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4.
Lancet Glob Health ; 9(2): e181-e188, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33482139

RESUMO

BACKGROUND: The Global Fund to Fight AIDS, Tuberculosis and Malaria is a robust vertical global health programme. The extent to which vertical programmes financially support health security has not been investigated. We, therefore, endeavoured to quantify the extent to which the budgets of this vertical programme support health security. We believe this is a crucial area of work as the global community works to combine resources for COVID-19 response and future pandemic preparedness. METHODS: We examined budgets for work in Kenya, Uganda, Vietnam, Democratic Republic of the Congo, Guatemala, Guinea, India, Indonesia, Nigeria, and Sierra Leone from January, 2014 to December, 2020. These ten countries were selected because of the robustness of investments and the availability of data. Using the International Health Regulations Joint External Evaluation (JEE) tool as a framework, we mapped budget line items to health security capacities. Two researchers independently reviewed each budget and mapped items to the JEE. Budgets were then jointly reviewed until a consensus was reached regarding if an item supported health security directly, indirectly, or not at all. The budgets for the study countries were inputted into a single Microsoft Excel spreadsheet and line items that mapped to JEE indicators were scaled up to their respective JEE capacity. Descriptive analyses were then done to determine the total amount of money budgeted for activities that support health security, how much was budgeted for each JEE capacity, and how much of the support was direct or indirect. FINDINGS: The research team reviewed 37 budgets. Budgets totalled US$6 927 284 966, and $2 562 063 054 (37·0%) of this mapped to JEE capacities. $1 330 942 712 (19·2%) mapped directly to JEE capacities and $1 231 120 342 (17·8%) mapped indirectly to JEE capacities. Laboratory systems, antimicrobial resistance, and the deployment of medical countermeasures and personnel received the most overall budgetary support; laboratory systems, antimicrobial resistance, and workforce development received the greatest amount of direct budgetary support. INTERPRETATION: Over one-third of the Global Fund's work also supports health security and the organisation has budgeted more than $2 500 000 000 for activities that support health security in ten countries since 2014. Although these funds were not budgeted specifically for health security purposes, recognising how vertical programmes can synergistically support other global health efforts has important implications for policy related to health systems strengthening. FUNDING: Resolve to Save Lives: An Initiative of Vital Strategies.


Assuntos
Organização do Financiamento/economia , Saúde Global/economia , Cooperação Internacional , Orçamentos , /prevenção & controle , Países em Desenvolvimento , Programas Governamentais/economia , Humanos , Pandemias/prevenção & controle , Estados Unidos
10.
BMC Public Health ; 20(1): 436, 2020 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-32245377

RESUMO

BACKGROUND: Mental health and poverty are strongly interlinked. There is a gap in the literature on the effects of poverty alleviation programmes on mental health. We aim to fill this gap by studying the effect of an exogenous income shock generated by the Child Support Grant, South Africa's largest Unconditional Cash Transfer (UCT) programme, on mental health. METHODS: We use biennial data on 10,925 individuals from the National Income Dynamics Study between 2008 and 2014. We exploit the programme's eligibility criteria to estimate instrumental variable Fixed Effects models. RESULTS: We find that receiving the Child Support Grant improves adult mental health by 0.822 points (on a 0-30 scale), 4.1% of the sample mean. CONCLUSION: Our findings show that UCT programmes have strong mental health benefits for the poor adult population.


Assuntos
Organização do Financiamento/economia , Transtornos Mentais/economia , Saúde Mental/economia , Pobreza/psicologia , Assistência Pública/economia , Adulto , Criança , Feminino , Humanos , Masculino , Transtornos Mentais/epidemiologia , Pobreza/economia , África do Sul/epidemiologia
11.
PLoS One ; 15(4): e0227593, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32294089

RESUMO

Genomic editing technologies are developing rapidly, promising significant developments for biomedicine, agriculture and other fields. In the present investigation, we analyzed and compared the process of innovation for six genomic technologies: viral vectors, RNAi, TALENs, meganucleases, ZFNs and CRISPR/Cas including the profile of the main research institutions and their funders, to understand how innovation evolved and what institutions influenced research trajectories. A Web of Science search of papers on viral vectors RNAi, CRISPR/Cas, TALENs, ZFNs and meganucleases was used to build a citation network of 16,746 papers. An analysis of network clustering combined with text mining was performed. For viral vectors, a long-term process of incremental innovation was identified, which was largely publicly funded in the United States and the European Union. The trajectory of RNAi research included clusters related to the study of RNAi as a biological phenomenon and its use in functional genomics, biomedicine and pest control. A British philanthropic organization and a US pharmaceutical company played a key role in the development of basic RNAi research and clinical application respectively, in addition to government and academic institutions. In the case of CRISPR/Cas research, basic science discoveries led to the technical improvements, and these two in turn provided the information required for the development of biomedical, agricultural, livestock and industrial applications. The trajectory of CRISPR/Cas research exhibits a geopolitical division of the investigation efforts between the US, as the main producer and funder of basic research and technical improvements, and Chinese research institutions increasingly leading applied research. Our results reflect a change in the model for financing science, with reduced public financing for basic science and applied research on publicly funded technological developments in the US, and the emergence of China as a scientific superpower, with implications for the development of applications of genomic technologies.


