2008 Aids Community Support & Art Outcomes S Afr Edwin Wouterswvdamme
This study analyzed data from 268 patients enrolled in South Africa's public sector antiretroviral treatment (ART) program to assess the impact of baseline health, patient characteristics, and community support on ART outcomes after 6 and 12 months. The results showed that delayed ART initiation reduced treatment response, while support from treatment buddies, community health workers, and support groups significantly improved outcomes. Community support had a greater positive influence on outcomes over time, suggesting it can help address human resource shortages in scaling up ART programs.
This document discusses the costs associated with increasing access to artemisinin combination therapy (ACT) for malaria treatment in Cambodia. It finds that in addition to the costs of ACT drugs, substantial investments are needed for appropriate delivery systems, including:
- The cost of blister packaging ACT drugs locally, which was higher than estimated due to low production rates.
- The annual costs per capita of $0.44-0.69 for malaria outreach teams and village malaria workers who improved access to diagnosis and treatment in remote communities.
- The total annual costs of $19.31 and $11.28 per patient treated for the outreach teams and village workers respectively, which included costs of rapid diagnostic tests and drugs
This editorial discusses two dimensions of epidemics - their bio-demographic burden and their psychological impact through fear. It notes that epidemics trigger social perceptions of panic, blame and need for authority response beyond just quantifiable disease impacts. Decision-making for epidemic control aims to balance both dimensions but is complicated by fear, uncertainty and time pressure, often resulting in overreaction. Managing public perception of risk and feeling of control is important for effective and efficient epidemic response.
2004 Tmih Out Of Pocket Expenditure In Cambodia 1194wvdamme
This document summarizes a study on out-of-pocket health expenditures and debt in poor households in Cambodia during a dengue epidemic. The study found that:
1) Households that exclusively used private providers paid an average of $103 out-of-pocket, while those that combined private and public providers paid $32, and those that only used public hospitals paid $8.
2) Households financed these costs through savings, selling consumables, selling assets, and borrowing money. After treatment, 63% of households were in debt, with those using private providers more likely to borrow or sell assets.
3) A follow-up found that most households with initial debts were unable to pay
2007 Bmc H Serv Chi&Che Deva 1472 6963 7 43wvdamme
This document summarizes a study on two Indian community health insurance (CHI) schemes and whether they protect households from catastrophic health expenditures. The two schemes studied were ACCORD, which provides insurance to indigenous people in Tamil Nadu, and SEWA, which insures self-employed women in Gujarat. Both schemes cover hospitalization costs up to a maximum limit. The study reviewed insurance claims from 2003-2004 to analyze out-of-pocket payments and catastrophic expenditures. The results showed that both schemes halved the number of households experiencing catastrophic expenditures compared to having no insurance. However, 4% of ACCORD households and 23% of SEWA households still experienced catastrophic expenditures, related to low incomes, low maximum limits
2008 Pov Ill Book Challenges In Identifying Poor Oddar Meanchey Cambodiawvdamme
This document summarizes a study that assessed household eligibility for a Health Equity Fund (HEF) in Oddar Meanchey, Cambodia four years after an initial pre-identification process. The study evaluated three tools to assess HEF eligibility: 1) a scoring tool used in the original pre-identification, 2) interviewer assessments, and 3) a socioeconomic status index. The results showed high targeting errors across all three tools, suggesting that the original HEF eligibility granted through pre-identification four years prior did not accurately reflect households' current poverty status. Regular updates of pre-identification combined with post-identification are recommended to minimize targeting errors in the future.
Las propagandas criativas son formas ingeniosas de comunicar ideas a través de medios no tradicionales como stickers, grafitis, intervenciones urbanas u otros medios alternativos que atraen la atención del público de manera original. Estas técnicas buscan generar conciencia sobre diversos temas de interés público de una forma atractiva y memorable más allá de los canales convencionales.
