Integrated care for people with long-term mental and physical health conditions in low-income and middle-income countries

ObjectivesTo assess the effects of integrated models of care for people with multimorbidity including at least diabetes or hypertension in low-income and middle-income countries (LMICs) on health and process outcomes.DesignSystematic review.Data sourcesWe searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, LILACS, Africa-Wide, CINAHL and Web of Science up to 12 December 2019.Eligibility criteriaWe included randomised controlled trials (RCTs), non-RCTs, controlled before-and-after studies and interrupted time series (ITS) studies of people with diabetes and/or hypertension plus any other disease, in LMICs; assessing the effects of integrated care.Data extraction and synthesisTwo authors independently screened retrieved records; extracted data and assessed risk of bias. We conducted meta-analysis where possible and assessed certainty of evidence using Grading of Recommendations Assessment, Development and Evaluation.ResultsOf 7568 records, we included five studies—two ITS studies and three cluster RCTs. Studies were conducted in South Africa (n=3), Uganda/Kenya (n=1) and India (n=1). Integrated models of care compared with usual care may make little or no difference to mortality (very low certainty), the number of people achieving blood pressure (BP) or diabetes control (very low certainty) and access to care (very low certainty); may increase the number of people who achieve both HIV and BP/diabetes control (very low certainty); and may have a very small effect on achieving HIV control (very low certainty). Interventions to promote integrated delivery of care compared with usual care may make little or no difference to mortality (very low certainty), depression (very low certainty) and quality of life (very low certainty); and may have little or no effect on glycated haemoglobin (low certainty), systolic BP (low certainty) and total cholesterol levels (low certainty).ConclusionsCurrent evidence on the effects of integrated care on health outcomes is very uncertain. Programmes and policies on integrated care must consider context-specific factors related to health systems and populations.PROSPERO registration numberCRD42018099314.

Download Full-text

Caregivers’ Mental Health and Somatic Symptoms During COVID-19

The Journals of Gerontology Series B ◽

10.1093/geronb/gbaa121 ◽

2020 ◽

Cited By ~ 2

Author(s):

Sung S Park

Keyword(s):

Mental Health ◽

Physical Health ◽

Negative Binomial ◽

Somatic Symptoms ◽

Health Conditions ◽

Group Differences ◽

Short Term ◽

The Impact ◽

Mental And Physical Health

Abstract Objectives This study examines differences in the mental and physical health of the U.S. population during the early stages of the COVID-19 pandemic among 3 groups: noncaregivers, short-term caregivers (1 year or less), and long-term caregivers (greater than 1 year). Methods Data from the Understanding America Study are used to describe group differences in reports of psychological distress and somatic symptoms. Logistic and negative binomial regression models are used to examine whether these differences persist after adjusting for demographic, socioeconomic, and prepandemic health conditions. To understand within-group differences in caregiving demands, the intensity of care provided by short-term and long-term caregivers, as well as selected patients’ health conditions are summarized. Results Adults’ mental and physical health varied substantially by caregiver status. Caregivers continued to fare worse than noncaregivers in terms of mental health and fatigue, and long-term caregivers were more likely to report headache, body aches, and abdominal discomfort than both short-term caregivers and noncaregivers, net of controls. The nature of caregiving differed between short-term and long-term caregivers, with the latter more likely to provide greater hours of care, and to be looking after patients with permanent medical conditions. Discussion Efforts to understand and mitigate the impact of the pandemic on population health should include caregivers, whose mental and physical health were already vulnerable before COVID-19.

Download Full-text

Coping with healthcare costs for chronic illness in low-income and middle-income countries: a systematic literature review

BMJ Global Health ◽

10.1136/bmjgh-2019-001475 ◽

2019 ◽

Vol 4 (4) ◽

pp. e001475 ◽

Cited By ~ 4

Author(s):

Adrianna Murphy ◽

Catherine McGowan ◽

Martin McKee ◽

Marc Suhrcke ◽

Kara Hanson

Keyword(s):

