This article presents an analysis of the territorial dynamics of the specialized healthcare network, focusing on medium and high complexity care in hospitals in the municipalities that make up the Belém Metropolitan Region. The analysis is based on secondary data from DATASUS available on the National Health Facility Registry (CNES) up to January 2022. The findings show that the private network accounts for the largest proportion of services in the region; however, the service capacity of the SUS is greater than that of the private sector due to the large volume of services outsourced to private facilities via public-private partnerships, with philanthropic hospitals allocating the largest proportion of services to public patients. This should not be confused with universal coverage, as public patient access to private services may be restricted by legal and institutional barriers depending on the form of access (open-door or closed-door).
O artigo apresenta uma análise sobre a atuação da rede de atenção especializada do SUS, com a delimitação dos serviços de média e de alta complexidade da rede hospitalar dos municípios que compõem a Região Metropolitana de Belém. A discussão se fundamenta na revisão dos dados secundários captados na plataforma do DATASUS e disponibilizados no Cadastro Nacional de Estabelecimentos de Saúde do Brasil (CNES) até janeiro de 2022. Constatou-se que a territorialidade da alta complexidade é formada majoritariamente pela rede privada, contudo a capacidade de atendimento da rede SUS sobrepôs à oferta direcionada ao atendimento não universal, em razão da ampla reserva de serviços privados ao convênio SUS, na qual os hospitais filantrópicos apresentaram maior disposição à demanda universal. Em contrapartida, a ampla presença do Estado nos serviços de alta complexidade não deve ser pensada como uma cobertura universal, devido ao fato de as formas de acesso a esses serviços apresentarem filtros de natureza jurídico-institucional, ou, em outras palavras, o que o SUS denomina de hospitais de portas abertas ou fechadas.
Delivery of Health Care , Health Services Accessibility , National Health Programs , Brazil , Humans , Delivery of Health Care/organization & administration , National Health Programs/organization & administration , Private Sector , Public-Private Sector Partnerships/organization & administration , Cities
In 2019, the National Evidence-based Healthcare Collaborating Agency (NECA) in Korea established a health technology reassessment (HTR) system to manage the life cycle of health technologies and develop operational measures promoting the efficient use of healthcare resources. The purpose of this study is to introduce the detailed implementation process and practical functional methods of the HTR implemented by NECA.The HTR is a structured multidisciplinary method for analyzing health technologies currently used in the healthcare system based on the latest information on parameters, such as clinical safety, effectiveness, and cost-effectiveness of optimizing the use of healthcare resources as well as social and ethical issues. All decision-making stages of the HTR are carefully reviewed and transparently managed. The HTR committee makes significant decisions, and the subcommittee decides the details related to the assessment process.Since the pilot began in 2018, 262 cases have been reassessed, of which, 126 cases (48.1 percent) were health services not covered by the National Health Insurance (NHI). Over the past 5 years, approximately 130 recommendations for the in-use technologies were determined by the HTR committee. In the near future, it will be necessary to officially develop and establish a Korean HTR system and a legal foundation to optimize the NHI system.
Technology Assessment, Biomedical , Cost-Benefit Analysis , Decision Making , National Health Programs/organization & administration , Republic of Korea , Technology Assessment, Biomedical/organization & administration
The scope of this article is an analysis of the proliferation of community medical clinics in the municipalities that comprise the Metropolitan Region of Belem. An investigation was conducted into the performance of the primary health care network of Brazil's Unified Health System, with a view to getting a better understanding of the reasons for, and origins of, the proactive stance of the community health sector. The discussion is based on the review of primary and secondary data, obtained via fieldwork in 119 community clinics in the Metropolitan Region of Belem, and information from Brazil's Unified Health System data center. It was revealed that the community health clinic sector has benefited extensively in recent years from the intensification of underfunding of Brazil's Unified Health System, especially the primary health care network, which is undergoing a process of fragmentation. This is directly responsible for the reduction and disruption of multiprofessional primary health care teams, in addition to the losses suffered in the supplementary health sector. The community clinics adopt an spontaneous and contradictory care model created by the private sector to meet the repressed demand of Brazil's Unified Health System.
