Establishment of Advanced Regulatory Innovation for Clinical Trials Transformation (ARICTT): a multi-stakeholder public-private partnership-based organization to accelerate the transformation of clinical trials

Clinical trials have evolved with digital technologies and tend towards patient-centricity. A multi-stakeholder approach is needed to address the emerging complexities in clinical trials. In particular, the introduction of digital technologies and an emphasis on patient-centricity are the major trends in clinical trials. In response, we established a public-private partnership-based organization named Advanced Regulatory Innovation for Clinical Trials Transformation (ARICTT). Eleven organizations in total, from academia, industry, and regulatory agencies, participate in ARICTT. Based on multi-stakeholder collaboration from academia, industry, and government/regulatory bodies, we collected and prioritized current topics in clinical trials based on an internal survey. We established a three-year roadmap with axes that were termed trend, goal, structure, theme, topic, and method. In addition, we planned the development of recommendations based on real-world cases with feasibility studies. We developed appropriate organizational structure to fulfill the roadmap of ARICTT. The selected topics were decentralized clinical trials during the first year, followed by the three topics that were awarded the highest priority according to the internal survey: advances in the informed consent process, supporting sites using digital technology, and an effective recruitment strategy. We developed a case-based recommendation paper presenting an overview of the regulatory landscape and practical considerations with explanatory cases. We also designed and conducted fully decentralized trials to evaluate considerations in real-world settings for the selected topics. Overall engagement and communication were supported by the online platform and annual symposiums. In conclusion, we established a multi-stakeholder, public-private partnership-based organization to accelerate the transformation of clinical trials.

Exploring private sector perspectives on barriers and facilitators in availing tuberculosis care cascade services: a qualitative study from the Indian state

INTRODUCTION

The private sector plays an important role in tuberculosis (TB) elimination by providing access to quality TB care services like diagnosis and treatment, advocacy for preventive measures, innovation to address challenges in TB elimination, vaccines etc. The study aims to understand the perspectives of private practitioners on patients' TB care cascade to reinforce existing interventions by assuring the quality of care to TB patients.

METHODS

The study utilized a qualitative design through in-depth interviews of private practitioners and was conducted in Ranchi and Purbi Singhbhum District of Jharkhand State from March-August 2021. The pilot-tested, semi-structured, open-ended interview guide questionnaire collected information from private practitioners on various aspects of the TB care cascade. The data from the provider interviews were transcribed into multiple codes and themes on the TB program. An inductive analysis was carried out with a focus on content credibility to eliminate bias. Ethical approval was received from the Institutional Ethics Committee of the Indian Institute of Public Health Gandhinagar (IIPHG), India. Written consent was taken from the private practitioners involved in the study.

RESULT

In-depth interviews of 17 private practitioners reveal various factors contributing to delays in TB care cascades, especially delay in access to TB diagnosis and TB Care, delay in providing treatment once after diagnosis and poor adherence to the TB treatment. According to the perception of private practitioners, there was an array of client, provider and system side factors affecting the TB care cascade gaps positively and negatively. Positive aspects mainly emerged from interviews: strong governance, consistent supply chain management, innovative PPP models and financial schemes reducing out-of-pocket expenditure (OOPE). Various factors affecting the TB care cascade negatively include awareness among the patient, socio-economic status, approach and decision-making power of providers, adverse effects of drugs, staff capacity building, etc. CONCLUSIONS: Engaging private practitioner in TB elimination efforts is critical to achieving global targets and reducing the burden of TB. The study helps to determine geography-specific barriers and facilitators of the TB care cascade to achieve the aim of providing universal access to TB healthcare with the inclusion of private practitioners.

Achievements and pitfalls in improving Pediatric Oncology Nursing standards: A public-private partnership project

RATIONALE

Approximately 8,000 new cases of pediatric cancer arise annually in Pakistan. However, there is a dire survival rate of 30-35% due to various factors, especially a lack of competent nurses in pediatric oncology care. Public-private partnerships (PPP) supported by a My Child Matters (MCM) Grant from Sanofi Espoir Foundation was granted to Indus Hospital & Health Network (IH&HN) to improve pediatric nursing standards.

METHODS

Starting in 2016, nurses from hospitals across Pakistan were enrolled in a continuing education program, which included a comprehensive, hands-on training component. A group chat was created following the training for communication and mentorship regarding challenges faced locally.

RESULTS

Seventy-seven pediatric oncology nurses were successfully trained by IH&HN over three years.