Chronic Illness ◽

Coping Strategies ◽

Low Income ◽

Financial Risk ◽

Long Term Effects ◽

Financial Risk Protection ◽

Middle Income ◽

Middle Income Countries ◽

Risk Protection

BackgroundExperiencing illness in low-income and middle-income countries (LMICs) can incur very high out-of-pocket (OOP) payments for healthcare and, while the existing literature typically focuses on levels of expenditure, it rarely examines what happens when households do not have the necessary money. Some will adopt one or more ‘coping strategies’, such as borrowing money, perhaps at exorbitant interest rates, or selling assets, some necessary for their future income, with detrimental long-term effects. This is particularly relevant for chronic illnesses that require consistent, long-term OOP payments. We systematically review the literature on strategies for financing OOP costs of chronic illnesses in LMICs, their correlates and their impacts on households.MethodsWe searched MEDLINE, EconLit, EMBASE, Global Health and Scopus on 22 October 2018 for literature published on or after 1 January 2000. We included qualitative or quantitative studies describing at least one coping strategy for chronic illness OOP payments in a LMIC context. Our narrative review follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines.ResultsForty-seven papers were included. Studies identified coping strategies for chronic illness costs that are not traditionally addressed in financial risk protection research (eg, taking children out of school, sending them to work, reducing expenditure on food or education, quitting work to give care). Twenty studies reported socioeconomic or other correlates of coping strategies, with poorer households and those with more advanced disease more vulnerable to detrimental strategies. Only six studies (three cross-sectional and three qualitative) included evidence of impacts of coping strategies on households, including increased labour to repay debts and discontinuing treatment.ConclusionsMonitoring of financial risk protection provides an incomplete picture if it fails to capture the effect of coping strategies. This will require qualitative and longitudinal research to understand the long-term effects, especially those associated with chronic illness in LMICs.

Download Full-text

40 years after Alma-Ata, is building new hospitals in low-income and lower-middle-income countries beneficial?

BMJ Global Health ◽

10.1136/bmjgh-2018-001293 ◽

2019 ◽

Vol 3 (Suppl 3) ◽

pp. e001293 ◽

Cited By ~ 1

Author(s):

Fanny Chabrol ◽

Lucien Albert ◽

Valéry Ridde

Keyword(s):

Low Income ◽

Environmental Sustainability ◽

Public Hospitals ◽

Decision Makers ◽

Middle Income ◽

Middle Income Countries ◽

Geographical Inequalities ◽

Urban Rural ◽

Hospital Construction

Public hospitals in low-income and lower-middle-income countries face acute material and financial constraints, and there is a trend towards building new hospitals to contend with growing population health needs. Three cases of new hospital construction are used to explore issues in relation to their funding, maintenance and sustainability. While hospitals are recognised as a key component of healthcare systems, their role, organisation, funding and other aspects have been largely neglected in health policies and debates since the Alma Ata Declaration. Building new hospitals is politically more attractive for both national decision-makers and donors because they symbolise progress, better services and nation-building. To avoid the ‘white elephant’ syndrome, the deepening of within-country socioeconomic and geographical inequalities (especially urban–rural), and the exacerbation of hospital-centrism, there is an urgent need to investigate in greater depth how these hospitals are integrated into health systems and to discuss their long-term economic, social and environmental sustainability.

Download Full-text

Tenofovir resistance in early and long-term treated patients on first-line antiretroviral therapy in eight low-income and middle-income countries

AIDS ◽

10.1097/qad.0000000000002623 ◽

2020 ◽

Vol 34 (13) ◽

pp. 1965-1969

Author(s):

Seth C. Inzaule ◽

Michael R. Jordan ◽

Amandine Cournil ◽

Amalia Girón-Callejas ◽

Santiango Avila-Rios ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Low Income ◽

First Line ◽

Middle Income ◽

Middle Income Countries

Download Full-text

Investigating equalisation of health inequalities during adolescence in four low-income and middle-income countries: an analysis of the Young Lives cohort study

BMJ Open ◽

10.1136/bmjopen-2018-022114 ◽

2018 ◽

Vol 8 (9) ◽

pp. e022114 ◽

Cited By ~ 1

Author(s):

Joseph L Ward ◽

Russell M Viner

Keyword(s):