Fake antimalarial drugs pose a major threat to malaria control in Southeast Asia. A survey of antimalarial drugs purchased in pharmacies and shops across the region found that 53% of artesunate tablets labeled as such did not contain any artesunate. All counterfeit artesunate tablets were labeled as manufactured by Guilin Pharma and had packaging that was increasingly difficult to distinguish from genuine products. The prevalence of counterfeit artesunate increased 15% compared to a previous survey, with the exception of Myanmar which saw an 18% decrease. A small percentage (9%) of mefloquine samples also contained inadequate active ingredients, undermining treatment and confidence in antimalarials. The proliferation of
2008 Aids Community Support & Art Outcomes S Afr Edwin Wouterswvdamme
This study analyzed data from 268 patients enrolled in South Africa's public sector antiretroviral treatment (ART) program to assess the impact of baseline health, patient characteristics, and community support on ART outcomes after 6 and 12 months. The results showed that delayed ART initiation reduced treatment response, while support from treatment buddies, community health workers, and support groups significantly improved outcomes. Community support had a greater positive influence on outcomes over time, suggesting it can help address human resource shortages in scaling up ART programs.
This document discusses the costs associated with increasing access to artemisinin combination therapy (ACT) for malaria treatment in Cambodia. It finds that in addition to the costs of ACT drugs, substantial investments are needed for appropriate delivery systems, including:
- The cost of blister packaging ACT drugs locally, which was higher than estimated due to low production rates.
- The annual costs per capita of $0.44-0.69 for malaria outreach teams and village malaria workers who improved access to diagnosis and treatment in remote communities.
- The total annual costs of $19.31 and $11.28 per patient treated for the outreach teams and village workers respectively, which included costs of rapid diagnostic tests and drugs
This editorial discusses two dimensions of epidemics - their bio-demographic burden and their psychological impact through fear. It notes that epidemics trigger social perceptions of panic, blame and need for authority response beyond just quantifiable disease impacts. Decision-making for epidemic control aims to balance both dimensions but is complicated by fear, uncertainty and time pressure, often resulting in overreaction. Managing public perception of risk and feeling of control is important for effective and efficient epidemic response.
2004 Tmih Out Of Pocket Expenditure In Cambodia 1194wvdamme
This document summarizes a study on out-of-pocket health expenditures and debt in poor households in Cambodia during a dengue epidemic. The study found that:
1) Households that exclusively used private providers paid an average of $103 out-of-pocket, while those that combined private and public providers paid $32, and those that only used public hospitals paid $8.
2) Households financed these costs through savings, selling consumables, selling assets, and borrowing money. After treatment, 63% of households were in debt, with those using private providers more likely to borrow or sell assets.
3) A follow-up found that most households with initial debts were unable to pay
2007 Bmc H Serv Chi&Che Deva 1472 6963 7 43wvdamme
This document summarizes a study on two Indian community health insurance (CHI) schemes and whether they protect households from catastrophic health expenditures. The two schemes studied were ACCORD, which provides insurance to indigenous people in Tamil Nadu, and SEWA, which insures self-employed women in Gujarat. Both schemes cover hospitalization costs up to a maximum limit. The study reviewed insurance claims from 2003-2004 to analyze out-of-pocket payments and catastrophic expenditures. The results showed that both schemes halved the number of households experiencing catastrophic expenditures compared to having no insurance. However, 4% of ACCORD households and 23% of SEWA households still experienced catastrophic expenditures, related to low incomes, low maximum limits
2008 Pov Ill Book Challenges In Identifying Poor Oddar Meanchey Cambodiawvdamme
This document summarizes a study that assessed household eligibility for a Health Equity Fund (HEF) in Oddar Meanchey, Cambodia four years after an initial pre-identification process. The study evaluated three tools to assess HEF eligibility: 1) a scoring tool used in the original pre-identification, 2) interviewer assessments, and 3) a socioeconomic status index. The results showed high targeting errors across all three tools, suggesting that the original HEF eligibility granted through pre-identification four years prior did not accurately reflect households' current poverty status. Regular updates of pre-identification combined with post-identification are recommended to minimize targeting errors in the future.
Las propagandas criativas son formas ingeniosas de comunicar ideas a través de medios no tradicionales como stickers, grafitis, intervenciones urbanas u otros medios alternativos que atraen la atención del público de manera original. Estas técnicas buscan generar conciencia sobre diversos temas de interés público de una forma atractiva y memorable más allá de los canales convencionales.
