scholarly journals Trends and outcomes in primary health care expenditures in low-income and middle-income countries, 2000–2017

2021 ◽  
Vol 6 (8) ◽  
pp. e005798
Author(s):  
Matthew T Schneider ◽  
Angela Y Chang ◽  
Sawyer W Crosby ◽  
Stephen Gloyd ◽  
Anton C Harle ◽  
...  
Keyword(s):  
Low Income ◽  
Primary Healthcare ◽  
Health Expenditures ◽  
Middle Income Country ◽  
Income Country ◽  
P Value ◽  
Care Providers ◽  
Middle Income ◽  
Middle Income Countries ◽  
Per Capita

IntroductionAs the world responds to COVID-19 and aims for the Sustainable Development Goals, the potential for primary healthcare (PHC) is substantial, although the trends and effectiveness of PHC expenditure are unknown. We estimate PHC expenditure for each low-income and middle-income country between 2000 and 2017 and test which health outputs and outcomes were associated with PHC expenditure.MethodsWe used three data sources to estimate PHC expenditures: recently published health expenditure estimates for each low-income and middle-income country, which were constructed using 1662 country-reported National Health Accounts; proprietary data from IQVIA to estimate expenditure of prescribed pharmaceuticals for PHC; and household surveys and costing estimates to estimate inpatient vaginal delivery expenditures. We employed regression analyses to measure the association between PHC expenditures and 15 health outcomes and intermediate health outputs.ResultsPHC expenditures in low-income and middle-income countries increased between 2000 and 2017, from $41 per capita (95% uncertainty interval $33–$49) to $90 ($73–$105). Expenditures for low-income countries plateaued since 2014 at $17 per capita ($15–$19). As national income increased, the proportion of health expenditures on PHC generally decrease; however, the fraction of PHC expenditures spent via ambulatory care providers grew. Increases in the fraction of health expenditures on PHC was associated with lower maternal mortality rate (p value≤0.001), improved coverage of antenatal care visits (p value≤0.001), measles vaccination (p value≤0.001) and an increase in the Health Access and Quality index (p value≤0.05). PHC expenditure was not systematically associated with all-age mortality, communicable and non-communicable disease (NCD) burden.ConclusionPHC expenditures were associated with maternal and child health but were not associated with reduction in health burden for other key causes of disability, such as NCDs. To combat changing disease burdens, policy-makers and health professionals need to adapt primary healthcare to ensure continued impact on emerging health challenges.

scholarly journals How primary healthcare workers obtain information during consultations to aid safe prescribing in low-income and lower middle-income countries: a systematic review

2020 ◽  
Vol 5 (4) ◽  
pp. e002094 ◽  
Author(s):  
Chris Smith ◽  
Michelle Helena van Velthoven ◽  
Nguyen Duc Truong ◽  
Nguyen Hai Nam ◽  
Vũ Phan Anh ◽  
...  
Keyword(s):  
Low Income ◽  
Primary Healthcare ◽  
Healthcare Workers ◽  
Health Workers ◽  
Internet Access ◽  
Sources Of Information ◽  
Quality Of Reporting ◽  
Middle Income ◽  
Middle Income Countries ◽  
Registration Number

BackgroundWe systematically reviewed the evidence on how primary healthcare workers obtain information during consultations to support decision-making for prescribing in low and lower middle-income countries.MethodsWe searched electronic databases, consulted the Healthcare Information For All network, hand searched reference lists, ran citation searches of included studies and emailed authors of identified papers. Two reviewers extracted data and appraised quality with relevant tools.ResultsOf 60 497 records found, 23 studies met our inclusion criteria. Fourteen studies were observational and nine were interventional. Frequently mentioned sources of information were books, leaflets, guidelines, aids and the internet. These sources were sometimes out of date and health workers reported being confused which to use. Internet access varied and even when it was available, use was limited by technical issues. Of the five electronic tools that were assessed, four had positive outcomes. Tools assisted prescribers with medicine selection and dosage calculations, which increased prescribing accuracy. The quality of reporting varied but was overall low.DiscussionStudies indicated a lack of up-to-date and relevant medicine information in low and lower middle-income settings. Internet-based sources appeared to be useful when it is possible to download content for offline use and to update when there is internet access. Electronic tools showed promise, but their accuracy needs to be validated and they should focus on giving actionable advice to guide prescribers.PROSPERO registration numberCRD42018091088.

scholarly journals Primary healthcare system performance in low-income and middle-income countries: a scoping review of the evidence from 2010 to 2017

