Costing Interventions for Developing an Essential Package of Health Services: Application of a Rapid Method and Results From Pakistan.

BACKGROUND: The Federal Ministry of National Health Services, Regulations and Coordination (MNHSR&C) in Pakistan has committed to progress towards universal health coverage (UHC) by 2030 by providing an Essential Package of Health Services (EPHS). Starting in 2019, the Disease Control Priorities 3rd edition (DCP3) evidence framework was used to guide the development of Pakistan's EPHS. In this paper, we describe the methods and results of a rapid costing approach used to inform the EPHS design process. METHODS: A total of 167 unit costs were calculated through a context-specific, normative, ingredients-based, and bottom-up economic costing approach. Costs were constructed by determining resource use from descriptions provided by MNHSR&C and validated by technical experts. Price data from publicly available sources were used. Deterministic univariate sensitivity analyses were carried out. RESULTS: Unit costs ranged from 2019 US$ 0.27 to 2019 US$ 1478. Interventions in the cancer package of services had the highest average cost (2019 US$ 837) while interventions in the environmental package of services had the lowest (2019 US$ 0.68). Cost drivers varied by platform; the two largest drivers were drug regimens and surgery-related costs. Sensitivity analyses suggest our results are not sensitive to changes in staff salary but are sensitive to changes in medicine pricing. CONCLUSION: We estimated a large number of context-specific unit costs, over a six-month period, demonstrating a rapid costing method suitable for EPHS design.

COVID VS. NON-COVID Age-Specific Mortality In Islamabad: A Comparative Cross-Sectional Survey.

BACKGROUND: COVID-19 the ongoing pandemic. Mortality due to other reasons, other than COVID-19 across age groups reduced which was anecdotally reported from Pakistan. This survey was undertaken to assess the number of deaths recorded in Islamabad from 1st March 2019 to 30th May 2019 and from 1st March 2020 to 30th May 2020 and compare the two estimates by age and gender while documenting the cause of deaths. METHODS: The cross-sectional study was conducted in the Islamabad from 11th to 16th June 2020, comprising of secondary data received on age, gender, cause of death and months of death from the both, large private-public hospitals records and graveyards registers. Data was entered in both SPSS and Microsoft Excel and analysed using SPSS 22. RESULTS: The total number of hospitals and graveyards approached in ICT were 14 and 4 respectively. The total number of deaths reported from these during March to June in 2019 and 2020 were 2,389; out of which 1,225 (51.3%) deaths were recorded in 2019 and 1,162 (48.6%) deaths in 2020. In both years, predominant variables with more mortality were both age and gender between 61-70 years of age 511 (21.4%) 1,395 (58.4%) males respectively. CONCLUSIONS: More deaths were reported in males with old age. Cardio vascular diseases and neurological disorders were the leading causes of mortality. Not much of a larger difference in number of deaths between the both years was seen. Scarcity of data and unavailability of evidence make the anecdotal reports mere just a rumour.

Caesarian-sections and early initiation of breast-feeding practices in tertiary care hospitals of Islamabad.

OBJECTIVE: To assess the effect of caesarean section and factors influencing early initiation of breastfeeding by mothers. METHODS: The cross-sectional study was conducted at Pakistan Institute Of Medical Sciences, Islamabad, and Polyclinic Hospital, Islamabad, Pakistan, from November 2016 to January 2017, and comprised women who had given birth through caesarean section. Data was collected using a standardised questionnaire which was modified accordingly. Data was analysed using SPSS 20. RESULTS: Of the 150 subjects 18-49 years, 95(63.3%) breastfed their babies but not within the initial hour of the birth, as 104(69.3%) were in the recovery room post-surgery. As such, 141(94%) infants were given formula feeds. Overall, 120(80%) babies met their mother between 1 and five hours. In 54(57%) babies, breastfeeding was started within 6- 12 hours after birth, and 149(98.7%) women had postoperative pain which delayed initiation of breastfeeding. CONCLUSIONS: Caesarean sections were found to be associated with reduced breastfeeding rates in the initial one hour post-surgery.