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 Distribution of under-5 deaths in the neonatal, postneonatal, and childhood periods: a multicountry analysis in 64 low- and middle-income countries

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Zhihui Li ◽  
Omar Karlsson ◽  
Rockli Kim ◽  
S. V. Subramanian
Keyword(s):  
Low Income ◽  
Age Groups ◽  
Low Income Countries ◽  
Gdp Per Capita ◽  
Demographic And Health Surveys ◽  
Relative Distribution ◽  
Middle Income ◽  
Middle Income Countries ◽  
Per Capita ◽  
Low And Middle Income

Abstract Background As under-5 mortality rates declined all over the world, the relative distribution of under-5 deaths during different periods of life changed. To provide information for policymakers to plan for multi-layer health strategies targeting child health, it is essential to quantify the distribution of under-5 deaths by age groups. Methods Using 245 Demographic and Health Surveys from 64 low- and middle-income countries conducted between 1986 and 2018, we compiled a database of 2,437,718 children under-5 years old with 173,493 deaths. We examined the share of deaths that occurred in the neonatal (< 1 month), postneonatal (1 month to 1 year old), and childhood (1 to 5 years old) periods to the total number of under-5 deaths at both aggregate- and country-level. We estimated the annual change in share of deaths to track the changes over time. We also assessed the association between share of deaths and Gross Domestic Product (GDP) per capita. Results Neonatal deaths accounted for 53.1% (95% confidence interval [CI]: 52.7, 53.4) of the total under-5 deaths. The neonatal share of deaths was lower in low-income countries at 44.0% (43.5, 44.5), and higher in lower-middle-income and upper-middle income countries at 57.2% (56.8, 57.6) and 54.7% (53.8, 55.5) respectively. There was substantial heterogeneity in share of deaths across countries; for example, the share of neonatal to total under-5 deaths ranged from 20.9% (14.1, 27.6) in Eswatini to 82.8% (73.0, 92.6) in Dominican Republic. The shares of deaths in all three periods were significantly associated with GDP per capita, but in different directions—as GDP per capita increased by 10%, the neonatal share of deaths would significantly increase by 0.78 percentage points [PPs] (0.43, 1.13), and the postneonatal and childhood shares of deaths would significantly decrease by 0.29 PPs (0.04, 0.54) and 0.49 PPs (0.24, 0.74) respectively. Conclusions Along with the countries’ economic development, an increasing proportion of under-5 deaths occurs in the neonatal period, suggesting a need for multi-layer health strategies with potentially heavier investment in newborn health.

scholarly journals An implementation model for scaling up oral pre-exposure prophylaxis in Kenya: Jilinde project

2021 ◽  
Vol 5 ◽  
pp. 113
Author(s):  
Daniel Were ◽  
Abednego Musau ◽  
Mary Mugambi ◽  
Marya Plotkin ◽  
Mark Kabue ◽  
...  
Keyword(s):  
Scale Up ◽  
Scaling Up ◽  
Policy Coordination ◽  
Middle Income ◽  
Implementation Model ◽  
Middle Income Countries ◽  
Community Ownership ◽  
Exposure Prophylaxis ◽  
Oral Prep ◽  
Low And Middle Income

Oral pre-exposure prophylaxis (PrEP) is an efficacious way to lower the risk of HIV acquisition among high-risk individuals. Despite the World Health Organization’s 2015 recommendation that all persons at substantial risk of HIV infection be provided with access to oral PrEP, the rollout has been slow in many low- and middle-income countries. Initiatives for national rollout are few, and subtle skepticism persists in several countries about the feasibility of national PrEP implementation. We describe the conceptual design of the Jilinde project, which is implementing oral PrEP as a routine service at a public health scale in Kenya. We describe the overlapping domains of supply, demand, and government and community ownership, which combine to produce a learning laboratory environment to explore the scale-up of PrEP. We describe how Jilinde approaches PrEP uptake and continuation by applying supply and demand principles and ensures that government and community ownership informs policy, coordination, and sustainability. We describe the “learning laboratory” approach that informs strategic and continuous learning, which allows for adjustments to the project. Jilinde’s conceptual model illustrates how the coalescence of these concepts can promote scale-up of PrEP in real-world conditions and offers critical lessons on an implementation model for scaling up oral PrEP in low- and middle-income countries.

