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Country size bias in global health: cross-country comparison of malaria policy and foreign aid
Springer Science and Business Media LLC - - 2021
Tomas Jezek
AbstractBackground

Foreign aid has been shown to be favourably biased towards small countries. This study investigated whether country size bias also occurs in national malaria policy and development assistance from international agencies.

Methods

Data from publicly available sources were collected with countries as observational units. The exploratory data analysis was based on the conceptual framework with socio-economic, environmental and institutional parameters. The strength of relationships was estimated by the Pearson and polychoric correlation coefficients. The correlation matrix was explored by factor analysis.

Results

Malaria burden is strongly correlated with GDP per capita, total health expenditure per capita, HDI; moderately with latitude, weakly with elevation, urban population share, per capita funding from the Global Fund, PMI USAID, UK government and UNICEF. Small country status is strongly correlated with population size, land area, island status; moderately with development assistance received per capita, weakly with funding per capita from Global Fund, government NMP and PMI USAID. Policy score 1, a variable derived from our factor analysis and related to malaria endemicity, is significantly strongly correlated with the malaria burden, moderately with HDI, GDP per capita, total health expenditure per capita, PMI USAID funding; weakly with island status, urban population share, latitude, coastal population share, total government expenditure and trade openness, Global Fund funding, World Bank funding, UK government funding, and UNICEF funding per capita. Policy score 2, which captures variation not related to malaria endemicity, is significantly weakly related to the ICRG index, PMI USAID funding per capita and small country status.

Conclusions

The results suggest that malaria burden and economic development are bidirectionally related. Economic development can contribute to a reduction in the malaria burden. Country size does not negatively impact malaria burden, but it does account for greater development assistance per capita from selected international agencies. National malaria policy is associated with parameters related to public governance and is modified in small countries. Small country bias is present in the distribution of socio-economic resources and the allocation of foreign aid. Small countries are characterized by distinct environmental and socio-political properties.

The ‘experimental public’ in longitudinal health research: views of local leaders and service providers in rural South Africa
Springer Science and Business Media LLC - - 2017
Rhian Twine, Gillian Lewando Hundt, Kathleen Kahn
Probing popular and political discourse on antimicrobial resistance in China
Springer Science and Business Media LLC - Tập 4 - Trang 1-9 - 2019
An Yi Yu, Susan Rogers Van Katwyk, Steven J. Hoffman
Antimicrobial resistance (AMR) is an increasing threat to global public health that is largely exacerbated by the overuse and misuse of antimicrobial medicines. As the largest antimicrobials producer and user in the world, China has a critical role to play in combatting AMR. By examining Chinese news articles and policy statements, we aim to provide an authentic understanding of public discourse in China on AMR. A search was conducted using two of the most comprehensive digital libraries for Chinese news media documents. Chinese policy documents were retrieved from official Chinese government websites. Records from June 2016 to May 2017 were included. Grounded theory was used to analyze included records, and we followed an iterative thematic synthesis process to categorize the key themes of each document. Across 64 news articles, most articles delivered general knowledge about AMR and debunked AMR-related myths, explored the implications of AMR-relevant policies, and discussed the misuse of antimicrobials in the agricultural sector. All policy documents provided guidance for healthcare workers, encouraging them to better manage antimicrobial prescriptions and usage. While the Chinese media actively educates the public on strategies for AMR prevention, certain news articles risk misleading readers by downplaying the hazards of domestic AMR issues. Further, although several national policies are geared towards combatting AMR, the government faces difficult challenges in overcoming public misconceptions regarding antimicrobial use. Records from the regional level should also be examined to further explore China’s public discourse on AMR.
Assessment of the availability and rationality of unregistered fixed dose drug combinations in Nepal: a multicenter cross-sectional study
Springer Science and Business Media LLC - Tập 2 - Trang 1-13 - 2017
Arjun Poudel, Mohamed Izham Mohamed Ibrahim, Pranaya Mishra, Subish Palaian
The medications that are registered and available in a country are meant for the prevention and treatment of ailments and diseases. However, a lack of effective regulatory bodies and operative control mechanisms, especially in developing countries, promotes irrational and inappropriate use of medicines. This study aims to evaluate the availability and rationality of unregistered fixed-dose drug combinations (FDCs) in Nepal. A snowball sampling method with visits to 20 retail pharmacies in each of five major cities in Nepal was used to assess the availability of unregistered FDCs. To justify the rationality of the FDCs obtained from these five cities, the toolkit developed by Health Action International Asia-Pacific (HAI-AP) was used. Altogether, 41 unregistered FDCs were obtained from the five cities. Among the total 41 FDCs, a majority were anti-inflammatory/analgesic/antipyretics. A maximum of eight drugs and a minimum of two drugs per combination were present among the total 41 FDCs, with a majority in the form of tablets followed by suspensions. The cost ranges from a minimum of 3.7 Nepalese Rupees (NRs) (= USD 0.05) to a maximum of 240 NRs (= USD 3.15). None of the FDCs fulfilled all the fundamental requirements as stated in the toolkit; thus, they were categorized as ‘irrational’. Unregistered FDCs are available in the Nepalese pharmaceutical market. All the unregistered FDCs found in our study were ‘irrational’ as per the HAI-AP toolkit. Regulatory authorities should initiate strict monitoring and appropriate regulatory mechanisms to prohibit the use of unregistered and irrational FDCs.
Impact of federalization for health financing and workforce in Nepal
Springer Science and Business Media LLC - Tập 8 Số 1
Meifang Chen, Dhirendra Man Thapa, Recchioni Ma, D. E. Weissglass, Hao Li, Biraj Karmachaya
Abstract

