Browsing by Author "Yamey, Gavin"

Background Four major noncommunicable diseases (NCDs)—cardiovascular diseases (CVD), diabetes, chronic respiratory diseases, and cancer—have become the leading causes of disability-adjusted life-years in China. Curbing these diseases is critical in the Healthy China 2030 plan, a national health promotion strategy. A key question is whether the plan will expand service capacity for people with NCDs, and also reduce the financial burden that people in China suffer in paying for those services. In order to inform this question, this study examined (i) the current use of healthcare services in China by people with different types of NCDs; (ii) the financial burden they experience in seeking such care; and (iii) whether socioeconomic status (SES) factors influence both their use of healthcare services and the financial burden of service use.Method We used data from the 2018 wave of a nationally representative survey, called China Health and Retirement Longitudinal Study (CHARLS). We included all participants who were interviewed in the 2018 survey. We examined three types of outcomes: perceived healthcare needs (measured by self-reported health), the use of healthcare services, and the financial burden of such use (as assessed by out-of-pocket expenses [OOP] and catastrophic health expenditure [CHE]). The indicators we used were four major NCDs, and SES factors (including education status, employment status, income level, residence status, and different health insurance schemes: Urban Employee Basic Medical Insurance [UEBMI], and Urban-Rural Resident Medical Insurance [URRMI]). Logistic regression models were used to assess effects of having four NCDs and SES factors on people’s perceived needs, healthcare service use, and CHE. Negative binomial models were performed to assess the effects of four major NCDs and SES factors on the number of times that healthcare services were used. Multiple linear regression models were adopted to examine the associations between four major NCDs, SES factors, the financial burden of service use, and the distance from the healthcare facility to home. Results A total of 20,813 respondents were included in our analyses. Compared with having one or more of the four major NCDs, there is some evidence that having no NCDs was associated with lower odds of having an outpatient visit in the last month (odds ratio [OR]=0.86), a hospitalization in the last year (OR=0.87) or taking purchased medicine in the last month (OR=0.82). People without NCDs may also have lower OOP for purchasing medicines in the last month compared with those with one or more of the four major NCDs (exponentiated β = 0.87). However, no evidence of differences was found in healthcare service use and the financial burden of the service use between people with four major NCDs and people with other types of NCDs. In relation to SES factors, (i) residency status: people living in rural areas may have higher baseline odds (OR = 1.11) of taking self-purchased medicine, more hospital admissions during the past year (IRR = 1.25), longer distance traveled from home to their last outpatient visit (exponentiated β = 1.28), and longer distance traveled from home to their last inpatient visit facility (exponentiated β = 1.25) than those who were in urban areas. (ii) health insurance type: some evidence showed that people without health insurance may have worse self-perceived health (OR = 1.53), lower odds of going to an outpatient visit in the last month (OR=0.71), and lower odds of an inpatient visit in the last year (OR=0.32) compared with people covered by UEBMI. People without health insurance also may travel further from home to an inpatient facility (exponentiated β = 3.39) and have higher odds of experiencing CHE (OR = 1.37) compared with people with UEBMI. People covered with URRMI may have poorer self-perceived health (OR = 1.21), lower odds of having an inpatient visit in the last year (OR=0.73), lower number of hospital admissions in the last year (IRR = 0.77) and lower OOP expenses for the last outpatient visit (exponentiated β = 0.77) than people with UEBMI. They also may travel longer distances from their home to an inpatient facility (exponentiated β = 2.06) than people with UEBMI. Conclusion There was no evidence showed that there were differences between having one or more of these four major NCDs versus having other types of NCDs in people’s self-perceived health, their use of healthcare services, and the financial burden of such service use, thus we should not overlook the prevention and management of other types of NCDs. In addition, continuous attention should be paid to the prevention and management of four major NCDs in China. Despite the Chinese government’s efforts to improve the health system to ensure universal health coverage in China, efforts should be further taken in providing financial protection to people in less-resourced settings (i.e., people living in rural areas and those without a health insurance plan) and to avoid inequality in healthcare service use that favors richer people.

Dental caries accounts for the primary burden of disease globally,1 a burden which falls heavily on those least able to access treatment.2 Despite this burden, oral health remains neglected on the global agenda. Thus, we sought to conduct a qualitative study to determine why oral health occupies the position it does on the global agenda as well as what factors might promote or prevent its ascent. Virtual interviews were conducted with key oral health stakeholders identified by the Lancet Commission on Oral Health and coded to reveal underlying themes. Our study found several reasons for the neglect of oral health by global health policymakers. These include the separation of oral health care from comprehensive health care; the lack of research and data on oral health; competing interests from multinational food companies that promote and sell sugary foods and beverages; and the dental profession’s propensity for treatment over prevention. Integration of oral health into UHC schemes, expanded research and data collection, sugar taxation, and task-shifting were identified as potential avenues to facilitate oral health’s prioritization on the global agenda.

