Evaluating Health Inequality in Five Caribbean Basin Countries Using EQ-5D-5L.

BACKGROUND: EQ-5D-5L is a standardized health outcomes instrument that can be added to national surveys to measure inequality in health outcomes. The aim of this study was to produce baseline values of health inequality using EQ-5D-5L for five countries in the Caribbean Basin region based on national surveys in 2012-2014. METHODS: The EQ-5D-5L questionnaire was included in adult population surveys of Barbados, Belize, Colombia, Jamaica and Trinidad and Tobago. EQ-5D-5L measures were calculated for demographic groups using stratifiers from the World Health Organization's PROGRESS-Plus framework, and generalized linear models were used to test for association between EQ-5D-5L and the PROGRESS-Plus variables. Ordered logit models were used to obtain odds ratios for the effect of the PROGRESS-Plus variables on reporting problems on the EQ-5D-5L dimensions. The Kakwani index was calculated for each country. RESULTS: Data were obtained for representative samples in each country, giving a combined total of 11,284 respondents. Different patterns of inequality were observed among the five countries. The biggest drivers of inequality were age and gender, and the biggest EQ-5D factors were self-care in Belize and pain/discomfort in the other four countries. CONCLUSION: This study demonstrated that the EQ-5D-5L instrument can easily be added to national surveys. Inequality measures from this study can be used as baseline values for comparisons with future similar surveys in these five countries to infer changes in health inequality as measured by EQ-5D outcomes. These can be used to track the performance of policy initiatives aimed at specific demographic groups.

Health-Related Quality of Life Population Norms for Belize Using EQ-5D-5L.

OBJECTIVES: There has been a growing interest in the use of EQ-5D health outcomes measures in Latin America and the Caribbean. Population norms data provide a benchmark against which clinicians, researchers, and policy makers can compare the health status of patient, treatment, or demographic groups. This study aimed to provide EQ-5D-5L population norms for Belize. METHODS: The EQ-5D-5L questionnaire was included in a national survey in Belize in 2014. The survey also captured key demographic variables. EQ-5D-5L health states, EQ-5D visual analog scale (EQ VAS) scores, and EQ-5D-5L index values (based on the Trinidad and Tobago value set) were obtained for key demographic groups in Belize. RESULTS: A representative sample of 2078 respondents completed the survey. The mean index value, EQ VAS score, and ceiling level for Belize were 0.947, 82.6, and 67.8%, respectively. Similar to other Caribbean countries, Belizeans self-reported relatively high EQ VAS scores and ceiling levels compared with non-Caribbean regions. Men reported generally higher health status than women, health status declined as age rises, and the dimensions with the highest burden were pain/discomfort and mobility. CONCLUSIONS: This study provides researchers and practitioners in Belize with tools to use EQ-5D-5L. Users can apply the EQ VAS scores and EQ-5D-5L states presented herein as reference values. Until an EQ-5D-5L value set is created for Belize, the Trinidad and Tobago index values can be applied to Belizean-reported EQ-5D-5L states, which can then be compared with the index values presented in this study.

EQ-5D self-reported health in Barbados and Jamaica with EQ-5D-5L population norms for the English-speaking Caribbean.

BACKGROUND: The EQ-5D instrument is increasingly used in clinical and resource allocation decision making in developed and developing countries. EQ-5D valuation and population norms studies have been undertaken for Trinidad and Tobago, however no population norms or value sets have been generated for the other Caribbean countries. The aims of this study were to provide population norms for Barbados and Jamaica, and to develop a set of population norms that could be used by the other English-speaking Caribbean countries. METHODS: The EQ-5D-5L self-reported health questionnaire was included in surveys of representative samples of adults in Barbados and adults in Jamaica in 2013. EQ-5D health states, mean EQ VAS scores and mean EQ-5D-5L index values (using the Trinidad and Tobago value set) were calculated for demographic groups in both countries based on 2347 respondents from Barbados and 1423 from Jamaica. A set of 'Caribbean' norms were developed by combining the Barbados and Jamaica data with norms recently published for Trinidad and Tobago. RESULTS: Data were obtained for 2347 and 1423 respondents in Barbados and Jamaica respectively. The mean index and EQ VAS values were 0.943 and 81.9 for Barbados, and 0.948 and 87.8 for Jamaica. The health states most commonly observed in the two countries were similar. Generally the demographic patterns of self-reported health were consistent with those found in other studies. Some differences between the countries were observed in the patterns of rates of reporting problems on the EQ-5D dimensions among age-gender groups specifically for anxiety/depression and pain/discomfort CONCLUSION: This study has produced a set of EQ-5D population norms that can be used as base-line values in clinical and clinico-economic analyses for Barbados and Jamaica and for the English-Speaking Caribbean region.

Status report on indicators. 20 goals for a decade in HRH

The Terms of Reference required, inter alia, updating the 20 Regional Goals for Human Resources for Health. These 20 Regional Goals are indicators developed by PAHO to measure a country's progress in meeting the development of its health related human resources, since the development of human resources is particularly critical for health care delivery. The methodology involved detailed discussions with a broad variety of stakeholders since the majority of the goals have a qualitative component. A comparative few of the goals do feature a quantitative component, such as goals 1, 2 and 3, which seek to ascertain the ratio of physicians and health personnel per population. These 20 goals were first measured in Belize in 2009. This updated 2012 measurement found some areas of improvement since 2009 but also noted that there were some areas where there was regression. More specifically, improvements were noted in the areas of human resources density ratio, public health & intercultural competencies of PHC workers, the HRH Unit and public health & management competencies of health services and program managers, while regression was noted in the areas of qualified nurses to physician ratio, urban rural disparity in the distribution of health personnel, and the proportion of precarious employment among health services providers. While indicators are often necessary to measure progress and to facilitate comparison across countries, some lessons learnt are that a wholesale adoption of indicators sans localized modification may often not provide a true picture of on the ground realities. With specific reference to Belize, given its population density as one of the lowest in the region, major health facilities such as regional hospitals are geographically distant and rural populations are generally served via a series of health centers, health posts and mobile clinics. Hence while it may be ideal that health professionals recruited from rural communities serve those communities, the reality is that by these professionals remaining in the rural health facilities, their professional growth and development remains stunted due to the limited opportunities at a rural facility. It is also worthy to mention that no study has been done in Belize to ascertain the impact of employment status on staff morale vis-à-vis service delivery. Belize relies on contractual employment to legally secure the services of certain highly qualified health specialists. Given the indicator as currently defined in the Handbook, this is regarded as "precarious employment." The reality however is substantially different, and seeking modifications in their contractual status may not be feasible and would not necessarily translate to enhanced productivity. Other developments external to Belize are likely to impact Belize's human resources in health. In the United States of America, the passage of the Patient Protection and Affordable Care Act ­ more popularized as "Obamacare" in 2010 - and the requirement of universal coverage starting in 2014 will result in a huge demand for primary health care physicians in that country. Enhanced remuneration and what may be regarded as better employment prospects may orient Belize's health professionals towards migration, given that a certain percentage of Belize's workforce in health are nonnationals. This will likely aggravate the human resources deficits in health across the country. In preparing for this looming challenge, Belize may wish to consider upgrading the skills set of its Community Health Workers and the nurses who are first point of contact with the health system. This will be cost effective since training for these categories of health professionals is offered locally and it costs substantially less to train a CHW and a nurse, as opposed to a doctor. Via this approach, more effective and efficient use will also be made of the country's comparatively scarce primary health care physician and contribute towards the Ministry of Health's goal of Equal Health for All.