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1.
Malawi Med J ; 31(3): 177-183, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31839886

RESUMO

Background: The global health community and funding agencies are currently engaged in ensuring that worthwhile research-based programmes are sustainable. Despite its importance, few studies have analysed the sustainability of global health interventions. In this paper, we aim to explore barriers and facilitators for the wider implementation and sustainability of a mobile health (mHealth) intervention (Supporting LIFE Community Case Management programme) in Malawi, Africa. Methods: Between January and March 2017, a qualitative approach was used to carry out and analyse 13 in-depth semi-structured interviews with key stakeholders across all levels of healthcare provision in Malawi to explore their perceptions with regards to the implementation and sustainability of the mHealth programme. Data were analysed thematically by two reviewers. Results: Overall, our analysis found that the programme was successful in achieving its goals. However, there are many challenges to the wider implementation and sustainability of this programme, including the absence of monetary resources, limited visibility outside the healthcare sector, the lack of integration with community-based and nationwide programmes, services and information and communication technologies, and the limited local capacity in relation to the maintenance, further development, and management. Conclusions: Future developments should be aligned with the strategic goals and interests of the Ministry of Health and engage with national and international stakeholders to develop shared goals and strategies for nationwide scale-up. These developments should also focus on building local capacity by educating trainers and ensuring that training methods and guidelines are appropriately accredited based on national policies. Our findings provide a framework for a variety of stakeholders who are engaged in sustaining mHealth programmes in resource-poor settings and can be used to develop an evidence-based policy for the utilization of technology for healthcare delivery across developing countries.


Assuntos
Administração de Caso/organização & administração , Assistência à Saúde/organização & administração , Avaliação de Programas e Projetos de Saúde , Telemedicina/organização & administração , Participação da Comunidade , Assistência à Saúde/métodos , Humanos , Entrevistas como Assunto , Malaui , Pesquisa Qualitativa
2.
Infect Dis Poverty ; 8(1): 99, 2019 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-31791412

RESUMO

BACKGROUND: The World Health Organization (WHO) End TB Strategy has established a milestone to reduce the number of tuberculosis (TB)- affected households facing catastrophic costs to zero by 2020. The role of active case finding (ACF) in reducing patient costs has not been determined globally. This study therefore aimed to compare costs incurred by TB patients diagnosed through ACF and passive case finding (PCF), and to determine the prevalence and intensity of patient-incurred catastrophic costs in Nepal. METHODS: The study was conducted in two districts of Nepal: Bardiya and Pyuthan (Province No. 5) between June and August 2018. One hundred patients were included in this study in a 1:1 ratio (PCF: ACF, 25 consecutive ACF and 25 consecutive PCF patients in each district). The WHO TB patient costing tool was applied to collect information from patients or a member of their family regarding indirect and direct medical and non-medical costs. Catastrophic costs were calculated based on the proportion of patients with total costs exceeding 20% of their annual household income. The intensity of catastrophic costs was calculated using the positive overshoot method. The chi-square and Wilcoxon-Mann-Whitney tests were used to compare proportions and costs. Meanwhile, the Mantel Haenszel test was performed to assess the association between catastrophic costs and type of diagnosis. RESULTS: Ninety-nine patients were interviewed (50 ACF and 49 PCF). Patients diagnosed through ACF incurred lower costs during the pre-treatment period (direct medical: USD 14 vs USD 32, P = 0.001; direct non-medical: USD 3 vs USD 10, P = 0.004; indirect, time loss: USD 4 vs USD 13, P <  0.001). The cost of the pre-treatment and intensive phases combined was also lower for direct medical (USD 15 vs USD 34, P = 0.002) and non-medical (USD 30 vs USD 54, P = 0.022) costs among ACF patients. The prevalence of catastrophic direct costs was lower for ACF patients for all thresholds. A lower intensity of catastrophic costs was also documented for ACF patients, although the difference was not statistically significant. CONCLUSIONS: ACF can reduce patient-incurred costs substantially, contributing to the End TB Strategy target. Other synergistic policies, such as social protection, will also need to be implemented to reduce catastrophic costs to zero among TB-affected households.


