embase, and SCOPUS and included model-based evaluations of RSV vaccinations. Two reviewers performed the selection, data extraction, and quality evaluation with EVIDEM. Cost-effectiveness (CE) estimates were converted to $US purchasing power parity (PPP), year 2018 values. Potential economic and epidemiological outcomes were summarised for maternal, infant, children, and elderly vaccinations. The PROSPERO identifier is CRD42019122570. RESULTS In total, 22 model-based studies were reviewed. On average, a potential 27% reduction in RSV hospitalisations in infants was projected for maternal vaccination and 50% for direct infant immunisation. The CE of maternal vaccination was $US1766-5857 PPP 2018/disability-adjusted life-years (DALYs) for Global Alliance for Vaccines and Immunisation (Gavi)-eligible countries. For England, the maximum cost-effective price of maternal vaccination was estimated at $US81.5 PPP 2018. Infant vaccination was associated with higher CE ratios in low- and high-income settings. Vaccination of neonates born before the RSV season was the most cost effective in high-income settings. Higher values for vaccine effectiveness, duration of protection, and vaccine uptake increased the benefits. Due to indirect effects, the vaccination of school-age children and a cocooning strategy were effective alternatives to protect infants, and the vaccination of children aged < 5 years had a beneficial impact on the elderly. CONCLUSION RSV vaccines with anticipated characteristics may reduce a sizeable proportion of the RSV burden. The results are subject to uncertainty because of the limited epidemiological and clinical data. Data on RSV incidence and hospitalisation risk for granular age strata should be prioritised to facilitate the evaluation of RSV interventions and decision making.
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Affiliation(s)
- Marina Treskova
- Immunization Unit, Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany.
| | | | - Stefan Scholz
- Immunization Unit, Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Viktoria Schönfeld
- Immunization Unit, Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Ole Wichmann
- Immunization Unit, Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Thomas Harder
- Immunization Unit, Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
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El Bcheraoui C, Weishaar H, Pozo-Martin F, Hanefeld J. Assessing COVID-19 through the lens of health systems' preparedness: time for a change. Global Health 2020; 16:112. [PMID: 33213482 PMCID: PMC7675393 DOI: 10.1186/s12992-020-00645-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 11/13/2020] [Indexed: 12/21/2022] Open
Abstract
The last months have left no-one in doubt that the COVID-19 pandemic is exerting enormous pressure on health systems around the world, bringing to light the sub-optimal resilience of even those classified as high-performing. This makes us re-think the extent to which we are using the appropriate metrics in evaluating health systems which, in the case of this pandemic, might have masked how unprepared some countries were. It also makes us reflect on the strength of our solidarity as a global community, as we observe that global health protection remains, as this pandemic shows, focused on protecting high income countries from public health threats originating in low and middle income countries. To change this course, and in times like this, all nations should come together under one umbrella to respond to the pandemic by sharing intellectual, human, and material resources. In order to work towards stronger and better prepared health systems, improved and resilience-relevant metrics are needed. Further, a new model of development assistance for health, one that is focused on stronger and more resilient health systems, should be the world’s top priority.
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Affiliation(s)
- Charbel El Bcheraoui
- Evidence-Based Public Health, Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany.
