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Preview: Health Policy and Planning - Advance Access

Health Policy and Planning Advance Access

Published: Sat, 02 Sep 2017 00:00:00 GMT

Last Build Date: Sat, 02 Sep 2017 06:44:29 GMT


Hospitalizations for primary care sensitive conditions: association with socioeconomic status and quality of family health teams in Belo Horizonte, Brazil


Hospitalizations for primary care sensitive conditions (HPCSC) have been used as a measure of the effectiveness of primary care. Few studies, however, have measured the quality of primary health care (PHC) and how it impacts HPCSC trends. We employed previously calculated quality scores of PHC attributes (access, continuous/ongoing care, coordinated care and comprehensive care) assigned to health centres and investigated the correlation between these quality scores and HPCSC time trends in public hospitals in the city of Belo Horizonte, Brazil, adjusted by demographic and socioeconomic factors between 2010 and 2013. Socioeconomic risk was determined using the Health Vulnerability Index, a composite indicator including sanitation, habitation, education, income and health variables. Between 2010 and 2013, 447 500 hospitalizations, excluding births, were recorded in Belo Horizonte. Of these, 85 211 were HPCSC (19% of total admissions). Of 145 health centres, 133 were analysed in this study, with 75 059 HPCSC in the 4-year period. In the initial univariate model, only the PCH attribute ‘access’ and ‘social vulnerability’ had an effect on hospitalization rates. In the multilevel analysis, socioeconomic vulnerability became the only predictor of HPCSC rates. A 10% increase in high socioeconomic risk population meant an increase of 5 HPCSC/10 000 in women and 4/10 000 in men for each individual primary care unit, while a 10% increase in low-risk population meant a reduction in HPCSC of 6/10 000 in women and 5/10 000 in men. The results support the importance of using HPCSC as a measure of PHC effectiveness, considering individual, health service-related and socioeconomic characteristics; however, additional measures of effectiveness of care provided by family health teams seem necessary to assess PHC performance.

Costing essential services package provided by a non-governmental organization network in Bangladesh


The health profile of Bangladesh has improved remarkably, yet gaps in delivering quality health care remain. In response to the need for evidence to quantify resources for providing health services in Bangladesh, this study estimates unit costs of providing the essential services package (ESP) in the not-for-profit sector. This study used a stratified sampling approach to select 18 static clinics, which had fixed facilities, from 330 non-profit clinics under Smiling Sun network in Bangladesh. Costs were estimated from the providers’ perspective, using both top-down and bottom-up methods, from July 2014 to June 2015. In total, there were 1115 observations (clients) for the 13 primary care services analysed. The estimated 2015 average costs per visit were: antenatal care ($7.03), postnatal care ($4.57), control of diarrheal diseases ($1.32), acute respiratory infection ($1.53), integrated management of child illness ($2.02), sexually transmitted infections ($4.70), reproductive tract infections ($3.56), tuberculosis ($41.65), limited curative care ($4.30), immunization ($2.23), family planning ($0.72), births by normal delivery ($29.45) and C-section ($114.83). Unit costs varied widely for each service, both between individual patients and among clinic level means. The coefficient of variation for the 13 services averaged 66%, implying potential inefficiencies. In addition, 32.9% of clients were not offered any lab test during the first antenatal visit. The unit cost of essential services differed by the type and location of clinics. Ultra clinics, on average, incurred 37% higher costs than vital (outpatient type) clinics, and urban clinics spent 40% more than rural clinics to deliver a unit of service. The study suggests that inefficiency and quality concerns exist in health service delivery in some facilities. Increasing the volume of clients through demand-side mechanisms and standardization of services would help address those concerns. Unit costs of services provide essential information for estimating resource needs for scaling up the ESPs.

HIV/AIDS National Strategic Plans of Sub-Saharan African countries: an analysis for gender equality and sex-disaggregated HIV targets


National Strategic Plans (NSPs) for HIV/AIDS are country planning documents that set priorities for programmes and services, including a set of targets to quantify progress toward national and international goals. The inclusion of sex-disaggregated targets and targets to combat gender inequality is important given the high disease burden among young women and adolescent girls in Sub-Saharan Africa, yet no comprehensive gender-focused analysis of NSP targets has been performed. This analysis quantitatively evaluates national HIV targets, included in NSPs from eighteen Sub-Saharan African countries, for sex-disaggregation. Additionally, NSP targets aimed at reducing gender-based inequality in health outcomes are compiled and inductively coded to report common themes. On average, in the eighteen countries included in this analysis, 31% of NSP targets include sex-disaggregation (range 0–92%). Three countries disaggregated a majority (>50%) of their targets by sex. Sex-disaggregation in data reporting was more common for targets related to the early phases of the HIV care continuum: 83% of countries included any sex-disaggregated targets for HIV prevention, 56% for testing and linkage to care, 22% for improving antiretroviral treatment coverage, and 11% for retention in treatment. The most common target to reduce gender inequality was to prevent gender-based violence (present in 50% of countries). Other commonly incorporated target areas related to improving women’s access to family planning, human and legal rights, and decision-making power. The inclusion of sex-disaggregated targets in national planning is vital to ensure that programmes make progress for all population groups. Improving the availability and quality of indicators to measure gender inequality, as well as evaluating programme outcomes by sex, is critical to tracking this progress. This analysis reveals an urgent need to set specific and separate targets for men and women in order to achieve an equitable and effective HIV response and align government planning with international priorities for gender equality.

The impact of prevention and control of infectious disease law on diarrhoea control: a 5-year evaluation in multiple provinces in Vietnam


To address to burden of infectious diseases such as diarrhoea, the Vietnamese government has enacted the Law on Prevention and Control of Infectious Diseases (LPCIDs) since July 2008. However, no evaluation of the impact of the LPCID has been conducted. This study aims to evaluate the impact of the LPCID on diarrhoeal control for the 5 years following the implementation of LPCID in Vietnam. We used an interrupted time series design using a segmented regression analysis to estimate the ‘province-level’ impact of LPCID and then used random-effect meta-analysis to estimate the pooled effect sizes of the ‘country-level’ impact of LPCID on diarrhoeal control throughout Vietnam. The results show that the impacts varied by provinces. They were classified in four groups: ‘positive impact, positive impact without sustainability, possibly positive impact, no or negative impact’ of the LPCID. The meta-analysis indicated that the country-level impact of the LPCID became significant at 11 months after the LPCID took effect, with a decrease in level of diarrhoea of 9.7% (coefficient, −0.097; 95% CI: −19.1 to − 0.002) and a permanent downward trend of diarrhoea at a rate of 1.1% per month (coefficient, −0.011; 95% CI: −0.02 to − 0.003); whereas the trend in diarrhoea before the LPCID took effect was unchanging (coefficient, 0.002; 95% CI, 0–0.004). At 12, 24, 36, 48 and 60 months following the LPCID implementation date the levels of diarrhoea decreased by 10.9% (coefficient, −0.109; 95% CI: −0.203 to − 0.015), P < 0.01), 21.8% (coefficient, −0.218; 95% CI: −0.338 to − 0.098), P < 0.01), 31% (coefficient, −0.31; 95% CI: −0.474 to − 0.145), P < 0.01), 46.8% (coefficient, −0.468; 95% CI: −0.667 to − 0.27), P < 0.01), 48.2% (coefficient, −0.482; 95% CI: −0.708 to − 0.256), P < 0.01) respectively. The findings of this study reveal the effectiveness of the LPCID in reducing diarrhoea incidence in Vietnam. However, further studies should be conducted to better understanding the cost-effectiveness, acceptability, and sustainability of each component of the LPCID.