The document summarizes key findings from the ABCE (Access, Bottlenecks, Costs, and Equity) research project in Zambia. The project assessed facility capacity, service provision, patient perspectives, efficiency, and costs of health care delivery. It found gaps in capacity across facility types, with shortages of equipment, staff, and stock-outs of medicines and vaccines. It also found potential for improved efficiency, with the average facility using only 42% of resources. Costs per patient visit varied by facility and service type.
The document provides an overview of the Access, Bottlenecks, Costs, and Equity (ABCE) research project in Uganda. The project collected data from 247 health facilities and over 3,900 patient interviews between 2012-2013. Key findings include: gaps between reported and functional service capacity at facilities, especially for non-HIV services; high availability of HIV/AIDS services but lower availability for non-communicable diseases; and efficiency scores varied widely both across and within facility platforms, indicating potential for expanded service provision.
The document provides an overview of the ABCE (Access, Bottlenecks, Costs, and Equity) project in Ghana which collected primary data from 240 health facilities across the country. Key findings include that while facility personnel and capacity have increased in recent years, availability of diagnostic testing and human resources vary substantially between facility types. The study also found opportunities to improve efficiency and increase service outputs given current resource levels. Results of the ABCE project can help inform health policy in Ghana by identifying areas of strength and those needing further development in the country's health system.
The ABCE project in Kenya collected data from 254 health facilities and over 4,200 patient exit interviews from 2012. Key findings include:
- Primary care facilities reported providing services but often lacked full capacity, especially in rural areas. Equipment, staffing, and diagnostic capacities were often inadequate.
- Patients generally paid some fees but amounts varied. Over 75% of public health center patients paid 20 KSH or less.
- Efficiency scores averaged 41% and generally declined with lower levels of care. Significant potential existed to increase service production given resources.
- Costs per patient visit varied by facility and output, with outpatient visits generally the lowest cost.
SM2015 is an ambitious project with the Ministry of Health and local support. This presentation outlines the design and activities around the data collection and analysis of the evaluation, as well as the results, conclusions, and future activities.
Don't miss our upcoming webinars! Subscribe today.
In this webinar:
1) Attendees will be provided with an overview of the drug approval and reimbursement processes.
2) People will be taken through a review of the updated CADTH patient group/clinician input processes.
3) Everyone will have a better understanding of how the processes are connected and flow into one another.
View the YouTube video here: https://youtu.be/-Bv9DZvSITk
Follow CCSN on social media:
Twitter - https://twitter.com/survivornetca
Facebook - https://www.facebook.com/CanadianSurvivorNet
Instagram: https://www.instagram.com/survivornet_ca/
Pinterest - https://www.pinterest.com/survivornetwork
Don’t miss our upcoming webinars: Subscribe today!
In this webinar:
Join our presenters, Wayne Critchley from Global Public Affairs and Ryan Clarke from Advocacy Solutions, and CCSN to learn more about changes to the Patented Medicine Prices Review Board (PMPRB) and receive guidance about how to support the cancer community’s engagement at this stage of regulatory reform.
View the video:
https://youtu.be/4IsiptCD0Tw
To learn more about CCSN, visit us at survivornet.ca
Follow CCSN on social media:
Twitter - https://twitter.com/survivornetca
Facebook - https://www.facebook.com/CanadianSurvivorNet
Instagram: https://www.instagram.com/survivornet_ca/
Pinterest - https://www.pinterest.com/survivornetwork
The Integrated Disease Surveillance Project (IDSP) aims to establish a decentralized disease surveillance system in India to improve disease control. It integrates existing surveillance programs, coordinates surveillance activities, and establishes quality data collection, analysis, and feedback using information technology. The IDSP covers diseases like malaria, acute diarrheal diseases, tuberculosis, and measles. It is implemented in phases across states and union territories of India and involves strengthening laboratories, training health professionals, and creating an IT network to link surveillance sites. The goal is to provide data to enable efficient public health decision making and interventions for priority diseases.
Predicting cancer patients’ quality of life: an analysis of the relationship ...Kerry Sheppard
This document summarizes a study that used data from the Cancer 2015 cohort to analyze the relationship between cancer patients' quality of life (measured by EQ-5D utility scores), treatment regimens, and time. The study found that chemotherapy and radiotherapy had the largest negative effects on quality of life scores, particularly in the 1-2 months after treatment. Surgery had a smaller effect. Baseline quality of life was the strongest predictor of follow-up quality of life. The results provide insights into how different cancer treatments impact patients' quality of life over time.
The document provides an overview of the Access, Bottlenecks, Costs, and Equity (ABCE) research project in Uganda. The project collected data from 247 health facilities and over 3,900 patient interviews between 2012-2013. Key findings include: gaps between reported and functional service capacity at facilities, especially for non-HIV services; high availability of HIV/AIDS services but lower availability for non-communicable diseases; and efficiency scores varied widely both across and within facility platforms, indicating potential for expanded service provision.
The document provides an overview of the ABCE (Access, Bottlenecks, Costs, and Equity) project in Ghana which collected primary data from 240 health facilities across the country. Key findings include that while facility personnel and capacity have increased in recent years, availability of diagnostic testing and human resources vary substantially between facility types. The study also found opportunities to improve efficiency and increase service outputs given current resource levels. Results of the ABCE project can help inform health policy in Ghana by identifying areas of strength and those needing further development in the country's health system.
The ABCE project in Kenya collected data from 254 health facilities and over 4,200 patient exit interviews from 2012. Key findings include:
- Primary care facilities reported providing services but often lacked full capacity, especially in rural areas. Equipment, staffing, and diagnostic capacities were often inadequate.
- Patients generally paid some fees but amounts varied. Over 75% of public health center patients paid 20 KSH or less.
- Efficiency scores averaged 41% and generally declined with lower levels of care. Significant potential existed to increase service production given resources.
- Costs per patient visit varied by facility and output, with outpatient visits generally the lowest cost.
SM2015 is an ambitious project with the Ministry of Health and local support. This presentation outlines the design and activities around the data collection and analysis of the evaluation, as well as the results, conclusions, and future activities.
Don't miss our upcoming webinars! Subscribe today.
In this webinar:
1) Attendees will be provided with an overview of the drug approval and reimbursement processes.
2) People will be taken through a review of the updated CADTH patient group/clinician input processes.
3) Everyone will have a better understanding of how the processes are connected and flow into one another.
View the YouTube video here: https://youtu.be/-Bv9DZvSITk
Follow CCSN on social media:
Twitter - https://twitter.com/survivornetca
Facebook - https://www.facebook.com/CanadianSurvivorNet
Instagram: https://www.instagram.com/survivornet_ca/
Pinterest - https://www.pinterest.com/survivornetwork
Don’t miss our upcoming webinars: Subscribe today!
In this webinar:
Join our presenters, Wayne Critchley from Global Public Affairs and Ryan Clarke from Advocacy Solutions, and CCSN to learn more about changes to the Patented Medicine Prices Review Board (PMPRB) and receive guidance about how to support the cancer community’s engagement at this stage of regulatory reform.
View the video:
https://youtu.be/4IsiptCD0Tw
To learn more about CCSN, visit us at survivornet.ca
Follow CCSN on social media:
Twitter - https://twitter.com/survivornetca
Facebook - https://www.facebook.com/CanadianSurvivorNet
Instagram: https://www.instagram.com/survivornet_ca/
Pinterest - https://www.pinterest.com/survivornetwork
The Integrated Disease Surveillance Project (IDSP) aims to establish a decentralized disease surveillance system in India to improve disease control. It integrates existing surveillance programs, coordinates surveillance activities, and establishes quality data collection, analysis, and feedback using information technology. The IDSP covers diseases like malaria, acute diarrheal diseases, tuberculosis, and measles. It is implemented in phases across states and union territories of India and involves strengthening laboratories, training health professionals, and creating an IT network to link surveillance sites. The goal is to provide data to enable efficient public health decision making and interventions for priority diseases.
Predicting cancer patients’ quality of life: an analysis of the relationship ...Kerry Sheppard
This document summarizes a study that used data from the Cancer 2015 cohort to analyze the relationship between cancer patients' quality of life (measured by EQ-5D utility scores), treatment regimens, and time. The study found that chemotherapy and radiotherapy had the largest negative effects on quality of life scores, particularly in the 1-2 months after treatment. Surgery had a smaller effect. Baseline quality of life was the strongest predictor of follow-up quality of life. The results provide insights into how different cancer treatments impact patients' quality of life over time.
The document discusses integrated communicable disease surveillance and efforts towards integration in several countries in the Eastern Mediterranean region. It notes that integrated surveillance allows for more efficient data collection, analysis, and response across disease programs. Several countries are making progress on establishing integrated electronic platforms and national surveillance systems through partnerships with international organizations. Fully implementing integrated surveillance remains an ongoing challenge that requires resources, training, and political commitment over the long term.
Moving Toward Improved Measurement of Malaria Mortality at the Population LevelMEASURE Evaluation
This review summarizes the key limitations of using verbal autopsies to measure malaria mortality at the population level. The main limitations identified are the low sensitivity and specificity of existing verbal autopsy tools in determining malaria as the cause of death. There is also a lack of standardization in how verbal autopsies are implemented and analyzed across studies. Additional challenges include small sample sizes and potential for recall bias. The review concludes there is an urgent need to improve verbal autopsy methods to provide more accurate estimates of malaria mortality and track progress of malaria control goals.
Presentation from the 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks, organised by the European Centre of Disease Prevention and Control - Stockholm, 11-13 February 2015
Oncology Dynamics captures a substantial part of oncological patient treatment journey. It provides real world insights into how standards of care and treatment landscape differ across healthcare systems.