Assuntos
Busca de Comunicante/estatística & dados numéricos , Efeitos Psicossociais da Doença , Custos de Cuidados de Saúde , Tuberculose Pulmonar/economia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Busca de Comunicante/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nepal , Adulto Jovem
6.
Int J Equity Health ; 18(1): 193, 2019 12 10.
Artigo em Inglês | MEDLINE | ID: mdl-31823823

RESUMO

INTRODUCTION: Access to Liberia's health system is reliant on out-of-pocket (OOP) health expenditures which may prevent people from seeking care or result in catastrophic health expenditure (CHE). CHE and impoverishment due to OOP, which are used by the World Bank and World Health Organization as the sole measures of financial risk protection, are limited: they do not consider households who, following a health shock, do not incur expenditure because they cannot access the healthcare services they need (i.e., households forgoing healthcare (HFH) services). This paper attempts to overcome this limitation and improve financial risk protection by measuring HFH incidence and comparing it with CHE standard measures using household survey data from Liberia. METHODS: Data from the Liberia Household Income and Expenditure Survey 2014 were analysed. An OOP health expenditure is catastrophic when it exceeds a total or non-food household expenditure threshold. A CHE incidence curve, representing CHE incidence at different thresholds, was developed. To overcome CHE limitations, an HFH incidence measure was developed based on CHE, OOP and health shocks data: households incurring health shocks and having negligible OOP were considered to have forgone healthcare. HFH incidence was compared with standard CHE measures. RESULTS: CHE incidence and intensity levels depend on the threshold used. Using a 30% non-food expenditure threshold, CHE incidence is 2.1% (95% CI: 1.7-2.5%) and CHE intensity is 37.4% (95% CI: 22.7-52.0%). CHE incidence is approximately in line with other countries, while CHE intensity is higher than in other countries. CHE pushed 1.6% of households below the food poverty line in 2014. c approximately 4 times higher than CHE (8.0, 95% CI, 7.2-8.9%). CONCLUSION: Lack of financial risk protection is a significant problem in Liberia and it may be underestimated by CHE: this study confirms that HFH incidence can complement CHE measures in providing a complete picture of financial risk protection and demonstrates a simple method that includes measures of healthcare forgone as part of standard CHE analyses. This paper provides a new methodology to measure HFH incidence and highlights the need to consider healthcare forgone in analyses of financial risk protection, as well as the need for further development of these measures.


Assuntos
Doença Catastrófica/economia , Características da Família , Gastos em Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adulto , Pré-Escolar , Feminino , Alimentos/economia , Acesso aos Serviços de Saúde/economia , Humanos , Libéria , Masculino , Pessoa de Meia-Idade , Pobreza/estatística & dados numéricos , Inquéritos e Questionários
7.
Bull World Health Organ ; 97(12): 828-836, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31819291

RESUMO

Objective: To determine household and health-care provider costs associated with Plasmodium vivax infection across a range of endemic settings. Methods: We collected cost data alongside three multicentre clinical trials of P. vivax treatment in Afghanistan, Brazil, Colombia, Ethiopia, Indonesia, Philippines, Peru, Thailand and Viet Nam conducted between April 2014 to December 2017. We derived household costs from trial participant surveys administered at enrolment and again 2 weeks later to determine the costs of treatment and transportation, and the number of days that patients and their household caregivers were unable to undertake their usual activities. We determined costs of routine care by health-care providers by micro-costing the resources used to diagnose and treat P. vivax at the study sites. Findings: The mean total household costs ranged from 8.7 United States dollars (US$; standard deviation, SD: 4.3) in Afghanistan to US$ 254.7 (SD: 148.4) in Colombia. Across all countries, productivity losses were the largest household cost component, resulting in mean indirect costs ranging from US$ 5.3 (SD: 3.0) to US$ 220.8 (SD: 158.40). The range of health-care provider costs for routine care was US$ 3.6-6.6. The cost of administering a glucose-6-phosphate-dehydrogenase rapid diagnostic test, ranged from US$ 0.9 to 13.5, consistently lower than the costs of the widely-used fluorescent spot test (US$ 6.3 to 17.4). Conclusion: An episode of P. vivax malaria results in high costs to households. The costs of diagnosing and treating P. vivax are important inputs for future cost-effectiveness analyses to ensure optimal allocation of resources for malaria elimination.