O artigo apresenta uma análise sobre a difusão das clínicas médicas populares nos municípios que compõem a Região Metropolitana de Belém (RMB). Com o propósito de compreender as razões e as origens do avanço do setor de saúde popular, promoveu-se uma investigação sobre a atuação da rede de atenção básica à saúde (ABS) do Sistema Único de Saúde (SUS). A discussão se fundamenta na revisão de dados primários e secundários, captados via trabalho de campo nas 119 clínicas populares da RMB e via informações do DATASUS. Constatou-se que o setor das clínicas de saúde popular foi beneficiado amplamente nos últimos anos, mediante a intensificação do subfinanciamento do SUS, em particular da rede de ABS, que passa por um processo de fragmentação, responsáveis pela redução e pela desarticulação das equipes multiprofissionais de ABS, além das perdas apresentadas no setor de saúde suplementar. As clínicas populares seguem um modelo assistencial inacabado e contraditório, criado pela própria iniciativa privada para o preenchimento da demanda reprimida do SUS em razão de o acesso a essas instituições não garantir uma assistência universal e gratuita ou assegurar um tratamento continuo, motivo pelo qual uma ampla parcela destes usuários é devolvida ao SUS.
Delivery of Health Care , Primary Health Care , Brazil , Primary Health Care/organization & administration , Humans , Delivery of Health Care/organization & administration , National Health Programs/organization & administration , Community Health Services/organization & administration , Private Sector , Cities
BACKGROUND: The Federal Joint Committee has established requirements for centers for intensive care medicine which, in cooperation with other clinics, are to take on special tasks for intensive care medicine in a region. High demands are placed on these centers, which it may not be possible to meet without restructuring the existing intensive care structures. OBJECTIVE: In this study, an organizational model for a center for intensive care medicine based on broad interdisciplinary and interprofessional cooperation is presented for discussion. METHODS AND RESULTS: The organizational model contains proposals for integration of the centers for intensive care medicine into the clinic structure, the management team, the staff composition, the areas of clinical activity, and the further tasks of research, teaching, and education and training. CONCLUSION: Establishment of the centers for intensive care medicine provides new and forward-looking impetus for the further development of intensive care medicine in Germany. However, for the new organizational model to be implemented effectively, the necessary restructuring measures must be adequately refinanced and supported by hospital management and medical faculties. In addition, a sustained willingness for interdisciplinary and interprofessional cooperation is required on the part of all those involved, and employees in this model must be offered attractive long-term positions in intensive care medicine.
Critical Care , Interdisciplinary Communication , Models, Organizational , Germany , Humans , Critical Care/organization & administration , Patient Care Team/organization & administration , Interprofessional Relations , Curriculum , National Health Programs/organization & administration , Intersectoral Collaboration , Cooperative Behavior
Se realizó una evaluación quinquenal de los ejes sanitarios (que dan lugar a objetivos estratégicos con sus correspondientes metas e indicadores, áreas de intervención y líneas de acción) dentro del marco de la gestión sanitaria de uno de los 10 principales agentes de la seguridad social argentinos quien implementaba desde hacía 20 años un Programa Nacional de Atención Primaria de la Salud (PNAPS). El mismo promedió alrededor de 800 mil beneficiarios anuales dentro de una red asistencial nacional propia en el primer nivel de atención compuesta por 45 Centros de Atención Primaria (CAPs). Se implementó una investigación evaluativa que incluyó un trazado de línea de base con la valoración de cinco Ejes Sanitarios (ES). Se trata de un diseño de corte transversal de un periodo de 5 años. Se definieron metas, indicadores y recomendaciones para cada uno de los ES, recopilando información de fuentes diferentes y complementarias para su análisis. Los resultados mostraron una evolución favorable en el período evaluado, aunque el cumplimiento de las metas estuvo bastante alejado de lo propuesto de manera teórica. Conclusiones: este trabajo aporta información valiosa y original para subsidiar la toma de decisiones e incentivar la investigación en el ámbito de la APS, buscando reformular los actuales modelos de gestión y de atención de la salud (AU)