Fake antimalarial drugs pose a major threat to malaria control in Southeast Asia. A survey of antimalarial drugs purchased in pharmacies and shops across the region found that 53% of artesunate tablets labeled as such did not contain any artesunate. All counterfeit artesunate tablets were labeled as manufactured by Guilin Pharma and had packaging that was increasingly difficult to distinguish from genuine products. The prevalence of counterfeit artesunate increased 15% compared to a previous survey, with the exception of Myanmar which saw an 18% decrease. A small percentage (9%) of mefloquine samples also contained inadequate active ingredients, undermining treatment and confidence in antimalarials. The proliferation of
2004 Tmih Disease Control & Health Services In Guinea 1189wvdamme
The document analyzes the cost-effectiveness of epidemic control measures implemented in Guinea during cholera, measles, and meningococcal meningitis outbreaks from 1993-1995. Routine health services alone reduced potential deaths by an estimated 51% on average. Additional interventions further decreased potential deaths by an estimated 28% on average. The marginal cost per death averted was $29 for routine health services and $93 for additional interventions. The analysis found that strengthening health services to control epidemics, as was done in Guinea, was highly cost-effective.
2008 Ssm Art&Fhs Scale Up In S Afr Wvd Kk Gk Ssm6213wvdamme
This document discusses the challenges of scaling up antiretroviral treatment (ART) in Southern African countries with human resource shortages. It notes that the continuously growing caseload of people needing lifelong ART, shortages and uneven distribution of health workers, and the labor-intensive nature of current ART delivery models pose significant challenges. The document analyzes different scenarios for how health systems may adapt, including maintaining the status quo, strengthening the overall health system through task shifting and community-based care, or more technocratic reengineering of services. Achieving universal access to ART will require innovative approaches to address human resource constraints.
2006 Aids Real Challenges Art In S Sa Wvd+Kk+Mlwvdamme
This document summarizes the challenges of scaling up antiretroviral therapy (ART) in sub-Saharan Africa. It notes that while the WHO "3 by 5" initiative has made progress expanding ART access, the long-term outlook requires treating millions of people indefinitely. This growing caseload will overwhelm health systems unless new ART delivery models are developed. It also stresses that prevention efforts must be strengthened in parallel to reduce new HIV infections and make treatment sustainable over the long run. New strategies are needed to address both the escalating treatment needs and enhance prevention across communities and healthcare.
This document summarizes the experience of a Health Equity Fund (HEF) managed by a local NGO in Sotnikum, Cambodia. The HEF aimed to improve access to healthcare for the poor by identifying poor patients and paying their user fees. Over its first 25 months, the HEF supported 16% of hospitalized patients. The authors conducted interviews and found that while the HEF effectively improved financial access, poor patients still faced other barriers like geographical, informational, and intra-household constraints. The study concluded that the HEF model showed promising results with minimal benefits leaking to non-poor individuals, but that further research is needed in different contexts.
The New Deal is an approach used in Cambodia to improve the public health system. It involves providing performance-based bonuses to health staff from resources freed up by donors and user fees. The New Deal has been implemented in Sotnikum district, Thmar Pouk district, and several provincial hospitals with positive results after 2 years in Sotnikum and 1 year in Thmar Pouk. Activities have increased as staff are more motivated. New institutional arrangements like management committees and Health Equity Funds to help the poor access care have also yielded good results. The document analyzes the implementation and lessons learned from the New Deal experiments to help guide further health sector reforms in Cambodia.
2007 Hrh Doctors & Art In Cambodia 1478 4491 5 12wvdamme
1) The study examines the use of doctor time for antiretroviral treatment (ART) delivery in Siem Reap, Cambodia between 2004 and 2005.
2) It finds that the doctor time needed per patient was reduced by 14-33% from 2004 to 2005 due to fewer patient visits and shorter consultations.
3) Extrapolating to 2013, the clinic will need between 2 to 5 full-time doctors to provide ART based on assumptions about patient survival and further reductions in doctor time per patient.
2007 Hpp Panorama 4 He Fs In Cambodia Mathieu Czm015wvdamme
The document provides a comparative analysis of four health equity funds in Cambodia that aim to improve access to hospital care for poor patients. The key findings are:
1) The health equity fund model appears superior to traditional waiver systems in improving health service utilization among targeted poor groups.
2) Design aspects essential to the model's performance include the existence of donor funding, the presence of a driving agent, a clear separation of roles, appropriate identification techniques, and consideration of multiple barriers to health service utilization.
3) The comparative framework may be a useful tool for designing, operating, or evaluating similar strategies in other contexts, though early adoption of common documentation would facilitate generating evidence about comparative performance.
2006 Hrh Nurses In Swaziland 1478 4491 4 13wvdamme
population ratio is estimated at around 30 per
100 000.