Assuntos
Aminoquinolinas/uso terapêutico , Antimaláricos/uso terapêutico , Financiamento Pessoal/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Malária Vivax/tratamento farmacológico , Absenteísmo , Adolescente , Adulto , Idoso , Aminoquinolinas/economia , Antimaláricos/economia , Efeitos Psicossociais da Doença , Análise Custo-Benefício , Feminino , Saúde Global , Serviços de Saúde/economia , Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Econômicos , Transportes/economia , Adulto Jovem
8.
Environ Monit Assess ; 192(1): 35, 2019 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-31828438

RESUMO

It is more than 4 years since the 2030 agenda for sustainable development was adopted by the United Nations and its member states in September 2015. Several efforts are being made by member countries to contribute towards achieving the 17 Sustainable Development Goals (SDGs). The progress which had been made over time in achieving SDGs can be monitored by measuring a set of quantifiable indicators for each of the goals. It has been seen that geospatial information plays a significant role in measuring some of the targets, hence it is relevant in the implementation of SDGs and monitoring of their progress. Synoptic view and repetitive coverage of the Earth's features and phenomenon by different satellites is a powerful and propitious technological advancement. The paper reviews robustness of Earth Observation data for continuous planning, monitoring, and evaluation of SDGs. The scientific world has made commendable progress by providing geospatial data at various spatial, spectral, radiometric, and temporal resolutions enabling usage of the data for various applications. This paper also reviews the application of big data from earth observation and citizen science data to implement SDGs with a multi-disciplinary approach. It covers literature from various academic landscapes utilizing geospatial data for mapping, monitoring, and evaluating the earth's features and phenomena as it establishes the basis of its utilization for the achievement of the SDGs.


Assuntos
Monitoramento Ambiental/métodos , Desenvolvimento Sustentável , Objetivos , Nações Unidas
9.
Lancet Oncol ; 20(12): e672-e684, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31797794

RESUMO

Childhood cancers caused an estimated 75 000 deaths in children aged 0-14 years in 2018, of which 90% were in low-income and middle-income countries, and yet this group is missing from global health agendas. We examined global patterns in public and philanthropic funding for childhood cancer research-a proxy for global research activity-to address the critical gaps in knowledge. We used data from the Dimensions database to systematically search for and analyse 3414 grants from 115 funders across 35 countries between 2008 and 2016, organised by funding source, recipient, tumour type, research focus, and pipeline categories, to investigate trends over time. During this period, global funding for childhood cancer research was US$2 billion, of which $772 million (37·9%) was for general childhood cancer, $449 million (22·0%) was for leukaemias, and $330 million (16·2%) was for CNS tumours. $1·6 billion (77·7%) of funding was awarded from, and to, institutions based in the USA. Preclinical research received $1·2 billion (59·3%), and around $525 million (25·7%) included support for clinical trials, but only $113 million (5·5%) supported health-care delivery research. Overall, funding was inadequate and geographically inequitable, and new commitments to funding have declined since 2011.

11.
Artigo em Inglês | MEDLINE | ID: mdl-31847367

RESUMO

National and global health policies are increasingly recognizing the key role of the environment in human health development, which is related to its economic and social determinants, such as income level, technical progress, education, quality of jobs, inequality, education or lifestyle. Research has shown that the increase of GDP (Gross Domestic Product) per capita can provide additional funds for health but also for environmental protection. However, often, economic growth is associated with the accelerated degradation of the environment, and this in turn will result in an exponential increase in harmful emissions and will implicitly determine the increasing occurrence of non-communicable diseases (NCDs), mainly cardiovascular diseases, cancers and respiratory diseases. In this paper, we investigate the role and effects of economic growth, environmental pollution and non-communicable diseases on health expenditures, for the case of EU (European Union) countries during 2000-2014. In order to investigate the long-term and the short-term relationship between them, we have employed the Panel Autoregressive Distributed Lag (ARDL) method. Using the Pedroni-Johansen cointegration methods, we found that the variables are cointegrated. The findings of this study show that economic growth is one of the most important factors influencing the health expenditures both in the long- and short-run in all the 28 EU countries. With regards to the influence of CO2 emissions on health expenditure, we have found a negative impact in the short-run and a positive impact on the long-run. We have also introduced an interaction between NCDs and environmental expenditure as independent variable, a product variable. Finally, we have found that in all the three estimated models, the variation in environmental expenditure produces changes in NCDs' effect on health expenditure.


