scholarly journals Is the elimination of ‘sleeping sickness’ affordable? Who will pay the price? Assessing the financial burden for the elimination of human African trypanosomiasis Trypanosoma brucei gambiense in sub-Saharan Africa

2019 ◽  
Vol 4 (2) ◽  
pp. e001173 ◽  
Author(s):  
C Simone Sutherland ◽  
Fabrizio Tediosi
Keyword(s):  
Financial Risk ◽  
Human African Trypanosomiasis ◽  
Financial Burden ◽  
Direct Costs ◽  
Sub Saharan Africa ◽  
Financial Risk Protection ◽  
Trypanosoma Brucei Gambiense ◽  
Elimination Programme ◽  
Sub Saharan ◽  
Risk Protection

IntroductionProgramme to eliminate neglected tropical diseases (NTDs) have gained global recognition, and may allow for improvements to universal health coverage and poverty alleviation. It is hoped that elimination of human African trypanosomiasis (HAT) Trypanosoma brucei gambiense (Tbg) would assist in this goal, but the financial costs are still unknown. The objective of this analysis was to forecast the financial burden of direct costs of HAT Tbg to funders and society.MethodsIn order to estimate the total costs to health services and individuals: (1) potential elimination programmes were defined; (2) the direct costs of programmes were calculated; (3) the per case out-of-pocket payments (OOPs) by programme and financial risk protection indicators were estimated. The total estimated costs for control and elimination programme were reported up till 2020 in international dollars. The mean results for both direct programme costs and OOPs were calculated and reported along with 95% CIs.ResultsAcross sub-Saharan Africa, HAT Tbg maintaining ‘Control’ would lead to a decline in cases and cost US$630.6 million. In comparison, the cost of ‘Elimination’ programme ranged from US$410.9 million to US$1.2 billion. Maintaining ‘Control’ would continue to cause impoverishment and financial hardship to households; while all ‘Elimination’ programme would lead to significant reductions in poverty.ConclusionOverall, the total costs of either control or elimination programme would be near US$1 billion in the next decade. However, only elimination programme will reduce the number of cases and improve financial risk protection for households who are impacted by HAT Tbg.

scholarly journals Assessing and coping with the financial burden of Computed Tomography utilization in Limbe, Cameroon: a sequential explanatory mixed-methods study.

2020 ◽  
Author(s):  
Joshua Tambe ◽  
Lawrence Mbuagbaw ◽  
Pierre Ongolo-Zogo ◽  
Georges Nguefack-Tsague ◽  
Andrew Edjua ◽  
...  
Keyword(s):  
Low Socioeconomic Status ◽  
Financial Risk ◽  
Financial Burden ◽  
Multivariable Analysis ◽  
Financial Hardship ◽  
Financial Risk Protection ◽  
Low Socioeconomic ◽  
Ct Utilization ◽  
Explanatory Mixed Methods ◽  
Risk Protection

Abstract Background: Out-of-pocket (OOP) payments for healthcare services leads to unequal access to care with many not able to seek care or suffer catastrophic health expenditure and impoverishment. The cost of healthcare is on the rise and technological innovations in medical imaging are partly responsible. In this study we assess the risk of financial hardship after Computed Tomography (CT) utilization in a health facility in Cameroon and elaborate on how users adapt and cope.Methods: We carried out a sequential explanatory mixed methods study with a quantitative hospital-based survey of CT users followed by an in-depth interview of some purposively selected participants who reported risk of financial hardship after CT utilization. Data was summarized using frequencies, percentages and 95% confidence intervals. Logistic regression was used in multivariable analysis to determine predictors of risk of financial hardship. Identified themes from in-depth interviews were categorized. Quantitative and qualitative data were integrated.Results: A total of 372 participants were surveyed with a male to female sex ratio of 1:1.2. The mean age (standard deviation) was 52(17) years. CT scans of the head and facial bones accounted for 63% (95%CI: 59%, 68%) and the top three indications were suspected stroke (27% [95%CI: 22%, 32%]), trauma (14% [95%CI: 10%, 18%]) and persistent headaches with blurred vision (14% [95%CI: 10%, 18%]). Seventy-two percent (95%CI: 67%, 76%) of respondents declared being at risk of financial hardship after CT utilization and predictors in the multivariable analysis were low socioeconomic status (aOR: 0.19 [95%CI: 0.10, 0.38]; p<0.001) and not having any form of financial risk protection (aOR: 3.59 [95%CI: 1.31, 9.85]; p=0.013). Coping strategies included relying on family members and friends for financial assistance, lobbying hospital administration, social services and healthcare staff for a reduction of the direct cost, and borrowing of money.Conclusion: Lack of financial risk protection and a low socioeconomic status are associated with risk of financial hardship after CT utilization and diverse coping strategies are engaged to minimize the financial burden. Reducing OOP payments for CT scans and/or the direct cost will reduce this hardship and improve access to CT.