The adoption of its 2015 constitution has converted Nepal to a federal government while simultaneously resulted in significant reforms of the health system in Nepal in terms of both structure and commitment. In this commentary, we review evidence ranging from health financing to health workforce development to show that the impact of federalization on Nepal’s health system and its efforts to achieve equitable and affordable universal health care have been mixed. On the one hand, careful efforts of the federal government to support subnational governments during the transition appears to have avoided serious disruption, subnational governments have successfully taken on the financial burden of the health system, and increase subnational control has allowed more flexible adaptation to changing needs than might have otherwise been possible. On the other hand, financing resource and ability disparities across subnational governments contributes to significant disparities in workforce development, and subnational authorities appear to have underestimated significant health issues (e.g. NCDs) in their budgets. We then provide three recommendations to improve the success of the Nepalese system: (1) to assess whether the services covered by health financing and insurance schemes like the National Health Insurance Program adequately address the needs of the rising burden of NCDs in Nepal, (2) to set clear minimum requirements on key metrics for subnational health systems, and (3) to extend grant programs to address resource disparities.

Down the brain drain: a rapid review exploring physician emigration from West Africa
Springer Science and Business Media LLC - Tập 8 - Trang 1-16 - 2023
Tega Ebeye, HaEun Lee
The emigration of physicians from low- and middle-income countries (LMICs) to high-income countries (HICs), colloquially referred to as the “brain drain”, has been a topic of discussion in global health spheres for years. With the call to decolonize global health in mind, and considering that West Africa, as a region, is a main source of physicians emigrating to HICs, this rapid review aims to synthesize the reasons for, and implications of, the brain drain, as well as recommendations to mitigate physician emigration from West African countries to HICs. A literature search was conducted on PubMed, EMBASE and The Cochrane Library. Main inclusion criteria were the inclusion of West African trained physicians' perspectives, the reasons and implications of physician emigration, and recommendations for management. Data on the study design, reasons for the brain drain, implications of brain drain, and proposed solutions to manage physician emigration were extracted using a structured template. The Hawker Tool was used as a risk of bias assessment tool to evaluate the included articles. A total of 17 articles were included in the final review. Reasons for physician emigration include poor working conditions and remuneration, limited career opportunities, low standards of living, and sociopolitical unrest. Implications of physician emigration include exacerbation of low physician to population ratios, and weakened healthcare systems. Recommendations include development of international policies that limit HICs’ recruitment from LMICs, avenues for HICs to compensate LMICs, collaborations investing in mutual medical education, and incorporation of virtual or short-term consultation services for physicians working in HICs to provide care for patients in LMICs. The medical brain drain is a global health equity issue requiring the collaboration of LMICs and HICs in implementing possible solutions. Future studies should examine policies and innovative methods to involve both HICs and LMICs to manage the brain drain.
Obstacles to advancing women’s health in Mozambique: a qualitative investigation into the perspectives of policy makers
Springer Science and Business Media LLC - Tập 4 - Trang 1-10 - 2019
Mary Qiu, Talata Sawadogo-Lewis, Katia Ngale, Réka Maulide Cane, Amilcar Magaço, Timothy Roberton
