Adjustments in purchasing arrangements to support the COVID-19 health sector response: evidence from eight middle-income countries.

The COVID-19 pandemic has triggered several changes in countries' health purchasing arrangements to accompany the adjustments in service delivery in order to meet the urgent and additional demands for COVID-19-related services. However, evidence on how these adjustments have played out in low- and middle-income countries is scarce. This paper provides a synthesis of a multi-country study of the adjustments in purchasing arrangements for the COVID-19 health sector response in eight middle-income countries (Armenia, Cameroon, Ghana, Kenya, Nigeria, Philippines, Romania and Ukraine). We use secondary data assembled by country teams, as well as applied thematic analysis to examine the adjustments made to funding arrangements, benefits packages, provider payments, contracting, information management systems and governance arrangements as well as related implementation challenges. Our findings show that all countries in the study adjusted their health purchasing arrangements to varying degrees. While the majority of countries expanded their benefit packages and several adjusted payment methods to provide selected COVID-19 services, only half could provide these services free of charge. Many countries also streamlined their processes for contracting and accrediting health providers, thereby reducing administrative hurdles. In conclusion, it was important for the countries to adjust their health purchasing arrangements so that they could adequately respond to the COVID-19 pandemic, but in some countries financing challenges resulted in issues with equity and access. However, it is uncertain whether these adjustments can and will be sustained over time, even where they have potential to contribute to making purchasing more strategic to improve efficiency, quality and equitable access in the long run.

Impact of a sugar-sweetened beverage tax on sugar producers in Ukraine.

Taxes on sugar-sweetened beverages can promote health and raise revenue. Whether these taxes negatively impact domestic sugar producers, an argument often made by opponents, is understudied. We extended a simulation model based on a uniform specific volume-based tax of UAH 4/L in Ukraine. We estimated best- and worst-case scenarios for reductions in domestic sugar demand to be 162 and 23 000 metric tons. This is at worst ∼0.5% of current exports, meaning decreases in domestic demand could easily be absorbed by export markets given export trends. Due to highly protectionist sugar sector policy, sugar producers would not be able to fully substitute domestic sales revenues through increased export revenues, but the worst-case revenue gap was <0.5% of total sectoral output in recent years. Overall, introducing a tax on sugar-sweetened beverages in Ukraine is likely to have a very limited impact on domestic sugar producers.

Impact of the COVID-19 pandemic on Ukrainian mortality, 2020-2021.

The mortality impact of the COVID-19 pandemic in Ukraine has remained incomplete. We estimated excess deaths associated with the pandemic in Ukraine during 2020 and 2021. Excess deaths may be attributed directly to SARS-CoV-2 infection or indirectly to deaths associated with social and economic upheavals resulting from the pandemic. Data on all deaths registered in government-controlled Ukraine from 2016-2021 (N = 3,657,475) were utilized. Using a model-based approach, we predicted monthly excess deaths in 2020 and 2021. We estimated 47,578 excess deaths in 2020 as a whole (7.71% of all recorded deaths). This figure reflects both positive (higher than expected) excess deaths from June-December and negative (lower than expected) deaths in January and March-May. From June-December 2020, we estimated 59,363 excess deaths (15.75% of all recorded deaths in those months). In 2021, we estimated 150,049 excess deaths (21.01% of all recorded deaths). Positive excess deaths were detected across age groups even groups younger than 40 years. The number of excess deaths exceeded that of deaths with COVID-19 coded on the death certificate by more than two-fold in 2020, but that difference narrowed in 2021. We furthermore provide provisional estimates of the effect of low vaccine coverage on excess deaths in 2021 drawing from European cross-national evidence and provisional estimates of the hypothetical evolution of the pandemic in 2022 to serve as a rough basis for future studies analyzing the joint impacts of the COVID-19 pandemic and the Russian invasion on Ukrainian demography.

Реформа фінансування системи охорони здоров’я в Україні: прогрес та майбутні напрями: огляд звіту

У 2015 р. український уряд ініціював трансформаційну реформу системи охорони здоров’я, метою якої було поліпшення показників здоров’я населення та забезпечення фінансового захисту від надмірних витрат на охорону здоров’я «з кишені» пацієнтів. Реформа повинна була впроваджуватися шляхом модернізації та інтеграції системи надання послуг, запровадження змін до механізмів оплати надавачам медичних послуг, які б стимулювали ефективність, а також шляхом покращення якості медичних послуг. Кульмінацією реформи став новий закон про фінансування системи охорони здоров’я—Закон України «Про державні фінансові гарантії медичного обслуговування населення» 2017 р.,—яким було запроваджено гарантований пакет медичних послуг під назвою Програма медичних гарантій (ПМГ) і створено Національну службу здоров’я України (НСЗУ) в ролі стратегічного закупівельника послуг для цієї програми. Передбачалося, що з часом ПМГ буде розширюватися і зрештою охопить всі види медичної допомоги, а фінансування охорони здоров’я перейде від кошто рисного фінансування до методів фінансування, орієнтованих на результат, що забезпечить краще узгодження надаваних медичних послуг з потребами пацієнтів.