scholarly journals Factors influencing the scale-up of public health interventions in low- and middle-income countries: a qualitative systematic literature review

2019 ◽  
Vol 35 (2) ◽  
pp. 219-234 ◽  
Author(s):  
Susan E Bulthuis ◽  
Maryse C Kok ◽  
Joanna Raven ◽  
Marjolein A Dieleman
Keyword(s):  
Public Health ◽  
Scale Up ◽  
Scaling Up ◽  
Health Interventions ◽  
Public Health Interventions ◽  
Middle Income ◽  
Middle Income Countries ◽  
Factors Influencing ◽  
Low And Middle Income ◽  
The Way

Abstract To achieve universal health coverage, the scale-up of high impact public health interventions is essential. However, scale-up is challenging and often not successful. Therefore, a systematic review was conducted to provide insights into the factors influencing the scale-up of public health interventions in low- and middle-income countries (LMICs). Two databases were searched for studies with a qualitative research component. The GRADE-CERQual approach was applied to assess the confidence in the evidence for each key review finding. A multi-level perspective on transition was applied to ensure a focus on vertical scale-up for sustainability. According to this theory, changes in the way of organizing (structure), doing (practice) and thinking (culture) need to take place to ensure the scale-up of an intervention. Among the most prominent factors influencing scale-up through changes in structure was the availability of financial, human and material resources. Inadequate supply chains were often barriers to scale-up. Advocacy activities positively influenced scale-up, and changes in the policy environment hindered or facilitated scale-up. The most outstanding factors influencing scale-up through changes in practice were the availability of a strategic plan for scale-up and the way in which training and supervision was conducted. Furthermore, collaborations such as community participation and partnerships facilitated scale-up, as well as the availability of research and monitoring and evaluation data. Factors influencing scale-up through a change in culture were less prominent in the literature. While some studies articulated the acceptability of the intervention in a given sociocultural environment, more emphasis was placed on the importance of stakeholders feeling a need for a specific intervention to facilitate its scale-up. All identified factors should be taken into account when scaling up public health interventions in LMICs. The different factors are strongly interlinked, and most of them are related to one crucial first step: the development of a scale-up strategy before scaling up.

scholarly journals Global aid for nutrition-specific and nutrition-sensitive interventions and proportion of stunted children across low- and middle-income countries: does aid matter?

2019 ◽  
Vol 34 (Supplement_2) ◽  
pp. ii18-ii27 ◽  
Author(s):  
Hina Khalid ◽  
Sitara Gill ◽  
Ashley M Fox
Keyword(s):  
Fixed Effects ◽  
Development Assistance ◽  
Scale Up ◽  
World Health ◽  
Middle Income ◽  
Middle Income Countries ◽  
Per Capita ◽  
Nutrition Sensitive ◽  
The Relationship ◽  
Low And Middle Income

