Health Policy Open最新文献

{"title":"Resilience outcomes and associated factors among workers in community-based HIV care centres during the Covid-19 pandemic: A multi-country analysis from the EPIC program","authors":"Marion Di Ciaccio ,&nbsp;Nicolas Lorente ,&nbsp;Virginie Villes ,&nbsp;Axel Akpaka Maxence ,&nbsp;Claudia Marcela Vargas Pelaez ,&nbsp;José Rafael Guillen ,&nbsp;Ingrid Castillo ,&nbsp;Cinta Folch ,&nbsp;Rokhaya Diagne ,&nbsp;Lucas Riegel ,&nbsp;Rosemary M. Delabre ,&nbsp;Daniela Rojas Castro ,&nbsp;the EPIC study group","doi":"10.1016/j.hpopen.2023.100105","DOIUrl":"https://doi.org/10.1016/j.hpopen.2023.100105","url":null,"abstract":"<div><h3>Introduction</h3><p>Community health workers (CHW) were integral in the COVID-19 response, particularly concerning services for populations vulnerable to HIV. Little is known regarding the mental health of CHW during the COVID-19 crisis. The objective of this study was to study resilience of CHW working in HIV non-governmental organizations.</p></div><div><h3>Methods</h3><p>An anonymous online, cross-sectional questionnaire was implemented during 2021 among CHW in Benin, Colombia, Guatemala, and Spain. Three scales were used to assess mental health: the 6-item Brief-Resilience Scale, the 9-item Patient Scale Questionnaire and the 7‐item Generalized-Anxiety-Disorder scale. Logistic regression models were used to identify factors associated with “low” resilience vs “normal” or “high” resilience.</p></div><div><h3>Results</h3><p>Among 295 respondents, the median standardized resilience score was 58.33 (IQR = [50.0–75.0], n = 267), 18.52 (IQR = [7.4–33.3], n = 282) for standardized depression score and 19.05 (IQR = [4.8–33.3], n = 274) for standardized anxiety score. Standardized resilience score was negatively correlated with standardized anxiety score (rho = -0.49, p &lt; 0.001, n = 266) and standardized depression score (rho = -0.44, p &lt; 0.001, n = 267).</p></div><div><h3>Conclusions</h3><p>Normal or high level of resiliency in the HIV CHW were observed during the COVID-19 crisis. Self-efficacy, through COVID-19 prevention training, was a factor associated with resilience. Health policy must place CHW at the core of the healthcare system response to Covid‐19 and to future health emergencies, as they ensure continuity of care for many diseases including HIV among vulnerable populations.</p></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"5 ","pages":"Article 100105"},"PeriodicalIF":0.0,"publicationDate":"2023-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590229623000175/pdfft?md5=76f580d3d1b21418e867c72e258dc72b&pid=1-s2.0-S2590229623000175-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"92019753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Managing infectious disease outbreaks during an ongoing economic crisis in Nigeria: A call to action","authors":"Jeremiah Oluwamayowa Omojuyigbe,&nbsp;Omolabake Tikare,&nbsp;Ayodele Emmanuel Oke,&nbsp;Aisha Hassan","doi":"10.1016/j.hpopen.2023.100106","DOIUrl":"https://doi.org/10.1016/j.hpopen.2023.100106","url":null,"abstract":"","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"5 ","pages":"Article 100106"},"PeriodicalIF":0.0,"publicationDate":"2023-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590229623000187/pdfft?md5=53d3c251de3dca4503dabb8b54490efc&pid=1-s2.0-S2590229623000187-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91957388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In with the good, out with the bad – Investment standards for external funding of health?","authors":"Robert John Fryatt ,&nbsp;Mark Blecher","doi":"10.1016/j.hpopen.2023.100104","DOIUrl":"10.1016/j.hpopen.2023.100104","url":null,"abstract":"<div><p>In recent decades, external financing of health systems in low- and middle-income countries has helped achieve remarkable improvements across the world. However, these successes have not come without problems. There are a growing number of areas where external assistance can cause harm and even undermine the development of national health systems. Recent decades have seen a surge of knowledge on investing in health systems. We propose the setting up of investment standards for external assistance that aim to incentivize a more efficient evidence-based investment in a country’s health system, led by decision-makers in country. Using a more standardized process would lead to a better use of precious external assistance resources. The long-term goal would be fully functioning health systems with all the necessary essential public health functions in all countries.