| 1. |
- Allel, Kasim, et al.
(författare)
-
The contributions of public health policies and healthcare quality to gender gap and country differences in life expectancy in the UK
- 2021
-
Ingår i: Population Health Metrics. - : Springer Science and Business Media LLC. - 1478-7954. ; 19
-
Tidskriftsartikel (refereegranskat)abstract
- Background: In many high-income countries, life expectancy (LE) has increased, with women outliving men. This gender gap in LE (GGLE) has been explained with biological factors, healthy behaviours, health status, and sociodemographic characteristics, but little attention has been paid to the role of public health policies that include/affect these factors. This study aimed to assess the contributions of avoidable causes of death, as a measure of public health policies and healthcare quality impacts, to the GGLE and its temporal changes in the UK. We also estimated the contributions of avoidable causes of death into the gap in LE between countries in the UK.Methods: We obtained annual data on underlying causes of death by age and sex from the World Health Organization mortality database for the periods 2001-2003 and 2014-2016. We calculated LE at birth using abridged life tables. We applied Arriaga's decomposition method to compute the age- and cause-specific contributions into the GGLE in each period and its changes between two periods as well as the cross-country gap in LE in the 2014-2016 period.Results: Avoidable causes had greater contributions than non-avoidable causes to the GGLE in both periods (62% in 2001-2003 and 54% in 2014-2016) in the UK. Among avoidable causes, ischaemic heart disease (IHD) followed by injuries had the greatest contributions to the GGLE in both periods. On average, the GGLE across the UK narrowed by about 1.0 year between 2001-2003 and 2014-2016 and three avoidable causes of IHD, lung cancer, and injuries accounted for about 0.8 years of this reduction. England & Wales had the greatest LE for both sexes in 2014-2016. Among avoidable causes, injuries in men and lung cancer in women had the largest contributions to the LE advantage in England & Wales compared to Northern Ireland, while drug-related deaths compared to Scotland in both sexes.Conclusion: With avoidable causes, particularly preventable deaths, substantially contributing to the gender and cross-country gaps in LE, our results suggest the need for behavioural changes by implementing targeted public health programmes, particularly targeting younger men from Scotland and Northern Ireland.
|
|
| 2. |
- Dickin, Sarah, et al.
(författare)
-
Implementation of the Afya conditional cash transfer intervention to retain women in the continuum of care : a mixed-methods process evaluation
- 2022
-
Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 12:9
-
Tidskriftsartikel (refereegranskat)abstract
- Objectives: We report the results of a mixed-methods process evaluation that aimed to provide insight on the Afya conditional cash transfer (CCT) intervention fidelity and acceptability.Intervention, setting and participants: The Afya CCT intervention aimed to retain women in the continuum of maternal healthcare including antenatal care (ANC), delivery at facility and postnatal care (PNC) in Siaya County, Kenya. The cash transfers were delivered using an electronic card reader system at health facilities. It was evaluated in a trial that randomised 48 health facilities to intervention or control, and which found modest increases in attendance for ANC and immunisation appointments, but little effect on delivery at facility and PNC visits.Design: A mixed-methods process evaluation was conducted. We used the Afya electronic portal with recorded visits and payments, and reports on use of the electronic card reader system from each healthcare facility to assess fidelity. Focus group interviews with participants (N=5) and one-on-one interviews with participants (N=10) and healthcare staff (N=15) were conducted to assess the acceptability of the intervention. Data analyses were conducted using descriptive statistics and qualitative content analysis, as appropriate.Results: Delivery of the Afya CCT intervention was negatively affected by problems with the electronic card reader system and a decrease in adherence to its use over the intervention period by healthcare staff, resulting in low implementation fidelity. Acceptability of cash transfers in the form of mobile transfers was high for participants. Initially, the intervention was acceptable to healthcare staff, especially with respect to improvements in attaining facility targets for ANC visits. However, acceptability was negatively affected by significant delays linked to the card reader system.Conclusions: The findings highlight operational challenges in delivering the Afya CCT intervention using the Afya electronic card reader system, and the need for greater technology readiness before further scale-up.