Abstract Development assistance for health (DAH) has increased dramatically over the past two decades, and this increase has led to a debate on the benefits and perverse effects of scaling-up vs scaling back DAH, and the type of interventions DAH should support. Nutrition remains a contested category viewed as essential to achieving primary healthcare objectives but as falling outside of the direct ambit of the health system. Thus, despite the increase in DAH, it continues to remain an underfunded area and little is known about the relationship between aid for nutrition-specific and nutrition-sensitive interventions and the proportion of stunted children across low- and middle-income countries. We hypothesize that as nutrition-specific aid targets local needs of countries and is less fungible than nutrition-sensitive aid, it will contribute more to a reduction in the proportion of stunted children, with the steepest gains among countries that have the highest burden of malnutrition. We use fixed-effects regressions to examine the relationship between the proportion of stunted children and aid for nutrition interventions (specific and sensitive) to 116 low- and middle-income countries (2002–16). We construct our panel using the Creditor Reporting System, Institute of Health Metrics and Evaluation, Food and Agriculture Organization, World Health Organization and World Development indicators databases. We find a one-dollar increase in per capita nutrition-specific aid is associated with a reduction in the proportion of stunted children by 0.004 (P < 0.05). When stratified by burden of malnutrition, a one-dollar increase in per capita nutrition-specific aid to countries with the highest burden of malnutrition is associated with sharper reductions in the proportion of stunted children (0.013, P < 0.01). We also find a significant association for per capita nutrition-sensitive aid and proportion of stunted children when per capita aid for nutrition is lagged by 3 and 4 years (0.0002, P < 0.05), suggesting a long-run association between nutrition-sensitive aid and proportion of stunted children. Our findings suggest that in spite of criticisms that development assistance fails to adequately reach its intended beneficiaries, aid for nutrition has been successful at reducing the proportion of stunted children. Our findings imply a need to scale-up nutrition funding and improve targeting of aid.

scholarly journals District mental healthcare plans for five low-and middle-income countries: Commonalities, variations and evidence gaps

2016 ◽  
Vol 208 (s56) ◽  
pp. s47-s54 ◽  
Author(s):  
Charlotte Hanlon ◽  
Abebaw Fekadu ◽  
Mark Jordans ◽  
Fred Kigozi ◽  
Inge Petersen ◽  
...  
Keyword(s):  
Low Income ◽  
Methodological Approach ◽  
Mental Healthcare ◽  
Psychosocial Interventions ◽  
Middle Income ◽  
Site Specific ◽  
Middle Income Countries ◽  
Core Set ◽  
Resource Requirements ◽  
Low And Middle Income

BackgroundLittle is known about the service and system interventions required for successful integration of mental healthcare into primary care across diverse low- and middle-income countries (LMIC).AimsTo examine the commonalities, variations and evidence gaps in district-level mental healthcare plans (MHCPs) developed in Ethiopia, India, Nepal, Uganda and South Africa for the PRogramme for Improving Mental health carE (PRIME).MethodA comparative analysis of MHCP components and human resource requirements.ResultsA core set of MHCP goals was seen across all countries. The MHCPs components to achieve those goals varied, with most similarity in countries within the same resource bracket (low income v. middle income). Human resources for advanced psychosocial interventions were only available in the existing health service in the best-resourced PRIME country.ConclusionsApplication of a standardised methodological approach to MHCP across five LMIC allowed identification of core and site-specific interventions needed for implementation.

scholarly journals Barriers and facilitators for scaling up mental health and psychosocial support interventions in low- and middle-income countries for populations affected by humanitarian crises: a systematic review

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Jordan Troup ◽  
Daniela C. Fuhr ◽  
Aniek Woodward ◽  
Egbert Sondorp ◽  
Bayard Roberts
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
Psychosocial Support ◽  
Scale Up ◽  
Scaling Up ◽  
Barriers And Facilitators ◽  
Middle Income ◽  
Middle Income Countries ◽  
Humanitarian Crises ◽  
Low And Middle Income

Abstract Background Humanitarian crises increase the burden of mental disorders due to exposure to traumatic events and ongoing daily stressors. Effective mental health and psychosocial support (MHPSS) interventions exist, but barriers and facilitators for scaling up those interventions are less understood. The study aim was to identify barriers and facilitators for scaling up MHPSS interventions for populations affected by humanitarian crises in low- and middle-income countries. Methods A systematic review following PRISMA guidelines was conducted. Types of scale up were summarised, and barriers and facilitators analysed using the World Health Organization’s Expandnet framework of scaling up. Evidence quality was appraised using the Mixed Methods Appraisal Tool. Results Fourteen eligible studies were identified. Most described horizontal types of scale up, integrating services into primary and community care through staff training, task-sharing, and establishing referral and supervision mechanisms. Barriers were reported in a range of framework elements, but primarily related to those in the health system. The overall quality of studies were limited. Conclusion Few MHPSS interventions in humanitarian crises appear to have been scaled up, and scaling up efforts were largely horizontal which challenges long-term sustainability. Greater focus should be on both horizontal and vertical scaling up, which should be accompanied by higher quality research.