2019 ◽  
Vol 4 (Suppl 8) ◽  
pp. e001551 ◽  
Author(s):  
Asaf Bitton ◽  
Jocelyn Fifield ◽  
Hannah Ratcliffe ◽  
Ami Karlage ◽  
Hong Wang ◽  
...  
Keyword(s):  
Service Delivery ◽  
Scoping Review ◽  
Low Income ◽  
Primary Healthcare ◽  
Recent Literature ◽  
Future Research ◽  
Topic Area ◽  
Middle Income ◽  
Ample Evidence ◽  
Middle Income Countries

IntroductionThe 2018 Astana Declaration reaffirmed global commitment to primary healthcare (PHC) as a core strategy to achieve universal health coverage. To meet this potential, PHC in low-income and middle-income countries (LMIC) needs to be strengthened, but research is lacking and fragmented. We conducted a scoping review of the recent literature to assess the state of research on PHC in LMIC and understand where future research is most needed.MethodsGuided by the Primary Healthcare Performance Initiative (PHCPI) conceptual framework, we conducted searches of the peer-reviewed literature on PHC in LMIC published between 2010 (the publication year of the last major review of PHC in LMIC) and 2017. We also conducted country-specific searches to understand performance trajectories in 14 high-performing countries identified in the previous review. Evidence highlights and gaps for each topic area of the PHCPI framework were extracted and summarised.ResultsWe retrieved 5219 articles, 207 of which met final inclusion criteria. Many PHC system inputs such as payment and workforce are well-studied. A number of emerging service delivery innovations have early evidence of success but lack evidence for how to scale more broadly. Community-based PHC systems with supportive governmental policies and financing structures (public and private) consistently promote better outcomes and equity. Among the 14 highlighted countries, most maintained or improved progress in the scope of services, quality, access and financial coverage of PHC during the review time period.ConclusionOur findings revealed a heterogeneous focus of recent literature, with ample evidence for effective PHC policies, payment and other system inputs. More variability was seen in key areas of service delivery, underscoring a need for greater emphasis on implementation science and intervention testing. Future evaluations are needed on PHC system capacities and orientation toward social accountability, innovation, management and population health in order to achieve the promise of PHC.

scholarly journals Evidence gap map of performance measurement and management in primary healthcare systems in low-income and middle-income countries

2019 ◽  
Vol 4 (Suppl 8) ◽  
pp. e001451 ◽  
Author(s):  
Wolfgang Munar ◽  
Birte Snilstveit ◽  
Ligia Esther Aranda ◽  
Nilakshi Biswas ◽  
Theresa Baffour ◽  
...  
Keyword(s):  
Performance Measurement ◽  
Systematic Reviews ◽  
Low Income ◽  
Primary Healthcare ◽  
Implementation Strategies ◽  
Sub Saharan Africa ◽  
Audit And Feedback ◽  
Unintended Effects ◽  
Middle Income ◽  
Middle Income Countries

IntroductionWe mapped available evidence on performance measurement and management (PMM) strategies in primary healthcare (PHC) systems of low-income and middle-income countries (LMICs). Widely used, their effectiveness remains inconclusive. This evidence gap map characterises existing research and evidence gaps.MethodsSystematic mapping of performance measurement and management research in LMICs from 2000 to mid-2018; literature searches of seven academic databases and institutional repositories of impact evaluations and systematic reviews. Using a combination of manual screening and machine learning, four reviewers appraised 38 088 titles and abstracts, and extracted metadata from 137 impact evaluations and 18 systematic reviews that met the inclusion criteria. The resulting visual representation of the evidence base was uploaded to a web-based platform.ResultsSince 2000, the number of studies has increased; the first systematic reviews were completed in 2010. Two-thirds of the studies were conducted in sub-Saharan Africa and South Asia. Randomised controlled trials were the most frequently used study design. The evidence is concentrated in two types of PMM strategies: implementation strategies (in-service training, continuing education, supervision) and performance-based financing. Major gaps exist in accountability arrangements particularly the use of audit and feedback. The least studied types of outcomes were unintended effects, harm and social equity.ConclusionsThe evidence is clustered around interventions that are unlikely to achieve transformational change in health outcomes. The gaps identified suggest that routinely used PMM strategies are implemented without sufficient knowledge of their effects. Future efforts at redesigning PHC systems need to be informed by evidence on the most effective approaches for using PMM strategies.

scholarly journals Bridging the gap: aligning economic research with disease burden