This document discusses the challenges of implementing consistent infection prevention and control (IPC) standards across New Zealand's public health sector. It notes the lack of national standards and real-time data makes it difficult to assess performance, determine necessary interventions, and support clinical decision-making. Healthcare-associated infections impact patient safety and outcomes while increasing costs. The document advocates achieving a national IPC management system using a common software platform called ICNet to standardize data collection, facilitate real-time reporting and analysis, and enable quality improvement activities aimed at reducing infections like surgical site infections. Progress includes ICNet's adoption in several districts and a national surgical site infection monitoring program, though continued coordination and prioritization is needed to fully realize this vision.
This document provides an update on the Pediatric Vasculitis Initiative (PedVas) from its meeting at the 2015 CORD Rare Disease Conference. PedVas is an international collaboration between clinicians and researchers studying childhood vasculitis. It aims to support existing clinical networks through collection and analysis of biological samples and knowledge translation. The update describes two case studies of children diagnosed with vasculitis, preliminary clinical data on outcomes in pediatric systemic vasculitis, biomarker research identifying elevated S100A12 levels in active vasculitis, and gene expression profiling of samples collected through the initiative.
The Patient Values Project aims to better define, measure, and incorporate patient preferences into the cancer drug approval process in Canada. It involves a 3-phase approach: 1) Developing and administering a patient preferences survey; 2) Identifying metrics to measure values from survey data; 3) Generating a quantitative weight for patient values to be included in submissions to pCODR expert committees. The project seeks to empower patient groups to provide more objective, research-based input and allow for a more balanced assessment of new cancer drugs. It could ultimately help improve reimbursement decisions and be applied to other disease sites.
Main Presentation UK Diagnostic Summit 2018Walt Whitman
The document summarizes a conference on maximizing diagnostic technology to tackle antimicrobial resistance (AMR) in the UK. It discusses the UK AMR Diagnostic Collaborative, which provides leadership and alignment across the diagnostic system. Key areas of focus for 2018-2019 include diagnostic stewardship, innovation, and understanding how health policy can support rapid diagnostic adoption. Upcoming milestones are surveys on blood culture and industry engagement to help accelerate diagnostic usage and solutions. Continued focus on diagnostics is crucial as the government refreshes its AMR strategy and action plan.
The document provides an overview of ICNet Infection Case Management & Surveillance Software. It describes ICNet as a leading provider of infection control software with over 90 NHS Trust clients in the UK and international clients. Key features of ICNet include its web-based, real-time surveillance platform that provides proactive alerts and customizable reporting. ICNet can interface with various hospital information systems and has experience implementing its software and interfaces internationally. The document outlines ICNet's training and support services and provides examples of the types of customizable reports and analyses that ICNet can generate.
1) Comprehensive care centres that adhere to standards of care for inherited bleeding disorders like hemophilia have been shown to significantly improve health outcomes and reduce costs.
2) A 1970s study in Montreal found that home treatment of bleeding episodes supported by a comprehensive care centre reduced hospitalizations by 85% and costs by 85% for children with hemophilia.
3) Later studies also showed patients who received care at comprehensive care centres had lower risks of hospitalization and morbidity.
This document provides a summary of the Joint Review Mission final report on improving access to health services in Ethiopia. The review assessed progress on implementing health sector objectives, identified health system bottlenecks, and explored best practices. Some key findings included:
- Antenatal care coverage reached its highest level of 98% in 2006, increasing from 71.4% in 2002. Postnatal care also increased but regional variations exist.
- Institutional deliveries increased in visited health facilities from the previous year due to functional community health groups, ambulance services, and committed health workers. However, the target of 60% was not met nationally.
- Deliveries attended by skilled health personnel rose from 16.8% in 2002
2016 indicator reference guide viral load suppression at 12 months#GOMOJO, INC.
1) This indicator measures the percentage of ART patients with a viral load result documented within the past 12 months. Viral load testing is important for monitoring treatment effectiveness and preventing drug resistance.
2) The numerator is the number of ART patients (adults and children) with a viral load result documented in their medical record within the past 12 months. The denominator is the number of ART patients reviewed whose medical records were examined.
3) Achieving high rates of viral load testing is critical for monitoring treatment outcomes and scaling up HIV treatment programs. Support for viral load testing includes procurement of reagents, transportation of samples, and clinical mentoring at ART sites.
Don't miss our upcoming webinars. Subscribe today!
Join Alies, a patient partner, and Ambreen, a patient-oriented researcher as they talk about Equity-Mobilizing Partnerships in Community (EMPaCT) a patient partnership model co-designed to center the voices of diverse community members and build capacity for equitable patient-oriented partnerships. In this webinar, Alies and Ambreen describe how they engaged multiple stakeholders including institutional leadership, funding bodies, knowledge users and most importantly, the patient community to identify common goals and intersecting opportunities and channelled them to create clear health-equity oriented pathways to change.
View the YouTube video: https://youtu.be/O2FKVsO0x_E
Follow CCSN on social media:
Twitter - https://twitter.com/survivornetca
Facebook - https://www.facebook.com/CanadianSurvivorNet
Instagram: https://www.instagram.com/survivornet_ca/
Pinterest - https://www.pinterest.com/survivornetwork
Information System for the Enhancement of Research in Primary CareZoe Mitchell
This document describes SIDIAP, a database created in 2010 to promote primary care research using clinical data from electronic medical records of over 5.8 million patients in Catalonia, Spain. SIDIAP contains socio-demographic, clinical, prescription, and hospitalization data. It adds value through high population coverage, validated data, and symbiosis with health providers. Researchers can apply to use de-identified data for studies. Limitations include some unavailable variables, but improvements are being made. Examples of respiratory research include COPD prescription patterns and identifying gaps in alpha-1 antitrypsin deficiency diagnosis.
Federal HAI Data Summit May 2012 plenary two-master_slides noel slides 11 t...Noel Eldridge
The document summarizes discussions from the 2012 HAI Data Summit. It provides an overview of key HHS data sources for healthcare-associated infections and discusses measurement strategies for HAI reduction programs like the Partnership for Patients initiative. The summit addressed inconsistencies between HAI reporting systems and priorities for developing consistent public reporting policies. It also presented baseline HAI rates and goals for reducing certain targeted HAIs like CLABSI, CAUTI, C. difficile, and ventilator-associated pneumonia by 2013. Finally, it discussed the resource requirements hospitals face for participating in various HAI surveillance and quality improvement projects.
Regulating Drugs in Canada provides an overview of Health Canada's regulation of pharmaceuticals and medical devices. There are three main access streams for therapeutic products: pre-market review and approval; clinical trials for investigational testing; and special access for non-marketed products to treat serious conditions. Health Canada regulates over 14,000 marketed pharmaceutical products and 35,000 medical device licenses. The drug review and approval process has evolved significantly over time to incorporate more clinical and post-market safety data, international harmonization, and earlier access to promising new therapies for serious diseases.
The Institute for Health Metrics and Evaluation is a global health institute that provides scientific measurements and evaluations of population health. It collects various types of health-related data, including social determinants, risks factors, population surveys, and facility data. However, health data is often difficult to access due to issues like privacy, capacity, and a sense of ownership. Health Data Innovation is changing this by encouraging data sharing through open data portals, funding for innovation, and engaging individuals to manage and share their own health data. This enables a virtuous cycle where more data is collected and shared, fueling further innovation and making more timely data available.
The document discusses how the Institute for Health Metrics and Evaluation at the University of Washington uses maps and spatial analysis to inform global health decision making. It summarizes their work on the Global Burden of Disease study which quantifies health loss from diseases, injuries and risk factors in 187 countries. It describes how they measure and analyze data inputs, manage missing data, use covariates and risk factors, conduct spatial-temporal regression, and perform small area estimation to analyze health patterns at subnational levels. Remaining challenges include adding more spatial covariates and conducting disease burden studies at local levels.
The document discusses integrated communicable disease surveillance and efforts towards integration in several countries in the Eastern Mediterranean region. It notes that integrated surveillance allows for more efficient data collection, analysis, and response across disease programs. Several countries are making progress on establishing integrated electronic platforms and national surveillance systems through partnerships with international organizations. Fully implementing integrated surveillance remains an ongoing challenge that requires resources, training, and political commitment over the long term.
Moving Toward Improved Measurement of Malaria Mortality at the Population LevelMEASURE Evaluation
This review summarizes the key limitations of using verbal autopsies to measure malaria mortality at the population level. The main limitations identified are the low sensitivity and specificity of existing verbal autopsy tools in determining malaria as the cause of death. There is also a lack of standardization in how verbal autopsies are implemented and analyzed across studies. Additional challenges include small sample sizes and potential for recall bias. The review concludes there is an urgent need to improve verbal autopsy methods to provide more accurate estimates of malaria mortality and track progress of malaria control goals.
Presentation from the 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks, organised by the European Centre of Disease Prevention and Control - Stockholm, 11-13 February 2015
Oncology Dynamics captures a substantial part of oncological patient treatment journey. It provides real world insights into how standards of care and treatment landscape differ across healthcare systems.
This document discusses the challenges of implementing consistent infection prevention and control (IPC) standards across New Zealand's public health sector. It notes the lack of national standards and real-time data makes it difficult to assess performance, determine necessary interventions, and support clinical decision-making. Healthcare-associated infections impact patient safety and outcomes while increasing costs. The document advocates achieving a national IPC management system using a common software platform called ICNet to standardize data collection, facilitate real-time reporting and analysis, and enable quality improvement activities aimed at reducing infections like surgical site infections. Progress includes ICNet's adoption in several districts and a national surgical site infection monitoring program, though continued coordination and prioritization is needed to fully realize this vision.