As countries transition from low income to middle income countries, they gradually lose donor aid. Donor aid for HIV in Ghana is slowly declining and more commitment from the government is expected for funding HIV/AIDS programs. Vulnerable populations are disproportionally affected by HIV and might be at greater risk as donors exit Ghana. This research used semi-structured interviews with 26 key informants to understand how vulnerable populations could be affected by the transition away from donor aid for HIV. This study found that vulnerable populations in Ghana mostly receive support from civil society organizations (CSOs) that are funded by donors. As funding transitions to government, CSOs are likely to reduce the scope of their work, and populations will lose access to some key preventative activities. In addition, HIV programs will be focused on the general population as opposed to the most vulnerable. Finally, if the transition is managed properly, involving key stakeholders at early stages of the process and ensuring partnerships between government and CSOs, it could in fact empower vulnerable populations to have increased decision-making power.

Background: When Ghana undergoes economic growth, and becomes a middle-income country, it will face the loss of official development assistance (ODA), including ODA for health. PEPFAR has been supporting Ghana for many years and now is reducing its funding in Ghana.

Methods: This is a qualitative study based on 21 in-depth, key informant interviews conducted between May and October 2019. Study participants were individuals who are involved in Ghana’s national HIV/AIDS response; they included government officials, technical officers from international organizations, staff from donor agencies, and staff from local civil society organizations (CSOs).

Results: PEPFAR has been playing a significant role for Ghana’s national HIV/AIDS control. However, it is reducing its funding in Ghana because of Ghana’s poor performance and government commitment. PEPFAR is transiting its work focus to only the Western Region in order to achieve epidemic control in this region. This transition will bring many challenges to Ghana such as financial, governance, and system challenges. The government of Ghana and CSOs in Ghana have been aware of PEPFAR’s transition for some time, and initial plans are conducted to manage this transition. At the same time, PEPFAR is trying to initiate conversations with other donors to fill in the potential gaps.

Conclusions: Transition is shared responsibility. PEPFAR as a donor could publish its specific transition plan for Ghana to navigate this transition. Ghana as a recipient country could make more commitment to perform better with donor findings. Donors will not provide permanent assistance; transition is a good chance for country to stand fully on its own feet. Mobilizing domestic resources is important to sustain Ghana as a country itself and manage the transition.

Background: Previous pandemics have shown that disruption of essential services could undo decades of efforts to reduce maternal and child mortality. Therefore, preventing disruption of essential services such as immunizations, skilled birth delivery, antenatal care etc. and safeguarding adequate sources of maternal and child health funding should be a key priority for governments and health donors. This study will aim to understand the impact of COVID-19 on maternal and child health services and how donors and policymakers are determining financing and policy priorities amid the COVID-19 pandemic. Methods: A qualitative study was conducted with thirteen health experts from key bilateral and multilateral organizations and international NGOs. In addition to these interviews, relevant publications such as donor policies on their responses to COVID-19 were also reviewed and synthesized. Key informants provided written consent and all interviews were audio-recorded. Results: Governments across the world should increase their efforts to sustain essential health services for mothers and children. In addition, donors must provide greater support for weak health systems by granting extensions in loan repayments and providing technical assistance and essential supplies for health workers. Use of digital technologies, collaborative information sharing processes and flexibility in funding streams have been considered the best form of support that donors can provide. Conclusion: This study contributes to understanding the key role played by contemporary global health actors involved in formulating the initial policy responses and guidelines for countries during the COVID-19 pandemic on continuation of essential services such as maternal and child health. The findings can help understand the preliminary steps taken by the donor community to respond to the pandemic and can lay the groundwork to determine the future direction of financing and key health priority areas.

The global distribution of COVID-19 vaccines has been inequitable: around 8 in 10 people in high-income countries have had at least one dose, compared with just 1 in 10 in low-income countries. Similar global vaccine inequity was seen in past pandemics, such as the 2009 H1N1 pandemic. The COVID-19 Vaccine Global Access Facility (COVAX), launched by the Coalition for Epidemic Preparedness (CEPI), Gavi, the Vaccine Alliance (Gavi), and the World Health Organization (WHO), aimed to equitably distribute vaccines worldwide. COVAX was an unprecedented mechanism—the first attempt to create a pandemic vaccine buyers’ club for all nations of all income levels. COVAX can serve as a case study: by determining what challenges and successes it has had during COVID-19, we can determine what elements a future pandemic vaccine facility (which we can call “PANVAX”) may need to ensure equity in the next pandemic. In this qualitative study, 14 in-depth interviews were conducted across 4 different stakeholder groups to elicit expert opinions on COVAX and on the design of a future PANVAX. These four stakeholder groups were pharmaceutical company representatives, COVAX administrators, academics, and national governments. Key informants argued that the concept of COVAX was strong and COVAX succeeded in securing participation from pharmaceutical companies, but it suffered from many challenges, including vaccine supply shortages and delays, challenges in negotiating with vaccine companies, internal governance challenges, and a lack of participation by high-income countries in the buyers’ club. They also suggested that in a future pandemic vaccine facility, there needs to be upfront funding, investment into the entire vaccine development process, regional vaccine capacity building, and a ‘day-job’ for the facility when there is no pandemic to keep the facility running. Overall, this study found that COVAX was faced by challenges that were both of its own making and outside of its control. For future pandemics, there is a clear need for a facility that has sufficient upfront funding for purchasing and investing into all aspects of the vaccine process, and that has responsibilities outside of pandemic or emergency response. By focusing on regional vaccine self-sufficiency, several issues can be addressed both for pandemic response and public health benefits.

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