2021 ◽  
Vol 6 (6) ◽  
pp. e005673
Author(s):  
Lauren A Do ◽  
Patricia G Synnott ◽  
Siyu Ma ◽  
Daniel A Ollendorf
Keyword(s):  
Cost Effectiveness ◽  
Low Income ◽  
Disease Burden ◽  
Ordinary Least Squares ◽  
Middle Income Country ◽  
Income Country ◽  
Economic Research ◽  
Base Case ◽  
Middle Income ◽  
Essential Interventions

IntroductionCost-effectiveness analysis (CEA) is critical for identifying high-value interventions that address significant unmet need. This study examines whether CEA study volume is proportionate to the burden associated with 21 major disease categories.MethodsWe searched the Tufts Medical Center CEA and Global Health CEA Registries for studies published between 2010 and 2019 that measured cost per quality-adjusted life-year or cost per disability-adjusted life-year (DALY). Stratified by geographical region and country income level, the relationship between literature volume and disease burden (as measured by 2019 Global Burden of Disease estimates of population DALYs) was analysed using ordinary least squares linear regression. Additionally, the number of CEAs per intervention deemed ‘essential’ for universal health coverage by the Disease Control Priorities Network was assessed to evaluate how many interventions are supported by cost-effectiveness evidence.ResultsThe results located below the regression line but with relatively high burden suggested disease areas that were ‘understudied’ compared with expected study volume. Understudied disease areas varied by region. Higher-income and upper-middle-income country (HUMIC) CEA volume for non-communicable diseases (eg, mental/behavioural disorders) was 100-fold higher than that in low-income and lower-middle-income countries (LLMICs). LLMIC study volume remained concentrated in HIV/AIDS as well as other communicable and neglected tropical diseases. Across 60 essential interventions, only 33 had any supporting CEA evidence, and only 21 had a decision context involving a low-income or middle-income country. With the exception of one intervention, available CEA evidence revealed the 21 interventions to be cost-effective, with base-case findings less than three times the GDP per capita.ConclusionOur analysis highlights disease areas that require significant policy attention. Research gaps for highly prevalent, lethal or disabling diseases, as well as essential interventions may be stifling potential efficiency gains. Large research disparities between HUMICs and LLMICs suggest funding opportunities for improving allocative efficiency in LLMIC health systems.

scholarly journals Out-of-pocket health expenditures and antimicrobial resistance in low-income and middle-income countries: an economic analysis

2015 ◽  
Vol 15 (10) ◽  
pp. 1203-1210 ◽  
Author(s):  
Marcella Alsan ◽  
Lena Schoemaker ◽  
Karen Eggleston ◽  
Nagamani Kammili ◽  
Prasanthi Kolli ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Economic Analysis ◽  
Low Income ◽  
Health Expenditures ◽  
Middle Income ◽  
Middle Income Countries

scholarly journals Cost of scaling up mental healthcare in low-and middle-income countries

2007 ◽  
Vol 191 (6) ◽  
pp. 528-535 ◽  
Author(s):  
Dan Chisholm ◽  
Crick Lund ◽  
Shekhar Saxena
Keyword(s):  
Low Income ◽  
Scale Up ◽  
Mental Healthcare ◽  
Scaling Up ◽  
Psychosocial Treatment ◽  
Economic Evaluations ◽  
Middle Income ◽  
Middle Income Countries ◽  
Per Capita ◽  
Low And Middle Income

BackgroundNo systematic attempt has been made to calculate the costs of scaling up mental health services in low-and middle-income countries.AimsTo estimate the expenditures needed to scale up the delivery of an essential mental healthcare package over a 10-year period (2006–2015).MethodA core package was defined, comprising pharmacological and/or psychosocial treatment of schizophrenia, bipolar disorder, depression and hazardous alcohol use. Current service levels in 12 selected low-and middle-income countries were established using the WHO–AIMS assessment tool. Target-level resource needs were derived from published need assessments and economic evaluations.ResultsThe cost per capita of providing the core package attarget coverage levels (in US dollars) ranged from $1.85 to $2.60 per year in low-income countries and $3.20 to $6.25 per year in lower-middle-income countries, an additional annual investment of $0.18–0.55 per capita.ConclusionsAlthough significant new resources need to be invested, the absolute amount is not large when considered at the population level and against other health investment strategies.

scholarly journals Preconception air pollution exposure and glucose tolerance in healthy pregnant women in a middle income country