This document provides an update on the Pediatric Vasculitis Initiative (PedVas) from its meeting at the 2015 CORD Rare Disease Conference. PedVas is an international collaboration between clinicians and researchers studying childhood vasculitis. It aims to support existing clinical networks through collection and analysis of biological samples and knowledge translation. The update describes two case studies of children diagnosed with vasculitis, preliminary clinical data on outcomes in pediatric systemic vasculitis, biomarker research identifying elevated S100A12 levels in active vasculitis, and gene expression profiling of samples collected through the initiative.
The Patient Values Project aims to better define, measure, and incorporate patient preferences into the cancer drug approval process in Canada. It involves a 3-phase approach: 1) Developing and administering a patient preferences survey; 2) Identifying metrics to measure values from survey data; 3) Generating a quantitative weight for patient values to be included in submissions to pCODR expert committees. The project seeks to empower patient groups to provide more objective, research-based input and allow for a more balanced assessment of new cancer drugs. It could ultimately help improve reimbursement decisions and be applied to other disease sites.
Main Presentation UK Diagnostic Summit 2018Walt Whitman
The document summarizes a conference on maximizing diagnostic technology to tackle antimicrobial resistance (AMR) in the UK. It discusses the UK AMR Diagnostic Collaborative, which provides leadership and alignment across the diagnostic system. Key areas of focus for 2018-2019 include diagnostic stewardship, innovation, and understanding how health policy can support rapid diagnostic adoption. Upcoming milestones are surveys on blood culture and industry engagement to help accelerate diagnostic usage and solutions. Continued focus on diagnostics is crucial as the government refreshes its AMR strategy and action plan.
The document provides an overview of ICNet Infection Case Management & Surveillance Software. It describes ICNet as a leading provider of infection control software with over 90 NHS Trust clients in the UK and international clients. Key features of ICNet include its web-based, real-time surveillance platform that provides proactive alerts and customizable reporting. ICNet can interface with various hospital information systems and has experience implementing its software and interfaces internationally. The document outlines ICNet's training and support services and provides examples of the types of customizable reports and analyses that ICNet can generate.
1) Comprehensive care centres that adhere to standards of care for inherited bleeding disorders like hemophilia have been shown to significantly improve health outcomes and reduce costs.
2) A 1970s study in Montreal found that home treatment of bleeding episodes supported by a comprehensive care centre reduced hospitalizations by 85% and costs by 85% for children with hemophilia.
3) Later studies also showed patients who received care at comprehensive care centres had lower risks of hospitalization and morbidity.
This document provides a summary of the Joint Review Mission final report on improving access to health services in Ethiopia. The review assessed progress on implementing health sector objectives, identified health system bottlenecks, and explored best practices. Some key findings included:
- Antenatal care coverage reached its highest level of 98% in 2006, increasing from 71.4% in 2002. Postnatal care also increased but regional variations exist.
- Institutional deliveries increased in visited health facilities from the previous year due to functional community health groups, ambulance services, and committed health workers. However, the target of 60% was not met nationally.
- Deliveries attended by skilled health personnel rose from 16.8% in 2002
2016 indicator reference guide viral load suppression at 12 months#GOMOJO, INC.
1) This indicator measures the percentage of ART patients with a viral load result documented within the past 12 months. Viral load testing is important for monitoring treatment effectiveness and preventing drug resistance.
2) The numerator is the number of ART patients (adults and children) with a viral load result documented in their medical record within the past 12 months. The denominator is the number of ART patients reviewed whose medical records were examined.
3) Achieving high rates of viral load testing is critical for monitoring treatment outcomes and scaling up HIV treatment programs. Support for viral load testing includes procurement of reagents, transportation of samples, and clinical mentoring at ART sites.
Don't miss our upcoming webinars. Subscribe today!
Join Alies, a patient partner, and Ambreen, a patient-oriented researcher as they talk about Equity-Mobilizing Partnerships in Community (EMPaCT) a patient partnership model co-designed to center the voices of diverse community members and build capacity for equitable patient-oriented partnerships. In this webinar, Alies and Ambreen describe how they engaged multiple stakeholders including institutional leadership, funding bodies, knowledge users and most importantly, the patient community to identify common goals and intersecting opportunities and channelled them to create clear health-equity oriented pathways to change.
View the YouTube video: https://youtu.be/O2FKVsO0x_E
Follow CCSN on social media:
Twitter - https://twitter.com/survivornetca
Facebook - https://www.facebook.com/CanadianSurvivorNet
Instagram: https://www.instagram.com/survivornet_ca/
Pinterest - https://www.pinterest.com/survivornetwork
Information System for the Enhancement of Research in Primary CareZoe Mitchell
This document describes SIDIAP, a database created in 2010 to promote primary care research using clinical data from electronic medical records of over 5.8 million patients in Catalonia, Spain. SIDIAP contains socio-demographic, clinical, prescription, and hospitalization data. It adds value through high population coverage, validated data, and symbiosis with health providers. Researchers can apply to use de-identified data for studies. Limitations include some unavailable variables, but improvements are being made. Examples of respiratory research include COPD prescription patterns and identifying gaps in alpha-1 antitrypsin deficiency diagnosis.
Federal HAI Data Summit May 2012 plenary two-master_slides noel slides 11 t...Noel Eldridge
The document summarizes discussions from the 2012 HAI Data Summit. It provides an overview of key HHS data sources for healthcare-associated infections and discusses measurement strategies for HAI reduction programs like the Partnership for Patients initiative. The summit addressed inconsistencies between HAI reporting systems and priorities for developing consistent public reporting policies. It also presented baseline HAI rates and goals for reducing certain targeted HAIs like CLABSI, CAUTI, C. difficile, and ventilator-associated pneumonia by 2013. Finally, it discussed the resource requirements hospitals face for participating in various HAI surveillance and quality improvement projects.
Regulating Drugs in Canada provides an overview of Health Canada's regulation of pharmaceuticals and medical devices. There are three main access streams for therapeutic products: pre-market review and approval; clinical trials for investigational testing; and special access for non-marketed products to treat serious conditions. Health Canada regulates over 14,000 marketed pharmaceutical products and 35,000 medical device licenses. The drug review and approval process has evolved significantly over time to incorporate more clinical and post-market safety data, international harmonization, and earlier access to promising new therapies for serious diseases.
The Institute for Health Metrics and Evaluation is a global health institute that provides scientific measurements and evaluations of population health. It collects various types of health-related data, including social determinants, risks factors, population surveys, and facility data. However, health data is often difficult to access due to issues like privacy, capacity, and a sense of ownership. Health Data Innovation is changing this by encouraging data sharing through open data portals, funding for innovation, and engaging individuals to manage and share their own health data. This enables a virtuous cycle where more data is collected and shared, fueling further innovation and making more timely data available.
The document discusses how the Institute for Health Metrics and Evaluation at the University of Washington uses maps and spatial analysis to inform global health decision making. It summarizes their work on the Global Burden of Disease study which quantifies health loss from diseases, injuries and risk factors in 187 countries. It describes how they measure and analyze data inputs, manage missing data, use covariates and risk factors, conduct spatial-temporal regression, and perform small area estimation to analyze health patterns at subnational levels. Remaining challenges include adding more spatial covariates and conducting disease burden studies at local levels.
1. Maternal and child mortality in the United States has increased in recent decades according to findings from the GBD 2013 study, unlike trends in other developed nations which have seen continued declines.
2. The reasons for rising mortality in the US are unclear but may be related to increasing rates of non-communicable diseases and comorbidities among women of reproductive age as well as declining health insurance coverage and access to care.
3. While congenital birth defects have decreased substantially in the US, rates of neonatal disorders and injuries continue to outpace declines in other countries, driving higher rates of child mortality overall.
RBF districts saw increases in some key health indicators compared to control districts, including institutional deliveries and the timing of first antenatal care visits. Quality of services improved in some areas for RBF districts such as structural quality indices and availability of some delivery equipment. Health systems were strengthened under RBF, with increases in facility governance, autonomy, and job satisfaction reported compared to control districts. The results provide evidence that RBF had a positive impact on priority health services in Zambia.
Findings and implications of the Global Burden of Disease Study 2010
Royal Society, London, 14 December 2012
Professor Theo Vos
School of Population Health
The document summarizes the findings of the Global Burden of Diseases, Injuries, and Risk Factors 2010 study conducted by 486 authors from 302 institutions in 50 countries. The study analyzed 291 diseases and injuries, 1,160 disabling sequelae, 67 risk factors, and provided 650 million findings for 187 countries from 1990-2010. Key observations included rapid demographic changes outside sub-Saharan Africa, a progressive disease transition from communicable to non-communicable causes, a disability transition resulting in more years lived with disability, a global risk factor transition, and sub-Saharan Africa still facing a large burden from MDGs 4, 5 and 6.
Dr. Ali Mokdad from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington presents the latest U.S. County Life Expectancy estimates from 1989 to 2009, at the Association of Health Care Journalists conference in Atlanta, GA, April 19, 2012.
Community healthcare financing the Zambia experience byDr Dally Menda, CHAZachapkenya
This document summarizes different models of community-based health financing in Zambia, including community managed user fees, performance-based financing (PBF), provider-based health insurance, and a care and prevention model (CPT). It describes features of each model, such as how communities are involved in setting fees, allocating funds, and managing resources. The document also discusses some successes and challenges of these models, such as increased resources for health and community ownership, but also potential conflicts between health facilities and communities.
