Assessment of the Current State of Pharmacovigilance System in Pakistan Using Indicator-Based Assessment Tool

Objectives: Pakistan felt the need for an effective and robust pharmacovigilance (PV) system after one of the deadliest drug-related tragedies causing more than 300 deaths in 2012. The country set up its national PV center in 2015 and joined WHO’s Program for International Drug Monitoring (PIDM) in 2018 as a full member. The current study was aimed to evaluate the PV system’s functionality, identify the gaps, areas of improvement, and a strategy to lead a functional PV system in Pakistan.Methods: The descriptive cross-sectional study was conducted by providing an interviewer-administered questionnaire of the PV system across Pakistan by utilizing the Indicator based Pharmacovigilance assessment tool (IPAT). By a convenience sampling method 36 study participants were selected from the Drug Regulatory Authority of Pakistan (DRAP), drug administration of provincial health departments of 4 provinces and federally affiliated areas, 5 national public health programs, and 23 public and private hospitals. The assessment includes document review, interviews of the key informants by structured open-ended questions, and a review of websites of relevant organizations.Results: Drug Regulatory Authority of Pakistan (DRAP) with a national PV center received a 75% overall performance score on IPAT. To be regarded as “minimally functioning,” a country’s PV and drug safety system must meet all core indicators. DRAP scored 80.76% on the core indicators so cannot be deemed functional at this time. The only province with a regional PV center, Punjab, had scored 72.13% on relevant parameters. Despite receiving funding from the Global Fund, none of the National Public Health Programs (PHPs) have PV centers or associated activities. All hospitals except two private hospitals could not qualify the minimum requirements for functional PV. The absence of a legal framework for mandatory ADR reporting, lack of drug information center, budgetary constraints, no active surveillance activities, the nonexistence of pharmacovigilance risk assessment expert committee, and insufficient coordination among stakeholders were identified as major gaps.Conclusion: The results of the study reveal that Pakistan’s PV system is not fully functional at all levels. A two-phased strategy encompassing the non-financial and financial interventions is proposed to improve the PV systems at the national, provincial, PHPs, and hospitals levels.

House of People Participation in Health: A Place to Attend People's Representatives to Plan, Implement, and Monitor Health Programs

The article's abstract is not available.

Identification of Reproductive Health Monitoring Indicators in Iran

Introduction As a result of recent demographic changes, Iran has revised its reproductive health programs. To respond to the essential need for monitoring the new programs and policies, this study aimed to identify tailored, appropriate, and measurable RH indicators in the Iranian context, using available evidence and international indicators.Method This is an applied mixed-methods research, which was conducted in four phases: Identification of goals of RH policies and programs, scoping review of the RH indicators in the literature, developing and ranking the identified indicators, and finalization of indicators. Qualitative content analysis was used to analyze the textual data of the documents and policies. We analyzed the studies in the scoping review by narrative synthesis. The final indicators were selected through the consensus of experts, with a cut-off point of 75%. Result We identified 689 indicators through document analysis and scoping review. After three round of screening, a total of 37 RH indicators were finalized. The first five indicators with the highest score were: total fertility rate, population under 15 years, total population, population aged 65 years and older, and age-specific fertility rate.Conclusion: The nature and number of indicators for monitoring and evaluation of reproductive health programs might vary at different organizational levels; hence the need to develop specific indicators for each level is pivotal. In addition, the need for collection, processing and dissemination of reliable data for evaluation of these programs is essential.

Do Canadians Support Tailored and Targeted Public Health Programs? A Discrete Choice Experiment

Background. We aimed to assess public support of tailored and targeted public health interventions for various marginalized communities.Methods. We conducted a discrete choice experiment using a web-based survey advertised to Facebook and Instagram users living in Canada, aged >16. Participants were asked to choose between funding two hypothetical public health programs. Each program was described by its purpose; expected increase in life expectancy; and target group. Demographically-weighted generalized linear mixed-effects models were constructed to identify program factors associated with program selection.Results. 23,889 exercises were completed by 3,054 participants. Selected programs were less likely to focus on prevention (vs. treatment). For each 1-year increase in the marginal years of life gained, there was a 15% increase in the odds of a program being selected. Interventions tailored to marginalized communities or targeting stigmatized health conditions were less likely to be selected compared with interventions targeted to the general population or targeting chronic health conditions. Noteworthy exceptions included an increased preference for interventions aligning with the perceived needs of marginalized communities (e.g. HIV and men who have sex with men).Conclusions. Stigmatizing perceptions of health conditions and key populations likely influence public health programming preferences of Canadians. Informational campaigns highlighting disparities experienced by marginalized populations may improve support for targeted and tailored interventions.