Реформа фінансування системи охорони здоров’я в Україні: прогрес та майбутні напрями

У 2015 р. український уряд ініціював трансформаційну реформу системи охорони здоров’я, метою якої було поліпшення показників здоров’я населення та забезпечення фінансового захисту від надмірних витрат на охорону здоров’я «з кишені» пацієнтів. Реформа повинна була впроваджуватися шляхом модернізації та інтеграції системи надання послуг, запровадження змін до механізмів оплати надавачам медичних послуг, які б стимулювали ефективність, а також шляхом покращення якості медичних послуг. Кульмінацією реформи став новий закон про фінансування системи охорони здоров’я—Закон України «Про державні фінансові гарантії медичного обслуговування населення» 2017 р.,—яким було запроваджено гарантований пакет медичних послуг під назвою Програма медичних гарантій (ПМГ) і створено Національну службу здоров’я України (НСЗУ) в ролі стратегічного закупівельника послуг для цієї програми. Передбачалося, що з часом ПМГ буде розширюватися і зрештою охопить всі види медичної допомоги, а фінансування охорони здоров’я перейде від кошто рисного фінансування до методів фінансування, орієнтованих на результат, що забезпечить краще узгодження надаваних медичних послуг з потребами пацієнтів.

A survey and optical microscopy in pilot comparative analysis of generic and original nimesulide granules.

BACKGROUND: Secondary to increased development of generic nonsteroidal anti-inflammatory drugs (NSAIDs), there is a lack of simple and inexpensive ways of pilot detection of differences between the batches of generic drugs and the original ones. OBJECTIVES: To determine the peculiarities of the use of generic NSAIDs in routine practice through a pilot survey of dentists and to conduct a pilot comparative analysis of generic and original NSAIDs containing nimesulide granules using optical microscopy. METHODS: The first part of the study included a pilot survey Convenience sampling of 192 dentists to study the use of generic NSAIDs in their routine practice. The second part included the use of a pilot optical microscopy of nimesulide particles isolated from four drugs: original drug (NA) and generic ones (NB, NC, ND). RESULTS: In the questionnaires, dentists pointed to a 68.7% lower clinical efficacy and a 62.6% higher percentage of side effects of generic NSAIDs compared to the original ones. Based on the results of pilot optical microscopy, a statically significant difference in the size distribution of the drug substance particles in all generic nimesulide granules was determined as follows: NB (χ2: 15.15; p < 0.01); NC (χ2: 11.09; p < 0.05); ND (χ2: 1625.34; p < 0.001) compared with the original drug NA. CONCLUSIONS: A pilot survey of dentists showed that doctors noted the practical difference in the effects of the original and generic NSAIDs. A significant difference in the size of nimesulide particles and their distribution in generic drugs NB, NC, ND compared to the original NA suggests a possible difference in bioavailability and bioequivalence.

The effect of hyaluronic acid on the periodontium in spontaneous periodontitis in rats / El efecto del ácido hialurónico sobre el periodonto en periodontitis espontánea en ratas

SUMMARY: The aim of the article was to study changes in periodontal tissues in rats with spontaneous periodontitis (SP) and to evaluate the effect of hyaluronic acid (HA) on the state of the periodontium. Wistar rats with signs of SP were divided into 6 groups: 1) intact group; 2) intact animals with HA "HD-1,0 MDa"; 3) SP group; 4) SP with HA "S-2,4 MDa"; 5) SP with HA "ST-2,4 MDa"; 6) SP with HA "HD-1,0 MDa". The study of the periodontium rats with SP noted the main structural changes (collagen reduction, resorption of alveolar bone, dilatation and stasis of the vessels of the periodontium, gingival papilla and tooth pulp), which were assessed as moderate. Morphological evidence of inflammation was infiltration of neutrophils into the connective tissue of the gums, without the formation of abscesses. Local administration of HA did not cause additional structural damage in periodontal tissues of rats with SP, but also did not affect changes in the microvascular system of periodontium and tooth pulp, periodontal ligaments, only a tendency to inhibit alveolar bone resorption in rats was noted. One can consider the tendency to improve the condition of periodontal tissues in the group of rats injected with high molecular HA and HA with mannitol (2.4 MDa).