Public Insurance and Financial Risk Protection: Lessons from Thailand

2010 ◽  
Author(s):  
Phusit Prakongsai ◽  
Vuthiphan Vongmomgkol ◽  
Warisa Panich-Kriangkrai ◽  
Walaiporn Patcharanarumol ◽  
Viroj Tangcharoensathien
Keyword(s):  
Financial Risk ◽  
Financial Risk Protection ◽  
Public Insurance ◽  
Risk Protection

Making Thailand’s UHC ‘SAFE’ (sustainable, affordable, fair and efficient)

2020 ◽  
Vol 20 (2) ◽  
pp. 231-236
Author(s):  
Somsak Chunharas
Keyword(s):  
Health Services ◽  
Financial Risk ◽  
National Development ◽  
Financial Risk Protection ◽  
Thai Population ◽  
Health Security ◽  
Strategic Purchasing ◽  
Strategic Approach ◽  
Public Sector Health ◽  
Risk Protection

Thai UHC has been established through national efforts to learn from international as well as national development of how to build a system-wide financial risk protection for the Thai population while also ensuring effective coverage of health services. One of the key strategic approach is establishing a strategic purchasing organization called national health security office (NHSO) since 2002. Many lesson have been learnt and shared here hoping that they are generic enough to guide actions and policy decisions either for countries starting UHC or those who have had some models going on. For example, a professionally run strategic purchasing body with certain degree of autonomy is key but the needs to harmonize multiple schemes are also challenging, technically as well as politically. The effective use of and support for existing public sector health services systems is another key lesson. The challenge of making the systems sustainable, affordable fair and efficient have been with us since the very beginning and we shares some of the approaches to address this issue to ensure that UHC will be properly supported politically, professionally managed while maintaining a well balanced demand side with the view to ensure that UHC is creating better health and not merely more access to services.

scholarly journals Spatiotemporal variation and socioeconomic factors of financial hardships of out-of-pocket health expenditure in Pakistan

2021 ◽  
Vol 27 (10) ◽  
pp. 962-973
Author(s):  
Ashar Muhammad Malik ◽  
Iqbal Azam ◽  
Amir Khan ◽  
Faisal Rifaq ◽  
Kinza Chaudhary
Keyword(s):  
Socioeconomic Factors ◽  
Rural Areas ◽  
Health Expenditure ◽  
Financial Risk ◽  
National Level ◽  
Spatiotemporal Variation ◽  
Financial Risk Protection ◽  
Middle Income ◽  
Services Delivery ◽  
Risk Protection

Background: Financial hardships of out-of-pocket health expenditure (OPHE) is a growing concern for health policy makers in many low and middle-income countries. Spatiotemporal variation between Pakistan’s four provinces over 2001-2015 is discussed, which would help comparing existing health services delivery and financial risk protection plans. Aims: In this paper, we estimate financial hardship of OPHE in Pakistan. Methods: We use the data sets of the household integrated economic surveys 2001-02, 2005-06, 2010-11 and 2015-16. We estimate OPHE share in household total and non-subsistence expenditure, catastrophic headcount at the threshold of OPHE ≥ 10% of total expenditure or OPHE ≥ 25% of non-subsistence expenditure. We estimate impoverishment of OPHE using national poverty lines. Finally, we explore socioeconomic factors of financial hardships of OPHE. Results: Over the years, catastrophic headcount and impoverishment of OPHE had decreased at national level (–1.3% points) and in the provinces of Sindh (-7.8% points) and Khyber Pukhtoonkhawa (KPK), (–2.8% points). The province of KPK and the year 2005-06 witnessed the highest incidence of financial catastrophe (26.89% points) and impoverishment (4.8% points) of OPHE. Households in rural areas, in the middle and rich quintiles and those headed by a male were more likely to encounter financial catastrophe and impoverishment due to OPHE. Conclusion: Inter-provincial variation in financial hardships of OPHE provide aide to provincial level priority setting. The high impact of OPHE in the non-poor, in rural areas, and in KPK calls for enhanced targeting of financial risk protection plans.