</p></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"5 ","pages":"Article 100104"},"PeriodicalIF":0.0,"publicationDate":"2023-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590229623000163/pdfft?md5=bb42e2cfd2cdaaf4cfa0be9eb0cd7ac0&pid=1-s2.0-S2590229623000163-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136154021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Variation in Medicaid and commercial coverage of cell and gene therapies","authors":"Molly T. Beinfeld ,&nbsp;Julia A. Rucker ,&nbsp;Nola B. Jenkins ,&nbsp;Lucas A. de Breed ,&nbsp;James D. Chambers","doi":"10.1016/j.hpopen.2023.100103","DOIUrl":"https://doi.org/10.1016/j.hpopen.2023.100103","url":null,"abstract":"<div><p>Growth in the availability of cell and gene therapies (CGTs) promises significant innovation in the treatment of serious diseases, but the high cost and one-time administration of CGTs has also raised concern about strain on health plan budgets and inequity in access. We used coverage information from the Tufts Medical Center Specialty Drug Evidence and Coverage (SPEC) database for 18 large commercial health plans in the US and information from state Medicaid websites to examine variation in coverage of 11 CGTs in August 2021. We found that US commercial and Medicaid health plans imposed restrictions in 53.5 % and 68.3 % of their coverage policies for the 11 included CGTs, respectively. In addition, we identified significant variation in access to CGTs across commercial plans and across Medicaid plans. Coverage restrictions for certain CGTs were more common than others; clinical requirements were often (but not always) consistent with the inclusion criteria for the clinical trial central to the drug’s approval. We conclude that there is variation in access to CGTs, creating differential patient access.</p></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"5 ","pages":"Article 100103"},"PeriodicalIF":0.0,"publicationDate":"2023-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590229623000151/pdfft?md5=0e2ff485bbf69751b569aff26579e612&pid=1-s2.0-S2590229623000151-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91957387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Out-of-pocket expenditure among patients with diabetes in Bangladesh: A nation-wide population-based study","authors":"Zakir Hossain ,&nbsp;Moriam Khanam ,&nbsp;Abdur Razzaque Sarker","doi":"10.1016/j.hpopen.2023.100102","DOIUrl":"10.1016/j.hpopen.2023.100102","url":null,"abstract":"<div><h3>Background and objectives</h3><p>Diabetes has become one of the fastest growing public health emergencies worldwide. The objective of this study was to estimate the average annual out-of-pocket cost of diabetes treatment as well as to find out the catastrophic health expenditure (CHE) and their determinants in Bangladeshi context.</p></div><div><h3>Data and methods</h3><p>The study utilised data from the most recent nationally representative Household Income and Expenditure Survey 2016–2017. The incidence of CHE was estimated by applying 10% and 25% of the annual total household expenditure threshold levels. The factors associated with CHE was presented as adjusted odds ratio with 95% confidence intervals.</p></div><div><h3>Results</h3><p>The annual average out-of-pocket cost per diabetes patient was US$ 323 (BDT 25,473). The cost of medication was the main cost driver contributed for 75.43% of the total out-of-pocket cost. The incidence of CHE was 14.34%, and 5.86% of the study households for 10% and 25% of the threshold levels, respectively. The patient aged more than 60 (AOR: 4.89; CI 0.82 to 28.95), uneducated (AOR: 1.83; CI 0.25 to 2.12), comorbid condition (AOR: 1.62; CI 0.94 to 2.79), small household size (AOR: 3.20; CI 0.58 to 17.51), rural resident (AOR: 1.85; CI 0.46 to 1.57), poorest asset quintile (AOR: 4.06; CI 1.43 to 13.87) and private facility type (AOR: 8.16; CI 3.46 to 19.;25) were significantly associated with the incidence of CHE due to diabetes treatment.</p></div><div><h3>Conclusions</h3><p>There are considerable out-of-pocket costs needed for diabetes care in Bangladesh. The evidence of catastrophic expenditure suggests the urgent need to improve financial risk protection to ensure access to care.</p></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"5 ","pages":"Article 100102"},"PeriodicalIF":0.0,"publicationDate":"2023-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2f/50/main.PMC10514070.