A five-year evaluation of the health axes (which give rise to strategic objectives with their corresponding goals and indicators, areas of intervention and lines of action) was carried out within the framework of health management of one of the 10 main argentine social security agents who had been implementing a National Primary Health Care Program (PNAPS) for 20 years. It averaged around 800,000 annual beneficiaries within its own national care network at the first level of care made up of 45 Primary Care Centers (CAPs). An evaluative investigation was implemented that included a baseline drawing with the assessment of five Sanitary Axis (ES). It is a cross-sectional design of a period of 5 years. Goals, indicators and recommendations were defined for each of the ES, collecting information from different and complementary sources for analysis. Results: they showed a favorable evolution in the period evaluated, although the fulfillment of the goals was quite far from what was theoretically proposed. The results of this work provides valuable and original information to support decision-making and encourage research in the field of PHC, seeking to reformulate current management and health care models (AU)
Humans , Primary Health Care/organization & administration , Primary Health Care/trends , Local Health Strategies , Quality Indicators, Health Care , Family Practice/statistics & numerical data , Health Services Research/statistics & numerical data , Local Health Systems , National Health Programs/organization & administration , National Health Programs/statistics & numerical data
BACKGROUND: Enrollment in and adherence to a diabetes pay-for-performance (P4P) program can lead to desirable processes and outcomes of diabetes care. However, knowledge is limited on the potential exclusion of patients with individual or neighborhood social risks or interruption of services in the disease-specific P4P program without mandatory participation under a single-payer health system. OBJECTIVE: To investigate the impact of individual and neighborhood social risks on exclusion from and adherence to the diabetes P4P program of patients with type 2 diabetes (T2D) in Taiwan. METHODS: This study used data from Taiwan's 2009-2017 population-based National Health Insurance Research Database, 2010 Population and Housing Census, and 2010 Income Tax Statistics. A retrospective cohort study was conducted, and study populations were identified from 2012 to 2014. The first cohort comprised 183,806 patients with newly diagnosed T2D, who had undergone follow up for 1 year; the second cohort consisted of 78,602 P4P patients who had undergone follow up for 2 years after P4P enrollment. Binary logistic regression models were used to examine the associations of social risks with exclusion from and adherence to the diabetes P4P program. RESULTS: T2D patients with higher individual social risks were more likely to be excluded from the P4P program, but those with higher neighborhood-level social risks were slightly less likely to be excluded. T2D patients with the higher individual- or neighborhood-level social risks showed less likelihood of adhering to the program, and the person-level coefficient was stronger in magnitude than the neighborhood-level one. CONCLUSIONS: Our results indicate the importance of individual social risk adjustment and special financial incentives in disease-specific P4P programs. Strategies for improving program adherence should consider individual and neighborhood social risks.