Assuntos
Desenvolvimento Econômico , Poluição Ambiental/efeitos adversos , Poluição Ambiental/economia , Gastos em Saúde/estatística & dados numéricos , Doenças não Transmissíveis/economia , Dióxido de Carbono/efeitos adversos , União Europeia , Saúde Global , Produto Interno Bruto , Política de Saúde , Humanos , Fatores Socioeconômicos
12.
Artigo em Inglês | MEDLINE | ID: mdl-31878112

RESUMO

The mortality-to-incidence ratio (MIR) is associated with the clinical outcomes of different types of cancer as well as the ranking of health care systems. However, the association between MIRs for testicular cancer and health care disparities, including differences in expenditures and health system rankings, has not yet been reported. We used the Spearman's rank correlation coefficient (CC) to analyze the correlation between testicular cancer MIRs and both total expenditures on health/gross domestic product (e/GDP) and the World Health Organization's (WHO) health system rankings. After screening the data for quality and missing information, 57 countries were chosen for analysis. Generally, developed countries and regions had relatively high rates of incidence/mortality, but with a favorable MIR. Among the continents, Europe had the highest incidence rates, whereas the highest MIRs were in Africa. Globally, favorable testicular cancer MIRs were observed in countries with both a high e/GDP and a good WHO ranking (R2 = 0.325, p < 0.001 and CC = -0.568, p < 0.001; R2 = 0.367, p < 0.001 and CC = 0.655, p < 0.001, respectively). In conclusion, the MIR for testicular cancer varies in countries and regions based on both their total health expenditure and their health care system ranking.


Assuntos
Gastos em Saúde , Disparidades em Assistência à Saúde , Neoplasias Testiculares/epidemiologia , Saúde Global , Produto Interno Bruto , Humanos , Incidência , Masculino , Organização Mundial da Saúde
13.
Int J Equity Health ; 18(1): 196, 2019 12 18.
Artigo em Inglês | MEDLINE | ID: mdl-31849334

RESUMO

BACKGROUND: Kenya is experiencing persistently high levels of inequity in health and access to care services. In 2018, decades of sustained policy efforts to promote equitable, affordable and quality health services have culminated in the launch of a universal health coverage scheme, initially piloted in four Kenyan counties and planned for national rollout by 2022. Our study aims to contribute to monitoring and evaluation efforts alongside policy implementation, by establishing a detailed, baseline assessment of socio-economic inequality and inequity in health care utilization in Kenya shortly before the policy launch. METHODS: We use concentration curves and corrected concentration indexes to measure socio-economic inequality in care use and the horizontal inequity index as a measure of inequity in care utilization for three types of care services: outpatient care, inpatient care and preventive and promotive care. Further insights into the individual and household level characteristics that determine observed inequality are derived through decomposition analysis. RESULTS: We find significant inequality and inequity in the use of all types of care services favouring richer population groups, with particularly pronounced levels for preventive and inpatient care services. These are driven primarily by differences in living standards and educational achievement, while the region of residence is a key driver for inequality in preventive care use only. Pro-rich inequalities are particularly pronounced for care provided in privately owned facilities, while public providers serve a much larger share of individuals from lower socio-economic groups. CONCLUSIONS: Through its focus on increasing affordability of care for all Kenyans, the newly launched universal health coverage scheme represents a crucial step towards reducing disparities in health care utilization. However in order to achieve equity in health and access to care such efforts must be paralleled by multi-sectoral approaches to address all key drivers of inequity: persistent poverty, disparities in living standards and educational achievement, as well as regional differences in availability and accessibility of care.


