This document analyzes the costs and benefits of screening and treatment programs for four non-communicable diseases in Andhra Pradesh, India: cardiovascular disease, diabetes, cervical cancer, and breast cancer. It finds that adequately screening and treating these diseases can effectively reduce mortality rates in a cost-effective manner. While costs of the programs are substantial, the economic and health benefits of averted deaths are much greater, resulting in benefit-cost ratios above 1 for cardiovascular disease, diabetes, and cervical cancer screening and treatment. Key interventions like polypill treatment for cardiovascular disease and metformin treatment for diabetes show especially high benefits relative to their costs. Increased funding for primary care-based non-communicable disease programs could generate significant returns on investment.
With a population of nearly 30 million people, WHO estimates that approximately 13% of the population in Ghana suffer from a mental disorder, of which 3% suffer from a severe mental disorder and the other 10% suffer from a moderate to mild mental disorder (WHO, 2007).
In recent years, Ghana, like many other developing countries has been going through an epidemiologic transition where the proportion of deaths from non-communicable diseases is rapidly increasing, particularly cardiovascular related diseases, cancers and diabetes (IHME, 2019).
This second edition of the health system review of Philippines shows the major changes that have occurred over the 7 years since the last review. Channelling of funds from sin tax to Health has shown unprecedented levels of finances are now available for UHC. PhilHealth has dramatically increased coverage of people as well as service providers that it works with from both government and non-government sectors. However major challenges remain; regional and socioeconomic disparities in the availability and accessibility of resources are prominent and there is a need to improve regulation of service providers. Philippines HiT reports on the current health system reforms undertaken including challenges of incorporating primary health care as in the overall health architecture of the country.
This is primarily based on a chapter from our most recent publication.
I want to acknowledge the authors of the chapter:
Melisa Tan, Victoria Haldane, Sue-Anne Toh & Helena Legido-Quigley from NUS
Martin McKee from LSHTM
Summary of the current 4 main NCDs situation in Asia including risk factors
Examples of health system response
Challenges
With a population of nearly 30 million people, WHO estimates that approximately 13% of the population in Ghana suffer from a mental disorder, of which 3% suffer from a severe mental disorder and the other 10% suffer from a moderate to mild mental disorder (WHO, 2007).
In recent years, Ghana, like many other developing countries has been going through an epidemiologic transition where the proportion of deaths from non-communicable diseases is rapidly increasing, particularly cardiovascular related diseases, cancers and diabetes (IHME, 2019).
This second edition of the health system review of Philippines shows the major changes that have occurred over the 7 years since the last review. Channelling of funds from sin tax to Health has shown unprecedented levels of finances are now available for UHC. PhilHealth has dramatically increased coverage of people as well as service providers that it works with from both government and non-government sectors. However major challenges remain; regional and socioeconomic disparities in the availability and accessibility of resources are prominent and there is a need to improve regulation of service providers. Philippines HiT reports on the current health system reforms undertaken including challenges of incorporating primary health care as in the overall health architecture of the country.
This is primarily based on a chapter from our most recent publication.
I want to acknowledge the authors of the chapter:
Melisa Tan, Victoria Haldane, Sue-Anne Toh & Helena Legido-Quigley from NUS
Martin McKee from LSHTM
Summary of the current 4 main NCDs situation in Asia including risk factors
Examples of health system response
Challenges
UNIVERSAL HEALTH COVERAGE IN INDIA-PATH AHEAD -DR HARIVANSH CHOPRAHarivansh Chopra
how to achieve universal health coverage in india .what are the govt initiatives and what more innovations are required to achieve it.what is the status of health manpower specially doctors and supper specialist and how their number can be increased in short time. is double shift in medical colleges is the answer or providing direct md/ms is the answer.the health planner and niti ayoug has to look into all these possibilties. do we need to redefine the definition of primary health care?simply increasing gdp on health can result in the provision of universal health coverage in india ?
According to the Global Burden of Disease (GBD), malaria represents the largest cause of death and morbidity in the country as measured by disability-adjusted life years (DALYs) (IHME, 2019). In 2017, the disease was responsible for around 19,000 deaths, almost as much as the combined death toll from HIV/AIDs and tuberculosis (IHME, 2019).
The People’s Republic of China has made great achievements in improving health status over the past six decades, mainly due to the government’s commitment to health, provision of cost effective public health programmes, growing coverage of health financial protection mechanisms and investments in an extensive health-care delivery network.
Dr Magure investigates the role of health delivery systems and looks at how health can be delivered in the future.