Diabetes Mellitus , National Health Programs , Reimbursement, Incentive , Single-Payer System , Single-Payer System/organization & administration , Diabetes Mellitus/therapy , Risk Factors , Humans , Male , Female , Young Adult , Adult , Middle Aged , Aged , Regression Analysis , Taiwan , National Health Programs/organization & administration , Retrospective Studies
BACKGROUND: Index-linked HIV testing for children, whereby HIV testing is offered to children of individuals living with HIV, has the potential to identify children living with undiagnosed HIV. The "Bridging the Gap in HIV Testing and Care for Children in Zimbabwe" (B-GAP) study implemented and evaluated the provision of index-linked HIV testing for children aged 2-18 years in Zimbabwe. We conducted a process evaluation to understand the considerations for programmatic delivery and scale-up of this strategy. METHODS: We used implementation documentation to explore experiences of the field teams and project manager who delivered the index-linked testing program, and to describe barriers and facilitators to index-linked testing from their perspectives. Qualitative data were drawn from weekly logs maintained by the field teams, monthly project meeting minutes, the project coordinator's incident reports and WhatsApp group chats between the study team and the coordinator. Data from each of the sources was analysed thematically and synthesised to inform the scale-up of this intervention. RESULTS: Five main themes were identified related to the implementation of the intervention: (1) there was reduced clinic attendance of potentially eligible indexes due to community-based differentiated HIV care delivery and collection of HIV treatment by proxy individuals; (2) some indexes reported that they did not live in the same household as their children, reflecting the high levels of community mobility; (3) there were also thought to be some instances of 'soft refusal'; (4) further, delivery of HIV testing was limited by difficulties faced by indexes in attending health facilities with their children for clinic-based testing, stigma around community-based testing, and the lack of familiarity of indexes with caregiver provided oral HIV testing; (5) and finally, test kit stockouts and inadequate staffing also constrained delivery of index-linked HIV testing. CONCLUSIONS: There was attrition along the index-linked HIV testing cascade of children. While challenges remain at all levels of implementation, programmatic adaptations of index-linked HIV testing approaches to suit patterns of clinic attendance and household structures may strengthen implementation of this strategy. Our findings highlight the need to tailor index-linked HIV testing to subpopulations and contexts to maximise its effectiveness.
HIV Infections , HIV Testing , Child , Humans , HIV Infections/diagnosis , HIV Testing/methods , HIV Testing/standards , Social Stigma , Zimbabwe , National Health Programs/organization & administration , National Health Programs/statistics & numerical data , Demography , Male , Female , Infant , Child, Preschool , Adolescent , Adult
Essential packages of health services (EPHS) are a critical tool for achieving universal health coverage, especially in low-income and lower middle-income countries. However, there is a lack of guidance and standards for monitoring and evaluation (M&E) of EPHS implementation. This paper is the final in a series of papers reviewing experiences using evidence from the Disease Control Priorities, third edition publications in EPHS reforms in seven countries. We assess current approaches to EPHS M&E, including case studies of M&E approaches in Ethiopia and Pakistan. We propose a step-by-step process for developing a national EPHS M&E framework. Such a framework would start with a theory of change that links to the specific health system reforms the EPHS is trying to accomplish, including explicit statements about the 'what' and 'for whom' of M&E efforts. Monitoring frameworks need to consider the additional demands that could be placed on weak and already overstretched data systems, and they must ensure that processes are put in place to act quickly on emergent implementation challenges. Evaluation frameworks could learn from the field of implementation science; for example, by adapting the Reach, Effectiveness, Adoption, Implementation and Maintenance framework to policy implementation. While each country will need to develop its own locally relevant M&E indicators, we encourage all countries to include a set of core indicators that are aligned with the Sustainable Development Goal 3 targets and indicators. Our paper concludes with a call to reprioritise M&E more generally and to use the EPHS process as an opportunity for strengthening national health information systems. We call for an international learning network on EPHS M&E to generate new evidence and exchange best practices.
Health Services , National Health Programs , Humans , Ethiopia , Health Policy , National Health Programs/organization & administration , Pakistan , Health Care Reform , Health Services Research
BACKGROUND: In Chile, an eventual implementation of a plan with universal health coverage is a challenge. The already implemented explicit health guarantees plan (GES) could be a benchmark. For this reason, it is important to obtain information about the results of its implementation. AIM: To identify the social determinants of health that influence the access to GES. MATERIAL AND METHODS: The National Socioeconomic Characterization Survey performed in 2017 was used as a data source. The beneficiaries of 20 diseases covered by GES and inquired in the survey were considered for the present study. RESULTS: People with the higher probability of access to GES plan belong to the lowest income quintiles, are nationals, live in the central-southern metropolitan Santiago, have lower education, have a public health insurance program (FONASA) and are aged mostly over 60 years. The diseases with the highest probability of access to the program are primary arterial hypertension, type 1 and type 2 diabetes mellitus, acute myocardial infarction, moderate and severe bronchial asthma, breast cancer, colon cancer, and bipolar disorder. CONCLUSIONS: The access probability to the GES program is in line with the epidemiological profile of the Chilean population, and with a greater social vulnerability.