scholarly journals Optimizing treatment cascades for mental healthcare in Mozambique: preliminary effectiveness of the Systems Analysis and Improvement Approach for Mental Health (SAIA-MH)

2020 ◽  
Author(s):  
Katrin E Fabian ◽  
Alberto Muanido ◽  
Vasco F J Cumbe ◽  
Nelia Manaca ◽  
Leecreesha Hicks ◽  
...  
Keyword(s):  
Mental Health ◽  
Systems Analysis ◽  
Implementation Strategy ◽  
Scale Up ◽  
Mental Healthcare ◽  
Post Intervention ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

Abstract Substantial investments are being made to scale-up access to mental healthcare in low- and middle-income countries, but less attention has been paid to quality and performance of nascent public-sector mental healthcare systems. This study tested the initial effectiveness of an implementation strategy to optimize routine outpatient mental healthcare cascade performance in Mozambique [the Systems Analysis and Improvement Approach for Mental Health (SAIA-MH)]. This study employed a pre–post design from September 2018 to August 2019 across four Ministry of Health clinics among 810 patients and 3234 outpatient mental health visits. Effectiveness outcomes evaluated progression through the care cascade, including: (1) initial diagnosis and medication selection; (2) enrolling in follow-up care; (3) returning after initial consultation within 60 days; (4) returning for follow-up visits on time; (5) returning for follow-up visits adherent to medication and (6) achieving function improvement. Clustered generalized linear models evaluated odds of completing cascade steps pre- vs post-intervention. Facilities prioritized improvements focused on the follow-up cascade, with 62.5% (10 of 16) monthly system modifications targeting medication adherence. At baseline, only 4.2% of patient visits achieved function improvement; during the 6 months of SAIA-MH implementation, this improved to 13.1% of patient visits. Multilevel logistic regression found increased odds of returning on time and adherent [aOR = 1.53, 95% CI (1.21, 1.94), P = 0.0004] and returning on time, adherent and with function improvement [aOR = 3.68, 95% CI (2.57, 5.44), P &lt; 0.0001] after SAIA-MH implementation. No significant differences were observed regarding other cascade steps. The SAIA-MH implementation strategy shows promise for rapidly and significantly improving mental healthcare cascade outcomes, including the ultimate goal of patient function improvement. Given poor baseline mental healthcare cascade performance, there is an urgent need for evidence-based implementation strategies to optimize the performance of mental healthcare cascades in low- and middle-income countries.

scholarly journals Tuberculosis and Non-Communicable Disease Multimorbidity: An Analysis of the World Health Survey in 48 Low- and Middle-Income Countries

2021 ◽  
Vol 18 (5) ◽  
pp. 2439
Author(s):  
Brendon Stubbs ◽  
Kamran Siddiqi ◽  
Helen Elsey ◽  
Najma Siddiqi ◽  
Ruimin Ma ◽  
...  
Keyword(s):  
Health Survey ◽  
Low Income ◽  
World Health ◽  
Low Income Countries ◽  
Multivariable Logistic Regression Analysis ◽  
World Health Survey ◽  
Middle Income ◽  
Middle Income Countries ◽  
The World ◽  
Low And Middle Income