Presented at 'Moving Forward with Pro-poor Reconstruction in Zimbabwe' International Conference, Harare, Zimbabwe, (25 and 26 August 2009)
As the burden of NCDs increases, various countries have introduced new and innovative modes of managing them in primary healthcare setting. APO, in conjunction with Duke Kunshan University, China, conducted a 4-country study (Bangladesh, China, Nepal and Viet Nam) to understand the different approaches used in involving CHWs in preventing and managing NCDs. Access full publication here http://bit.ly/2XnWwcd
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
Localization of Universal Health Coverage for Equitable Health Outcomes in NepalDeepak Karki
Presentation entitled "Localization of Universal Health Coverage for Equitable Health Outcomes in Nepal" by Dr Shiva Raj Adhikari on the 18th Anniversary of Nepalt Health Economics Association.
Paper presented at 'Nepal Development Conference: Views and Visions of Nepali Ph.D. Scholars Residing in the UK for the Development of Nepal' organised by Embassy of Nepal, London, 7 November 2020
Pius Tih Muffih, PhD, MPH, Director, Cameroon Baptist Convention Health Services discusses the organization's Know Your Numbers program, which is a partnership with the local government to screen adults for hypertension and obesity at the 2018 CCIH conference.
UNIVERSAL HEALTH COVERAGE IN INDIA-PATH AHEAD -DR HARIVANSH CHOPRAHarivansh Chopra
how to achieve universal health coverage in india .what are the govt initiatives and what more innovations are required to achieve it.what is the status of health manpower specially doctors and supper specialist and how their number can be increased in short time. is double shift in medical colleges is the answer or providing direct md/ms is the answer.the health planner and niti ayoug has to look into all these possibilties. do we need to redefine the definition of primary health care?simply increasing gdp on health can result in the provision of universal health coverage in india ?
According to the Global Burden of Disease (GBD), malaria represents the largest cause of death and morbidity in the country as measured by disability-adjusted life years (DALYs) (IHME, 2019). In 2017, the disease was responsible for around 19,000 deaths, almost as much as the combined death toll from HIV/AIDs and tuberculosis (IHME, 2019).
The People’s Republic of China has made great achievements in improving health status over the past six decades, mainly due to the government’s commitment to health, provision of cost effective public health programmes, growing coverage of health financial protection mechanisms and investments in an extensive health-care delivery network.
Dr Magure investigates the role of health delivery systems and looks at how health can be delivered in the future.
Presented at 'Moving Forward with Pro-poor Reconstruction in Zimbabwe' International Conference, Harare, Zimbabwe, (25 and 26 August 2009)
As the burden of NCDs increases, various countries have introduced new and innovative modes of managing them in primary healthcare setting. APO, in conjunction with Duke Kunshan University, China, conducted a 4-country study (Bangladesh, China, Nepal and Viet Nam) to understand the different approaches used in involving CHWs in preventing and managing NCDs. Access full publication here http://bit.ly/2XnWwcd
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
Localization of Universal Health Coverage for Equitable Health Outcomes in NepalDeepak Karki
Presentation entitled "Localization of Universal Health Coverage for Equitable Health Outcomes in Nepal" by Dr Shiva Raj Adhikari on the 18th Anniversary of Nepalt Health Economics Association.
Paper presented at 'Nepal Development Conference: Views and Visions of Nepali Ph.D. Scholars Residing in the UK for the Development of Nepal' organised by Embassy of Nepal, London, 7 November 2020
Pius Tih Muffih, PhD, MPH, Director, Cameroon Baptist Convention Health Services discusses the organization's Know Your Numbers program, which is a partnership with the local government to screen adults for hypertension and obesity at the 2018 CCIH conference.
Epidemiology of Non Communicable Diseases (NCDs)Prabesh Ghimire
Declaration: The materials incorporated in this document have come from variety of sources and compiler bears no responsibilities for any information contained herein. The compiler acknowledges all the sources although references have not been explicitly cited for all the contents in this document.
Decision makers in the healthcare field like doctors, patients and policy makers need access to clinical evidence to address issues that have bearing on the health of the population and the treatment prescribed and thereby on the financials implications of the healthcare industry.
Presentation by our Keynote Speaker, Leslie J. Kohman, MD at our Cancer Mission 2020 28th Congressional District Summit in Buffalo, NY. Dr. Kohman is the Professor of Surgery Medical Director at Upstate Cancer Center in Syracuse, NY.
Cost-benefit analysis of Medication Assisted Treatment and Needle-Syringe Pro...Irma Kirtadze M.D.