Health Services Accessibility , National Health Programs , Social Determinants of Health , Aged , Chile , Humans , National Health Programs/organization & administration , Socioeconomic Factors , Universal Health Insurance/organization & administration
BACKGROUND: Most people with chronic Chagas disease do not receive specific care and therefore are undiagnosed and do not receive accurate treatment. This manuscript discusses and evaluates a collaborative strategy to improve access to healthcare for patients with Chagas in Bolivia, a country with the highest prevalence of Chagas in the world. METHODS: With the aim of reinforcing the Chagas National Programme, the Bolivian Chagas Platform was born in 2009. The first stage of the project was to implement a vertical pilot program in order to introduce and consolidate a consensual protocol-based healthcare, working in seven centers (Chagas Platform Centers). From 2015 on the model was extended to 52 primary healthcare centers, through decentralized, horizontal scaling-up. To evaluate the strategy, we have used the WHO ExpandNet program. RESULTS: The strategy has significantly increased the number of patients cared for, with 181,397 people at risk of having T. cruzi infection tested and 57,871 (31·9%) new diagnostics performed. In those with treatment criteria, 79·2% completed the treatment. The program has also trained a significant number of health personnel through the specific Chagas guidelines (67% of healthcare workers in the intervention area). CONCLUSIONS: After being recognized by the Chagas National Programme as a healthcare model aligned with national laws and priorities, the Bolivian platform of Chagas as an innovation, includes attributes that they have made it possible to expand the strategy at the national level and could also be adapted in other countries.
Chagas Disease/diagnosis , Chagas Disease/drug therapy , National Health Programs/organization & administration , Antiparasitic Agents/therapeutic use , Bolivia/epidemiology , Comprehensive Health Care/organization & administration , Health Personnel/education , Health Services Accessibility , Humans , Trypanosoma cruzi
BACKGROUND: National dementia guidelines provide recommendations about the most effective approaches to diagnosis and interventions. Guidelines can improve care, but some groups such as people with minority characteristics may be disadvantaged if recommended approaches are the same for everyone. It is not known if dementia guidelines address specific needs related to patient characteristics. The objectives of this review are to identify which countries have national guidelines for dementia and synthesise recommendations relating to protected characteristics, as defined in the UK Equality Act 2010: age, disability, gender identity, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex, and sexual orientation. METHODS AND FINDINGS: We searched CINAHL, PsycINFO, and Medline databases and the Guideline International Network library from inception to March 4, 2020, for dementia guidelines in any language. We also searched, between April and September 2020, Google and the national health websites of all 196 countries in English and in each country's official languages. To be included, guidelines had to provide recommendations about dementia, which were expected to be followed by healthcare workers and be approved at a national policy level. We rated quality according to the iCAHE guideline quality checklist. We provide a narrative synthesis of recommendations identified for each protected characteristic, prioritising those from higher-quality guidelines. Forty-six guidelines from 44 countries met our criteria, of which 18 were rated as higher quality. Most guidelines (39/46; 85%) made at least one reference to protected characteristics, and we identified recommendations relating to age, disability, race (or culture, ethnicity, or language), religion, sex, and sexual orientation. Age was the most frequently referenced characteristic (31/46; 67%) followed by race (or culture, ethnicity, or language; 25/46; 54%). Recommendations included specialist investigation and support for younger people affected by dementia and consideration of culture when assessing whether someone had dementia and providing person-centred care. Guidelines recommended considering religion when providing person-centred and end-of-life care. For disability, it was recommended that healthcare workers consider intellectual disability and sensory impairment when assessing for dementia. Most recommendations related to sex recommended not using sex hormones to treat cognitive impairment in men and women. One guideline made one recommendation related to sexual orientation. The main limitation of this study is that we only included national guidelines applicable to a whole country meaning guidelines from countries with differing healthcare systems within the country may have been excluded. CONCLUSIONS: National guidelines for dementia vary in their consideration of protected characteristics. We found that around a fifth of the world's countries have guidelines for dementia. We have identified areas of good practice that can be considered for future guidelines and suggest that all guidelines provide specific evidence-based recommendations for minority groups with examples of how to implement them. This will promote equity in the care of people affected by dementia and help to ensure that people with protected characteristics also have high-quality clinical services.