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41136263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of funding disruptions on large-scale teen pregnancy prevention research projects","authors":"Gina Gonzalez Hofert ,&nbsp;Genevieve Martinez-Garcia ,&nbsp;Lauren Tingey ,&nbsp;Michele Ybarra ,&nbsp;Ash Philliber ,&nbsp;Jordan Karas ,&nbsp;Melanie Grafals ,&nbsp;Milagros Garrido ,&nbsp;Sarah Parchem ,&nbsp;Erin Yager-DeConcini","doi":"10.1016/j.hpopen.2023.100101","DOIUrl":"10.1016/j.hpopen.2023.100101","url":null,"abstract":"<div><p>To advance the field of teen pregnancy prevention, new interventions must be developed and tested. The federal Teen Pregnancy Prevention program (TPP) funds the evaluation of promising interventions. We report on a funding disruption to 21 TPP Tier 2B research grantees across the US that was unusual for its ideological causation, sudden timing, severity, and ultimately court decisions compelling the agency to reverse the decision. We address the following question: How did challenges presented by the attempted funding termination impact grantees’ ability to continue with their intended research? Results from grantee surveys in 2019 demonstrate the funding disruption negatively impacted participant recruitment, organizational collaboration, program delivery, research rigor, and compromised grantees’ ability to complete high-quality evaluations. Results also show most projects could continue, with modified research goals, when funding was reinstated. We conclude administrations should avoid arbitrarily and prematurely terminating research projects. However, there is merit in reinstating funds to projects should a disruption occur. Results from this work are particularly relevant as we anticipate how health research projects may manage other disruptions to funding or timetables, such as those caused by COVID-19. Results are relevant to policy makers, researchers, government and private funders, grantees, and technical assistance teams.</p></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"5 ","pages":"Article 100101"},"PeriodicalIF":0.0,"publicationDate":"2023-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f7/f6/main.PMC10458667.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10108792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health-care policies during the COVID-19 pandemic in Mexico: A continuous case of heterogeneous, reactive, and unequal response","authors":"Daniela Bautista-Reyes ,&nbsp;Jimena Werner-Sunderland ,&nbsp;Alondra Coral Aragón-Gama ,&nbsp;José Roberto Cabral Duran ,&nbsp;Karla Daniela Contreras Medina ,&nbsp;Manuel Urbina-Fuentes ,&nbsp;Elysse Bautista-González","doi":"10.1016/j.hpopen.2023.100100","DOIUrl":"10.1016/j.hpopen.2023.100100","url":null,"abstract":"<div><h3>Background</h3><p>The pandemic in Mexico underlined pre-existing health-care system inequalities. Within the first six months of the COVID-19 pandemic, 154 health policies across health institutions were found to be uncoordinated and heterogeneous, leading to health inequalities in access and potential health outcomes.</p></div><div><h3>Data &amp; methods</h3><p>Using a rapid qualitative research methodology, data was collected using purposive sampling of institutional policies published for public access on the official websites of the four public health institutions in Mexico from June 16th, 2020 to October 30th, 2021. This policy review used archival analysis to understand the differences in health-care policies during the COVID-19 pandemic in Mexico. These policies were classified under the RREAL framework and as a continuation of our first publication.</p></div><div><h3>Results</h3><p>During this study, categories of public health response and vaccination dominated the policies enacted. The SSA was the main author of publications. There seems to be a more unified policy response. However, health inequalities persist.</p></div><div><h3>Conclusions</h3><p>The Mexican government continued to be reactive to the increase in cases or the arrival of new variants, rather than preventative. Research and development of policies need to work together in soaring cases like COVID-19 to work more effectively against the economic and epidemiological burden of a pandemic. It is suggested that this “vaccination” should be included in the RREAL classification. Other sectors (i.e. the ministry of foreign affairs) should be considered relevant players in the future management of a pandemic.</p></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"5 ","pages":"Article 100100"},"PeriodicalIF":0.0,"publicationDate":"2023-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/45/b9/main.PMC10471918.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10149309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proposal for a national diagnostics action plan for the United States","authors":"Gigi Kwik Gronvall ,&nbsp;Sujeet B. Rao ,&nbsp;Susan Van Meter ,&nbsp;Adam Borden ,&nbsp;Tom Inglesby","doi":"10.1016/j.hpopen.2023.100099","DOIUrl":"10.1016/j.hpopen.2023.100099","url":null,"abstract":"<div><p>Providing a definitive diagnostic test in a disease emergency is critical to limit pathogen spread, develop and deploy medical countermeasures, and mitigate the social and economic harms of a serious epidemic. While major accomplishments have accelerated test development, expanded laboratory testing capacity, and established widespread point-of-care testing, the United States does not have a plan to rapidly respond, to develop, manufacture, deploy, and sustain diagnostic testing at a national