Goal Of Coverage Research Articles

Future Challenges of Nursing in Health System of Iran.

Purpose: Nursing development is considered as one of the most important ways to achieve the universal health coverage and sustainable development goals in different countries. Nursing in Iran has the potential to provide services at all levels of universal health coverage. Therefore, planning for nursing in Iran needs to recognize the future challenges. This study aims to explore the future challenges of nursing in the health system of Iran from the perspective of nursing experts.Methods: In this qualitative study, 11 semi-structured interviews were conducted with nursing experts by purposive sampling in 2017–2018. Interviews were recorded and transcribed and framework analysis method was used to analysis the data.Results: The results showed that a favorable future requires planning in three areas of nursing “governance challenges” including centralized nursing stewardship, policy-making and legislation, monitoring and evaluation, and cooperation and communication with other institutions, “inadequacy of professional development with social demands” including community-based nursing, nursing upgrades with disease patterns, expanding home care, expanding care centers, and use of technology, “human resource challenges “including nursing education tailored to the needs of the community, empowering nursing managers, recruiting and retaining nurses, and specialized nursing.Conclusions: A favorable future requires a coherent nursing government, professional development of nursing based on social demands, and enhancing human resources in line with the emerging needs of the future.

Ultra Deep Whole Exome Sequencing of Classical Hodgkin Lymphoma (cHL) Reveals Novel Recurrent Somatic Mutations

Background: Although cHL patients who receive standard therapy have a high rate of event-free and overall survival, 5% - 10% of patients will be refractory to initial therapy and up to 1/3 will relapse. Thus, improved prognostication and identification of new treatment targets are needed. High throughput sequencing can identify recurrent somatic mutations that potentially drive lymphomagenesis and impact treatment response. However, Hodgkin-Reed-Sternberg (HRS) cells have a low (~1%) abundance in cHL biopsies, creating a challenge for comprehensive detection of somatic mutations in bulk lymphoma biopsies. We hypothesized that ultra deep exome sequencing can address this challenge, by providing a more widely available approach to HRS cell characterization compared to HRS cell purification.Methods: We performed exome sequencing on 32 fresh frozen samples from 31 cHL patients obtained prior to treatment (27) or after relapse (4) with paired normal skin samples (31). Sequencing was performed using the Illumina HiSeq platform (2 x 150bp reads) with a >1,000X median coverage goal. Sequence data was aligned to GRC38 and SNVs and INDELs were called with multiple algorithms. We employed several variant filtering strategies, including manual review, to remove common polymorphisms, sequencing artifacts, and false positives.Results: In total 7,000Gb were sequenced across all samples with an average of 1,100Gb/sample. The median depth of coverage was 1,009X for lymphoma and 926X for normal tissue. After filtering, 4,734 somatic SNVs and INDELs were identified, with an average of 33 protein-coding variants/case, excluding a single hyper-mutated case. The hyper-mutated patient had 3,684 variants, several of which are in DNA mismatch repair genes including: EXO1, MLH3, and MUS81 . We identified 296 genes with mutations observed in two or more patients. We confirmed previously identified genes with recurrent mutations in cHL (e.g., TNFAIP3 [18.8%], B2M [12.5%], XPO1 [9.4%]). We identified one B2M start loss mutation, which is consistent with other studies (Reichel et al. Blood 2015). However, our overall detection of B2M mutations was lower than previous reports (70%; Reichel et al. Blood 2015). Several recurrently mutated genes in our dataset are not well characterized in cHL and may contribute to disease development or progression. IGLL5 [21.9%] has been shown to be mutated in DLBCL and CLL, with a mutation pattern consistent with off-target activation-induced deaminase (AID) activity. ITPKB [12.5%], which functions as a negative regulator of PI3K, has been recently discussed as a tumor suppressor in DLBCL and detected in cfDNA from cHL patients. RYR1 [15.6%] encodes a Ca+ channel expressed in normal B cells, and was previously reported as recurrently mutated in DLBCL, Burkitt, and mantle cell lymphoma. Our work confirmed that components of the JAK/STAT pathway including SOCS1 [18.8%] and STAT6 [9.4%] are mutated in cHL. We also identified mutations associated with SWI/SNF chromatin remodeling complexes (e.g., BCL7A [6.3%], ARID1A [6.3%], SMARCA4 [3.1%], SMARCA2 [3.1%], SMARCD1/2 [3.1%]), which have not previously been reported as recurrently mutated in cHL. Finally, we observed mutations in 11 histone genes (e.g., HIST1H1B [6.3%]), extending the importance of histone gene mutations in lymphomas from germinal center B cells.Conclusions: Recurrent somatic mutations withincHL were identified via ultra deep exome sequencing, providing a strategy to identify somatic variation that does not require HRS cell purification. We have confirmed known recurrent genes within cHL and identified previously unreported mutated genes and pathways. These data suggest that cHL genomes harbor recurrent SNVs and INDELs that can inform new targets for cHL treatment and prognostication [Display omitted] DisclosuresMehta-Shah:Celgene: Research Funding; Verastem: Research Funding; Bristol Myers-Squibb: Research Funding. Kahl:Gilead: Consultancy; Celgene: Consultancy; ADC Therapeutics: Research Funding; Seattle Genetics: Consultancy; Genentech: Consultancy.