Dementia , Guidelines as Topic , National Health Programs , Prejudice/prevention & control , Social Discrimination/prevention & control , Humans , National Health Programs/organization & administration , National Health Programs/standards , United Kingdom
COVID-19/prevention & control , National Health Programs/organization & administration , Pandemics/prevention & control , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/mortality , COVID-19 Testing , Capacity Building , Global Health/statistics & numerical data , Healthcare Disparities/ethnology , Humans , International Cooperation , Surge Capacity , Time Factors , Trust
COVID-19/epidemiology , National Health Programs/organization & administration , Pandemics , SARS-CoV-2 , COVID-19/virology , Data Collection , Endemic Diseases/prevention & control , Endemic Diseases/statistics & numerical data , Health Workforce/organization & administration , Hospitalization/statistics & numerical data , Humans , Risk Assessment , Trust , United States/epidemiology
BACKGROUND: In Chile, an eventual implementation of a plan with universal health coverage is a challenge. The already implemented explicit health guarantees plan (GES) could be a benchmark. For this reason, it is important to obtain information about the results of its implementation. AIM: To identify the social determinants of health that influence the access to GES. MATERIAL AND METHODS: The National Socioeconomic Characterization Survey performed in 2017 was used as a data source. The beneficiaries of 20 diseases covered by GES and inquired in the survey were considered for the present study. RESULTS: People with the higher probability of access to GES plan belong to the lowest income quintiles, are nationals, live in the central-southern metropolitan Santiago, have lower education, have a public health insurance program (FONASA) and are aged mostly over 60 years. The diseases with the highest probability of access to the program are primary arterial hypertension, type 1 and type 2 diabetes mellitus, acute myocardial infarction, moderate and severe bronchial asthma, breast cancer, colon cancer, and bipolar disorder. CONCLUSIONS: The access probability to the GES program is in line with the epidemiological profile of the Chilean population, and with a greater social vulnerability.
Humans , Aged , Social Determinants of Health , Health Services Accessibility , National Health Programs/organization & administration , Socioeconomic Factors , Chile , Universal Health Insurance/organization & administration
COVID-19/diagnosis , Emergency Service, Hospital/statistics & numerical data , Patient Acceptance of Health Care/statistics & numerical data , COVID-19/epidemiology , COVID-19/transmission , Emergency Service, Hospital/organization & administration , Humans , National Health Programs/organization & administration , National Health Programs/statistics & numerical data , Retrospective Studies , Surge Capacity/standards , Surge Capacity/statistics & numerical data , Taiwan/epidemiology
Las pandemias siempre han perturbado los sistemas de atención de salud, incluida la prevención y el control de enfermedades endémicas. Esta alteración ha dado lugar a un aumento de la carga de enfermedad en los períodos posteriores a una pandemia. La crisis de salud y económica creada por la actual pandemia COVID-19, así como las medidas de salud pública para detener su propagación, pueden tener un impacto en la transmisión, diagnóstico, tratamiento, prevención y control de la tuberculosis (TBC). Los niños son un grupo vulnerable especialmente propenso a sufrir parte del daño. Es necesario recuperar cuanto antes las actividades de pesquisa, diagnóstico y tratamiento de la TBC de manera de disminuir el impacto que la pandemia por Covid19 tendrá en la morbimortalidad por TBC.