| | - Heide Weishaar
- Evidence-Based Public Health, Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany
| | - Francisco Pozo-Martin
- Evidence-Based Public Health, Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany
| | - Johanna Hanefeld
- Evidence-Based Public Health, Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany
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9
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Ibrahim N, Ramke J, Pozo-Martin F, Gilbert CE. Willingness to pay for cataract surgery is much lower than actual costs in Zamfara state, northern Nigeria. Ophthalmic Epidemiol 2017; 25:227-233. [PMID: 29182463 DOI: 10.1080/09286586.2017.1408845] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Direct medical and non-medical costs incurred by those undergoing subsidised cataract surgery at Gusau eye clinic, Zamfara state, were recently determined. The aim of this study was to assess the willingness to pay for cataract surgery among adults with severe visual impairment or blindness from cataract in rural Zamfara and to compare this to actual costs. METHODS In three rural villages served by Gusau eye clinic, key informants helped identify 80 adults with bilateral severe visual impairment or blindness (<6/60), with cataract being the cause in at least one eye. The median amount participants were willing to pay for cataract surgery was determined. The proportion willing to pay actual costs of the (i) subsidised surgical fee (US$18.5), (ii) average non-medical expenses (US$25.2), and (iii) average total expenses (US$51.2) at Gusau eye clinic were calculated. Where participants would seek funds for surgery was determined. RESULTS Among 80 participants (38% women), most (n = 73, 91%) were willing to pay something, ranging from <US$1 to US$186 (median US$18.5, interquartile range 6.2-31.1). Approximately half of the participants (n = 41) were willing to pay US$18.5 (78% men), one-third (n = 26) were willing to pay US$25.2 (77% men); and 11% (n = 9) were willing to pay US$51.2 (all men). Only six participants (8%) already had the money to pay; one quarter (n = 20) would need to sell possessions to raise the funds. CONCLUSION Willingness to pay for cataract surgery among adults with operable cataract in rural Zamfara state is far lower than current costs of undergoing surgery. People who were widowed-most of whom were women-were willing to pay least. Further financial support is required for cataract surgery to be universally accessible.
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Affiliation(s)
- Nazaradden Ibrahim
- a Zamfara State Eye Care Programme, Ministry of Health , Gusau , Nigeria
| | - Jacqueline Ramke
- b Department of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences , University of Auckland , Auckland , New Zealand
| | - Francisco Pozo-Martin
- c Department of Global Health and Development , London School of Hygiene and Tropical Medicine , London , UK
| | - Clare E Gilbert
- d International Centre for Eye Health, Clinical Research Unit, Department of Infectious & Tropical Diseases , London School of Hygiene and Tropical Medicine , London , UK
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10
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Blanchet K, Nam SL, Ramalingam B, Pozo-Martin F. Governance and Capacity to Manage Resilience of Health Systems: Towards a New Conceptual Framework. Int J Health Policy Manag 2017; 6:431-435. [PMID: 28812842 PMCID: PMC5553211 DOI: 10.15171/ijhpm.2017.36] [Citation(s) in RCA: 151] [Impact Index Per Article: 21.6] [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: 10/04/2016] [Accepted: 03/13/2017] [Indexed: 11/21/2022] Open
Abstract
The term resilience has dominated the discourse among health systems researchers since 2014 and the onset of the Ebola outbreak in West Africa. There is wide consensus that the global community has to help build more resilient health systems. But do we really know what resilience means, and do we all have the same vision of resilience? The present paper presents a new conceptual framework on governance of resilience based on systems thinking and complexity theories. In this paper, we see resilience of a health system as its capacity to absorb, adapt and transform when exposed to a shock such as a pandemic, natural disaster or armed conflict and still retain the same control over its structure and functions.
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Affiliation(s)
- Karl Blanchet
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Sara L Nam
- Options Consultancy Services Ltd, London, UK
| | | | - Francisco Pozo-Martin
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
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11
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ten Hoope-Bender P, Nove A, Sochas L, Matthews Z, Homer CSE, Pozo-Martin F. The 'Dream Team' for sexual, reproductive, maternal, newborn and adolescent health: an adjusted service target model to estimate the ideal mix of health care professionals to cover population need. Hum Resour Health 2017; 15:46. [PMID: 28676120 PMCID: PMC5496136 DOI: 10.1186/s12960-017-0221-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 06/22/2017] [Indexed: 06/01/2023]
Abstract