scale. To address this gap, we are proposing a <strong>National Diagnostics Action Plan</strong> that describes the steps that are urgently needed to prepare for future infectious disease emergencies, as well as the actions we must take at the first signs of such’ events. These recommendations require substantial collaboration between the US government (USG) and the private sector to solve a series of challenges now, as well as to prepare for the massive and rapid scale-up of laboratory and point-of-care test development and testing capacity in future emergencies. The recommendations include establishing pre-event contracts; ensuring rapid access to clinical samples; creating a permanent public–private testing coordinating body to allow for rapid information sharing and improved cooperation among the USG, test developers, and clinical laboratories; and accelerating testing rollout at the beginning of an event—and thus, the effective public health management of a disease crisis.</p></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"5 ","pages":"Article 100099"},"PeriodicalIF":0.0,"publicationDate":"2023-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10336495/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9820458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVAX – Time to reconsider the strategy and its target","authors":"David Bell ,&nbsp;Garrett W. Brown ,&nbsp;Wellington A. Oyibo ,&nbsp;Samiratou Ouédraogo ,&nbsp;Blagovesta Tacheva ,&nbsp;Elena Barbaud ,&nbsp;Andreas Kalk ,&nbsp;Valéry Ridde ,&nbsp;Elisabeth Paul","doi":"10.1016/j.hpopen.2023.100096","DOIUrl":"10.1016/j.hpopen.2023.100096","url":null,"abstract":"<div><p>COVAX, the international initiative supporting COVID-19 vaccination campaigns globally, is budgeted to be the costliest public health initiative in low- and middle-income countries, with over 16 billion US dollars already committed. While some claim that the target of vaccinating 70% of people worldwide is justified on equity grounds, we argue that this rationale is wrong for two reasons. First, mass COVID-19 vaccination campaigns do not meet standard public health requirements for clear expected benefit, based on costs, disease burden and intervention effectiveness. Second, it constitutes a diversion of resources from more cost-effective and impactful public health programmes, thus reducing health equity. We conclude that the COVAX initiative warrants urgent review.</p></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"4 ","pages":"Article 100096"},"PeriodicalIF":0.0,"publicationDate":"2023-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d2/b1/main.PMC10098302.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9709358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Whether or not to enroll, and stay enrolled? A Tanzanian cross-sectional study on voluntary health insurance","authors":"Alphoncina Kagaigai ,&nbsp;Amani Thomas Mori ,&nbsp;Amani Anaeli ,&nbsp;Sverre Grepperud","doi":"10.1016/j.hpopen.2023.100097","DOIUrl":"10.1016/j.hpopen.2023.100097","url":null,"abstract":"<div><p>Lower-middle income countries (LMICs) have invested significant effort into expanding insurance coverage as a means of improving access to health care. However, it has proven challenging to fulfill these ambitions. This study investigates to what extent variables associated with the enrollment decision (stay never-insured or enroll) differ from variables associated with the dropout decision (stay insured or drop out). A cross-sectional survey that included 722 households from rural districts in Tanzania was conducted and multinomial logistic regressions were performed to determine the associations between independent variables and membership status (never-insured, dropouts, or currently insured). Both the decision to enrollment and the decision to drop out were significantly associated with the presence of chronic disease and perceptions about the quality of services provided, insurance scheme management, and traditional healers. The effect of other variables, such as age, gender and educational level of the household head, household income, and perceptions about premium affordability and benefit-premium ratios, varied across the two groups. To improve voluntary health insurance coverage, policymakers must simultaneously increase the enrollment rate among the never-insured and reduce the dropout rate among the insured. Our conclusions suggest that policies to increase insurance scheme enrollment rates should differ for the two uninsured groups.</p></div>","PeriodicalId":34527,"journal":{"name":"Health Policy Open","volume":"4 ","pages":"Article 100097"},"PeriodicalIF":0.0,"publicationDate":"2023-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/7e/11/main.PMC10297742.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9735931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}