Assuntos
Pesquisa Biomédica/tendências , Tecnologia Biomédica/tendências , Organização do Financiamento/tendências , Edição de Genes/tendências , Invenções/tendências , Pesquisa Biomédica/economia , Pesquisa Biomédica/métodos , Pesquisa Biomédica/organização & administração , Tecnologia Biomédica/economia , Tecnologia Biomédica/métodos , Tecnologia Biomédica/organização & administração , Sistemas CRISPR-Cas , China , Organização do Financiamento/economia , Organização do Financiamento/métodos , Edição de Genes/economia , Edição de Genes/métodos , Vetores Genéticos , Invenções/economia , Liderança , Política , Interferência de RNA , Estados Unidos , Vírus/genética
16.
Bull World Health Organ ; 98(1): 30-39, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31902960

RESUMO

Objective: To estimate the level and trend of development assistance for community health worker-related projects in low- and middle-income countries between 2007 and 2017. Methods: We extracted data from the Organisation for Economic Co-operation and Development's creditor reporting system on aid funding for projects to support community health workers (CHWs) in 114 countries over 2007-2017. We produced estimates for projects specifically described by relevant keywords and for projects which could include components on CHWs. We analysed the pattern of development assistance by purpose, donors, recipient regions and countries, and trends over time. Findings: Between 2007 and 2017, total development assistance targeting CHW projects was around United States dollars (US$) 5 298.02 million, accounting for 2.5% of the US$ 209 277.99 million total development assistance for health. The top three donors (Global Fund to Fight AIDS, Tuberculosis and Malaria, the government of Canada and the government of the United States of America) provided a total of US$ 4 350.08 million (82.1%) of development assistance for these projects. Sub-Saharan Africa received a total US$ 3 717.93 million, the largest per capita assistance over 11 years (US$ 0.39; total population: 9 426.25 million). Development assistance to projects that focused on infectious diseases and child and maternal health received most funds during the study period. Conclusion: The share of development assistance invested in the CHW projects was small, unstable and decreasing in recent years. More research is needed on tracking government investments in CHW-related projects and assessing the impact of investments on programme effectiveness.


Assuntos
Agentes Comunitários de Saúde/organização & administração , Países em Desenvolvimento/economia , Organização do Financiamento/organização & administração , Saúde Global , Cooperação Internacional , Agentes Comunitários de Saúde/economia , Agentes Comunitários de Saúde/normas , Organização do Financiamento/economia , Humanos
17.
Soc Sci Med ; 244: 112662, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31726268

RESUMO

Following three decades of international financial institutions implementing austerity measures in sub-Saharan Africa, many health systems remain chronically underfinanced. During this period, countries like Tanzania have moved from a post-independence vision of a strong social sector providing free care for citizens, to a model of increased privatization of public health facilities, shifting the burden of self-financing to individual health facilities and the constituents they serve. Drawing on longitudinal ethnographic research and document analysis undertaken between 2008 and 2017 within three publicly-funded hospitals in north-central Tanzania, this article examines the actions and perspectives of administrators to explore how novel shifts towards semi-privatization of public facilities are perceived as taken-for-granted solutions to funding shortfalls. Specifically, hospital administrators used "side hustle" strategies of projectification and market-based income generating activities to narrow the gap between inadequate state financing and necessary recurrent expenditures. Examples from publicly-funded hospitals in Tanzania demonstrate that employing side hustles to address funding conundrums derives from perverse incentives: while these strategies are supposed to generate revenues to sustain or bolster services to poor clients, in practice these market-based approaches erode the ability of publicly-funded hospitals to meet their obligations to the poorest. These cases show that neoliberal ideas promoting health financing through public-private initiatives offer little opportunity in practice for strengthening health systems in low income countries, undermining those health systems' ability to achieve the goal of universal health care.