Nurses
The total number of registered nurses in Swaziland was
estimated at 2317 in 2004. Of the 1484 established posts
for nurses in the public and mission sectors, only 1108
were filled (Table 1). This means that 19% of nursing posts
were vacant. The majority of nurses are employed in the
public sector, with only around 300 nurses working in the
mission sector. Based on the information available, we
estimate that
land in 2004. Of these, only around 80 were actually
employed in the public sector, giving a doctor:population
ratio of around 7 per 100 000. The remaining 102 doctors
This document outlines the principles and steps of statistical analysis, including data, variables, estimation, statistics, and time series versus cross-section data. It discusses key statistical concepts like the mean, standard deviation, variance, range, mode, and graphs. It also covers hypothesis testing using z-tests, t-tests, F-tests, and chi-square tests and how this relates to rejecting or failing to reject the null hypothesis. Finally, it discusses how cross-section data analysis can provide a concise summary of relationships between variables in a survey dataset.
2008 Shsop Fin Obstetric Care Vouchers In Cambodia Por &Cwvdamme
1) Voucher and Health Equity Fund (HEF) schemes in Cambodia aimed to improve access to safe delivery for poor pregnant women by increasing facility deliveries at public health centers and hospitals.
2) The programs increased the number of deliveries at public facilities, with voucher and HEF beneficiaries accounting for about one-third of total facility deliveries.
3) However, the impact on improving access remained limited due to various financial and non-financial barriers. To be fully effective, vouchers and HEFs need to be complemented by supply-side interventions that also address issues like staff incentives and transportation barriers.
2008 Pov Ill Book Comparative Anal Social Assistance Cambodia Belgium Itmwvdamme
This document summarizes and compares public social assistance systems in Belgium and Health Equity Funds in Cambodia. It describes Belgium's long-standing, multi-purpose social assistance system operated through public centers. It then discusses Cambodia's Health Equity Funds, which aim to pay healthcare costs for the poorest. Finally, it considers potential lessons from Belgium's experience for designing social assistance programs in low- and middle-income countries, such as the importance of addressing political as well as technical dimensions and considering expanding services beyond only the destitute.
2008 Mal J Access To Act In Cambodia Yeung 1475 2875 7 96wvdamme
This document summarizes a study on access to artemisinin combination therapy (ACT) for malaria treatment in remote areas of Cambodia. It finds that without specific interventions, only a small percentage of people received biological diagnosis or ACT treatment. However, both village malaria worker (VMW) schemes and malaria outreach teams (MOTs) significantly increased access to trained providers and ACT treatment. The study highlights the challenge of ensuring effective malaria treatment in remote communities with limited formal healthcare access, but finds that community-based approaches like VMWs can help address this challenge.
This document discusses the debate around "vertical" versus "horizontal" financing of health services in developing countries. It argues that a "diagonal" approach, which aims to achieve disease-specific results through strengthening health systems, offers a better solution. The Global Fund and new International Health Partnership initiatives may help broaden the scope of Global Fund financing in this diagonal direction. However, this evolution faces challenges due to limited Global Fund resources and potential constraints from the IMF on countries' ability to expand health spending even with increased foreign aid. The authors argue for a gradual transformation of the Global Fund into a more diagonal and horizontal fund, while maintaining features like civil society participation that help ensure aid additionality.
2007 P Lo S Medicine 04 04 13 Ooms Medicines Without Doctorswvdamme
The document discusses the Global Fund's intention to focus more on fighting AIDS, tuberculosis, and malaria, and leave strengthening of health systems and support for health workers to other organizations. This could create a "Medicines without Doctors" situation. The authors argue that supporting health worker salaries is crucial for expanding treatment, as shown in Mozambique and Malawi which face major health workforce gaps. The Global Fund's novel approach of sustained international funding for treatment programs is what these countries need to strengthen their workforces long-term. However, some actors want to limit the Global Fund's role in health systems strengthening.
2007 Tmih Artekin Trial Malaria In Cambodiawvdamme
- The study aimed to compare the efficacy and tolerability of dihydroartemisinin–piperaquine (DHA–PQP) to a 3-day regimen of mefloquine and artesunate (MAS3) for the treatment of uncomplicated falciparum malaria in Cambodia.