This presentation was produced by Addiction Research Center Alternative Georgia for the Addiction Research Development in Georgia Project funded by United States Agency for International Development (USAID) and Czech Development Agency (CzDA).
As part of the IFPRI Egypt Seminar in partnership with the National Nutrition Committee (ASRT affiliated): "100 million healthy lives: Scientific evidence on the double burden of malnutrition in Egypt"
Epidemiology./Biostatistics class on lung cancer screening including description of lung cancer, natural history and treatment, lung cancer statistics, lung cancer risk factors, NLST results, NLST follow-on, criteria for a good screening test, USPSTF and CMS lung cancer screening guidelines, and challenges to screening
In Ghana, the prevalence of onsite sanitation is more than 85%. This means that when the receptacles containing the faecal sludge are full they have to be collected and treated before discharging into the environment. Unfortunately, there are very few treatment plants available in the country and fecal sludge is mostly dumped into water bodies, drains, trenches, farms, bushes, and other unauthorized places.
Urban sanitation coverage in Ghana like in many other developing countries is low with only 25% of the people with access to basic sanitation (improved, non-shared sanitation) (Appiah-Effah et al., 2019). Already, poor urban sanitation is strongly linked to increased disease burdens and associated cost (Berendes et al., 2018; Prüss-Ustün et al., 2019).
The Accra Metropolitan Area (AMA) is suffering from a major urban infrastructure gap. The region’s increasing economic growth has triggered rapid urbanization, characterized by expansion of built-up environment – roads, parking lots, and other structures with impervious surfaces that do not allow water to infiltrate easily so as to replenish the water table.
The economic growth literature suggests that the volume of infrastructure stock as well as its quality positively and impacts economic growth by, among others, decreasing the cost of production and transportation of goods and services, improving the productivity of input factors, and creating indirect positive externalities.
Poverty remains a problem. There is an overall reduction in national poverty over the last 3 decades, but this masks the persistent spatial concentration of poverty and high inequality.
Poverty remains a problem in Ghana. There is an overall reduction in national poverty over the last 3 decades, but this masks the persistent spatial concentration of poverty and high inequality.
Integration of the youth (15- to 34-year-olds) in Ghana, who represents 35 percent of the population, into full and productive employment can be an important driver for growth and sustained development. The inability to improve labor productivity in the country continues to limit the performance of firms and enterprises across different economic sectors.
Over 1.6 million people died globally in 2017 from harmful exposure to PM2.5 emissions from household use of solid fuels such as wood, coal, charcoal, and agricultural residues for cooking according to estimates by the Global Burden of Disease 2017 (GBD 2017) Project.
Although the free senior high school (SHS) policy has greatly increased enrolment, it has led to a mismatch in the demand for secondary education and the available educational infrastructure. The double-track system was introduced to circumvent this hurdle.
Ghana has made great strides in education enrolment in the MDG and SDG era, with near universal primary school enrolment and equality between boys and girls (World Bank, 2019).
TB is responsible for around 5 percent of total deaths in Ghana annually, and the decline in TB burden is markedly slow, with an average 2.5 percent reduction in TB incidence year on year (GTB 2018).
Over the last three decades, Ghana has invested large amounts of effort in implementing various strategies to reduce maternal and child mortality in the country.
The health status of Ghanaians has evolved over time, from predominant inflictions from infectious diseases and negative maternal and child health outcomes that prevailed at the time of independence in the late 1950s, to the addition of non-communicable diseases (NCDs) such as hypertension, stroke, diabetes, cancers, etc. that prevail in present times.
ZGB - The Role of Generative AI in Government transformation.pdfSaeed Al Dhaheri
This keynote was presented during the the 7th edition of the UAE Hackathon 2024. It highlights the role of AI and Generative AI in addressing government transformation to achieve zero government bureaucracy
Many ways to support street children.pptxSERUDS INDIA
By raising awareness, providing support, advocating for change, and offering assistance to children in need, individuals can play a crucial role in improving the lives of street children and helping them realize their full potential
Donate Us
https://serudsindia.org/how-individuals-can-support-street-children-in-india/
#donatefororphan, #donateforhomelesschildren, #childeducation, #ngochildeducation, #donateforeducation, #donationforchildeducation, #sponsorforpoorchild, #sponsororphanage #sponsororphanchild, #donation, #education, #charity, #educationforchild, #seruds, #kurnool, #joyhome
Understanding the Challenges of Street ChildrenSERUDS INDIA
By raising awareness, providing support, advocating for change, and offering assistance to children in need, individuals can play a crucial role in improving the lives of street children and helping them realize their full potential
Donate Us
https://serudsindia.org/how-individuals-can-support-street-children-in-india/
#donatefororphan, #donateforhomelesschildren, #childeducation, #ngochildeducation, #donateforeducation, #donationforchildeducation, #sponsorforpoorchild, #sponsororphanage #sponsororphanchild, #donation, #education, #charity, #educationforchild, #seruds, #kurnool, #joyhome
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Given the small scale of housing associations and their relative high cost per home what is the point of them and how do we justify their continued existance
Russian anarchist and anti-war movement in the third year of full-scale warAntti Rautiainen
Anarchist group ANA Regensburg hosted my online-presentation on 16th of May 2024, in which I discussed tactics of anti-war activism in Russia, and reasons why the anti-war movement has not been able to make an impact to change the course of events yet. Cases of anarchists repressed for anti-war activities are presented, as well as strategies of support for political prisoners, and modest successes in supporting their struggles.