RESUMEN: El objetivo del artículo fue estudiar los cambios en los tejidos periodontales en ratas con periodontitis espontánea (PE) y evaluar el efecto del ácido hialurónico (HA) sobre el estado del periodonto. Las ratas Wistar con signos de PE se dividieron en 6 grupos: 1) grupo intacto; 2) animales intactos con HA "HD-1,0 MDa"; 3) grupo PE; 4) PE con HA "S-2,4 MDa"; 5) PE con HA "ST-2,4 MDa"; 6) PE con HA "HD-1,0 MDa". En las ratas con PS se observaron los principales cambios estructurales (reducción de colágeno, reabsorción del hueso alveolar, dilatación y estasis de los vasos del periodonto, papila gingival y pulpa dentaria), que fueron evaluados como moderados. La evidencia morfológica de inflamación fue la infiltración de neutrófilos en el tejido conectivo de las encías, sin la formación de abscesos. La administración local de HA no causó daño estructural adicional en los tejidos periodontales de las ratas con PE, pero tampoco se produjo cambios en el sistema microvascular del periodonto y en la pulpa dental y ligamentos periodontales.Se observó una tendencia a inhibir la resorción del hueso alveolar. Se puede considerar la tendencia a mejorar el estado de los tejidos periodontales en el grupo de ratas inyectadas con HA de alto peso molecular y HA con manitol (2,4 MDa).

Diabetes care cascade in Ukraine: an analysis of breakpoints and opportunities for improved diabetes outcomes.

BACKGROUND: Diabetes is one of the leading causes of poor health and high care costs in Ukraine. To prevent diabetes complications and alleviate the financial burden of diabetes care on patients, the Ukrainian government reimburses diabetes medication and provides glucose monitoring, but there are significant gaps in the care continuum. We estimate the costs of providing diabetes care and the most cost-effective ways to address these gaps in the Poltava region of Ukraine. METHODS: We gathered data on the unit costs of diabetes interventions in Poltava and estimated expenditure on diabetes care. We estimated the optimal combination of facility-based and outreach screening and investigated how additional funding could best be allocated to improve glucose control outcomes. RESULTS: Of the ~ 40,000 adults in diabetes care, only ~ 25% achieved sustained glucose control. Monitoring costs were higher for those who did not: by 10% for patients receiving non-pharmacological treatment, by 61% for insulin patients, and twice as high for patients prescribed oral treatment. Initiatives to improve treatment adherence (e.g. medication copayment schemes, enhanced adherence counseling) would address barriers along the care continuum and we estimate such expenditures may be recouped by reductions in patient monitoring costs. Improvements in case detection are also needed, with only around two-thirds of estimated cases having been diagnosed. Outreach screening campaigns could play a significant role: depending on how well-targeted and scalable such campaigns are, we estimate that 10-46% of all screening could be conducted via outreach, at a cost per positive patient identified of US$7.12-9.63. CONCLUSIONS: Investments to improve case detection and treatment adherence are the most efficient interventions for improved diabetes control in Poltava. Quantitative tools provide essential decision support for targeting investment to close the gaps in care.

Assessment of appropriateness of hospitalisations in Ukraine: analytical framework, method and findings.

OBJECTIVES: This article reviews the applicability of a customised version of the Appropriateness Evaluation Protocol (AEP) to evaluate the magnitude of inappropriate hospitalisations in two regions of Ukraine. DATA AND METHODS: The original AEP was modified to develop a customised tool, which included criteria for the appropriateness of hospitalisation and duration of inpatient stay. The customisation of the tool followed the Delphi procedure. We randomly selected 381 medical records to test the feasibility and reliability of the method and 800 medical records to evaluate the scope of inappropriate hospitalisations. We used descriptive and analytical statistics, receiver operating characteristic curve analysis and Cohen's kappa to check the consistency between the findings of primary reviewers and experts. RESULT: We observed high levels of agreement in conclusions of primary reviewers (reference standard) and experts during testing of the reliability and validity of the method. The external validity check showed that the use of the tool by different experts provided high accuracy: 95.1 sensitivity, 76.6 specificity and area under ROC-curve (AUC)=0.948 (р<0.001) for analysis of the appropriateness of admissions; 95.3 sensitivity, 84.7 specificity and AUC=0.900 (р=0.001) for the duration of hospitalisations. Cohen's kappa coefficient (κ) indicated agreement in expert evaluations of 0.915 (95% СІ 0.799 to 1.000) and 0.812 (95% СІ 0.749 to 0.875), respectively.We found that over one-third of admissions (38.1%; 95% СІ 33.9 to 43.5) and over half of total bed-days were unnecessary (57.4%; 95% СІ 56.4 to 58.5). The highest levels of stay were observed in hospitals' general medicine departments (64.6%; 95% СІ 63.0 to 66.3)compared with other departments included in the analysis. CONCLUSION: The proposed method is robust in assessing the appropriateness of hospitalisations and duration of inpatient stays. The quantified levels of unnecessary hospital care indicate the need for improving efficiency and quality of care and optimising the excessive hospital capacities in Ukraine.