This document outlines an agenda for a data visualization workshop. It discusses why visualizing data is important for exploring patterns, communicating results, and telling stories. Examples are given of historical visualizations that helped identify cholera outbreaks and military campaigns. The main steps for visualizing data are introduced: being clear on objectives, preparing the data, building visualizations using appropriate tools, and ensuring success. Global Burden of Disease visualizations are presented as examples for research settings. The document concludes with encouraging questions and further resources.
MEASURE Evaluation PIMA poster on maternal morbidity and mortality. Access a larger version at https://www.measureevaluation.org/pima/maternal-and-reproductive-health/maternal-mortality-poster.
The document discusses the Global Burden of Disease (GBD) study and methodology for assigning disability weights. It provides details on:
- The GBD aims to measure disease burden globally in terms of years lived with disability (YLD) and disability-adjusted life years (DALYs).
- Disability weights provide a scale from 0 (perfect health) to 1 (death) to quantify the severity of non-fatal health outcomes.
- The study involved household surveys in multiple countries and an internet survey to derive weights for 220 health states based on paired comparisons of health state descriptions.
- Statistical modeling was used to analyze the paired comparison data and map the results to a 0-1 disability weight
Monitoring and Evaluation Workshops: An approach to improve malaria informati...MEASURE Evaluation
The document summarizes regional monitoring and evaluation workshops held from 2010-2015 for malaria programs in sub-Saharan Africa. The workshops were organized by MEASURE Evaluation in collaboration with academic institutions and aimed to strengthen M&E capacity and skills among national malaria control program staff. Results from assessments found that participants retained knowledge and were able to apply what they learned to their work, but that additional modules were needed on malaria surveillance for pre-elimination contexts. Over 500 people applied to the workshops and 218 participants from 28 countries completed them.
“Follow the money” in order to better understand the framework for global health governance: this presentation by Dr. Tim Mackey employs IHME-coordinated research while teaching the evolution of global health financing.
This document proposes solutions to improve primary healthcare access in rural India. It discusses establishing mobile hospitals with basic medical facilities to increase accessibility and availability in remote villages. It also suggests developing affordable medical technologies like devices for non-invasive anemia and blood sugar detection. An Interactive Voice Response System is proposed to provide medical advice and disease management via telephone. Health awareness would be raised through village campaigns, pamphlets and utilizing ASHA workers. Policy recommendations include regulating medical devices, funding healthcare startups and establishing a rural telehealth program using mobile phones. The goal is to universalize quality primary healthcare access for rural India's population.
The Solomon Islands HiT determines that the country’s health system has significant weaknesses but also considerable strengths. Despite the range and difficulty of issues facing policy-makers in the Solomon Islands, there have been significant achievements in health, including considerable progress in advancing population health status. The performance of the health system is positive, achieving high coverage, high satisfaction levels, and steady progress on health outcomes. Nonetheless, the country faces important health challenges that could undermine development gains made to date
The document summarizes Kenya's health care system structure and organization. It begins with background on health issues in Kenya like malaria, tuberculosis, and HIV/AIDS. It then defines a health system and describes Kenya's system. Kenya's system is structured in a step-wise manner from dispensaries up to national referral hospitals. It is organized across several administrative levels from community to county to national. The roles of the Ministry of Health and other actors in service delivery are also outlined. With devolution in 2010, county governments now manage health care delivery while the national government focuses on policy and national facilities.
Keith Willet: Pharmacy's role in the urgent and emergency care review Nuffield Trust
The document discusses proposals from the Urgent and Emergency Care Review in the UK to reform urgent and emergency care services. It outlines plans to provide more responsive urgent care outside hospitals, treat non-life threatening issues close to home, and ensure serious issues are treated in specialized centers. It also discusses expanding the role of community pharmacies, improving NHS 111, and creating Urgent Care Networks to better coordinate care across providers. The goal is to provide the right care, in the right place, first time for urgent and emergency patients.
This document discusses proposals to reform urgent and emergency care in England. It outlines plans to provide more responsive urgent care outside hospitals. For serious/life-threatening needs, centers with expertise and facilities would be established. Current systems are described, including millions of pharmacy visits, NHS 111 calls, GP consultations, and A&E attendances annually. Reforms proposed include better self-care information, an enhanced NHS 111 service, improved use of summary care records, more same-day access to primary/community care, and ambulance services providing mobile treatment. Urgent care centers and networks connecting all services are also discussed. Payment reforms and addressing workforce and information sharing challenges are highlighted.
Presentation from the 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks, organised by the European Centre of Disease Prevention and Control - Stockholm, 11-13 February 2015
The Thailand HiT reports that sustained political commitment to the health of the population since the 1970s has resulted in significant investment in health infrastructure, in particular primary health care, district and provincial referral hospitals, and strengthened the overall functioning of the Thai health system. After Thailand achieved universal health coverage in 2002, public expenditure on health significantly increased from 63% to 77% and out-of-pocket expense was reduced from 27.2% to 12.4% of the total health spending in 2011.
This lecture discusses different outpatient care settings for delivering healthcare, including retail clinics, urgent care centers, and emergency departments. It notes issues with overcrowding in emergency departments, with many visits being non-emergency cases that could be handled elsewhere. This is due in part to problems accessing primary care and a lack of after-hours options. Solutions proposed include improving access to primary care medical homes, telephone triage systems, and expanding availability of after-hours clinics.
This document discusses telehealth models in 21st century healthcare. It provides an overview of telehealth definitions and benefits, including improving access to care for aging and chronic disease populations. The University of Virginia Center for Telehealth is presented as a case study, serving over 41,000 patients across Virginia through telestroke, telepsychiatry, tele-ophthalmology and remote patient monitoring programs. The document concludes with discussing needed policy changes to improve Medicare and Medicaid reimbursement and licensing requirements to further support telehealth expansion.
All party parliamentary inquiry into rural health and care. TELEMEDICINEJosep Vidal-Alaball
This document discusses the experience with telemedicine programs in rural Catalonia. It summarizes that since 2010, several successful telemedicine programs have been implemented, including teledermatology and teleaudiometries. These programs allow primary care physicians to take photos of lesions or injuries and send them via electronic medical records to specialists, who provide treatment plans. This has reduced dermatology waiting times from 30 to 16 days on average. A cost analysis found telemedicine saved over €780,000 from 2011-2019, providing an average €15 savings per visit primarily benefiting patients. Telemedicine referral rates were higher for rural versus urban centers. During the COVID-19 pandemic, non-face-to-face visits increased greatly,
Integrated health & social care: service transformation supported by technolo...flanderscare
The document provides an overview of integrated health and social care in North Kent, including:
1) It discusses the complexities of the current health and social care system in Kent and past pilots using telehealth and telecare that demonstrated benefits like reduced admissions and costs.
2) It outlines the current agenda around the Pioneer Programme and Better Care Fund aimed at integrating services.
3) North Kent's approach focuses on transforming services to promote independence, provide the right care in the right place, and deliver seamless integrated care for those with complex needs through measures like shared care plans and integrated primary care teams.
Duncan Maru presented on the challenges of building healthcare systems in rural Nepal. Some key challenges included a lack of infrastructure, healthcare workers and supplies. The document discussed two cases that highlighted issues - a tuberculosis infection due to poor ventilation and safety protocols, and an infant's death due to lack of oxygen, emergency equipment and training. Maru emphasized the need for reflective reviews of adverse events, transparency in data reporting, and innovations to strengthen logistics, energy and management systems in order to deliver high quality care in resource-poor areas.
The document discusses primary health care (PHC) which aims to make essential health care accessible to all communities. It was defined at the 1978 Alma Ata conference as health care based on practical and socially acceptable methods. Key elements of PHC include health promotion, immunizations, maternal and child care, essential drugs, and control of endemic diseases. Principles of PHC are equity, community participation, appropriate technology, and a multisectoral approach. Pakistan's PHC system has multiple levels from basic health units and rural health centers to tehsil and district hospitals. However, it faces challenges like shortages of doctors, nurses and health facilities.
Telemedicine in Skilled Nursing Facilities by Reza SadeghianReza Sadeghian
This document discusses using telemedicine in skilled nursing facilities to help avoid unnecessary hospitalizations. It finds that two-thirds of nursing home residents are on Medicaid and most are also enrolled in Medicare. These residents frequently experience avoidable hospitalizations, which are expensive and disruptive. The document outlines a study using telemedicine carts equipped with examination tools to help nurse practitioners manage acute changes in residents' conditions and palliative care assessments remotely rather than transferring residents to hospitals unnecessarily. The study found the telemedicine approach helped avoid hospital transfers 60% of the time with estimated cost savings of $396,000.
Transforming Urgent and Emergency Care: Safer, Better, Faster mckenln
Dr. Steve Lloyd is a principal GP, clinical lead for 111/OOH services, and chair of several clinical groups focused on urgent and emergency care. He discusses challenges facing emergency and urgent care systems, including increased demand exacerbating strain on hospitals. Medicine, society, and patients have changed, but the NHS has changed little. While attendances have increased only slightly, emergency admissions have risen significantly, especially in older populations, and it is estimated that 20-30% of admissions of people over 75 could potentially be avoided with high-quality decision making and sufficient community services. Ongoing developments to address these challenges include implementing the urgent and emergency care review, establishing regional project management offices, allocating capital funding, developing new payment
This document proposes solutions to improve universal access to quality primary healthcare in India. It discusses establishing a mobile healthcare delivery system using customized vans staffed with doctors and nurses that visit villages on a set schedule. It also proposes expanding medical insurance coverage to the poor and marginalized. Community engagement programs would train local healthcare workers and spread awareness. Transparency measures like a public health information system and grievance redressal are recommended to build confidence. Key indicators like maternal mortality rate and infant mortality rate would be monitored to assess the program's effectiveness. The total estimated annual cost is Rs. 10,665 crore with additional costs for community engagement programs and a health information system.