Understanding Human Papillomavirus Vaccine Promotions and Hesitancy in Northern California Through Examining Public Facebook Pages and Groups.

Human papillomavirus (HPV) vaccination coverage among adolescents is lower in rural regions and remains under the 80% coverage goal by Healthy People 2030. Through both sentiment analysis and topic modeling, this research examines how local health agencies and groups in nine Northern California counties promote HPV vaccines through Facebook and how target populations react to promotion posts in comments that elucidate their sentiments and hesitancy toward HPV vaccination. In January 2021, we identified 2,105 public Facebook pages and 1,065 groups related to health within the counties and collected a total of 212 posts and 505 comments related to the HPV vaccine. The posts were published between 2010 and 2021, with the majority (83%) published after 2017. There were large variations of Facebook activities across counties. We categorized four counties with HPV vaccination initiation rates below 40% as low-coverage counties and five counties with rates above 40% as high-coverage counties. In general, low-coverage counties had fewer Facebook activities in comparison to high coverage. Results showed that, on average, comments about the HPV vaccine exhibited more positive emotion, more negative emotion, and more anger than the posts. Overall, thematic topics that emerged from posts centered around awareness and screening of HPV and cervical cancer, STI testing services, information sources, and calls to action for health services. However, comment topics did not correspond to posts and were mostly related to vaccine hesitancy, discussing vaccine risks, safety concerns, and distrust in vaccine science, citing misinformation. When comparing high- versus low-coverage counties, posts expressed similar sentiments; however, comments within high-coverage counties expressed more anger than in low-coverage counties. Comments from both high- and low-coverage counties expressed concerns with vaccine safety, risks, and injury. It is important to note that commenters exchanged information sources and tried to address misinformation themselves. Our results suggest that the promotion of HPV vaccines from public Facebook pages and groups is limited in frequency and content diversity. This illustrates problems with generalized social media vaccination promotion without community tailoring and addressing specific hesitancy concerns. Public health agencies should listen to the thoughts of targeted audiences reflected through comments and design relevant messages to address these concerns for HPV vaccination promotion.

Achieving Universal Health Coverage as a Goal of Vietnam’s Socio-Economic Development

Aim.The presented study aims to analyze and identify the “bottlenecks” Vietnam may face on the way to achieving the goal of universal health coverage of the country’s population.Tasks.The authors analyze the situation regarding the implementation of sustainable development goals in terms of ensuring the availability of health services; assess the situation regarding the availability of health services in Vietnam; assess the potential of health insurance to achieve universal health coverage as a goal of Vietnam’s socio-economic development.Methods.This study uses statistical, empirical, and comparative analysis.Results.Achieving the goal of universal health coverage in the country requires more than just financing health care. It reflects the importance of ensuring equal access to quality health services and enforcing the right to health, especially for vulnerable groups. The authors analyze population coverage, the organization of the financing system, and the cost of medical care for households. Funding for health programs in Vietnam is increasing. However, due to the enduring poverty in the country, households spending a large share of their own funds on health services, and the number of challenges associated with the COVID-19 new coronavirus pandemic, there is still a risk of not achieving the goal of universal coverage in the near term.Conclusions.To achieve the set goal, Vietnam needs to introduce effective mechanisms of compulsory and voluntary health insurance (VHI). This additional financial protection is seen as a way to enable more people to use the necessary services without the risk of catastrophic health care costs, thus effectively approaching the goal of universal health coverage for the citizens of the Socialist Republic of Vietnam (SRV).