Estimating the impact of donor programs on child mortality in low- and middle-income countries: a synthetic control analysis of child health programs funded by the United States Agency for International Development

Background Significant levels of funding have been provided to low- and middle-income countries for development assistance for health, with most funds coming through direct bilateral investment led by the USA and the UK. Direct attribution of impact to large-scale programs funded by donors remains elusive due the difficulty of knowing what would have happened without those programs, and the lack of detailed contextual information to support causal interpretation of changes. Methods This study uses the synthetic control analysis method to estimate the impact of one donor’s funding (United States Agency for International Development, USAID) on under-five mortality across several low- and middle-income countries that received above average levels of USAID funding for maternal and child health programs between 2000 and 2016. Results In the study period (2000–16), countries with above average USAID funding had an under-five mortality rate lower than the synthetic control by an average of 29 deaths per 1000 live births (year-to-year range of − 2 to − 38). This finding was consistent with several sensitivity analyses. Conclusions The synthetic control method is a valuable addition to the range of approaches for quantifying the impact of large-scale health programs in low- and middle-income countries. The findings suggest that adequately funded donor programs (in this case USAID) help countries to reduce child mortality to significantly lower rates than would have occurred without those investments.

The effectiveness of training community mental health therapists in an evidence-based intervention for ASD: Findings from a hybrid effectiveness-implementation trial in outpatient and school-based mental health services

An Individualized Mental Health Intervention for ASD (AIM HI) was developed in collaboration with community stakeholders for delivery in mental health services in response to therapist- and caregiver-identified need to improve services for children with autism spectrum disorder (ASD). Primary findings from a cluster randomized Hybrid Type 1 effectiveness-implementation trial conducted in publicly funded mental health programs demonstrated the effectiveness of AIM HI therapist training on child and caregiver outcomes. This study examined therapist outcomes and therapist experience as a moderator of training effects. Mental health programs were randomized to immediate AIM HI training or usual care. Therapists and child/caregiver clients were recruited from participating programs. Therapists in the AIM HI training condition received consultation for 6 months while delivering AIM HI. Differences between training conditions were examined using multilevel modeling. Therapists receiving AIM HI training were observed to use more extensive active teaching strategies with caregivers, engagement strategies with children, strategies promoting continuity of care, and had more structured sessions with more extensively pursued skill building. Therapist licensure moderated some training outcomes. The current study provides support for evidence-based practice implementation in usual care mental health services. Lay abstract Publicly funded mental health services play an important role in caring for school-age children with autism spectrum disorder (ASD); however, therapists report a lack of specialized ASD training, which families identity as a barrier in obtaining mental health services for their children. An Individualized Mental Health Intervention for ASD (AIM HI) was developed in collaboration with community stakeholders to respond to identified needs of children and community therapists. The current study examined the effects of therapist training in AIM HI on the changes in therapist practice, including therapists’ use of evidence-based intervention strategies in session. Data were collected from a study conducted in community outpatient and school based mental health programs randomly assigned to receive AIM HI therapist training or observation of routine care. Therapist and child clients were enrolled from participating programs. Therapists in AIM HI training received training and consultation for 6 months while delivering the AIM HI intervention to a participating client; therapists in usual care delivered routine care. Both groups of therapists video recorded psychotherapy sessions which were scored by trained raters. Differences between training groups were examined using multilevel modeling. Therapists trained in AIM HI were observed to use more extensive active teaching strategies with caregivers, engagement strategies with children, strategies promoting continuity of care, and had more structured sessions with more effective pursuit of caregiver and children skill teaching. Therapist licensure moderated some training outcomes.

Respondent-driven sampling: Advantages and disadvantages from a sampling method

This article summarizes the main elements, advantages, and disadvantages of Respondent-driven Sampling (RDS). Some criticisms regarding the feasibility of the inherent assumptions, their point estimators, and the obtained variances are pointed out. This article also comments on the problems observed in the quality of reports. Surveys using RDS should be methodologically sound as they are being applied to define priorities in health programs and develop national and international policies for financing service delivery, among other uses. However, there is considerable potential for bias related to implementation and analytical errors. There is limited empirical evidence on how representative the results obtained by RDS are, and the quest to improve the methodology is still in progress. Nevertheless, to have confidence in RDS results, we must verify that the social structure of the networks conforms to the assumptions required by the theory, that the sampling assumptions are reasonably fulfilled, and that the quality of the report is optimal, particularly for methodological and analytical items.

The Revolution of Education Accelerated as a Consequence of the Pandemic

Medical education has changed dramatically since its inception, from informal medical education without defined objectives or techniques to a formal medical education regulated by the government and academic groups. Now, a structured curriculum with well-defined goals and objectives, appropriate educational strategies, and the incorporation of digital tools will efficiently contribute to future health professionals facing their challenges in their practice. Surely the technological advancement that occurred due to the pandemic is here to stay. Although there are still challenges to be solved, the first steps are for them to be acknowledged and documented. This chapter's objective is to show how to structure an online theoretical course and its curriculum and discuss the implementation of hybrid models of education and virtual simulation in health programs.