BACKGROUND A competent, enabled and efficiently deployed health workforce is crucial to the achievement of the health-related sustainable development goals (SDGs). Methods for workforce planning have tended to focus on 'one size fits all' benchmarks, but because populations vary in terms of their demography (e.g. fertility rates) and epidemiology (e.g. HIV prevalence), the level of need for sexual, reproductive, maternal, newborn and adolescent health (SRMNAH) workers also varies, as does the ideal composition of the workforce. In this paper, we aim to provide proof of concept for a new method of workforce planning which takes into account these variations, and allocates tasks to SRMNAH workers according to their competencies, so countries can assess not only the needed size of the SRMNAH workforce, but also its ideal composition (the 'Dream Team'). METHODS An adjusted service target model was developed, to estimate (i) the amount of health worker time needed to deliver essential SRMNAH care, and (ii) how many workers from different cadres would be required to meet this need if tasks were allocated according to competencies. The model was applied to six low- and middle-income countries, which varied in terms of current levels of need for health workers, geographical location and stage of economic development: Azerbaijan, Malawi, Myanmar, Peru, Uzbekistan and Zambia. RESULTS Countries with high rates of fertility and/or HIV need more SRMNAH workers (e.g. Malawi and Zambia each need 44 per 10,000 women of reproductive age, compared with 20-27 in the other four countries). All six countries need between 1.7 and 1.9 midwives per 175 births, i.e. more than the established 1 per 175 births benchmark. CONCLUSIONS There is a need to move beyond universal benchmarks for SRMNAH workforce planning, by taking into account demography and epidemiology. The number and range of workers needed varies according to context. Allocation of tasks according to health worker competencies represents an efficient way to allocate resources and maximise quality of care, and therefore will be useful for countries working towards SDG targets. Midwives/nurse-midwives who are educated according to established global standards can meet 90% or more of the need, if they are part of a wider team operating within an enabled environment.
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Affiliation(s)
- Petra ten Hoope-Bender
- Technical Adviser Sexual and Reproductive Health and Rights, United Nations Population Fund, Geneva, Switzerland
| | - Andrea Nove
- Instituto de Cooperación Social Integrare, Calle Balmes, 30, 3° - 1, 08007 Barcelona, Spain
- Novametrics Ltd, Derby, United Kingdom
| | - Laura Sochas
- London School of Economics, London, United Kingdom
| | - Zoë Matthews
- Department of Social Statistics and Demography, University of Southampton, Southampton, United Kingdom
| | - Caroline S. E. Homer
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, Ultimo, NSW Australia
| | - Francisco Pozo-Martin
- Instituto de Cooperación Social Integrare, Calle Balmes, 30, 3° - 1, 08007 Barcelona, Spain
- Department of Global Health and Development, Faculty of Public Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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12
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Castro Lopes S, Guerra-Arias M, Buchan J, Pozo-Martin F, Nove A. A rapid review of the rate of attrition from the health workforce. Hum Resour Health 2017; 15:21. [PMID: 28249619 PMCID: PMC5333422 DOI: 10.1186/s12960-017-0195-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 02/23/2017] [Indexed: 06/06/2023]
Abstract
BACKGROUND Attrition or losses from the health workforce exacerbate critical shortages of health workers and can be a barrier to countries reaching their universal health coverage and equity goals. Despite the importance of accurate estimates of the attrition rate (and in particular the voluntary attrition rate) to conduct effective workforce planning, there is a dearth of an agreed definition, information and studies on this topic. METHODS We conducted a rapid review of studies published since 2005 on attrition rates of health workers from the workforce in different regions and settings; 1782 studies were identified, of which 51 were included in the study. In addition, we analysed data from the State of the World's Midwifery (SoWMy) 2014 survey and associated regional survey for the Arab states on the annual voluntary attrition rate for sexual, reproductive, maternal and newborn health workers (mainly midwives, doctors and nurses) in the 79 participating countries. RESULTS There is a diversity of definitions of attrition and barely any studies distinguish between total and voluntary attrition (i.e. choosing to leave the workforce). Attrition rate estimates were provided for different periods of time, ranging from 3 months to 12 years, using different calculations and data collection systems. Overall, the total annual attrition rate varied between 3 and 44% while the voluntary annual attrition rate varied between 0.3 to 28%. In the SoWMy analysis, 49 countries provided some data on voluntary attrition rates of their SRMNH cadres. The average annual voluntary attrition rate was 6.8% across all cadres. CONCLUSION Attrition, and particularly voluntary attrition, is under-recorded and understudied. The lack of internationally comparable definitions and guidelines for measuring attrition from the health workforce makes it very difficult for countries to identify the main causes of attrition and to develop and test strategies for reducing it. Standardized definitions and methods of measuring attrition are required.
