An Italian Model for the Management of Cancer patients during COVID-19 pandemic: the Oncological Orientation region Center (COrO) of Taranto (ROP)

Objective: The recent outbreak of COVID-19 caused a limitation of the resources of the National Health System and the necessity to formulate novel practice recommendation for oncological care. To date there are not available any management guidelines for cancer patients in case of pandemic. Each center has tried to manage its own needs and requests independently, often reducing access to treatment and diagnostic exams to patients. Here we have described the management of cancer patients during COVID-19 infection with suggestions of some practical approaches applied by our Regional Center for Oncological Orientation (COrO) in S.G. Moscati Hospital (Taranto-Italy). Subjects and Methods: Our strategies were the minimization of interruption of cancer treatment through the extension of Taranto's Health Regional (CorO). The extension of oncological network, assisted by the General Management of Taranto ASL through agreements with private structures in Taranto 's area allowed cancer patients to receive up to 11 different types of services, according to their needs(first investigation or follow up)and representing an exclusive organization on the entire Italian territory. Results: Thanks to the organization of the COrO in 2020, 1406 first oncological visits and 566 preparatory treatments were carried out, 372 of exemption for oncological pathology (free health care) were activated, 1742 instrumental investigations and 7 cases of civil invalidity were performed(certificate of disability). Conclusions: We have overcome the barriers to care of oncology patients that has led to a total reduction of waiting lists representing a practical application model that can be extended in to other healthcare settings.

The Limits of Free Health Care Schemes: the Case of Access to Care for Beneficiaries of the Moroccan Medical Assistance Scheme (RAMed) Suffering From Cancer

Background: The article discusses the limitations of a free-of-charge scheme for the poor in the case of cancer patients. The literature on free access to hospitals, especially on the African continent, has already mentioned these limits: occasional payments for care and transport. The particularly ambitious Moroccan free-of-charge scheme (RAMEd) presents the same problemsMethods: It is based on a qualitative survey of 120 patients and 30 doctors or nurses with whom we conducted semi-structured interviews over several months.Results: The results show that patients continue to pay for care and medical imaging as well as their transport to the hospital. They pay for care and examinations that are not available at the hospital or wait for them to be available, which is a danger to their chances of survival.Conclusions: The limitation of the RAMed is that it does not cover the cost of transport or the structural deficiencies of the hospital. The result is the paradox of a free service that is costly for patients. We stress that targeted policies cannot replace structural policies and, on their own, do not remedy inequalities, particularly territorial inequalities.

Hidden Tales of Ebola: Airing the Forgotten Voices of Ugandan “Ebola Nurses”

Introduction According to the Centers for Disease Control and Prevention, Ebola has affected the lives of thousands, including health care workers. With few studies describing the experience of nurses who survived Ebola, the study aimed to describe Ugandan nurses’ experiences. Method Using a phenomenological design, in-depth interviews were conducted among five Ugandan nurses who contracted Ebola and survived. Result Thematic analysis revealed themes of expectations of dying, hopelessness, loneliness, and betrayal by family, community, and the health system. Discussion Results support the need for policies targeting holistic practice protocols to protect all health care professionals during future outbreaks. Last, nursing survivors should have access to government-guaranteed support programs, including free health care and financial stipends. These results and recommendations transcend to the current reality of living with COVID-19 (coronavirus disease 2019). Efficient practice protocols could protect all rights and privileges and contribute to access to treatment and stigma removal.

State led innovations for achieving universal health coverage in a low resource setting Odisha, India: opportunities and challenges

Background: Odisha, a developing state of India, has introduced an innovative scheme known as Biju Swasthya Kalyan Yojana (BSKY), which aims at providing free health care to all the people. This paper examines the scope, key features, challenges and potentiality of BSKY to achieve universal health coverage (UHC) in Odisha.Methods: We reviewed policy documents and conducted qualitative interviews with key state government officials and other stakeholders to understand implement processes and constraints.Results: The scheme intends to provide free health care to all people in public health care institutions and additionally, 71 lakh poor households can avail health care services from the empanelled private hospitals with financial coverage up to 5 lakhs per family and women members up to 10 lakhs annually. This is implemented in assurance mode by merging state-run schemes- Rashtriya Swasthya Bima Yojana (RSBY), Biju Krushak Kalyan Yojana (BKKY) and Odisha State treatment fund (OSTF). The implementing agency is introducing several measures to control unnecessary health care utilisation and cost. Gate keeping mechanism and reserved packages by public hospital are major initiatives in this direction. Further, efforts to settle claims on time and IT related challenges are teething problems of the scheme. The findings further suggest that public expenditure on health stands at 1.3% of GSDP and inadequate human resources and health infrastructure are affecting service delivery.Conclusions: Achieving UHC with such a low public spending on health and different service delivery constraints looks ambitious. Odisha may learn from other countries to implement UHC phase wise.

How would Widespread Community Transmission of Covid-19 in Sri Lanka look like? A Population-based Prediction

Covid-19 is a viral disease which has briskly invaded the globe, Sri Lanka being no exception. If community transmission of Covid-19 occurs, it will have serious demands on Sri Lanka’s free health care system. Objective of this study was to simulate the widespread community transmission of Covid-19 in Sri Lanka. We used the Susceptibility, Infected and Removed (SIR) model through the Penn State University CHIME Model incorporated to ArcGIS Pro. We simulated introduction of one case of Covid-19 to each of the 26 health districts and ran the model for 365 days. During simulated scenario, the number patients requiring admissions, ICU care and mechanical ventilation will peak at 1942, 583 and 388 per day respectively around 213 days from the onset of widespread community transmission. The cumulative number of cases needing admission, ICU care and ventilation will be 245,916, 73,775 and 49,183 after 365 days. Colombo and Gampaha districts will report the highest number of daily total numbers of hospitalized cases, each which will be over 1680. Health authorities must be ready for the worst-case scenarios of the Covid-19 outbreak to sustain public health response to reduce morbidity and mortality.

Households experiencing catastrophic costs due to tuberculosis in Uganda: magnitude and cost drivers

Background Tuberculosis (TB) patients in Uganda incur large costs related to the illness, and while seeking and receiving health care. Such costs create access and adherence barriers which affect health outcomes and increase transmission of disease. The study ascertained the proportion of Ugandan TB affected households incurring catastrophic costs and the main cost drivers. Methods A cross-sectional survey with retrospective data collection and projections was conducted in 2017. A total of 1178 drug resistant (DR) TB (44) and drug sensitive (DS) TB patients (1134), 2 weeks into intensive or continuation phase of treatment were consecutively enrolled across 67 randomly selected TB treatment facilities. Results Of the 1178 respondents, 62.7% were male, 44.7% were aged 15–34 years and 55.5% were HIV positive. For each TB episode, patients on average incurred costs of USD 396 for a DS-TB episode and USD 3722 for a Multi drug resistant tuberculosis (MDR TB) episode. Up to 48.5% of households borrowed, used savings or sold assets to defray these costs. More than half (53.1%) of TB affected households experienced TB-related costs above 20% of their annual household expenditure, with the main cost drivers being non-medical expenditure such as travel, nutritional supplements and food. Conclusion Despite free health care in public health facilities, over half of Ugandan TB affected households experience catastrophic costs. Roll out of social protection interventions like TB assistance programs, insurance schemes, and enforcement of legislation related to social protection through multi-sectoral action plans with central NTP involvement would palliate these costs.