Thumbnail picture is by MediaZona, you may read their report on anti-war arson attacks in Russia here: https://en.zona.media/article/2022/10/13/burn-map
Links:
Autonomous Action
http://Avtonom.org
Anarchist Black Cross Moscow
http://Avtonom.org/abc
Solidarity Zone
https://t.me/solidarity_zone
Memorial
https://memopzk.org/, https://t.me/pzk_memorial
OVD-Info
https://en.ovdinfo.org/antiwar-ovd-info-guide
RosUznik
https://rosuznik.org/
Uznik Online
http://uznikonline.tilda.ws/
Russian Reader
https://therussianreader.com/
ABC Irkutsk
https://abc38.noblogs.org/
Send mail to prisoners from abroad:
http://Prisonmail.online
YouTube: https://youtu.be/c5nSOdU48O8
Spotify: https://podcasters.spotify.com/pod/show/libertarianlifecoach/episodes/Russian-anarchist-and-anti-war-movement-in-the-third-year-of-full-scale-war-e2k8ai4
2. Communicable,
maternal,
perinatal and
nutritional
conditions
37%
Injuries
10% CVD
24%
Cancers
6%
Respiratory
diseases
11%
Other NCDs Diabetes
10% 2%
NCDs are estimated to account for 53% of all deaths.
NCD mortality
2008 estimates males females
Total NCD deaths (000s) 2967.6 2273.8
NCD deaths under age 60 38.0 32.1
(percent of all NCD deaths)
Age-standardized death rate per 100 000
All NCDs 781.7 571.0
Cancers 78.8 71.8
Chronic respiratory diseases 178.4 125.5
Cardiovascular diseases and diabetes 386.3 283.0
Why Non-Communicable Disease ?
Morbidity due to non-communicable disease (NCDs) increased
significantly
World Health Organization - NCD Country Profiles , 2011.
3.
4. NCDs Targeted for Intervention
In line with the National Program for Prevention and
Control of Cancer, Diabetes, CVD and Stroke (NPCDCS)
- CVD:
- Diabetes:
- Cervical Cancer:
- Breast Cancer:
Four Interventions:
5. Burden in Andhra Pradesh - 4 interventions
1990 2016
CVD 4878.26 5960.02
Diabetes 1559 1859
Cervical Cancer 113.52 89.97
Breast Cancer 82.89 121.69
DALYs per100000
Interventions
6. 1. CVD: Secondary Prevention with
Multidrug Polypill
• Target: To screen 70% of all persons aged 30-69
for CVD
• Objective: To identify those who are at high risk of
CVD or with existing CVD
• Intervention: To treat identified persons with a
multidrug polypill, achieving 60% adherence to
treatment
• Outcome: Averting about 20% of CVD mortality
7. 2. Diabetes screening and treatment with
Metformin therapy
• Target: To screen all persons aged 30-
69 for diabetes
• Objective: To identify those who are at
high risk of diabetes
• Intervention: Achieve 50% coverage of
the target group annually, and 65%
adherence to Metformin treatment
• Outcome: Avoidance of diabetes in
about 30% of high risk individuals
8. 3. Cervical Cancer screening with VIA/VILI
• Target: To screen women in the age group 30-
69 one through VIA/VILI
• Objective: To identify women with lesions and
provide appropriate follow-up referral/treatment
• Intervention: To cover 30% of women in the
target group annually for the first 3-4 years, and
women entering the cohort in subsequent years
• Outcome: Averting about 35% of deaths through
screening and early detection
9. 4. Breast Cancer screening through CBE
• Target: Women in the age group 30-69
• Objective: To screen eligible women through
biennial Clinical Breast Exam (CBE)
• Intervention: To cover 50% of women in the target
group annually each year, eventually achieving
100% coverage of this age group
• Outcome: Averting about 16% of deaths through
screening and early detection
11. Cost Estimates
• Cost estimates based on secondary data sources
generated in similar contexts, extrapolated to
2018-2030
• The total costs include private costs of seeking
out-patient care, treatment costs and opportunity
costs of lost wages
• The aggregated costs were then applied to the
total target population and then discounted at 3%,
5% and 8%
12. Benefits
• Benefits were estimated based on the number of deaths
averted by the selected intervention, the estimated number
of years of life saved, multiplied by the value of one YLL
• Total deaths due to each selected disease for the specified
target population were estimated from the Global Burden of
Disease 2017
• Proportion of deaths possible to be averted were estimated
based on the available evidence in the literature
13. Intervention Costs
30-69 Population
70%
coverage
for CVD
Hypertensi
on
prevalence
Number
of cases
detected
60% adherence
to treatment
regimen
(Polypill)
Cost per
person
treated (Rs.)