The document discusses Catalonia's transition from a chronic care program to an integrated health and social care model. It describes Catalonia's healthcare system and the aging population it serves. It outlines strategic projects from the 2011-2015 Health Plan including developing integrated care pathways and classifying complex chronic patients. The chronic care program aims to identify these complex patients and develop shared intervention plans incorporating health and social needs. Risk stratification tools are used to segment the population and identify those at high risk of hospitalization. [/SUMMARY]
Martin Bardsley: analysis of virtual wardsNuffield Trust
This document summarizes a presentation on virtual wards, which are a form of case management that integrates health and social care. It describes predictive modeling to identify high-risk patients for virtual ward enrollment and the multidisciplinary staffing of virtual wards. Evaluations of virtual ward programs in different locations found they enrolled complex, high-cost patients but did not consistently reduce emergency admissions or costs in the short-term. Implementing large-scale service changes takes time and hospital use is not the only impact measure of these programs.
This document discusses healthcare challenges in Ghana and India and potential eHealth solutions. In Ghana, there is a focus on increasing healthcare access but physical infrastructure, medical personnel, and unequal rural/urban access remain problems. In India, high private spending, low insurance coverage, and unequal rural/urban access are issues. Potential eHealth solutions discussed include mobile health programs for communication, disease surveillance, and mother/child tracking in Ghana as well as a tele-radiology program and sickle cell screening in India. The document advocates for integrated, patient-centric care delivered across institutional and telehealth solutions to help bridge global healthcare access divides.
Similar to ABCE: Understanding the costs of and constraints to health service delivery in Zambia (20)
1) The document summarizes preliminary findings from a process evaluation of the Salud Mesoamerica Initiative (SMI) which aims to strengthen health systems in Mesoamerica.
2) Key findings include that SMI has improved health facility management, logistics and medical supply availability, information systems, and human resource training.
3) SMI also influenced policies by changing conversations to focus on results and accelerating policy approval processes in Chiapas, Mexico. However, stakeholders disagreed on whether SMI adequately prioritized the poor.
The document summarizes the results of a baseline study conducted as part of the Salud Mesoamérica Initiative, which aims to improve health indicators in Central American and Mexican countries. Key findings from household and health facility surveys in multiple countries are presented. Dried blood spot samples were also collected and tested to estimate measles immunization coverage, identifying gaps between reported vaccination and presence of antibodies. Health facility characteristics associated with discrepancies included lack of internet access and inconsistent receipt of requested vaccine supplies. The study highlights opportunities to strengthen vaccination programs and better measure coverage through biomarkers.
Este estudio evaluó la calidad de la información sobre mortalidad infantil en Yucatán, México entre 2015-2016. El análisis encontró que el sistema de registros vitales mostró buena calidad general pero con problemas en la certificación de causas de muerte, especialmente para neonatos. La concordancia entre registros médicos y estadísticas vitales varió según la causa. La Universidad de Yucatán diseñará intervenciones para mejorar la certificación de muertes infantiles.
The first phase of the “Under-5 Child Health and Mortality Statistics Project” sough to strengthen the evidence and understanding of key factors related to under-5 mortality in Yucatán, Mexico using Verbal Autopsy data collection tools with an added battery on search for care processes for U5 deaths which occurred in Yucatán during 2015-2016, and the triangulation of Verbal Autopsy reports with data from vital registration systems and medical records. This presentation, presented to stakeholders at a results dissemination workshop in October 2017 in Mérida, Yucatán, provides an overview of the project and summarizes key results and learnings from the research.
The second phase of the “Under-5 Child Health and Mortality Statistics Project” sough to strengthen the evidence and understanding of key factors related to under-5 mortality in Yucatán, Mexico through the implementation and evaluation of both community and facility-based interventions, aimed at improving recognition of alarm signs among mothers and caretakers for common causes of death in children and improving the quality of cause of death certification for deaths of children under 5, respectively. This presentation, presented virtually to stakeholders at a results dissemination workshop in January 2021, provides an overview of the project and summarizes key results and learnings from the research.
The Prospective Country Evaluation is an embedded mixed-methods evaluation platform designed to examine the Global Fund business model, investments and contribution to disease program outcomes and impact in eight countries. Findings were synthesized across the 8 countries to provide timely and actionable recommendations to support program improvements and accelerate progress towards the objectives of the Global Fund 2017-2022 Strategy.
Published in The Lancet in November 2018, GBD 2017 provides for the first time an independent estimation of population, for each of 195 countries and territories and the globe, using a standardized, replicable approach, as well as a comprehensive update on fertility. GBD 2017 incorporates major data additions and improvements, using a total of 68,781 data sources in the estimation process.
Expected human capital is a measure that combines education levels, functional health, and learning to assess a population's economic productivity. It is defined as the attributes of a population that contribute to economic growth through technology development and adoption. Expected human capital is calculated for each country by applying age-specific rates of education, health, and learning to demographic data. Higher expected human capital is correlated with higher GDP. Since 1990, many countries have improved their expected human capital through gains in education and health, leading to faster economic growth. Finland currently has the highest expected human capital while Niger, South Sudan and Chad have the lowest.
The document summarizes findings from the Saudi Health Interview Survey (SHIS) conducted in 2013. Some key findings include:
- 15.1% of Saudis ages 15 or older are hypertensive, 40.5% are borderline hypertensive
- 8.5% are hypercholesterolemic and 20% are borderline hypercholesterolemic
- 13.4% are diabetic and 16.3% are borderline diabetic
- 28.7% of Saudis are obese
This document discusses communicating population health data for impact. It notes that population health data from the Global Burden of Disease study can help answer questions about major health problems, diseases causing high mortality, diseases affecting older populations, prioritizing diseases for vaccine research, and the health burden of obesity. The data includes mortality and disability metrics for 301 diseases across 188 countries from 1990 to 2013. The goal is to share this data with global health organizations, governments, researchers, private sector groups, healthcare providers, investors, journalists, and the general public to help inform decision making. It emphasizes tailoring the sharing of data to the right audiences, formats, and timing.
The document discusses vital records and their importance as inputs for measuring population health through studies like the Global Burden of Disease. It describes how the Institute for Health Metrics and Evaluation uses vital registration data from over 130 countries, along with other sources, to measure mortality trends and causes of death globally. Challenges with obtaining and standardizing vital records data are addressed, such as accounting for garbage codes, and opportunities for future collaboration on analyzing vital records at subnational levels in countries like the United States are presented.
The document summarizes key points from the International Open Government Data Conference. It discusses the objectives of the conference, which was to share lessons learned about open government data and demonstrate its power. It also outlines some of the benefits of open data, such as improving accountability and creating economic opportunities. Finally, it emphasizes that successfully implementing open government data requires focusing on creating an ecosystem around the data through activities like skills training, prototyping, and scaling successful projects.
The document summarizes the work of the Institute for Health Metrics and Evaluation (IHME) at the University of Washington. IHME is a global health research institute funded by the Bill & Melinda Gates Foundation that aims to improve population health by providing rigorous analysis and measurements of global health data. IHME manages large quantities of health data from various sources to produce estimates on diseases, risk factors, and measures like disability-adjusted life years. IHME is developing solutions like its Global Health Data Exchange to improve access, transparency, and use of health data through standardized metadata and data sharing.
The document discusses the Global Burden of Disease Study, which systematically analyzes health data from various sources to quantify the global burden caused by diseases, injuries, and risk factors. It describes the four steps of big data analysis used: (1) accessing data from various sources like surveys and medical records, (2) preparing the data for analysis by extracting, correcting biases, and standardizing classifications, (3) analyzing the data using statistical modeling and expert review, and (4) translating the results into academic papers, reports, and interactive data visualizations to share key insights. The study has analyzed data from 187 countries from 1990-2010 to understand health loss by age, sex, and cause.
This document discusses the Global Burden of Disease study conducted by the Institute for Health Metrics and Evaluation. The study analyzes big data on global health to quantify the comparative magnitude of health loss from diseases, injuries, and risk factors by location, age, sex, and over time. It involved collaboration with hundreds of individuals from over 50 countries. The 2012 study, published in The Lancet, analyzed data from 187 countries for 1990, 2005, and 2010 on 291 causes of death, 66 risk factors, and key health metrics.