Adaptive coverage control for multi-USV system in complex environment with unknown obstacles

Aiming at the shortcomings of the existing control law based on the global information, this article studies the coverage problem of a given region in the plane using a team of USVs. The coverage goal, which is to cover a given search domain using multiple mobile sensors so that each point is surveyed until a certain preset level is achieved, is formulated in a mathematically precise problem statement. The adaptive control law is presented which enables multi-USV to navigate in a complex environment in the presence of unknown obstacles and guarantees that a fully connected multi-USV system attains the coverage goal. In particular, the dangerous area was divided into two different parts in order to enhance the searching efficiency. Finally, simulation results are presented to validate the feasibility and efficiency of the proposed approach.

PNS72 Charting the Progress of HTA in Asia: Are We Ready for Evidence Based Decision-Making?

This paper provides an update on the growing use of HTA in Asia and lessons for other countries seeking to advance HTA. This paper builds upon the research by Chootipongchaivat et al and the World Health Organization (WHO) identifying 18 “factors conducive to the development of HTA in Asia”. These factors were used to create a balanced scorecard to assess the progress of HTA. The authors scored the progress against each of the factors made in China, India, Indonesia, Malaysia, Philippines, South Korea, Taiwan, Thailand, and Vietnam. A scoring system on a scale of 1 to 5 was used wherein: 1=No progress on milestone; 2=milestone at early stages, ad hoc HTA use; 3=progress on milestone, routine HTA but limited impact; 4 = significant progress on milestone, routine HTA use but limited remit; and 5 = significant progress on milestone, routine HTA use that informs several decisions. Total scores indicated progress of HTA while milestone scores provided contextual insights within countries. A literature review and expert interviews were used to complete scorecards. South Korea and Thailand had highest scores of 73 and 71 points respectively, while Vietnam scored lowest at 28.5. Advanced HTA programs, such as Thailand and South Korea, have independent HTA agencies with a broad remit, explicit process and methods, network of researchers, and routine use of HTA. Countries like Taiwan and Malaysia fall in a middle tier, with established HTA programs with limited remit. The final tier consists of countries like China, India, Indonesia, Philippines, and Vietnam, emerging HTA processes. Universal Health Coverage (UHC) goals have catalyzed expansion of HTA. However, political will, technical expertise, and sustained financing remain challenges for sustainable HTA programs. While legislation supporting HTA is helpful, political will is key. Authors provide recommendations on areas for additional investments and opportunities for regional collaboration.

'It was quite a shock': A qualitative study of the impact of organisational and personal factors on newly qualified nurses' experiences.

To explore how newly qualified nurses' work experiences are constructed through the interplay between self, workplace and home-life influencing their retention. Nurses are critical to achieving the goal of universal health coverage. However, shortages of nursing staff are endemic. Of particular concern, newly qualified nurses are more likely to leave the nursing workforce. The point of transition to working as a newly qualified nurse is a time of vulnerability. Most studies attempt to discover why nurses leave. This study uses the concept of job embeddedness to examine the experience of this transition and first two years of practice to understand what might help newly qualified nurses stay. Qualitative approach using semi-structured telephone interviews. Self-selecting sample of nurses (n=23) who participated 1-year (n=12) and 2 years (n=11) post-qualification. Participants were part of a larger longitudinal cohort (n=867) study which has followed them since September 2013 when they entered nurse education in two Scottish universities. Thematic analysis was used to understand the interplay between organisation/workplace and the individual. Three themes were developed: transition shock; workplace factors and work/life balance. Two further subthemes were developed: experience of support and belonging; and feeling unsupported and alienated. Eight participants had changed job or left, and two were looking to leave nursing. This study highlights how the experience of transition shock can be positively or negatively impacted by the workplace environment, and how in turn this impacts the home environment. Ultimately, this impacts retention of newly qualified nurses. Having adequate support resources, such as staffing, supportive team morale, professional development and family-friendly work environment, can create a work environment where they feel the purpose and meaningfulness of working as a nurse. This 'job embeddedness' can potentially enhance nurse retention. Reporting follows the COREQ checklist.

National routine adult immunisation programmes among World Health Organization Member States: an assessment of health systems to deploy COVID-19 vaccines.