|
|
| 3. |
- Kittipittayakorn, Cholada
(författare)
-
Enhancing the Performance and Efficiency of Healthcare Systems Using Industrial Economic Principles and Statistical Techniques
- 2024
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Optimizing healthcare systems has become more crucial in recent years due to escalating healthcare demands and economic constraints. This dissertation employed industrial economic principles and advanced statistical methods to analyze the performance and efficiency of healthcare systems in Europe. The study provided a detailed analysis of how healthcare systems can enhance service delivery and maintain cost-effectiveness by integrating industrial economic theories with empirical data. The dissertation was organized into a series of analyses, each focusing on different aspects of healthcare system performance, resource allocation, operational efficiency, and forecasting future health demands, as well as evaluating the accuracy of these forecasting models. Statistical techniques such as time series and multilevel regression analyses were used to examine the interplay between healthcare resources, healthcare systems, and health outcomes across European nations. The two main healthcare models in Europe, the Beveridge and Bismarck models, were compared in terms of performance, efficiency, and resource allocation. The main findings revealed that effective resource allocation and efficient management practices can significantly enhance the performance of healthcare systems. The study indicated that a healthcare system's efficiency depends on its ability to adjust resource allocation to changes in demographic and economic conditions. Additionally, this dissertation forecasted future demands for healthcare services, social security benefits, and pensions by incorporating macro-level determinants such as economic growth, unemployment rates, and population density into the forecasting models. The accuracy of these models provided valuable insights for policymakers to effectively plan for future healthcare, social security, and pension needs. Moreover, this dissertation employed an economic evaluation to compare the cost-effectiveness of Beveridge-type and Bismarck-type healthcare systems over the past twenty years. An effectiveness ratio was applied to measure the relationship between inputs (medical spending) and outputs (health outcomes). These effectiveness ratios demonstrated which healthcare system yields better health outcomes for each dollar spent. Furthermore, the findings indicated that the efficiency of healthcare systems varies from country to country, highlighting the challenges of adopting a universal approach to healthcare policy. This dissertation contributes to the academic field by demonstrating how industrial economic principles can be applied to improve the performance and efficiency of healthcare systems. It offered a framework for evaluating healthcare performance and efficiency, which can inform future reforms to achieve sustainable, high-quality healthcare services. This study promotes a dynamic approach to healthcare planning that adapts to technological advancements and demographic changes to enhance population health.
|
|
| 4. |
- Pulkki-Brännström, Anni-Maria, et al.
(författare)
-
Participatory learning and action cycles with women s groups to prevent neonatal death in low-resource settings : A multi-country comparison of cost-effectiveness and affordability
- 2021
-
Ingår i: Health Policy and Planning. - : Oxford University Press. - 0268-1080 .- 1460-2237. ; 16:35
-
Tidskriftsartikel (refereegranskat)abstract
- WHO recommends participatory learning and action cycles with women's groups as a cost-effective strategy to reduce neonatal deaths. Coverage is a determinant of intervention effectiveness, but little is known about why cost-effectiveness estimates vary significantly. This article reanalyses primary cost data from six trials in India, Nepal, Bangladesh and Malawi to describe resource use, explore reasons for differences in costs and cost-effectiveness ratios, and model the cost of scale-up. Primary cost data were collated, and costing methods harmonized. Effectiveness was extracted from a meta-analysis and converted to neonatal life-years saved. Cost-effectiveness ratios were calculated from the provider perspective compared with current practice. Associations between unit costs and cost-effectiveness ratios with coverage, scale and intensity were explored. Scale-up costs and outcomes were modelled using local unit costs and the meta-analysis effect estimate for neonatal mortality. Results were expressed in 2016 international dollars. The average cost was $203 (range: $61-$537) per live birth. Start-up costs were large, and spending on staff was the main cost component. The cost per neonatal life-year saved ranged from $135 to $1627. The intervention was highly cost-effective when using income-based thresholds. Variation in cost-effectiveness across trials was strongly correlated with costs. Removing discounting of costs and life-years substantially reduced all cost-effectiveness ratios. The cost of rolling out the intervention to rural populations ranges from 1.2% to 6.3% of government health expenditure in the four countries. Our analyses demonstrate the challenges faced by economic evaluations of community-based interventions evaluated using a cluster randomized controlled trial design. Our results confirm that women's groups are a cost-effective and potentially affordable strategy for improving birth outcomes among rural populations.
|
|
| 5. |
- Ramani-Chander, Anusha, et al.
(författare)
-
Applying systems thinking to identify enablers and challenges to scale-up interventions for hypertension and diabetes in low-income and middle-income countries : protocol for a longitudinal mixed-methods study
- 2022
-
Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 12
-
Tidskriftsartikel (refereegranskat)abstract
- Introduction: There is an urgent need to reduce the burden of non-communicable diseases (NCDs), particularly in low-and middle-income countries, where the greatest burden lies. Yet, there is little research concerning the specific issues involved in scaling up NCD interventions targeting low-resource settings. We propose to examine this gap in up to 27 collaborative projects, which were funded by the Global Alliance for Chronic Diseases (GACD) 2019 Scale Up Call, reflecting a total funding investment of approximately US$50 million. These projects represent diverse countries, contexts and adopt varied approaches and study designs to scale-up complex, evidence-based interventions to improve hypertension and diabetes outcomes. A systematic inquiry of these projects will provide necessary scientific insights into the enablers and challenges in the scale up of complex NCD interventions.Methods and analysis: We will apply systems thinking (a holistic approach to analyse the inter-relationship between constituent parts of scaleup interventions and the context in which the interventions are implemented) and adopt a longitudinal mixed-methods study design to explore the planning and early implementation phases of scale up projects. Data will be gathered at three time periods, namely, at planning (T-P), initiation of implementation (T-0) and 1-year postinitiation (T-1). We will extract project-related data from secondary documents at T-P and conduct multistakeholder qualitative interviews to gather data at T-0 and T-1. We will undertake descriptive statistical analysis of T-P data and analyse T-0 and T-1 data using inductive thematic coding. The data extraction tool and interview guides were developed based on a literature review of scale-up frameworks.Ethics and dissemination: The current protocol was approved by the Monash University Human Research Ethics Committee (HREC number 23482). Informed consent will be obtained from all participants. The study findings will be disseminated through peer-reviewed publications and more broadly through the GACD network.
|
|