Despite substantial investment in women’s health over the past two decades, and enthusiastic government support for MDG 5 and SDG 3, health indicators for women in Mozambique remain among the lowest in the world. Maternal mortality stayed constant from 2003 to 2011, with an MMR of 408; the estimated HIV prevalence for women of 15–24 years is over twice that for men; and only 12.1% of women are estimated to be using modern contraception. This study explores the perspectives of policy makers in the Mozambican health system and affiliates on the challenges that are preventing Mozambique from achieving greater gains in women’s health. We conducted in-depth interviews with 39 senior- and mid-level policy makers in the Ministry of Health and affiliated institutions (32 women, 7 men). Participants were sampled using a combination of systematic random sampling and snowball sampling. Participants were asked about their experiences formulating and implementing health policies and programs, what is needed to improve women’s health in Mozambique, and the barriers and opportunities to achieving such improvement. Participants unanimously argued that women’s health is already sufficiently prioritized in national health policies and strategies in Mozambique; the problem, rather, is the implementation and execution of existing women’s health policies and programs. Participants raised challenges related to the policy making process itself, including an ever-changing, fragmented decision-making process, lack of long-term perspective, weak evaluation, and misalignment of programs across sectors. The disproportionate influence of donors was also mentioned, with lack of ownership, rapid transitions, and vertical programming limiting the scope for meaningful change. Finally, participants reported a disconnect between policy makers at the national level and realities on the ground, with poor dissemination of strategies, limited district resources, and poor consideration of local cultural contexts. To achieve meaningful gains in women’s health in Mozambique, more focus must be placed on resolving the bottleneck that is the implementation of existing policies. Barriers to implementation exist across multiple health systems components, therefore, solutions to address them must also reach across these multiple components. A holistic approach to strengthening the health system across multiple sectors and at multiple levels is needed.
Engaging the communities in Wuhan, China during the COVID-19 outbreak
Springer Science and Business Media LLC - Tập 5 - Trang 1-4 - 2020
Jie Zhu, Yi Cai
During the early stage of the COVID-19 outbreak in Wuhan, the lockdown of the densely-populated metropolis caused panic and disorderly behavior among its population. Community governance systems (CGSs) were mobilized to lead community engagement to address the challenges and issues brought about by the sudden quarantine measures, still unprecedented in any part of the world during that time. This commentary aims to describe and analyze the roles of the CGSs, its implementation of culturally-tailored strategies and the performance of new functions as called for by the outbreak. We will introduce the community governance structure which has two parallel administrative units of government including the branches of the Communist Party of China (CPC). The pandemic showed that the roles of the CGSs evolved and may continue to be improved in the future. It is important to engage the community and to have community-based approaches in addressing issues brought about by lockdowns. This community experience in Wuhan provides important lessons for the rest of the world.
Phân bố địa lý của bệnh tăng uric huyết ở Trung Quốc đại lục: một nghiên cứu tổng hợp hệ thống và phân tích meta Dịch bởi AI
Springer Science and Business Media LLC - Tập 5 Số 1 - 2020
Huang Jia-yun, Zheng Feei, Yutong Zhang, Zhongxiao Wan, Yeshan Li, Honglan Zhou, Anna Chu, Yeong Yeh Lee
Tóm tắt Nền tảng

Fructose đóng vai trò quan trọng trong quá trình chuyển hóa phức tạp của axit uric trong cơ thể con người. Tuy nhiên, nồng độ axit uric trong máu cao, được gọi là tăng uric huyết, là yếu tố nguy cơ chính cho sự phát triển của gout. Do đó, chúng tôi đã thực hiện một phân tích meta cập nhật về tỷ lệ và phân bố địa lý của tăng uric huyết trong dân số chung tại Trung Quốc đại lục bằng cách tìm kiếm tài liệu hệ thống.

 Phương pháp

Năm cơ sở dữ liệu điện tử đã được sử dụng để tìm kiếm các bài viết liên quan được xuất bản cho đến năm 2019. Tất cả các tính toán được thực hiện bằng phần mềm Comprehensive Meta-Analysis (CMA). Chúng tôi đã bao gồm 108 bài viết đủ tiêu chuẩn (172 nghiên cứu theo giới tính, 95 nghiên cứu theo vùng và 107 nghiên cứu theo loại hình nghiên cứu) với tổng kích thước mẫu là > 808,505 người tham gia.