Assuntos
Disparidades em Assistência à Saúde/economia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Adulto , Criança , Pré-Escolar , Características da Família , Feminino , Pesquisas sobre Serviços de Saúde , Gastos em Saúde/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Quênia , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Cobertura Universal do Seguro de Saúde , Adulto Jovem
14.
Global Health ; 15(1): 87, 2019 12 18.
Artigo em Inglês | MEDLINE | ID: mdl-31856877

RESUMO

BACKGROUND: Cities are an important driving force to implement the Sustainable Development Goals (SDGs) and the New Urban Agenda. The SDGs provide an operational framework to consider urbanization globally, while providing local mechanisms for action and careful attention to closing the gaps in the distribution of health gains. While health and well-being are explicitly addressed in SDG 3, health is also present as a pre condition of SDG 11, that aims at inclusive, safe, resilient and sustainable cities. Health in All Policies (HiAP) is an approach to public policy across sectors that systematically takes into account the health implications of decisions, seeks synergies, and avoids harmful health impacts in order to improve population health and health equity. HiAP is key for local decision-making processes in the context of urban policies to promote public health interventions aimed at achieving SDG targets. HiAPs relies heavily on the use of scientific evidence and evaluation tools, such as health impact assessments (HIAs). HIAs may include city-level quantitative burden of disease, health economic assessments, and citizen and other stakeholders' involvement to inform the integration of health recommendations in urban policies. The Barcelona Institute for Global Health (ISGlobal)'s Urban Planning, Environment and Health Initiative provides an example of a successful model of translating scientific evidence into policy and practice with regards to sustainable and healthy urban development. The experiences collected through ISGlobal's participation implementing HIAs in several cities worldwide as a way to promote HiAP are the basis for this analysis. AIM: The aim of this article is threefold: to understand the links between social determinants of health, environmental exposures, behaviour, health outcomes and urban policies within the SDGs, following a HiAP rationale; to review and analyze the key elements of a HiAP approach as an accelerator of the SDGs in the context of urban and transport planning; and to describe lessons learnt from practical implementation of HIAs in cities across Europe, Africa and Latin-America. METHODS: We create a comprehensive, urban health related SDGs conceptual framework, by linking already described urban health dimensions to existing SDGs, targets and indicators. We discuss, taking into account the necessary conditions and steps to conduct HiAP, the main barriers and opportunities within the SDGs framework. We conclude by reviewing HIAs in a number of cities worldwide (based on the experiences collected by co-authors of this publication), including city-level quantitative burden of disease and health economic assessments, as practical tools to inform the integration of health recommendations in urban policies. RESULTS: A conceptual framework linking SDGs and urban and transportplanning, environmental exposures, behaviour and health outcomes, following a HiAP rationale, is designed. We found at least 38 SDG targets relevant to urban health, corresponding to 15 SDGs, while 4 important aspects contained in our proposed framework were not present in the SDGs (physical activity, noise, quality of life or social capital). Thus, a more comprehensive HiAP vision within the SDGs could be beneficial. Our analysis confirmed that the SDGs framework provides an opportunity to formulate and implement policies with a HiAP approach. Three important aspects are highlighted: 1) the importance of the intersectoral work and health equity as a cross-cutting issue in sustainable development endeavors; 2) policy coherence, health governance, and stakeholders' participation as key issues; and 3) the need for high quality data. HIAs are a practical tool to implement HiAP. Opportunities and barriers related to the political, legal and health governance context, the capacity to inform policies in other sectors, the involvement of different stakeholders, and the availability of quality data are discussed based on our experience. Quantitative assessments can provide powerful data such as: estimates of annual preventable morbidity and disability-adjusted life-years (DALYs) under compliance with international exposure recommendations for physical activity, exposure to air pollution, noise, heat, and access to green spaces; the associated economic impacts in health care costs per year; and the number of preventable premature deaths when improvements in urban and transport planning are implemented. This information has been used to support the design of policies that promote cycling, walking, public, zero and low-emitting modes of transport, and the provision of urban greening or healthy public open spaces in Barcelona (e.g. Urban Mobility, Green Infrastructure and Biodiversity Plans, or the Superblocks's model), the Bus Rapid Transit and Open Streets initiatives in several Latin American cities or targeted SDGs assessments in Morocco. CONCLUSIONS: By applying tools such as HIA, HiAP can be implemented to inform and improve transport and urban planning to achieve the 2030 SDG Agenda. Such a framework could be potentially used in cities worldwide, including those of less developed regions or countries. Data availability, taking into account equity issues, strenghtening the communication between experts, decision makers and citizens, and the involvement of all major stakeholders are crucial elements for the HiAP approach to translate knowledge into SDG implementation.