Tuberculosis (TB) is a leading cause of mortality in low- and middle-income countries (LMICs). TB multimorbidity [TB and ≥1 non-communicable diseases (NCDs)] is common, but studies are sparse. Cross-sectional, community-based data including adults from 21 low-income countries and 27 middle-income countries were utilized from the World Health Survey. Associations between 9 NCDs and TB were assessed with multivariable logistic regression analysis. Years lived with disability (YLDs) were calculated using disability weights provided by the 2017 Global Burden of Disease Study. Eight out of 9 NCDs (all except visual impairment) were associated with TB (odds ratio (OR) ranging from 1.38–4.0). Prevalence of self-reported TB increased linearly with increasing numbers of NCDs. Compared to those with no NCDs, those who had 1, 2, 3, 4, and ≥5 NCDs had 2.61 (95% confidence interval (CI) = 2.14–3.22), 4.71 (95%CI = 3.67–6.11), 6.96 (95%CI = 4.95–9.87), 10.59 (95%CI = 7.10–15.80), and 19.89 (95%CI = 11.13–35.52) times higher odds for TB. Among those with TB, the most prevalent combinations of NCDs were angina and depression, followed by angina and arthritis. For people with TB, the YLDs were three times higher than in people without multimorbidity or TB, and a third of the YLDs were attributable to NCDs. Urgent research to understand, prevent and manage NCDs in people with TB in LMICs is needed.

scholarly journals Breast Cancer in Low- and Middle-Income Countries: An Emerging and Challenging Epidemic

2010 ◽  
Vol 2010 ◽  
pp. 1-5 ◽  
Author(s):  
Arafat Tfayli ◽  
Sally Temraz ◽  
Rachel Abou Mrad ◽  
Ali Shamseddine
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
Low Income ◽  
Therapeutic Interventions ◽  
Low Income Countries ◽  
Middle Income ◽  
Major Health ◽  
Middle Income Countries ◽  
Low And Middle Income

Breast cancer is a major health care problem that affects more than one million women yearly. While it is traditionally thought of as a disease of the industrialized world, around 45% of breast cancer cases and 55% of breast cancer deaths occur in low and middle income countries. Managing breast cancer in low income countries poses a different set of challenges including access to screening, stage at presentation, adequacy of management and availability of therapeutic interventions. In this paper, we will review the challenges faced in the management of breast cancer in low and middle income countries.

scholarly journals An International Analysis of Dialysis Services Reimbursement

2018 ◽  
Vol 14 (1) ◽  
pp. 84-93 ◽  
Author(s):  
Arjan van der Tol ◽  
Norbert Lameire ◽  
Rachael L. Morton ◽  
Wim Van Biesen ◽  
Raymond Vanholder
Keyword(s):  
Health Care ◽  
Peritoneal Dialysis ◽  
Replacement Therapy ◽  
Gdp Per Capita ◽  
Middle Income ◽  
Middle Income Countries ◽  
Number Of Patients ◽  
Kidney Replacement Therapy ◽  
Per Capita ◽  
Low And Middle Income

Background and objectivesThe prevalence of patients with ESKD who receive extracorporeal kidney replacement therapy is rising worldwide. We compared government reimbursement for hemodialysis and peritoneal dialysis worldwide, assessed the effect on the government health care budget, and discussed strategies to reduce the cost of kidney replacement therapy.Design, setting, participants, & measurementsCross-sectional global survey of nephrologists in 90 countries to assess reimbursement for dialysis, number of patients receiving hemodialysis and peritoneal dialysis, and measures to prevent development or progression of CKD, conducted online July to December of 2016.ResultsOf the 90 survey respondents, governments from 81 countries (90%) provided reimbursement for maintenance dialysis. The prevalence of patients per million population being treated with long-term dialysis in low- and middle-income countries increased linearly with Gross Domestic Product per capita (GDP per capita), but was substantially lower in these countries compared with high-income countries where we did not observe an higher prevalence with higher GDP per capita. The absolute expenditure for dialysis by national governments showed a positive association with GDP per capita, but the percent of total health care budget spent on dialysis showed a negative association. The percentage of patients on peritoneal dialysis was low, even in countries where peritoneal dialysis is better reimbursed than hemodialysis. The so-called peritoneal dialysis–first policy without financial incentive seems to be effective in increasing the utilization of peritoneal dialysis. Few countries actively provide CKD prevention.ConclusionsIn low- and middle-income countries, reimbursement of dialysis is insufficient to treat all patients with ESKD and has a disproportionately high effect on public health expenditure. Current reimbursement policies favor conventional in-center hemodialysis.

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