The results of cephalometric analysis in the dynamics of orthodontic treatment of patients with transversal anomalies of occlusion.

OBJECTIVE: Introduction: This article discusses the problems of the current issue of modern orthodontics aimed at increasing the effectiveness of diagnosis and treatment of transversal anomalies of occlusion in patients in periods of alternating and permanent bites by using standard orthodontic equipment in combination with orthopedic treatment by physical rehabilitation methods. In this work, the features of cephalometric indices in patients with transversal anomalies of occlusion have been studied, which make it possible to approach the choice of orthodontic treatment method in a comprehensive way. The aim was to prove the efficiency of the combination of standard orthodontic equipment with orthopedic treatment by physical rehabilitation methods. PATIENTS AND METHODS: Materials and methods: In order to study the characteristics of cephalometric indices in 9-15 years old patients with transversal anomalies of occlusion and to determine the criteria for the treatment effectiveness. Depending on the method of treatment, the patients were further divided into 2 subgroups: A and B. The method of treatment of subgroup A consisted of orthodontic treatment, which was carried out simultaneously with osteopathic correction of postural muscle imbalance by physical rehabilitation methods. Patients of subgroup B were treated exclusively by orthodontic treatment. The analysis of teleradiograms in the frontal projection was carried out using Dolphin software. RESULTS: Results: The effectiveness of the proposed regimens was carried out with the help of clinical and cephalometric indices which were studied before and after the orthodontic intervention. Clinical effectiveness of the performed orthodontic treatment was established in the absence of aesthetic disorders of facial features, normalisation and synchronization of the sizes of the upper and lower dentition, physiological positioning of the mandible, restoration of nasal breathing, disappearance of difficulties while chewing. CONCLUSION: Conclusions: When using proposed method (complex orthodontic treatment combined with physical rehabilitation methods) of orthodontic treatment, cephalometric analysis indices showed better dynamics, especially with unilateral cross-bite.

The Cost-Effectiveness of Integrating HIV Counseling and Testing into Primary Health Care in the Ukraine.

We estimate the number of HIV cases diagnosed, costs, and cost per HIV case detected associated with integrating HIV counseling and testing (HCT) into primary health care facilities in Ukraine. The study uses a difference-in-difference design with four districts implementing the intervention compared to 20 districts where HCT were offered only at specialized HIV clinics. There was a 2.01 (95 % CI: 1.12-3.61) times increase in the number of HIV cases detected per capita in intervention districts compared to other districts. The incremental cost of the intervention was $21,017 and the incremental cost per HIV case detected was $369. The average cost per HIV case detected before the intervention was $558. Engaging primary health care facilities to provide HCT is likely desirable from an efficiency point-of-view. However, the affordability of the intervention needs to be assessed because expansion will require additional investment.

Impact of hypoglycemia on daily life of type 2 diabetes patients in Ukraine.

This study evaluates the impact of hypoglycemia on the lives of Ukrainian patients with type 2 diabetes mellitus. The secondary objective was to explore patient-physician relationships and the attitudes of patients towards various informational resources on diabetes management. Three focus groups with 26 patients were conducted. Qualitative information was evaluated using content analysis. The results show that patients with type 2 diabetes mellitus in Ukraine are adapting to potential attacks of hypoglycemia; however, they still experience periodic manifestations of hypoglycemia that significantly affect their psychological well-being. This result is similar to observations made in other countries. Ukrainian patients >40 years old mainly receive information on disease management from endocrinologists, and rarely use internet resources on diabetes management. Information provision was especially important at the early stage of the disease, when patients lack information on hypoglycemia manifestations and could therefore fail to identify and manage it properly.