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Affiliation(s)
| | | | - James Buchan
- Queen Margaret University, Edinburgh, Scotland United Kingdom
- University of Technology, Sydney, Australia
| | - Francisco Pozo-Martin
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 1SH United Kingdom
| | - Andrea Nove
- ICS Integrare, calle Balmes 30,3-1a, 08007 Barcelona, Spain
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13
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Pozo-Martin F, Nove A, Lopes SC, Campbell J, Buchan J, Dussault G, Kunjumen T, Cometto G, Siyam A. Health workforce metrics pre- and post-2015: a stimulus to public policy and planning. Hum Resour Health 2017; 15:14. [PMID: 28202047 PMCID: PMC5312527 DOI: 10.1186/s12960-017-0190-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 02/09/2017] [Indexed: 05/19/2023]
Abstract
BACKGROUND Evidence-based health workforce policies are essential to ensure the provision of high-quality health services and to support the attainment of universal health coverage (UHC). This paper describes the main characteristics of available health workforce data for 74 of the 75 countries identified under the 'Countdown to 2015' initiative as accounting for more than 95% of the world's maternal, newborn and child deaths. It also discusses best practices in the development of health workforce metrics post-2015. METHODS Using available health workforce data from the Global Health Workforce Statistics database from the Global Health Observatory, we generated descriptive statistics to explore the current status, recent trends in the number of skilled health professionals (SHPs: physicians, nurses, midwives) per 10 000 population, and future requirements to achieve adequate levels of health care in the 74 countries. A rapid literature review was conducted to obtain an overview of the types of methods and the types of data sources used in human resources for health (HRH) studies. RESULTS There are large intercountry and interregional differences in the density of SHPs to progress towards UHC in Countdown countries: a median of 10.2 per 10 000 population with range 1.6 to 142 per 10 000. Substantial efforts have been made in some countries to increase the availability of SHPs as shown by a positive average exponential growth rate (AEGR) in SHPs in 51% of Countdown countries for which there are data. Many of these countries will require large investments to achieve levels of workforce availability commensurate with UHC and the health-related sustainable development goals (SDGs). The availability, quality and comparability of global health workforce metrics remain limited. Most published workforce studies are descriptive, but more sophisticated needs-based workforce planning methods are being developed. CONCLUSIONS There is a need for high-quality, comprehensive, interoperable sources of HRH data to support all policies towards UHC and the health-related SDGs. The recent WHO-led initiative of supporting countries in the development of National Health Workforce Accounts is a very promising move towards purposive health workforce metrics post-2015. Such data will allow more countries to apply the latest methods for health workforce planning.
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Affiliation(s)
- Francisco Pozo-Martin
- Instituto de Cooperación Social Integrare, calle Balmes 30, 3-1, 08007, Barcelona, Spain
| | - Andrea Nove
- Instituto de Cooperación Social Integrare, calle Balmes 30, 3-1, 08007, Barcelona, Spain.