- 464 patients were randomly assigned to receive either DHA–PQP or MAS3. The PCR-adjusted cure rates on day 63 were 97.5% for both treatments, demonstrating non-inferiority.
- There were no serious adverse events reported. However, significantly more episodes of vomiting, dizziness, palpitations, and sleep disorders were reported in the MAS3
This document describes chronic disease clinics in Cambodia that integrated care for HIV/AIDS, diabetes, and hypertension. Over three years, the clinics demonstrated the feasibility of this integrated care approach. Good outcomes were achieved through complementary adherence support strategies. Services were well-accepted by patients, which helped reduce stigma around HIV/AIDS. The experience showed how HIV/AIDS care can help address other common chronic diseases.
2007 Hrh Internat Health Volunteers Laleman Wvd & Co 1478 4491 5 19wvdamme
This document summarizes a study on the contribution of international health volunteers to the health workforce in sub-Saharan Africa. The study estimated that in 2005, volunteer organizations employed around 2,072 full-time international health volunteers in sub-Saharan Africa, with around 1,500 being doctors. The study also explored perceptions of these volunteers from the organizations that send them and from health managers in sub-Saharan Africa, finding more negative than positive views among the latter group.
This document summarizes the challenges of scaling up antiretroviral (ARV) therapy in low-income countries with a high burden of HIV/AIDS. It notes that while funding has increased, the rate of scaling up treatment has been slower than hoped. Key challenges are the need to transition health systems from acute to chronic care and insufficient human resources. Countries with the highest ratios of people living with HIV/AIDS to doctors and nurses will likely need to develop new delivery models that rely less on clinical staff. Existing models are also likely insufficient and new approaches adapted to local contexts will be needed to achieve the massive scale up required.
2006 Lancet Viewpoint Poverty And User Fees Uganda&Cambodiawvdamme
The document compares Uganda's abolition of user fees for public health care to Cambodia's establishment of health equity funds, noting that both increased access to care for the poor but through different approaches. Uganda took a universal approach by removing all user fees, while Cambodia targeted the poor through a system that reimburses costs and administers means testing. Key considerations for policymakers regarding targeting, benefits packages, quality of care incentives, and necessary funding levels are discussed.
2006 Expert Patients For Art Lit Review Kk&Wvdwvdamme
The document reviews expert patient programs for chronic disease management in high-income countries and explores their relevance for HIV/AIDS care in low-income countries with severe shortages of health care workers. It finds that current models of antiretroviral treatment delivery are too intensive in their use of skilled staff to scale up in most sub-Saharan African countries. However, chronic disease self-management programs that train lay people living with the conditions to support others have improved health outcomes and reduced healthcare use. Similarly, people living with HIV/AIDS currently play roles in HIV prevention, home-based care, treatment adherence and literacy that could be expanded under an expert patient model to help address the human resource constraints facing HIV treatment scale-up
The document discusses concerns about an overreaction to the potential threat of an influenza pandemic. While a catastrophic global pandemic is possible, the actual risk is relatively low compared to more common health threats. There is a tendency for the media and some experts to exaggerate rare health risks, distorting public perception and fueling unnecessary panic. Stockpiling of antiviral drugs is not necessarily the best response, as the effectiveness of such drugs is limited and their high cost could be better spent on more widespread health needs. An objective assessment of risk is needed to avoid an "iatrogenic pandemic of panic."
2004 Tmih Disease Control & Health Services In Guinea 1189wvdamme
The document analyzes the cost-effectiveness of epidemic control measures implemented in Guinea during cholera, measles, and meningococcal meningitis outbreaks from 1993-1995. Routine health services alone reduced potential deaths by an estimated 51% on average. Additional interventions further decreased potential deaths by an estimated 28% on average. The marginal cost per death averted was $29 for routine health services and $93 for additional interventions. The analysis found that strengthening health services to control epidemics, as was done in Guinea, was highly cost-effective.
2008 Ssm Art&Fhs Scale Up In S Afr Wvd Kk Gk Ssm6213wvdamme
This document discusses the challenges of scaling up antiretroviral treatment (ART) in Southern African countries with human resource shortages. It notes that the continuously growing caseload of people needing lifelong ART, shortages and uneven distribution of health workers, and the labor-intensive nature of current ART delivery models pose significant challenges. The document analyzes different scenarios for how health systems may adapt, including maintaining the status quo, strengthening the overall health system through task shifting and community-based care, or more technocratic reengineering of services. Achieving universal access to ART will require innovative approaches to address human resource constraints.