Assuntos
Política Pública , Desenvolvimento Sustentável , Saúde da População Urbana , Saúde Global , Equidade em Saúde , Avaliação do Impacto na Saúde , Humanos
15.
RECIIS (Online) ; 13(4): 923-934, out.-dez. 2019. ilus
Artigo em Português | LILACS | ID: biblio-1047679

RESUMO

Este artigo apresenta um trabalho que consistiu no levantamento quantitativo das publicações sobre a Agenda 2030 de Desenvolvimento Sustentável na América Latina, ou que foram escritas por autores afiliados às instituições da região, focando no tema saúde. Foram realizadas buscas em bancos de dados, para o período entre janeiro de 2009 e maio de 2017, e encontradas 127 publicações voltadas para o Objetivo de Desenvolvimento Sustentável 3 ­ Boa Saúde e Bem-Estar. A maior parcela dos resultados (92%) é constituída de artigos científicos que foram descritos segundo o ano e veículo de publicação, instituições de filiação dos autores e sua localização. Quase a metade das publicações (47%) foi feita sem a participação de organizações latino-americanas e em apenas 30% dos casos o primeiro autor pertence a uma organização latino-americana. Esse quadro se torna mais nítido quando se observa a concentração da produção latinoamericana em torno de organizações brasileiras: a produção científica sobre as resoluções da Agenda 2030 em relação à saúde ainda está ausente em grande parte do território latino-americano.


This article presents a work that consisted of a quantitative research about publications on Agenda 2030 on Sustainable Development in Latin America, or written by authors affiliated with institutions in the region, focusing on health. A search using databases on the subject for the period between January 2009 and May 2017 was made, and 127 publications focusing on Sustainable Development Goal 3 ­ Good Health and Well-Being. The majority (92%) of the publications were scientific articles and were described in relation to the year and vehicle of publication, authors' affiliation institutions and their location. Almost half of the publications (47%) were made without the participation of Latin American organizations and only 30% of cases have the first author who belongs to a Latin American organization. This picture becomes clearer when we see the concentration of Latin American production at Brazilian organizations: scientific production onAgenda 2030 regarding health is still absent in much of the Latin American territory.


Este artículo presenta un trabajo que ha consistido en el levantamiento cuantitativo de las publicaciones sobre la Agenda 2030 en América Latina o que fueron escritas por autores afiliados a instituciones de la región con el foco en salud. Se realizaron búsquedas en bancos de datos para el período entre 2009 y mayo de 2017. Se encontraron 127 publicaciones sobre el Objetivos de desarrollo sostenible 3 ­ Salud y Bienestar. Constituyen la mayoría (92%) artículos científicos que fueron descritos según el año y el vehículo de publicación, las instituciones de filiación de los autores y su ubicación. En casi la mitad de las publicaciones (47%) no hubo participación de organizaciones latinoamericanas y solamente en 30% de los casos el primer autor pertenece a una organización latinoamericana. Este cuadro es más nítido cuando observada la concentración de la producción latinoamericana en organizaciones brasileñas: La producción científica sobrela Agenda 2030 en el área de la salud todavía está ausente en gran parte de la América Latina.