scholarly journals Factors related to excessive out-of-pocket expenditures among the ultra-poor after discontinuity of PBF: a cross-sectional study in Burkina Faso

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Yvonne Beaugé ◽  
Valéry Ridde ◽  
Emmanuel Bonnet ◽  
Sidibé Souleymane ◽  
Naasegnibe Kuunibe ◽  
...  
Keyword(s):  
Burkina Faso ◽  
Financial Risk ◽  
Healthcare Services ◽  
Cross Sectional Study ◽  
Service Utilisation ◽  
Health Coverage ◽  
Sectional Study ◽  
Financial Risk Protection ◽  
Cross Sectional ◽  
Risk Protection

Abstract Background Measuring progress towards financial risk protection for the poorest is essential within the framework of Universal Health Coverage. The study assessed the level of out-of-pocket expenditure and factors associated with excessive out-of-pocket expenditure among the ultra-poor who had been targeted and exempted within the context of the performance-based financing intervention in Burkina Faso. Ultra-poor were selected based on a community-based approach and provided with an exemption card allowing them to access healthcare services free of charge. Methods We performed a descriptive analysis of the level of out-of-pocket expenditure on formal healthcare services using data from a cross-sectional study conducted in Diébougou district. Multivariate logistic regression was performed to investigate the factors related to excessive out-of-pocket expenditure among the ultra-poor. The analysis was restricted to individuals who reported formal health service utilisation for an illness-episode within the last six months. Excessive spending was defined as having expenditure greater than or equal to two times the median out-of-pocket expenditure. Results Exemption card ownership was reported by 83.64% of the respondents. With an average of FCFA 23051.62 (USD 39.18), the ultra-poor had to supplement a significant amount of out-of-pocket expenditure to receive formal healthcare services at public health facilities which were supposed to be free. The probability of incurring excessive out-of-pocket expenditure was negatively associated with being female (β = − 2.072, p = 0.00, ME = − 0.324; p = 0.000) and having an exemption card (β = − 1.787, p = 0.025; ME = − 0.279, p = 0.014). Conclusions User fee exemptions are associated with reduced out-of-pocket expenditure for the ultra-poor. Our results demonstrate the importance of free care and better implementation of existing exemption policies. The ultra-poor’s elevated risk due to multi-morbidities and severity of illness need to be considered when allocating resources to better address existing inequalities and improve financial risk protection.

scholarly journals α-d-Glucopyranosyl-(1→2)-[6-O-(l-tryptophanyl)-β-d-fructofuranoside]

Molbank ◽  
10.3390/m1066 ◽  
2019 ◽  
Vol 2019 (2) ◽  
pp. M1066
Author(s):  
Kwaku Kyeremeh ◽  
Samuel Kwain ◽  
Gilbert Mawuli Tetevi ◽  
Anil Sazak Camas ◽  
Mustafa Camas ◽  
...  
Keyword(s):  
Human African Trypanosomiasis ◽  
2D Nmr ◽  
Sub Saharan Africa ◽  
Western Region ◽  
Mangrove Plant ◽  
Chemical Profiling ◽  
Coptis Japonica ◽  
Full Structure ◽  
Sub Saharan ◽  
Uptake And Metabolism

The Mycobacterium sp. BRS2A-AR2 is an endophyte of the mangrove plant Rhizophora racemosa G. Mey., which grows along the banks of the River Butre, in the Western Region of Ghana. Chemical profiling using 1H-NMR and HRESI-LC-MS of fermentation extracts produced by the strain led to the isolation of the new compound, α-d-Glucopyranosyl-(1→2)-[6-O-(l-tryptophanyl)-β-d–fructofuranoside] or simply tortomycoglycoside (1). Compound 1 is an aminoglycoside consisting of a tryptophan moiety esterified to a disaccharide made up of β-d-fructofuranose and α-d-glucopyranose sugars. The full structure of 1 was determined using UV, IR, 1D, 2D-NMR and HRESI-LC-MS data. When tested against Trypanosoma brucei subsp. brucei, the parasite responsible for Human African Trypanosomiasis in sub-Saharan Africa, 1 (IC50 11.25 µM) was just as effective as Coptis japonica (Thunb.) Makino. (IC50 8.20 µM). The extract of Coptis japonica (Thunb.) Makino. is routinely used as laboratory standard due to its powerful antitrypanosomal activity. It is possible that, compound 1 interferes with the normal uptake and metabolism of tryptophan in the T. brucei subsp. brucei parasite.

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