Assuntos
Programas Governamentais/economia , Gastos em Saúde , Financiamento da Assistência à Saúde , Motivação , Setor Público/economia , Antropologia Cultural , Organização do Financiamento/economia , Equidade em Saúde , Instalações de Saúde/economia , Hospitais Públicos/economia , Humanos , Estudos de Casos Organizacionais , Política , Privatização/economia , Tanzânia
18.
Am J Ophthalmol ; 211: 132-141, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31730839

RESUMO

PURPOSE: To perform a comprehensive analysis of characteristics of ophthalmology trials registered in ClinicalTrials.gov. DESIGN: Cross-sectional study. METHODS: All 4,203 ophthalmologic clinical trials registered on ClinicalTrials.gov between October 1, 2007, and April 30, 2018, were identified by using medical subject headings (MeSH). Disease condition terms were verified by manual review. Trial characteristics were assessed through frequency calculations. Hazard ratios and 95% confidence intervals were determined for characteristics associated with early discontinuation. RESULTS: The majority of trials were multiarmed (73.6%), single-site (69.4%), randomized (64.8%), and had <100 enrollees (66.3%). A total of 33% used a data-monitoring committee (DMC), and 50.6% incorporated blinding. Other groups (51.6%) were funded by industry, whereas 2.6% were funded by the US National Institutes of Health (NIH). NIH trials were significantly more likely to address oncologic (NIH = 15.5%, Other = 3%, Industry = 1.5%; P < 0.001) or pediatric disease (NIH = 20.9%, Other = 5.9%, Industry = 1.4%; P < 0.001). Industry-sponsored trials (69.6% of phase 3 trials) were significantly more likely to be randomized (Industry = 68.7%, NIH = 58.9%, Other = 60.8%; P < 0.001) and blinded (Industry = 57.2%, NIH = 42.7%, Other = 43.5%; P < 0.001). A total of 359 trials (8.5%) were discontinued early, and 530 trials (12.6%) had unknown status. Trials were less likely to be discontinued if funded by sources other than industry (hazard ratio [HR], 0.72; 95% confidence interval [CI], 0.55-0.95; P = 0.021) and/or had a DMC (HR, 0.71; 95% CI, 0.55-0.92; P = 0.010). CONCLUSIONS: Ophthalmology trials in the past decade reveal heterogeneity across study funding sources. NIH trials were more likely to support historically underfunded subspecialties, whereas Industry trials were more likely to face early discontinuation. These trends emphasize the importance of carefully monitored and methodologically sound trials with deliberate funding allocation.


Assuntos
Ensaios Clínicos como Assunto/estatística & dados numéricos , Bases de Dados Factuais/estatística & dados numéricos , Oftalmologia/estatística & dados numéricos , Sistema de Registros/estatística & dados numéricos , Projetos de Pesquisa , Ensaios Clínicos como Assunto/economia , Estudos Transversais , Financiamento Governamental/economia , Organização do Financiamento/economia , Pesquisa sobre Serviços de Saúde , Humanos , National Institutes of Health (U.S.)/estatística & dados numéricos , National Library of Medicine (U.S.)/estatística & dados numéricos , Oftalmologia/economia , Apoio à Pesquisa como Assunto/economia , Estados Unidos
20.
Inform Health Soc Care ; 45(2): 130-150, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-30922142

RESUMO

Background: Ready access to reliable data is essential to support decision-making in patient care planning and delivery. Health information exchange (HIE), which is fundamental to achieve this, is currently limited in many low- and middle-income countries (LMICs), reflecting the lack of prioritization of this issue and the many barriers to its successful implementation.Objective: We sought to explore and understand stakeholders' perspectives on the context of and deployment strategies for HIE in Pakistan.Method: Data collection comprised interviews with purposefully selected groups of stakeholders across Pakistan, field notes, and a critical review of key national and international policy documents.Results: We identified reports of small pockets of effective HIE existing mainly in private hospitals, but in a patchy and fragmented form overall. Many problems were attributed to the absence of effective HIE, these ranging from 'delays in retrieving records' to contributing to 'the increase in antibiotic resistance'. The mindset of policymakers, poor infrastructure, lack of finance, training and data interoperability, and health-care providers' resistance to recording consultations due to poor documentation skills and concerns about liability considerations were highlighted as major barriers to HIE. Sharing regional health information with international organizations was perceived by some participants to increase the risk of regional espionage. A clear government policy directive for evidence-based decision-making, constant supply of electricity, training, widespread adoption of common data standards and public pressure to adopt mobile technology frameworks were identified as potential facilitators of HIE.Conclusion: HIE can be achieved with the support of the federal and provincial governments coupled with financial and technical backing from international donor organizations. The transition to HIE is likely to be very dependent on improving governance capabilities and bolstering the informatics skill-base in Pakistan and indeed many other LMICs.


Assuntos
Registros Eletrônicos de Saúde/organização & administração , Troca de Informação em Saúde/normas , Participação dos Interessados/psicologia , Atitude do Pessoal de Saúde , Países em Desenvolvimento , Registros Eletrônicos de Saúde/normas , Organização do Financiamento/economia , Humanos , Capacitação em Serviço , Entrevistas como Assunto , Paquistão , Pesquisa Qualitativa
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