Assuntos
Seguridade Social , Nível de Saúde , Comunicação Acadêmica , Desenvolvimento Sustentável , Bases de Dados Bibliográficas , Academias e Institutos , Atividades Científicas e Tecnológicas , Política de Saúde , América Latina
16.
Global Health ; 15(1): 64, 2019 12 18.
Artigo em Inglês | MEDLINE | ID: mdl-31847852

RESUMO

The WHO Eastern Mediterranean Region is endowed with deep intellectual tradition, interesting cultural diversity, and a strong societal fabric; components of a vibrant platform for promoting health and wellbeing. Health has a central place in the Sustainable Development Goals (SDGs) for at least three reasons: Firstly, health is shaped by factors outside of the health sector. Secondly, health can be singled out among several SDGs as it provides a clear lens for examining the progress of the entire development process. Thirdly, in addition to being an outcome, health is also a contributor to achieving sustainable development. Realizing this central role of health in SDGs and the significance of collaboration among diverse sectors, the WHO is taking action. In its most recent General Program of Work 2019-2023 (GPW 13), the WHO has set a target of promoting the health of one billion more people by addressing social and other determinants of health through multi-sectoral collaboration. The WHO Regional Office for the Eastern Mediterranean Region, through Vision 2023, aims at addressing these determinants by adopting an equity-driven, leaving no one behind approach. Advocating for Health in All Policies, multi-sectoral action, community engagement, and strategic partnerships are the cornerstone for this approach. The focus areas include addressing the social and economic determinants of health across the life course, especially maternal and child health, communicable diseases, non-communicable diseases, and injuries. The aspirations are noteworthy - however, recent work in progress in countries has also highlighted some areas for improvement. Joint work among different ministries and departments at country level is essential to achieve the agenda of sustainable development. For collaboration, not only the ministries and departments need to be engaged, but the partnerships with other stakeholders such as civil society and private sector are a necessity and not a choice to effectively pursue achievement of SDGs.


Assuntos
Equidade em Saúde/organização & administração , Desenvolvimento Sustentável , Organização Mundial da Saúde/organização & administração , Humanos , Região do Mediterrâneo
17.
BMC Health Serv Res ; 19(1): 966, 2019 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-31842861

RESUMO

BACKGROUND: Although public medical insurance covers over 95% of the population in China, disparities in health service use and out-of-pocket (OOP) health expenditure across income groups are still widely observed. This study aims to investigate the socio-economic disparities in perceived healthcare needs, informal care, formal care and payment for healthcare and explore their equity implication. METHODS: We assessed healthcare needs, service use and payment in 400 households in rural and urban areas in Jiangsu, China, and included only the adult sample (N = 925). One baseline survey and 10 follow-up surveys were conducted during the 7-month monitoring period, and the Affordability Ladder Program (ALP) framework was adopted for data analysis. Negative binomial/zero-inflated negative binomial and logit regression models were used to explore factors associated with perceived needs of care and with the use of self-treatment, outpatient and inpatient care respectively. Two-part model and logit regression modeling were conducted to explore factors associated with OOP health expenditure and with the likelihood of incurring catastrophic health expenditure (CHE). RESULTS: After adjusting for covariates, rural residence was significantly associated with more perceived healthcare needs, more self-treatment, higher probability of using outpatient and inpatient service, more OOP health expenditure and higher likelihood of incurring catastrophic expenditure (P < 0.05). Compared to the Urban Employee Basic Medical Insurance (UEBMI), enrollment in the New Rural Cooperative Medical Scheme (NRCMS) or in the Urban Resident Basic Medical Insurance (URBMI) was correlated with lower probability of ever using outpatient services, but with more outpatient visits when people were at risk of using outpatient service (P < 0.05). NRCMS/URBMI enrollment was also associated with higher likelihood of incurring CHE compared to UEBMI enrollment (OR = 2.02, P < 0.05); in stratified analysis of the rural and urban sample this effect was only significant for the rural population. CONCLUSIONS: The rural population in Jiangsu perceived more healthcare needs, had a higher probability of using both informal and formal healthcare services, and had more OOP health expenditure and a higher likelihood of incurring CHE. The inequity mainly exists in health care financing, and may be partially addressed through improving the benefit packages of NRCMS/URBMI.


Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde , Disparidades em Assistência à Saúde/estatística & dados numéricos , Programas Nacionais de Saúde/economia , Adulto , Idoso , Assistência Ambulatorial/economia , China , Feminino , Disparidades em Assistência à Saúde/economia , Humanos , Seguro Saúde/economia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , População Rural , População Urbana
19.
Health Syst Reform ; 5(4): 334-349, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31860402

RESUMO

"Global functions" of health cooperation refer to those activities that go beyond the boundaries of individual nations to address transnational issues. This paper begins by presenting a taxonomy of global functions and laying out the key value propositions of investing in such functions. Next, it examines the current funding flows to global functions and the estimated price tag, which is large. Given that existing financing mechanisms have not closed the gap, it then proposes a suite of options for directing additional funding to global functions and discusses the governance of this additional funding. These options are organized into resource mobilization mechanisms, pooling approaches, and strategic purchasing of global functions. Given its legitimacy, convening power, and role in setting global norms and standards, the World Health Organization (WHO) is uniquely placed among global health organizations to provide the overarching governance of global functions. Therefore, the paper includes an assessment of WHO's financial situation. Finally, the paper concludes with reflections on the future of aid for health and its role in supporting global functions. The concluding section also summarizes a set of key priorities in financing global functions for health.


Assuntos
Organização do Financiamento/métodos , Cooperação Internacional , Organização do Financiamento/normas , Saúde Global/economia , Saúde Global/normas , Prioridades em Saúde , Humanos
20.
Washington, D.C.; OPAS; 2019-12-31.
em Português | PAHO-IRIS | ID: phr-51837

RESUMO

[Prólogo]. A publicação “Agenda 2030 para abastecimento de água, esgotamento sanitário e higiene na América Latina e Caribe - Um olhar a partir dos direitos humanos” foi elaborada em coordenação com o centro colaborador FIOCRUZ, do Ministério da Saúde do Brasil, sob a supervisão geral da Equipe Técnica Regional de Água e Saneamento (ETRAS) da Unidade de Mudanças Climáticas e Determinantes Ambientais do Departamento de Doenças Transmissíveis e Determinantes Ambientais da Saúde da Organização Pan-Americana da Saúde (OPAS). Este documento foi inspirado pela necessidade de promover ações abrangentes na gestão de serviços de água e esgotamento sanitário com um enfoque dos direitos humanos no âmbito dos Objetivos de Desenvolvimento Sustentável (ODS); além disso, ratifica os resultados relatados em um estudo da OPAS (2016)1 sobre as profundas desigualdades entre áreas urbanas e rurais no acesso aos serviços de água e esgotamento sanitário, e a correlação com características como sexo, idade, renda, escolaridade, entre outros. O foco principal deste estudo é analisar as possibilidades de cumprimento das metas dos Objetivos de Desenvolvimento Sustentável 6.1 e 6.2 e dos direitos humanos à água e ao esgotamento sanitário nos países da América Latina e Caribe, incorporando a questão da desigualdade como eixo transversal, identificando os espaços onde está concentrada; portanto, este estudo também identifica onde esses direitos são mais violados e onde é necessário intervir. Neste exercício, uma avaliação institucional é incluída, do ponto de vista dos recursos humanos disponíveis, do nível de regulamentação e do financiamento necessário para o cumprimento dos mesmos, enfatizando desigualdades e outras características que determinam se há grupos populacionais excluídos ou invisíveis no desenho de políticas públicas específicas para o setor de água e esgotamento sanitário. Nesse sentido, o estudo apresenta evidências para que os Estados Membros levem em conta essa situação e garantam que “ninguém seja deixado para trás”, insistindo que o relatório dos indicadores dos ODS seja necessariamente discriminado por renda, sexo, idade, raça, etnia e localização geográfica, alinhando-se com os atributos que exigem o cumprimento dos direitos humanos à água e ao esgotamento sanitário.


Assuntos
Abastecimento de Água , Saneamento , Saneamento de Escolas , Indicadores de Desigualdade em Saúde , Desenvolvimento Sustentável , Higiene , Colômbia , Brasil , México , República Dominicana
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