Total cost 2017
(Rs.)
Male 9404990 6583493 0.164 1079693 647816 4107.7 2,661,032,679
Female 9036167 6325317 0.1 632532 379519 3958.7 1,502,401,944
10% screeing (Male) 5935677 292 1733217822
10% screeing (Female) 5945798 143 850249111
6,746,901,556
30-69
Populati
on
50%
screening
coverage
Diabetes
prevalence
Screening
cases
65%
Metoformin
treatment
Cost per
person
treated (Rs.)
Total cost 2017
(Rs.)
Male 9404990 4702495 0.157 738292 479890 2,103.03 1,009,222,288
Female 9036167 4518084 0.131 591869 384715 1,954.03 751,744,292
1,760,966,580
30% (OF 65% Metoformin treatment - Male) 143967 1,811.03 260,728,355
30% (OF 65% Metoformin treatment - Female) 115414 1,811.03 209,019,022
469,747,377
Intervention 1 - CVD
Intervention 2 - Diabetes
TOTAL
TOTAL
TOTAL
14. Intervention Costs
Screening one
time with
VIA/VILI
cost per
person 2017
(Rs.)
Total cost 2017
(Rs.)
Female 9036167 30% screening (3 yrs) 2710850 2813.1 7,625,892,536
5% next 10Yrs 451808 2813.1 1,270,982,089
Cryosurgery for 10% of women (Poli et al 2015)271085 2332.76 632,376,278
Cryosurgery for 3% of 5% 13554 2332.76 31,618,813
Total cost 1st 3years 8,258,268,814
From 4th Year 1,302,600,903
Female 9036167 50% coverage 4518084 550.13 2,485,533,314.79
Intervention 3 - Cervic Cancer
Intervention 4 - Breast Cancer
30-69 Population
21. Key Takeaways
• Adequate coverage of screening and treatment services at the
primary level can detect NCDs early and reduce treatment
costs
• It can also avert a large number of deaths in a cost-effective
manner
• Funding for NCD screening and treatment programs need to be
scaled-up substantially, and spent effectively at the primary
care level
• These findings could provide important inputs for the
decentralized health planning and monitoring recommended by
the National Health Policy 2017 and the NITI Aayog Action
Agenda 2017–2020.
22. Data Sources
1. Target population - India’s 2011 census age-specific data - Ministry of
Home Affairs website (data.gov.in).
2. Death and YLD numbers - Global Burden of Disease Study (2016) -
Institute for Health Metrics and Evaluation (IHME) University of
Washington, Seattle. http://www.hehalthdata.org/gbd/data
3. Data on burden of risk factors (hypertension, blood sugar levels) -
National Family Health Survey, NFHS -4
http://rchiips.org/NFHS/pdf/NFHS4/RJ_FactSheet.pdf.
4. Data on the private costs of health - National Sample Survey (NSS)
71st Round (2014) http://mospi.nic.in/.
23. Data Sources
Estimates of unit costs / deaths averted
a) Chow et al (Chow J, Darley S, Laxminarayan R. Cost-
effectiveness of disease interventions in India.
RFP DP 07-53, Resources for the Future, Washington DC;
2007).
(b) Nugent R. Benefits and costs of the NCD targets for the
post-2015 development agenda. Perspective paper,
Copenhagen Consensus Center (updated January 6, 2017);
(c) Gelband H, Jha P, Sankanarayanan R and Horton S. Cancer.
Disease Control Priorities Project – 3, 2016