2006 Aids Real Challenges Art In S Sa Wvd+Kk+Mlwvdamme
This document summarizes the challenges of scaling up antiretroviral therapy (ART) in sub-Saharan Africa. It notes that while the WHO "3 by 5" initiative has made progress expanding ART access, the long-term outlook requires treating millions of people indefinitely. This growing caseload will overwhelm health systems unless new ART delivery models are developed. It also stresses that prevention efforts must be strengthened in parallel to reduce new HIV infections and make treatment sustainable over the long run. New strategies are needed to address both the escalating treatment needs and enhance prevention across communities and healthcare.
This document summarizes the experience of a Health Equity Fund (HEF) managed by a local NGO in Sotnikum, Cambodia. The HEF aimed to improve access to healthcare for the poor by identifying poor patients and paying their user fees. Over its first 25 months, the HEF supported 16% of hospitalized patients. The authors conducted interviews and found that while the HEF effectively improved financial access, poor patients still faced other barriers like geographical, informational, and intra-household constraints. The study concluded that the HEF model showed promising results with minimal benefits leaking to non-poor individuals, but that further research is needed in different contexts.
The New Deal is an approach used in Cambodia to improve the public health system. It involves providing performance-based bonuses to health staff from resources freed up by donors and user fees. The New Deal has been implemented in Sotnikum district, Thmar Pouk district, and several provincial hospitals with positive results after 2 years in Sotnikum and 1 year in Thmar Pouk. Activities have increased as staff are more motivated. New institutional arrangements like management committees and Health Equity Funds to help the poor access care have also yielded good results. The document analyzes the implementation and lessons learned from the New Deal experiments to help guide further health sector reforms in Cambodia.
2007 Hrh Doctors & Art In Cambodia 1478 4491 5 12wvdamme
1) The study examines the use of doctor time for antiretroviral treatment (ART) delivery in Siem Reap, Cambodia between 2004 and 2005.
2) It finds that the doctor time needed per patient was reduced by 14-33% from 2004 to 2005 due to fewer patient visits and shorter consultations.
3) Extrapolating to 2013, the clinic will need between 2 to 5 full-time doctors to provide ART based on assumptions about patient survival and further reductions in doctor time per patient.
2007 Hpp Panorama 4 He Fs In Cambodia Mathieu Czm015wvdamme
The document provides a comparative analysis of four health equity funds in Cambodia that aim to improve access to hospital care for poor patients. The key findings are:
1) The health equity fund model appears superior to traditional waiver systems in improving health service utilization among targeted poor groups.
2) Design aspects essential to the model's performance include the existence of donor funding, the presence of a driving agent, a clear separation of roles, appropriate identification techniques, and consideration of multiple barriers to health service utilization.
3) The comparative framework may be a useful tool for designing, operating, or evaluating similar strategies in other contexts, though early adoption of common documentation would facilitate generating evidence about comparative performance.
2006 Hrh Nurses In Swaziland 1478 4491 4 13wvdamme
population ratio is estimated at around 30 per
100 000.
Nurses
The total number of registered nurses in Swaziland was
estimated at 2317 in 2004. Of the 1484 established posts
for nurses in the public and mission sectors, only 1108
were filled (Table 1). This means that 19% of nursing posts
were vacant. The majority of nurses are employed in the
public sector, with only around 300 nurses working in the
mission sector. Based on the information available, we
estimate that
land in 2004. Of these, only around 80 were actually
employed in the public sector, giving a doctor:population
ratio of around 7 per 100 000. The remaining 102 doctors
This document outlines the principles and steps of statistical analysis, including data, variables, estimation, statistics, and time series versus cross-section data. It discusses key statistical concepts like the mean, standard deviation, variance, range, mode, and graphs. It also covers hypothesis testing using z-tests, t-tests, F-tests, and chi-square tests and how this relates to rejecting or failing to reject the null hypothesis. Finally, it discusses how cross-section data analysis can provide a concise summary of relationships between variables in a survey dataset.
2008 Shsop Fin Obstetric Care Vouchers In Cambodia Por &Cwvdamme
1) Voucher and Health Equity Fund (HEF) schemes in Cambodia aimed to improve access to safe delivery for poor pregnant women by increasing facility deliveries at public health centers and hospitals.