More from Institute for Health Metrics and Evaluation - University of Washington (20)
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central19various
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central
10 Benefits an EPCR Software should Bring to EMS Organizations Traumasoft LLC
The benefits of an ePCR solution should extend to the whole EMS organization, not just certain groups of people or certain departments. It should provide more than just a form for entering and a database for storing information. It should also include a workflow of how information is communicated, used and stored across the entire organization.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
ABCE: Understanding the costs of and constraints to health service delivery in Zambia
1. Access, Bottlenecks, Costs, and Equity (ABCE):
Understanding the costs of and constraints to
health service delivery in Zambia
On behalf of the ABCE research team
Institute for Health Metrics and Evaluation | University of Zambia
January 2015
2. Overview
• Overview of the ABCE project in Zambia
• Key findings
o Facility capacity and service provision
o Non-HIV patient perspectives
o Efficiency and costs of care
o A focus on HIV: service provision and
patient characteristics
• Using ABCE work and findings for
policymaking
• Conclusions
4. Overview of the ABCE project in Zambia
ABCE study design and implementation
• Collaboration between UNZA and IHME
• Primary data collection
o September 2011 – April 2012
• Three main data collection mechanisms:
o ABCE Facility Survey
o Clinical chart extractions of HIV-positive patients on ART
o Patient Exit Interview Survey
5. Overview of the ABCE project in Zambia
ABCE Facility Survey
• Primary data collection from a
nationally representative sample of
188 facilities
• Collected data on a full range of
indicators
o Inputs, finances, outputs, supply-side
constraints and bottlenecks, indicators
for HIV care
• Randomly sampled a full range of
facility types
o All levels of hospitals, health centers
(urban and rural), health posts, drug
stores or pharmacies, and DHMTs
6. Overview of the ABCE project in Zambia
Clinical chart extraction
• Extracted data on HIV-positive patients currently enrolled in ART
• Chart data included patient demographic information, ART initiation
characteristics (e.g., CD4 cell count, WHO stage, drug regimen, referral points),
and patient outcomes
7. Overview of the ABCE project in Zambia
Patient Exit Interview Survey
• Over 2,700 structured interviews were conducted with patients
after they exited facilities from the ABCE sample.
• Interviewees included patients who sought HIV care and those
who presented at facilities for non-HIV services.
• Questions included reasons for the facility visit, satisfaction with
services, expenses paid associated with the facility visit, and HIV-
specific indicators.
8. Key findings from the ABCE project in Zambia
Facility capacity and service provision
9. Facility capacity and service provision
Availability of health services in 2011-2012
• Relatively high availability of key services across facilities:
o 88% provided family planning
o 86% had a formal immunization program
o 74% had HIV/AIDS care
o 75% stocked ACTs for treating malaria
• Other services remained fairly scarce, particularly at lower levels
of care:
o e.g., nutrition services were available at only 49% of urban health
centers, 38% of rural health centers, and 13% of health posts
10.
11.
12. Facility capacity and service provision
Gaps in reported and full capacity for care
• Many facilities reported providing a given service, but then lacked
the full capacity to provide that service.
o e.g., stocking out of key childhood immunizations or storing vaccines
outside the recommended temperature range
Service
Facilities reporting
capacity
Facilities with four key
childhood vaccines and
proper storage
temperature
Immunization services 86% 53%
13. Facility capacity and service provision
Availability of vaccines and capacity for immunization services
• All private hospitals and 88% of health posts stocked all four key
childhood vaccines (BCG, measles, OPV, pentavalent).
• After private hospitals, health posts and urban health centers had the
lowest levels of any vaccine stock-outs (13% and 15%, respectively).
o Pentavalent was the most commonly stocked-out vaccine.
• Among the 22 districts in the ABCE sample, four did not have any
facilities with a vaccine stock-out at the time of visit: Chadiza, Chama,
Kasempa, and Nyimba.
• Of the facilities that routinely stored vaccines, 28% had refrigerators
operating outside the optimal range (2°C to 8°C).
o More facilities had temperature readings below 2°C than above 8°C.
14. Facility capacity and service provision
Availability of vaccines, by platform, 2011-2012
16. Facility capacity and service provision
Vaccine storage temperature for immunization services, 2011-2012
17. Facility capacity and service provision
Availability of malaria treatment
• Majority of facilities stocked artemisinin-based combination
therapies (ACTs) at the time of facility visit.
o ACT availability ranged from 67% of private health centers to 90% of
level 2 and 3 hospitals.
• Across platforms, 10% of facilities had stocked out of ACTs at the
time of facility visit.
o Private health centers and rural health centers had the highest
proportion of facilities stocking out of ACTs (33% and 14%, respectively).
• Except for private health centers, 10% to 17% of facilities reported
never carrying ACTs.
o This did not vary much by level of care, facility ownership, or urbanicity.
18. Facility capacity for service provision
Availability of ACTs, by platform, 2011-2012
19. Facility capacity and service provision
Availability of modern contraceptives
• Condoms, injectables, and oral contraceptives were the most
widely available modern contraceptives across facilities.
• Excluding private hospitals, at least 70% of facilities offered
condoms and at least one type of female family planning method.
o 96% of rural health centers had these two forms of modern
contraceptives.
• Fewer facilities stocked condoms, at least one type of female
family planning method, and emergency contraceptives.
o Private hospitals and urban health centers had the highest availability of
these three contraceptives (50% of facilities for each platform).
20. Facility capacity for service provision
Availability of modern contraceptives, 2011-2012
21. Facility capacity and service provision
Capacity to test for and treat hypertension
• Most facilities had at least a blood pressure cuff or a type of
medication to treat high blood pressure.
o Level 1 hospitals and private hospitals had the highest capacity for full
case management, with 92% and 83% of facilities, respectively, stocking
antihypertensives and having a blood pressure cuff.
• An urban-rural divide emerged, with 9% of rural health centers
and 18% of health posts lacking both hypertension diagnostics and
treatment.
• A substantial number of private facilities had the diagnostic
equipment for hypertension but lacked antihypertensives –
whereas the opposite was more often true for public and NGO-
owned facilities (i.e., stocked antihypertensives but lacked a blood
pressure cuff).
22. Facility capacity for service provision
Capacity to test for and treat hypertension, 2011-2012
23. Facility capacity and service provision
Availability of and deficiencies in physical capital
• Power supply
o Access to functional electricity was largely divided by location.
Nearly 100% of urban facilities were connected to the energy grid.
38% of rural health centers and 47% of health posts lacked functional electricity.
o 30% of facilities with functional electricity also had a generator.
o About one-third of rural health centers and health posts were powered by
solar power, but none of these facilities had a generator.
• Water and sanitation
o Access to improved water sources varied by location and level of care.
77% of level 1 hospitals had piped water.
12% of health posts lacked any source of water on or near facility grounds.
o Primary waste systems followed an urban-rural divide.
o Nearly all facilities in urban areas had flush toilets.
o Two-thirds of rural health centers and health posts had covered pit latrines, but
about 25% of them also had uncovered pit latrines.
• Transportation and communication
o The majority of primary care facilities lacked emergency transportation and
did not have access to a facility-based phone.
24. Facility capacity and service provision
Availability of and deficiencies in physical capital, 2011-2012
25. Facility capacity and service provision
Availability of equipment across platforms
• Substantial gaps in equipment availability were found across all
facility types.
o 89% of level 2 and 3 hospitals did not have an ECG machine.
o 63% of urban health posts did not have a microscope.
o 53% of health posts lacked equipment to measure blood pressure.
• Private facilities generally had higher availability of equipment
than equivalent facilities in the public sector.
• A subset of facilities had all of the required medical equipment for
their level of care (five health posts, one urban health center, and
one rural health center).
26.
27. Facility capacity and service provision
Human resources for health, 2010
• Non-medical staff accounted for the largest proportion of
personnel across most facilities, ranging from 31% at private
health centers to 48% at level 2 and 3 hospitals.
• Urban facilities generally had more doctors, clinical officers (COs),
nurses, and midwives than rural facilities at the same level of care.
o Urban health centers averaged nine nurses per facility.
o Rural health centers averaged two nurses per facility.
• 62% of health centers had at least two skilled medical personnel
on staff, which was much higher than a 2009 baseline of 47%.
29. Facility capacity and service provision
Human resources for health: health centers, 2010
30. Facility capacity and service provision
Outputs, 2006-2010
• Outpatient visits remained relatively stable over time across
facilities.
o The clear exceptions were health posts and level 2 and 3 hospitals, at
which an average of 10% and 11% annual gains, respectively, in
outpatient visits occurred between 2006 and 2010.
• Inpatient visits gradually increased at most facilities.
o Rural health centers were the exception, with average inpatient visits
decreasing 19% between 2006 and 2010.
• ART visits rapidly rose across platforms from 2006 to 2010.
o There was 279% increase across all facilities.
o This growth was particularly evident among urban health centers, at
which average ART visits nearly quadrupled during this time.
31. Facility capacity and service provision
Outputs: average outpatient visits, by platform, 2006-2010
32. Facility capacity and service provision
Outputs: average inpatient visits, by platform, 2006-2010
33. Facility capacity and service provision
Outputs: average ART visits, by platform, 2006-2010
34. Key findings from the ABCE project in Zambia
Non-HIV patient perspectives
35. Non-HIV patient perspectives
Patient reports of expenses associated with facility visit
• As part of the Patient Exit Interview Survey, patients who did not
seek HIV services reported the types of expenses they had in
association with the facility visit.
• Zambian policy abolished user fees for primary health services and
medical care in rural areas in 2006.
• Based on the ABCE sample, few patients (6%) reported medical
expenses associated with visits to level 1 hospitals, rural health
centers, and health posts.
o Many more patients reported having transportation expenses.
37. Non-HIV patient perspectives
Levels of patient medical expenses
• Of patients who had medical expenses at public and NGO-owned
facilities, the majority spent less than 5 kwacha ($1).
• By contrast, most patients who had medical expenses at private
facilities spent more than 50 kwacha ($9) for care.
38. Efficiency and costs of care
Levels of patient medical expenses, by facility, 2011-2012
39. Non-HIV patient perspectives
Patient wait times at facilities
• A large portion of patients waited at least one hour before
receiving care at public and NGO-owned facilities, while most
patients who sought care at private facilities received care
within an hour.
• At level 2 and 3 hospitals, 53% of patients spent at least two
hours waiting for care. At private hospitals, nearly 60% of
patients received care within 30 minutes.