Pandemics have always disrupted health care systems, including the prevention and control of endemic diseases. This alteration has led to an increased burden of disease in the aftermath of a pandemic. The health and economic crisis created by the current COVID-19 pandemic, as well as public health measures to stop its spread, may have an impact on the transmission, diagnosis, treatment, prevention and control of tuberculosis. Children are a vulnerable group especially prone to suffering as part of the harm. It is necessary to recover as soon as possible the activities of investigation, diagnosis and treatment of tuberculosis in order to reduce the impact that the Covid19 pandemic will have on TB morbidity and mortality.
Humans , Child , Tuberculosis/prevention & control , Tuberculosis/epidemiology , COVID-19 , National Health Programs/organization & administration , Tuberculosis/diagnosis , Pandemics
COVID-19/epidemiology , Holistic Health , National Health Programs/organization & administration , Sustainable Development , COVID-19/economics , COVID-19/prevention & control , Communicable Disease Control/economics , Communicable Disease Control/organization & administration , Communicable Disease Control/statistics & numerical data , Humans , National Health Programs/economics , Pandemics/economics , Pandemics/prevention & control , Pandemics/statistics & numerical data , Population Health/statistics & numerical data , United Kingdom
China has made remarkable progress in reducing tuberculosis cases and deaths during the past three decades; however, it is still far from achieving the targets set out in the WHO End TB Strategy. Since the 2000s, China has tried to transform its vertical tuberculosis control programme led by the Chinese Center for Disease Control and Prevention (CDC) into an integrated system under the collaboration of CDC, tuberculosis-designated hospitals, and primary health centres. Such a transition has faced many challenges. Profit-driven practices in hospitals designated to tuberculosis and an absence of adequate tuberculosis-related training for health professionals are partially jeopardising the quality of tuberculosis care. In addition, primary health-care providers are not incentivised to make referrals and manage cases effectively. The CDC does not have the administrative power to influence hospital practices or deploy resources to support community-based tuberculosis control activities. Furthermore, an absence of policy coherence and effective coordination causes challenges for quality tuberculosis care that is affordable and accessible. Improving policy dialogues and multi-level coordination within the government is fundamental to successfully ending tuberculosis in China and other countries facing similar challenges.
Delivery of Health Care/organization & administration , Delivery of Health Care/standards , Health Policy , National Health Programs/organization & administration , National Health Programs/standards , Tuberculosis/prevention & control , China/epidemiology , Delivery of Health Care/economics , Forecasting , Goals , Humans , National Health Programs/economics
Countries across West Africa began reporting COVID-19 cases in February 2020. By March, the pandemic began disrupting activities to control and eliminate neglected tropical diseases (NTDs) as health ministries ramped up COVID-19-related policies and prevention measures. This was followed by interim guidance from the WHO in April 2020 to temporarily pause mass drug administration (MDA) and community-based surveys for NTDs. While the pandemic was quickly evolving worldwide, in most of West Africa, governments and health ministries took quick action to implement mitigation measures to slow the spread. The U.S. Agency for International Development's (USAID) Act to End NTDs | West program (Act | West) began liaising with national NTD programs in April 2020 to pave a path toward the eventual resumption of activities. This process consisted of first collecting and analyzing COVID-19 epidemiological data, policies, and standard operating procedures across the program's 11 countries. The program then developed an NTD activity restart matrix that compiled essential considerations to restart activities. By December 2020, all 11 countries in Act | West safely restarted MDA and certain surveys to monitor NTD prevalence or intervention impact. Preliminary results show satisfactory MDA program coverage, meaning that enough people are taking the medicine to keep countries on track toward achieving their NTD disease control and elimination goals, and community perceptions have remained positive. The purpose of this article is to share the lessons and best practices that have emerged from the adoption of strategies to limit the spread of the novel coronavirus during MDA and other program activities.
Anti-Infective Agents/therapeutic use , COVID-19/epidemiology , Mass Drug Administration , National Health Programs/organization & administration , Neglected Diseases/therapy , SARS-CoV-2 , Africa, Western , Anti-Infective Agents/administration & dosage , Humans , National Health Programs/standards , Practice Guidelines as Topic , Risk Factors , Time Factors , Tropical Climate , United States , United States Agency for International Development