2) The programs increased the number of deliveries at public facilities, with voucher and HEF beneficiaries accounting for about one-third of total facility deliveries.
3) However, the impact on improving access remained limited due to various financial and non-financial barriers. To be fully effective, vouchers and HEFs need to be complemented by supply-side interventions that also address issues like staff incentives and transportation barriers.
2008 Pov Ill Book Comparative Anal Social Assistance Cambodia Belgium Itmwvdamme
This document summarizes and compares public social assistance systems in Belgium and Health Equity Funds in Cambodia. It describes Belgium's long-standing, multi-purpose social assistance system operated through public centers. It then discusses Cambodia's Health Equity Funds, which aim to pay healthcare costs for the poorest. Finally, it considers potential lessons from Belgium's experience for designing social assistance programs in low- and middle-income countries, such as the importance of addressing political as well as technical dimensions and considering expanding services beyond only the destitute.
2008 Mal J Access To Act In Cambodia Yeung 1475 2875 7 96wvdamme
This document summarizes a study on access to artemisinin combination therapy (ACT) for malaria treatment in remote areas of Cambodia. It finds that without specific interventions, only a small percentage of people received biological diagnosis or ACT treatment. However, both village malaria worker (VMW) schemes and malaria outreach teams (MOTs) significantly increased access to trained providers and ACT treatment. The study highlights the challenge of ensuring effective malaria treatment in remote communities with limited formal healthcare access, but finds that community-based approaches like VMWs can help address this challenge.
This document discusses the debate around "vertical" versus "horizontal" financing of health services in developing countries. It argues that a "diagonal" approach, which aims to achieve disease-specific results through strengthening health systems, offers a better solution. The Global Fund and new International Health Partnership initiatives may help broaden the scope of Global Fund financing in this diagonal direction. However, this evolution faces challenges due to limited Global Fund resources and potential constraints from the IMF on countries' ability to expand health spending even with increased foreign aid. The authors argue for a gradual transformation of the Global Fund into a more diagonal and horizontal fund, while maintaining features like civil society participation that help ensure aid additionality.
2007 P Lo S Medicine 04 04 13 Ooms Medicines Without Doctorswvdamme
The document discusses the Global Fund's intention to focus more on fighting AIDS, tuberculosis, and malaria, and leave strengthening of health systems and support for health workers to other organizations. This could create a "Medicines without Doctors" situation. The authors argue that supporting health worker salaries is crucial for expanding treatment, as shown in Mozambique and Malawi which face major health workforce gaps. The Global Fund's novel approach of sustained international funding for treatment programs is what these countries need to strengthen their workforces long-term. However, some actors want to limit the Global Fund's role in health systems strengthening.
2007 Tmih Artekin Trial Malaria In Cambodiawvdamme
- The study aimed to compare the efficacy and tolerability of dihydroartemisinin–piperaquine (DHA–PQP) to a 3-day regimen of mefloquine and artesunate (MAS3) for the treatment of uncomplicated falciparum malaria in Cambodia.
- 464 patients were randomly assigned to receive either DHA–PQP or MAS3. The PCR-adjusted cure rates on day 63 were 97.5% for both treatments, demonstrating non-inferiority.
- There were no serious adverse events reported. However, significantly more episodes of vomiting, dizziness, palpitations, and sleep disorders were reported in the MAS3
This document describes chronic disease clinics in Cambodia that integrated care for HIV/AIDS, diabetes, and hypertension. Over three years, the clinics demonstrated the feasibility of this integrated care approach. Good outcomes were achieved through complementary adherence support strategies. Services were well-accepted by patients, which helped reduce stigma around HIV/AIDS. The experience showed how HIV/AIDS care can help address other common chronic diseases.
2007 Hrh Internat Health Volunteers Laleman Wvd & Co 1478 4491 5 19wvdamme
This document summarizes a study on the contribution of international health volunteers to the health workforce in sub-Saharan Africa. The study estimated that in 2005, volunteer organizations employed around 2,072 full-time international health volunteers in sub-Saharan Africa, with around 1,500 being doctors. The study also explored perceptions of these volunteers from the organizations that send them and from health managers in sub-Saharan Africa, finding more negative than positive views among the latter group.