• A greater proportion of patients received care within one
hour at urban health centers than rural health centers.
41. Non-HIV patient perspectives
Patient ratings of facilities
• Overall, patients gave high ratings for care received across
platforms.
o Private hospitals generally received the highest ratings across all
indicators.
• Patients rated staff interactions highly, especially for provider
respectfulness.
• Patients generally gave lower ratings to facility
characteristics, particularly for wait time.
44. Key findings from the ABCE project in Zambia
Efficiency and costs of care
45. Efficiency and costs of care
Estimating efficiency: Data Envelopment Analysis (DEA)
• DEA: quantifies the relationship between a facility’s resources (medical
staff, beds) and its production of services (outpatient visits, inpatient bed-
days, births, and ART visits) relative to comparably sized facilities in the
ABCE sample.
• Efficiency score: a value between 0% and 100%, reflecting the alignment
of facility resources to service production.
o 100% = maximum use of facility resources for output production
• Outpatient equivalent visits (OEV): weighting different outputs in a
standardized way to allow for direct comparisons across facilities.
o Average across facilities:
Inpatient bed-day = 3.7 outpatient visits
Birth = 10.6 outpatient visits
ART visit = 1.6 outpatient visits
46. Efficiency and costs of care
Average production of outputs across facilities
• Across platforms, facilities averaged a total of 8 outpatient
equivalent visits per medical staff per day, ranging from 3 visits at
private hospitals to 16 visits at health posts.
• Outpatient visits accounted for the largest proportion of patient
visits experienced per medical staff per day at primary care
facilities (health centers and health posts).
• Inpatient bed-days accounted for the largest proportion of patient
visits produced per medical staff per day at hospitals.
• Urban health centers recorded the largest volume of ART visits per
medical staff per day (0.9, as measured in OEV).
47. Efficiency and costs of care
Average production of outputs across facilities, 2010
Note: All visits are in outpatient equivalent visits, with an average of one inpatient bed-day equaling 3.7
outpatient visits; one birth equaling 10.6 outpatient visits; and one ART visit equaling 1.6 outpatient visits.
48. Efficiency and costs of care
Efficiency scores varied across and within platforms
• Across all facilities, the average efficiency score was 42%.
• 70% of facilities had an efficiency score at or less than 50%.
• Average efficiency scores were generally higher at public or NGO-
owned facilities than at private facilities at the same level of care.
• Tremendous range in efficiency scores among non-private facilities:
o At least one facility had an efficiency score of 78% or higher for each platform.
o Multiple facilities had efficiency scores close to 0% for each facility type.
• No consistent relationship between urbanicity and efficiency scores:
o Urban level 2 and 3 hospitals generally had higher efficiency scores than rural
hospitals.
o Rural health centers often had higher efficiency scores than urban health centers.
50. Efficiency and costs of care
Estimated potential for expanded service production
• We estimated that facilities had substantial potential for increasing
output production, especially among private facilities.
• An average of 13 additional visits, measured in OEV, could be
added across facilities, based on observed resources.
• This potential for expanded service production does not reflect
the quality of services delivered; it shows the alignment of facility
resources and output production.
• 14% of facilities in Zambia had an efficiency score of 80% or higher.
o Potential to learn from these facilities to further bolster efficiency.
51. Efficiency and costs of care
Estimated potential for expanded service production, 2010
52. Efficiency and costs of care
Cross-country comparison of efficiency
• Zambia showed less potential for expanded service provision, given
observed resources, than a subset of other countries in the ABCE project.
o Suggests that many Zambian facilities have already increased service
production.
53. Efficiency and costs of care
Estimating costs of care
• Using information produced through DEA, output-specific
spending by facilities was divided by outputs produced by each
facility.
• All cost data were adjusted for inflation and reported in 2010
Zambian kwacha.
o All US dollar estimates were based on the 2010 exchange rate of 5.34
kwacha per $1.
o All estimates were converted to align with the 2013 rebasing of the
kwacha by dividing cost estimates by 1,000.
54. Efficiency and costs of care
Average facility cost per visit, across outputs and by platform
• Facility costs per patient visit varied across platforms and by
output type.
• The average facility cost per outpatient visit was generally the
least expensive to produce, and births were the most expensive.
• Private hospitals generally spent the most per patient visit
produced, whereas health posts and rural health centers generally
produced patient visits at the lowest facility cost per output.
• Aside from births, level 1 hospitals had more similar average costs
per output to costs estimated for health centers than for other
hospitals.
55. Efficiency and costs of care
Average facility cost per visit, across outputs and by platform, 2010
56. Efficiency and costs of care
Cross-country comparison of output costs, 2010
• Zambian facilities averaged the least expensive production cost per
inpatient bed-day, and were on the lower end for outpatient visits
and births.
57. Key findings from the ABCE project in Zambia
A focus on HIV: service provision and patient characteristics
58. HIV service provision and patient characteristics
ART regimen at initiation, 2007-2010
• From 2007 to 2010, there was a continued transition away from
d4T-based ART regimens toward those with a TDF backbone for
ART initiates.
• Zambia was one of the first countries in sub-Saharan Africa to adopt TDF-
based therapies as its first line ARV.
• TDF prescription rates varied across facilities, from 11% to 100% in
2010.
o Health centers generally had slightly higher proportion of ART patients
initiating on TDF-based regimens than hospitals in 2010.
59. HIV service provision and patient characteristics
ART regimen at initiation, 2007-2010
60. HIV service provision and patient characteristics
ART regimen at initiation, by facility, 2010
61. HIV service provision and patient characteristics
Patient clinical characteristics at ART initiation: WHO staging
• There was a gradual shift toward ART initiation at earlier stages of
disease progression between 2007 and 2010.
• In 2007, 31% of patients initiated at WHO stage 1 or 2. In 2010,
53% began treatment at the same stages.
• There was substantial heterogeneity in ART initiation by WHO
stage across facilities in 2010.
o In general, level 2 and 3 hospitals saw a greater proportion of ART
patients starting therapy at WHO stage 1 than health centers.
62. HIV service provision and patient characteristics
WHO stage at initiation, 2007-2010
63. HIV service provision and patient characteristics
WHO stage at initiation, by facility, 2010
64. HIV service provision and patient characteristics
Patient clinical characteristics at ART initiation: CD4 cell count
• A greater proportion of ART patients began therapy at higher CD4
cell counts in 2010 than in 2007.
o In 2007, 34% of patients initiated at a CD4 cell count of 200 cells/mm3
or higher. In 2010, 45% of patients initiated at this level of CD4.
• Median CD4 cell count increased 31%, from 143 cells/mm3 in 2007
to 187 cells/mm3 in 2010.
• A substantial portion of ART patients still began therapy once they
were symptomatic.
o About 10% of patients initiated ART with a CD4 cell count less than 50
cells/mm3 from 2007 to 2010.
65. HIV service provision and patient characteristics
CD4 cell count at initiation, 2007-2010
66. HIV service provision and patient characteristics
Facility availability of patient clinical information
• Testing rates have remained stable over time, indicating that
recordkeeping has increased in parallel with rising ART patient
volumes.
• In 2010, a portion of ART initiates still did not receive key tests.
o 15% lacked a CD4 cell count
o 3% were not assigned a WHO stage
o 3% did not have a weight measurement
o 22% did not have a height measurement
• Much progress was made in administering follow-up tests during
the second year of therapy.
67. HIV service provision and patient characteristics
Facility availability of patient clinical information
68. HIV service provision and patient characteristics
HIV patient reports of expenses associated with visit
• As part of the Patient Exit Interview Survey, patients who sought
HIV services reported the types of expenses they had in
association with their facility visits.
• Zambian national policy stipulates that ART services should be free
at public facilities.
• Based on the ABCE sample, very few HIV patients (< 5%) reported
any medical expenses associated with visits to public facilities.
• More than 30% of HIV patients experienced some kind of
transportation expense at higher-level hospitals and urban health
centers.
69. HIV service provision and patient characteristics
HIV patient reports of expenses associated with visit, 2011-2012
70. HIV service provision and patient characteristics
HIV patient reports of wait times at facilities
• Overall, HIV patients reported relatively long wait times at
facilities and often spent more time waiting than non-HIV
patients at similar facilities.
• This was consistently found across platforms:
o Level 1 hospitals
43% of HIV patients waited at least two hours.
23% of non-HIV patients waited more than two hours.
o Urban health centers
21% of HIV patients received care within one hour.
41% of non-HIV patients received care within one hour.
71. HIV service provision and patient characteristics
HIV patient wait times at facilities, by platform, 2011-2012
72. HIV service provision and patient characteristics
HIV patient ratings of facilities
• Overall, HIV patients gave high ratings for care received
across platforms.
o Nearly 50% of HIV patients gave level 2 and 3 hospitals a 10 out of 10.
• HIV patients generally gave higher ratings, across facility
indicators, than non-HIV patients – except for wait time.
• Like non-HIV patients, HIV patients rated staff interactions
highly, especially for provider respectfulness.
• HIV patients gave high ratings of facility privacy, but rated
wait time very poorly – especially at hospitals.
73. HIV service provision and patient characteristics
HIV patient overall ratings of facilities, by platform, 2011-2012
74. HIV service provision and patient characteristics
Average HIV patient ratings of facility indicators, by platform, 2011-2012
75. HIV service provision and patient characteristics
Efficiency scores for facilities providing ART
• Across facilities with ART, the average efficiency score was 49%.
• ART facilities typically had higher levels of efficiency, compared to
all facilities in the ABCE sample.