| | - Sofia Castro Lopes
- Instituto de Cooperación Social Integrare, calle Balmes 30, 3-1, 08007, Barcelona, Spain
| | - James Campbell
- Health Systems and Innovations, WHO Headquarters, Geneva, Switzerland
- Global Health Workforce Network, WHO Headquarters, Geneva, Switzerland
| | - James Buchan
- School of Nursing Midwifery and Health, University of Technology Sydney, Sydney, Australia
| | - Gilles Dussault
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Teena Kunjumen
- Health Systems and Innovations, WHO Headquarters, Geneva, Switzerland
| | - Giorgio Cometto
- Global Health Workforce Network, WHO Headquarters, Geneva, Switzerland
| | - Amani Siyam
- Health Systems and Innovations, WHO Headquarters, Geneva, Switzerland
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Blanchet K, Lewis JJ, Pozo-Martin F, Satouro A, Somda S, Ilboudo P, Sarrassat S, Cousens S. A mixed methods protocol to evaluate the effect and cost-effectiveness of an Integrated electronic Diagnosis Approach (IeDA) for the management of childhood illnesses at primary health facilities in Burkina Faso. Implement Sci 2016; 11:111. [PMID: 27488566 PMCID: PMC4973038 DOI: 10.1186/s13012-016-0476-5] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 07/23/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Burkina Faso introduced the Integrated Management of Childhood Illnesses (IMCI) strategy in 2003. However, an evaluation conducted in 2013 found that only 28 % of children were assessed for three danger signs as recommended by IMCI, and only 15 % of children were correctly classified. About 30 % of children were correctly prescribed with an antibiotic for suspected pneumonia or oral rehydration salts (ORS) for diarrhoea, and 40 % were correctly referred. Recent advances in information and communication technologies (ICT) and use of electronic clinical protocols hold the potential to transform healthcare delivery in low-income countries. However, no evidence is available on the effect of ICT on adherence to IMCI. This paper describes the research protocol of a mixed methods study that aims to measure the effect of the Integrated electronic Diagnosis Approach innovation (an electronic IMCI protocol provided to nurses) in two regions of Burkina Faso. METHODS/DESIGN The study combines a stepped-wedge trial, a realistic evaluation and an economic study in order to capture the effect of the innovation after its introduction on the level of adherence, cost and acceptability. DISCUSSION The main challenge is to interconnect the three substudies. In integrating outcome, process and cost data, we focus on three key questions: (i) How does the effectiveness and the cost of the intervention vary by type of health worker and type of health centre? (ii) What is the impact of changes in the content, coverage and quality of the IeDA intervention on adherence and cost-effectiveness? (iii) What mechanisms of change (including costs) might explain the relationship between the IeDA intervention and adherence? TRIAL REGISTRATION Clinicaltrials.gov, NCT02341469 .
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Affiliation(s)
- Karl Blanchet
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - James J. Lewis
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Francisco Pozo-Martin
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | - Sophie Sarrassat
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Simon Cousens
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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15
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Ibrahim N, Pozo-Martin F, Gilbert C. Direct non-medical costs double the total direct costs to patients undergoing cataract surgery in Zamfara state, Northern Nigeria: a case series. BMC Health Serv Res 2015; 15:163. [PMID: 25881013 PMCID: PMC4404068 DOI: 10.1186/s12913-015-0831-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 03/30/2015] [Indexed: 12/12/2022] Open
Abstract
Background Cost is frequently reported as a barrier to cataract surgery, but few studies have reported costs of accessing surgery in Africa. The purpose of this prospective, facility based study was to compare direct non-medical cost with total direct cost of cataract surgery to patients, and to assess how money was found to cover costs. Methods Participants were those aged 17 years and above attending their first post-operative visit after first eye, subsidised, day case cataract surgery. Systematic random sampling was used to select participants who were interviewed to obtain data on socio-demographic details, and on expenditure during the assessment visit, the surgical visit, and the first follow-up visit. Costs were a) direct medical costs (patients’ costs for registration, investigations, surgery, medication), and b) direct non-medical costs (patients’ and escorts’ costs for transport, accommodation, meals). The source of funds to pay for the services received was also assessed. Results Almost two thirds (63%) of the 104 participants were men. The mean age of men was 64 (±12.5) years, being 63 (±12.9) years for women. All men were married and 35% of women were widows. 84% of men were household heads compared with 6% of women. The median total direct cost for all visits by all participants was N8,245 (US$51), being higher for men than women (N9,020; US$56 and N7,620; US$47) (p < 0.09) respectively. Direct non-medical cost constituted 49% of total direct cost. 92% of participants had adequate money to pay, but 8% had to sell possessions to raise the money. 20% of unmarried women sold possessions or took out a loan. Conclusion Despite the subsidy, cost is still likely to be a barrier to accessing cataract surgery, as the total direct costs represented at least 50 days income for 70% of the local population. Provision of transport would reduce direct non-medical costs.
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Affiliation(s)
| | - Francisco Pozo-Martin
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK.
| | - Clare Gilbert
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK. .,International Centre for Eye Health, Department of Clinical Research, London School of Hygiene & Tropical Medicine, Keppel Street, WC1E 7HT, London, UK.
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