DISCUSSION

Challenges included lack of government funding, shortage of specialist nurses, frequent shifting of nurses away from pediatric care, and indifferent attitudes. Success of the project could have been maximized if trained nurses were motivated and retained by hospitals.

CONCLUSION

Development and maintenance of PPP in national healthcare systems is essential to improve pediatric oncology nursing care.

Public Private Partnerships Delivering Smart Health to Combat the Tsunami of Noncommunicable Diseases

Key noncommunicable diseases (NCD) such as cardiovascular disease, diabetes, cancer and chronic respiratory disease are responsible for 71% of all deaths worldwide. Many of these deaths are premature and impact low- and middle-income countries (LMIC) the most. The economic realities in LMICs and their greater reliance on development assistance hinder investments in public health to adequately prevent risk factors for NCDs or manage established disease. Public private partnerships (PPP) can deliver smart health solutions to improve the health outcomes of those at risk of NCDs and those who have an illness. These solutions can range from simple digital concepts to complex technology constructs that can utilize artificial intelligence to intervene at many touch points along the patient journey. We present three case studies of smart health deployed through PPP to try improving outcomes.

Procurement innovation for a circular economy of construction and demolition waste: Lessons learnt from Suzhou, China

Amidst the global trend of advocating a circular economy, various nations and regions in recent years have started to explore innovative procurement models (e.g., Public Private Partnership [PPP]) in dealing with beset issues related to construction and demolition (C&D) waste. However, PPP is suffering from problems such as 'long negotiation time', 'lack of transparency', and 'uneven risk and return allocation', which in turn lead to 'ineffective delivery' and 'poor value for money'. Using a case study, this paper reports some lessons learnt from innovative practices of procuring C&D management services in Suzhou, China. It is discovered that the public and private sectors, without prior knowledge, are operating based on a general concession framework instead of negotiating a clear-cut agreement from the outset. Several key arrangements, such as price, concession period, and strategic operations, are based on relational contract-type of agreements, which are found particularly innovative for shortening the negotiation time, fostering the trust between the relevant parties, dealing with emerging ad hoc problems, and allowing sustainable development of the circular economy. To make such PPP work, it is critical to devise institutions to prevent corruption and opportunistic behaviors. This research provides useful references to developing a circular economy. Although they focus on C&D waste management, the research findings can be applied to other public procurement settings, such as municipal solid waste management service.

Does outsourcing paramedical departments of teaching hospitals affect educational status of the students?

BACKGROUND

There is an increasing trend of outsourcing public departments. Teaching hospitals also outsourced some of their departments to private sectors. The aim of this study was to investigate and compare the educational status of students in public and outsourced departments of teaching hospitals affiliated to Iran University of Medical Sciences.

METHODS

This study was conducted in six teaching hospitals of Iran University of Medical Sciences, which had public and outsourced teaching departments in 2015. One hundred fifty students from the departments of radiology, physiotherapy and laboratory participated in this study and their perceptions about their educational status were assessed. A valid and reliable questionnaire was used; participation in the study was voluntary. Descriptive statistics such as mean (SD), t-test and Kolmogorov-Smirnov were used.

RESULTS

No difference was detected between the educational status of students in public and outsourced departments of radiology, physiotherapy and laboratory (p>0.05).

CONCLUSION

Based on the students' perception, the private sectors could maintain the educational level of the teaching departments similar to the public departments. It is recommended to involve all the stakeholders such as hospital administrators, academic staff and students in the decision- making process when changes in teaching environments are being considered.

Analysis Of The Health Care System Of Pakistan: Lessons Learnt And Way Forward

BACKGROUND

Pakistani health care system is in progress and since last year, Pakistan has tried to make much improvement in its health care delivery system and has brought out many reforms.

METHODS

A systematic search of national and international literature was looked from peerreviewed databases form MEDLINE, CINAHL, and PubMed.

RESULTS

There is little strength in health care delivery system in Pakistan like making health policies, participating in Millennium Development Goals program, initiating vertical programs and introducing Public Private Partnership, improving human resource development and infrastructure by making Basic Health Unit and Rural Health Centres. However, these all programs are very limited in its scope and that is the reason that Pakistan's healthcare system is still not very efficient. There are numerous weaknesses like poor governance, lack of access and unequal resources, poor quality of Health Information Management System, corruption in health system, lack of monitoring in health policy and health planning and lack of trained staff.

CONCLUSIONS

Pakistan is improving very slowly in the health sector for the last five decades as is evident by its health indicators and above mentioned strengths and weaknesses. Therefore, the Government needs to take strong initiatives to change the current health care system.