• Potential to expand ART patient volumes, especially among level 1
hospitals.
76. HIV service provision and patient characteristics
Efficiency scores for facilities providing ART
77. HIV service provision and patient characteristics
Estimated potential for increased ART visits given resources
• We estimated that many facilities had potential for increasing
annual ART visits.
• Given observed facility resources, we estimated that an average of
9,063 additional ART visits could be added, per facility, each year.
• This gain represents a 117% increase in ART visits from the average
annual ART visits observed in 2010 (7,727 visits).
78. HIV service provision and patient characteristics
Estimated potential for increased ART visits given resources
79. HIV service provision and patient characteristics
Cross-country comparison of ART efficiency
• Zambia showed substantial potential for expanded ART provision,
given observed resources, and at a greater magnitude than Kenya
and Uganda.
80. HIV service provision and patient characteristics
Projected facility ART costs: analytical approach
• Four streams of data were used to project ART costs:
1. Average facility cost per ART visit, excluding ARVs, based on the ABCE
sample
2. Recommended number of annual visits for new and established ART
patients, based on 2010 national guidelines
3. The ARV regimens of ART patients in 2010 extracted from clinical charts
4. The ceiling ARV prices for 2010 published by the Clinton Health Access
Initiative (CHAI)
• Analytical steps for projecting ART costs
1. Visit costs: multiplied average facility cost per ART visit, excluding ARVs, by
the recommended number of annual visits observed for new and
established ART patients.
2. Total costs: using the relative proportion of TDF-, d4T-, and AZT-based
regimens observed for patients, applied the ceiling price for each ARV and
added projected ARV costs to estimated visit costs.
81. HIV service provision and patient characteristics
Projected facility ART costs, 2010
• ARVs accounted for a large portion of projected annual facility
costs for ART, but varied across patient types and platforms.
o New patients
ARVs accounted for 41% of total projected ART costs at level 2 and 3 hospitals.
ARVs accounted for 73% of total projected ART costs at rural health centers.
o Established patients
ARVs accounted for 61% of total projected ART costs at level 2 and 3 hospitals.
ARVs accounted for 86% of total projected ART costs at rural health centers.
• Facility costs for ARVs may be viewed as more stable over time,
whereas visit costs associated with ART services are likely to be
lower for established patients.
o Substantial implications for longer-term ART care and funding sources
82. HIV service provision and patient characteristics
Projected facility costs for ART, 2010
83. HIV service provision and patient characteristics
Cross-country comparison of ART costs, 2010
• Zambian facilities had higher ART costs than the average facility costs
estimated for Kenya and Uganda.
• ARVs accounted for 68% of annual facility costs in Zambia, which is slightly
less than Kenya (71%) and Uganda (73%).
85. Using ABCE for policymaking
Identifying health system progress and challenges
• Provides policymakers with the evidence to pinpoint areas of
success and for improvement as linked to national goals and
priorities.
• Enables direct comparisons across facility types and
ownership, allowing policymakers to contrast facility capacity
in the public sector with that of the private sector.
• Supports the timely use of data to inform policy dialogues.
86. Using ABCE for policymaking
ABCE Zambia policy report
http://www.healthdata.org/dcpn/zambia
88. Conclusions
Facility capacity for service provision
• High availability of a subset of services reflects how Zambia has
expanded service availability throughout the country.
o Family planning, immunization services, HIV/AIDS care, availability of ACTs.
• Substantial gaps in reported capacity and full capacity to provide services
found across all levels of care.
o This was particularly pronounced among primary care facilities and for the
management of NCDs.
• Facility infrastructure and the availability of functional electricity,
improved water, and sanitation systems largely followed an urban-rural
divide.
• All facility types experienced some equipment deficiencies, irrespective
of level of care.
• Non-medical staff generally accounted for the largest proportion of
facility personnel. Urban facilities generally had more skilled medical
personnel than rural facilities.
89. Conclusions
Facility production of health services
• Average patient volumes generally remained stable or gradually
increased over time, whereas ART visits rapidly increased between
2006 and 2010.
• Shortages in human resources and facility overcrowding have been
viewed as widespread; in the ABCE sample, most facilities
averaged fewer than eight visits per medical staff per day.
• Given observed facility resources, service production could be
potentially increased by an additional 13 outpatient equivalent
visits, on average, per facility.
• Annual ART visits could potentially increase as well, but at a larger
magnitude (a 117% gain).
90. Conclusions
Patient perspectives
• Among public facilities in rural areas, few patients reported any
medical expenses associated with their facility visit.
o This reflects Zambia’s prioritization of removing cost barriers to health
services.
• In general, a large portion of patients spent more time waiting at
facilities to receive care than the time they spent traveling to the
facility.
o Given average staffing observed across facilities and patients seen per
medical staff per day, it is unlikely that inadequate human resources are the
main driver of these long wait times.
• Patients gave high ratings of facilities, especially HIV patients.
o Staff interactions were regularly rated higher than facility characteristics.
o Patients gave fairly low ratings of wait time, particularly HIV patients.
91. Conclusions
Facility costs of care
• Average facility cost per patient visit differed substantially
across platforms and types of visits.
• In comparison with a subset of other countries in the ABCE
sample, Zambia had the lowest average facility cost per
inpatient bed-day in 2010.
• On average, ARVs accounted for a large proportion of ART
facility costs, but how much varied based on patient status
(new or established).
o Projected ART facility costs, including ARVs, were generally higher in
Zambia in comparison with Kenya and Uganda, but ARVs contributed
to a smaller portion of overall annual costs in Zambia (68%) than the
other two countries (71% and 73%, respectively).
92. Conclusions
Facility-based provision of ART services
• The shift away from d4T-based ART regimens and toward
TDF continued throughout Zambia – a significant success.
• Gradual progress took place for initiating ART patients at
earlier stages of disease, for both WHO staging and CD4 cell
counts.
• However, a portion of patients still began treatment after
becoming symptomatic in 2010.
• Steady improvements were made in collecting ART patient
clinical data, but too few did not receive key measures and
tests at initiation and during follow-up visits.
o Greater investment in ART patient recordkeeping and data collection
ought to be considered.
93. Conclusions
Priority considerations for future work
• Updated analyses across indicators to assess progress and to identify
areas that may require more investment.
• Targeting a broader set of facilities to capture a clearer picture of levels
and trends in facility performance.
• Linking estimates of efficiency to quality of the services produced at
facilities, as well as other factors.
o e.g., expediency with which patients receive care, demand for increased services
• Updated analyses for ART patient characteristics at initiation, to
determine more recent uptake of new eligibility guidelines.
• Generating estimates of cost effectiveness based on facility delivery of
services and costs of production, and linking to ongoing work on
estimating trends in health outcomes and disease burden.
** MOH goal was to have 60% of all facilities offering nutrition services by 2010; among the facilities in the ABCE sample, 42% had nutrition services in 2011-2012
Additional notes: this is Figure 3 from the ABCE Zambia policy report.
Additional notes: this is Figure 4 from the ABCE Zambia policy report.
Additional notes:
- Most level 2 and 3 hospitals had urban health centers with full stocks of vaccines supporting them or located near them
- Only four facilities stocked individual components of the pentavalent vaccine without the full pentavalent vaccine.
Additional notes:
- Hypertension may be considered one of the easier and least expensive NCDs/NCD-related risk factor to properly diagnose and treat, so it is possible that even fewer facilities are fully equipped to handle more complex conditions (e.g., diabetes, ischemic heart disease, stroke)
Additional notes:
- Results are based on the 2008 MOH guidelines for public facilities and we applied the same standards to private hospitals and private health centers
Additional notes: this is Figure 9 from the ABCE Zambia report.
Additional notes:
- Except for one urban health center, all health centers that didn’t have at least two skilled medical personnel were rural health centers
Additional notes:
- Each circle represents a facility and its number of personnel for 2010. The green vertical bar reflects the average across all facilities within a platform.
Additional notes:
- Each circle represents a facility and its number of personnel for 2010. The green vertical bar reflects the average across all facilities within a platform.
Additional notes:
- Vast majority of non-HIV patients presenting in the public sector did not pay medical expenses (green + yellow indicate no medical expenses – orange + red reflect some type of medical expense)
Additional notes:
- Very low percentage of patients who had medical expenses at rural health centers and level 1 hospitals.
Additional notes:
- Average across all facilities: 42%
- Each circle represents a facility and its efficiency score for a year between 2006 and 2010. The green vertical bar reflects the average across all facilities and years within a platform.
Additional notes:
- All visits are in outpatient equivalent visits, with an average of one inpatient bed-day equaling 3.7 outpatient visits; one birth equaling 10.6 outpatient visits; and one ART visit equaling 1.6 outpatient visits
- We estimated that, on average, facilities could produce an additional 13 outpatient equivalent visits, per facility, based on resources observed in 2010.
Additional notes:
All facility costs per ART visit exclude the costs of ARVs.
In the ABCE sample, only one private health center had ART patients in 2010 (average cost was 56 kwacha [$10]).
Health posts did not provide ART services in our sample.
All facilities
Additional notes:
- Each bar represents a facility and the proportion of ART initiates who started therapy on each regimen in 2010
Could shorten
Additional notes:
- The vast majority of HIV patients did not pay medical expenses (green + yellow indicate no medical expenses – orange + red reflect some type of medical expense)
Average for ART facilities was higher than all facilities, irrespective of ART service provision
Additional notes:
- We had insufficient data to estimate ART costs for private facilities
Additional notes:
*Zambia’s average ART visits per patients were estimated based on Uganda and Kenya.