 Kết quả

Tỷ lệ chung của tăng uric huyết trong dân số chung tại Trung Quốc đại lục là 17.4% (95% CI: 15.8–19.1%). Phân tích phân nhóm của chúng tôi chỉ ra rằng tỷ lệ chung theo vùng dao động từ 15.5 đến 24.6%. Những người sống ở vùng Đông Bắc và là nam giới có tỷ lệ mắc bệnh cao nhất (P < 0.001). Ngoài ra, một số tỉnh ở vùng Trung Nam, Đông và Đông Bắc báo cáo tỷ lệ cao (> 20%), đặc biệt là ở nam giới. Tỷ lệ mắc bệnh đã gia tăng kể từ năm 2005-2009 cho đến năm 2015-2019. Không có thiên lệch công bố nào được quan sát như được chỉ ra bởi biểu đồ phễu đối xứng và hệ số tương quan xếp hạng của Begg và Mazumdar (P = 0.392).

 Kết luận

Tỷ lệ tăng uric huyết đang gia tăng ở Trung Quốc, và các nghiên cứu trong tương lai nên điều tra mối liên hệ giữa tỷ lệ tăng uric huyết và các yếu tố nguy cơ của nó để giải quyết vấn đề, đặc biệt là trong các nhóm dễ tổn thương. Ngoài ra, nghiên cứu của chúng tôi là nghiên cứu toàn diện đầu tiên điều tra tỷ lệ chung của tăng uric huyết tại Trung Quốc đại lục, bao gồm sáu vùng khác nhau.

Household satisfaction and associated factors with community-based health insurance scheme in Ethiopia: systematic review and meta-analysis
Springer Science and Business Media LLC - Tập 8 - Trang 1-14 - 2023
Daniel Tarekegn Worede, Mengistie Kassahun Tariku, Melash Belachew Asresie, Belayneh Fentahun Shibesh
Community-based health insurance (CBHI) schemes are crucial for households to avoid financial hardship, improve healthcare quality, and engage in health policies. Household satisfaction is a key indicator for assessing healthcare quality and identifying service gaps. However, research on household satisfaction with CBHI in Ethiopia is limited. Therefore, this study aimed to evaluate household satisfaction and associated factors with CBHI schemes in Ethiopia. A comprehensive search of relevant literature was conducted using multiple databases, including PubMed, Google Scholar, Africa Journal Online, and Ethiopian Universities' institutional open-access online repositories. The search was carried out between January 25, 2023, and February 28, 2023. Twelve primary studies, including eight published and four unpublished, were identified and included in the analysis with a total sample size of 5311 participants. A protocol with the registration number CRD20531345698 is recorded on the Prospero database. Two authors, DT and MK, independently extracted the required data using a standardized form. The extracted data were then analyzed using STATA version 17 software. Heterogeneity was assessed using the Cochrane Q-test and I2 tests. Finally, a random-effect model was employed to calculate the overall household satisfaction with CBHI and to determine the associated factors. The meta-analysis showed that the overall household satisfaction with CBHI in Ethiopia was 62.26% (95% CI 53.25–71.21%). The study found regional variations in household satisfaction, with 63.40% in Oromia, 64.01% in Amhara, 49.58% in Addis Ababa, and 66.76% in SNNPs. The study identified several factors associated with household satisfaction and the CBHI scheme, including the availability of drugs (OR 2.13, 95% CI 1.47–2.78), friendly services (OR 3.85, 95% CI 1.60–6.10), affordability of premium (OR 2.80, 95% CI 1.97–3.63), and knowledge/awareness of CBHI (OR 2.52, 95% CI 1.73–3.33). The study provides valuable insights into household satisfaction with CBHI in Ethiopia, with a considerable proportion of enrolees being satisfied. The finding highlights regional variations in household satisfaction and underscores the need for tailored interventions and monitoring to enhance CBHI sustainability and effectiveness. The results suggest that healthcare providers and policymakers should prioritize the availability of drugs, friendly services, affordable premiums, and education to improve household satisfaction with CBHI schemes.
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