Health Inequalities ◽

Low Income ◽

Health Indicators ◽

Wealth Index ◽

Middle Income ◽

Socioeconomic Gradients ◽

Middle Income Countries ◽

Multiple Health ◽

Young Lives

ObjectiveTo investigate if socioeconomic gradients in health reduce during adolescence (the equalisation hypothesis) in four low-income and middle-income countries (LMIC).SettingAnalysis of the Young Lives Study cohorts in Ethiopia, Peru, Vietnam and India.ParticipantsA total of 3395 participants (across the four cohorts) aged 6–10 years at enrolment and followed up for 11 years.Outcomes measuredChange in income-related health inequalities from mid-childhood to late adolescence. Socioeconomic status was determined by wealth index quartile. The health indicators included were self-reported health, injuries in the previous 4 years, presence of long-term health problems, low mood, alcohol use, overweight/obesity, thinness and stunting. The relative risk of each adverse health outcome between highest and lowest wealth index quartile were compared across four waves of the study within each country.ResultsWe found steep socioeconomic gradients across multiple health indicators in all four countries. Socioeconomic gradients remained similar across all waves of the study, with no significant decrease during adolescence.ConclusionWe found no consistent evidence of equalisation for income-related health inequalities in youth in these LMIC. Socioeconomic gradients for health in these cohorts appear to persist and be equally damaging across the early life course and during adolescence.

Download Full-text

Performance-based financing in low-income and middle-income countries: isn’t it time for a rethink?

BMJ Global Health ◽

10.1136/bmjgh-2017-000664 ◽

2018 ◽

Vol 3 (1) ◽

pp. e000664 ◽

Cited By ~ 47

Author(s):

Elisabeth Paul ◽

Lucien Albert ◽

Badibanga N’Sambuka Bisala ◽

Oriane Bodson ◽

Emmanuel Bonnet ◽

...

Keyword(s):

Low Income ◽

Health Sector ◽

Policy Dialogue ◽

Open Approach ◽

Long Term Effects ◽

Middle Income ◽

Middle Income Countries ◽

Performance Based Financing ◽

Entry Points

This paper questions the view that performance-based financing (PBF) in the health sector is an effective, efficient and equitable approach to improving the performance of health systems in low-income and middle-income countries (LMICs). PBF was conceived as an open approach adapted to specific country needs, having the potential to foster system-wide reforms. However, as with many strategies and tools, there is a gap between what was planned and what is actually implemented. This paper argues that PBF as it is currently implemented in many contexts does not satisfy the promises. First, since the start of PBF implementation in LMICs, concerns have been raised on the basis of empirical evidence from different settings and disciplines that indicated the risks, cost and perverse effects. However, PBF implementation was rushed despite insufficient evidence of its effectiveness. Second, there is a lack of domestic ownership of PBF. Considering the amounts of time and money it now absorbs, and the lack of evidence of effectiveness and efficiency, PBF can be characterised as a donor fad. Third, by presenting itself as a comprehensive approach that makes it possible to address all aspects of the health system in any context, PBF monopolises attention and focuses policy dialogue on the short-term results of PBF programmes while diverting attention and resources from broader processes of change and necessary reforms. Too little care is given to system-wide and long-term effects, so that PBF can actually damage health services and systems. This paper ends by proposing entry points for alternative approaches.

Download Full-text

Tax Composition and Growth: A Broad Cross-country Perspective

German Economic Review ◽

10.1111/geer.12156 ◽

2019 ◽

Vol 20 (4) ◽

pp. e70-e106

Author(s):

Santiago Acosta-Ormaechea ◽

Sergio Sola ◽

Jiae Yoo

Keyword(s):

Low Income ◽

Income Taxes ◽

Low Income Countries ◽

Property Taxes ◽

Middle Income ◽

Middle Income Countries ◽

Long Run ◽

Development Levels ◽

Broad Cross Section

Abstract We investigate how changes in the composition of tax revenue affect long-run growth in a broad cross-section of countries. To do this, we construct a new dataset that covers 70 countries (23 high-, 23 middle- and 24 low-income countries), with at least 20 years of observations during the period 1970-2009. In the context of revenue-neutral reallocations, we find that increasing consumption and property taxes while reducing income taxes boosts long-term growth. Among income taxes, we find that social security contributions and personal income taxes tend to have a stronger negative association with growth relative to corporate income taxes. Results, however, depend on countries’ development levels, suggesting nonlinearities in the relation between taxes and growth even after controlling for convergence effects. Although results are robust for high- and middle-income countries, these are generally not significant for low-income countries.

Download Full-text