This document summarizes the challenges of scaling up antiretroviral (ARV) therapy in low-income countries with a high burden of HIV/AIDS. It notes that while funding has increased, the rate of scaling up treatment has been slower than hoped. Key challenges are the need to transition health systems from acute to chronic care and insufficient human resources. Countries with the highest ratios of people living with HIV/AIDS to doctors and nurses will likely need to develop new delivery models that rely less on clinical staff. Existing models are also likely insufficient and new approaches adapted to local contexts will be needed to achieve the massive scale up required.
2006 Lancet Viewpoint Poverty And User Fees Uganda&Cambodiawvdamme
The document compares Uganda's abolition of user fees for public health care to Cambodia's establishment of health equity funds, noting that both increased access to care for the poor but through different approaches. Uganda took a universal approach by removing all user fees, while Cambodia targeted the poor through a system that reimburses costs and administers means testing. Key considerations for policymakers regarding targeting, benefits packages, quality of care incentives, and necessary funding levels are discussed.
2006 Expert Patients For Art Lit Review Kk&Wvdwvdamme
The document reviews expert patient programs for chronic disease management in high-income countries and explores their relevance for HIV/AIDS care in low-income countries with severe shortages of health care workers. It finds that current models of antiretroviral treatment delivery are too intensive in their use of skilled staff to scale up in most sub-Saharan African countries. However, chronic disease self-management programs that train lay people living with the conditions to support others have improved health outcomes and reduced healthcare use. Similarly, people living with HIV/AIDS currently play roles in HIV prevention, home-based care, treatment adherence and literacy that could be expanded under an expert patient model to help address the human resource constraints facing HIV treatment scale-up
The document discusses concerns about an overreaction to the potential threat of an influenza pandemic. While a catastrophic global pandemic is possible, the actual risk is relatively low compared to more common health threats. There is a tendency for the media and some experts to exaggerate rare health risks, distorting public perception and fueling unnecessary panic. Stockpiling of antiviral drugs is not necessarily the best response, as the effectiveness of such drugs is limited and their high cost could be better spent on more widespread health needs. An objective assessment of risk is needed to avoid an "iatrogenic pandemic of panic."
2004 Lancet Art In S Afr Do The Job Kk & Wvd Smallwvdamme
This document summarizes key findings from visits to Malawi, Mozambique, Swaziland, and South Africa regarding scaling up access to antiretroviral treatment. It finds that lack of human resources is seen as the biggest obstacle, as health worker shortages are severe and increasing due to illness, death, and brain drain. While funds are becoming available for drugs, none of the countries have comprehensive strategies to address the shortage of qualified staff needed to implement ambitious national treatment plans, which aim to increase those receiving treatment by 50-fold or more within just a few years. Addressing the human resources crisis for health is critical to achieve treatment targets and ensure long-term sustainability of health systems overwhelmed by AIDS.
This editorial discusses the concept of "iatrogenic poverty", where illness itself can lead to poverty in developing countries through two pathways. First, the death or disability of an income earner reduces future income generation. Second, the costs of seeking treatment, including opportunity costs and direct costs, can force households to deplete their savings, sell assets, or fall into debt, potentially tipping them into poverty. The convergence of demand for modern treatments, supply of new medical technologies, and lack of regulation in transitional economies exacerbates this problem. Solutions proposed include social health insurance, reforms to improve healthcare provision and costs, and targeted social assistance to directly transfer resources to the poor.
2002 Tmih V07 P1001 Editorial On Aids Crisis & Ceawvdamme
This editorial discusses the controversy sparked by cost-effectiveness analyses that concluded HIV prevention is more cost-effective than providing antiretroviral therapy (HAART) in sub-Saharan Africa. While the analyses made valid points, the authors argue they overlooked key ethical and human rights considerations in directly linking their conclusions to policy recommendations. Specifically, (1) treating the sick is a basic human right regardless of cost, (2) cost-effectiveness is just one factor in complex policy decisions that must also consider equity and community values. Overall, the response showed that resource allocation for HIV/AIDS should ensure treatment including HAART is made globally accessible based on principles of health as a human right.
The document contrasts the paradigms and characteristics of primary health care (PHC) and emergency medical assistance (EMA). PHC aims to promote long-term health as part of development, using a reasonable share of resources. EMA focuses on short-term physical survival in emergencies, mobilizing all available resources. Care in PHC balances multiple objectives, while EMA prioritizes effectiveness. PHC services are permanent and decentralized, with financial participation. EMA emphasizes accessibility and temporary specialized services.