2020 ◽  
Author(s):  
Mehdi Zareie ◽  
Ali Gohari ◽  
Leyla Haghighi ◽  
Hafez Heydari ◽  
Mohammad miri
Keyword(s):  
Air Pollution ◽  
Glucose Tolerance ◽  
Pregnant Women ◽  
Fasting Blood Glucose ◽  
Tolerance Test ◽  
Middle Income Country ◽  
Income Country ◽  
P Value ◽  
Oral Glucose ◽  
Middle Income

Abstract Background: The effect of preconception exposure to air pollution on glucose tolerance during pregnancy in developing and middle-income countries is under debate yet. Therefore, this study aimed to assess the relationship between exposure to ambient particulate matter (PM) and traffic indicators with glucose tolerance in healthy pregnant women in Sabzevar, Iran (2019). Methods: Accordingly, 250 healthy pregnant women with singleton pregnancies of 24-26 weeks of gestations were participated in our study. Land use regression (LUR) models were applied to estimate the annual mean of PM1, PM2.5 and PM10 at residential address. Traffic indicators, including distance from home to the nearest major road (DHMR) as well as total streets length in 100, 300 and 500m buffers around the home (TSL-100, 300 and 500) were calculated using the street map of Sabzevar. Oral glucose tolerance test (OGTT) was used to assess glucose tolerance during pregnancy. Multiple linear regression adjusted for relevant covariates was used to estimate the association of fasting blood glucose (FBG), 1-h and 2-h post-load glucose with PMs and traffic indicators. Results: Exposure to PM1, PM2.5 and PM10 was significantly associated with higher FBG concentration. Higher TSL-100 was associated with higher FBG and 1-h glucose concentrations. Each one interquartile range (IQR) increase in DHMR the levels of FBG and 1-h post-load glucose were decreased -3.42 mg/dL (95% confidence interval (CI): -4.47, -2.37, P-value < 0.01) and -4.65 mg/dL (95% CI: -8.03, -1.26, P-value < 0.01), respectively. Conclusion: We found higher preconception exposure to air pollution and exposure to air pollution during pregnancy were negatively associated with glucose tolerance during pregnancy in a middle income country.

scholarly journals Nanomedicine for the poor: a lost cause or an idea whose time has yet to come?

Nanomedicine ◽  
2021 ◽  
Author(s):  
Vuk Uskoković
Keyword(s):  
Low Income ◽  
Low Income Countries ◽  
Gdp Per Capita ◽  
Lost Cause ◽  
Middle Income ◽  
Middle Income Countries ◽  
The Poor ◽  
Scientific Innovation ◽  
Per Capita ◽  
To Come

The most effective COVID-19 vaccines, to date, utilize nanotechnology to deliver immunostimulatory mRNA. However, their high cost equates to low affordability. Total nano-vaccine purchases per capita and their proportion within the total vaccine lots have increased directly with the GDP per capita of countries. While three out of four COVID-19 vaccines procured by wealthy countries by the end of 2020 were nano-vaccines, this amounted to only one in ten for middle-income countries and nil for the low-income countries. Meanwhile, economic gains of saving lives with nano-vaccines in USA translate to large costs in middle-/low-income countries. It is discussed how nanomedicine can contribute to shrinking this gap between rich and poor instead of becoming an exquisite technology for the privileged. Two basic routes are outlined: (1) the use of qualitative contextual analyses to endorse R&D that positively affects the sociocultural climate; (2) challenging the commercial, competitive realities wherein scientific innovation of the day operates.

scholarly journals Management of End Stage Renal Disease-Bangladesh Perspective

2014 ◽  
Vol 7 (1) ◽  
pp. 108-112 ◽  
Author(s):  
Harun Ur Rashid
Keyword(s):  
Renal Disease ◽  
Low Income ◽  
End Stage Renal Disease ◽  
Future Perspective ◽  
Middle Income ◽  
Middle Income Countries ◽  
Initial Stage ◽  
Per Capita ◽  
Stage Renal Disease ◽  
End Stage

End stage renal disease (ESRD) is an important cause of morbidity and mortality throughout the world. The treatment of renal replacement therapy (RRT) for patients with ESRD is expensive. There is a direct relationship between per capita income and treatment of ESRD. Eighty five per cent of the world’s population lives in low income or middle-income countries, where the mortality is highest in patients with chronic kidney disease. The future perspective is not satisfactory for Bangladesh where treatment of ESRD is out of reach for majority of people. Effort should made for prevention and treatment of CKD at an initial stage of disease.

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