IntroductionAs SARS-CoV-2 disproportionately affects adults, the COVID-19 pandemic vaccine response will rely on adult immunisation infrastructures.AimTo assess adult immunisation programmes in World Health Organization (WHO) Member States.MethodsWe evaluated country reports from 2018 on adult immunisation programmes sent to WHO and UNICEF. We described existing programmes and used multivariable regression to identify independent factors associated with having them.ResultsOf 194 WHO Member States, 120 (62%) reported having at least one adult immunisation programme. The Americas and Europe had the highest proportions of adult immunisation programmes, most commonly for hepatitis B and influenza vaccines (> 47% and > 91% of countries, respectively), while Africa and South-East Asia had the lowest proportions, with < 11% of countries reporting adult immunisation programmes for hepatitis B or influenza vaccines, and none for pneumococcal vaccines. In bivariate analyses, high or upper-middle country income, introduction of new or underused vaccines, having achieved paediatric immunisation coverage goals and meeting National Immunisation Technical Advisory Groups basic functional indicators were significantly associated (p < 0.001) with having an adult immunisation programme. In multivariable analyses, the most strongly associated factor was country income, with high- or upper-middle-income countries significantly more likely to report having an adult immunisation programme (adjusted odds ratio: 19.3; 95% confidence interval: 6.5–57.7).DiscussionWorldwide, 38% of countries lack adult immunisation programmes. COVID-19 vaccine deployment will require national systems for vaccine storage and handling, delivery and waste management to target adult risk groups. There is a need to strengthen immunisation systems to reach adults with COVID-19 vaccines.

Optimization for Locating Emergency Medical Service Facilities: A Case Study for Health Planning from China.

PurposeRational location of emergency medical service (EMS) facilities could improve access to EMS, and thus assist in saving patients’ lives and improving their health outcomes. A considerable amount of spatial optimization research has been devoted to the development of models to support location planning in the context of EMS, with extensive applications in policy making around the world. However, in China, studies on the location of EMS facilities have not been paid enough attention to, let alone their practical applications. This paper conducted location optimization for EMS facilities in Chengdu, one of the biggest cities in southwest China with more than 16.5 million population, aiming to optimize the EMS system by adding (upgrading) a minimum number of EMS facilities to achieve a given population coverage.MethodsLocation optimization was conducted according to regional health policy goal for the EMS system in Chengdu, China, 2017. The nearest-neighbor approach was used to calculate the shortest travel time based on geographical information system (GIS). The location set covering model was used to formulate the optimization problem under China’s context, and genetic algorithm (GA) was employed to determine the optimized locations.ResultsThe results showed that a minimum number of 55 new facilities were required to upgrade to EMS facilities to achieve the policy goal of 90% population coverage of EMS within 15 minutes. Access to EMS also improved substantially in terms of shortest travel time after facility upgrading. The weighted median shortest travel time to EMS facilities in Chengdu decreased by 14.57%, from 6.45 minutes to 5.51 minutes.ConclusionOur study showed that the solution could effectively achieve the policy goal of population coverage with a minimum number of new EMS facilities. Our findings would support evidence-based decision-making in future EMS planning in China.

Determinants of Immunization Coverage and Associated Factors among Children aged under Two-Year-Old in the National Immunization Program of Mewat district, Haryana (2019-2020)

Background: Vaccination against childhood communicable diseases through Expanded Program on Immunization is one of the most cost-effective public health interventions. Additional 1.5 million child deaths can be prevented if global vaccination coverage is improved. Mewat district has one of India’s lowest immunization rates despite a long-standing Universal Immunization Program and continues to sustain a high prevalence of vaccine-preventable diseases. This study investigates determinants of immunization status among children aged 0-23 months. Methods: A community-based cross-sectional study was conducted from December 2019 to June 2020, among 800 children aged 0-23months, randomly selected in one rural and one urban ward each from all 4 blocks of Mewat. Socio-demographic conditions and vaccine-related data were collected using a semi-structured questionnaire. Immunization was assessed by vaccination card and by mother’s recall where the card was unavailable. Results:Mewat has increased full immunization coverage from 13.1% in 2015-16 to 59.4%. Immunization card was available with 68.5% (292/426) beneficiaries. Dropout rates for Pentavalent1 to Pentavalent3 was 27.5% and 54% for Bacillus Calmette-Guerin to measles. After adjusting for the state of residence, religion, gender, paternal education, health professional presence during birth, place of vaccination and knowledge of mother on due dose were significantly associated with full immunization. Awareness gap and fear of side effects for vaccines were main reasons of vaccine hesitancy. Conclusion: Full immunization coverage in the district is sub optimal and behind the desired coverage goal, mainly due to vaccine hesitancy. Enhancing community knowledge about the benefits of vaccination is recommended.

Impact of campaign-style delivery of routine vaccines: a quasi-experimental evaluation using routine health services data in India.

The world is not on track to achieve the goals for immunization coverage and equity described by the World Health Organization’s Global Vaccine Action Plan. Many countries struggle to increase coverage of routine vaccination, and there is little evidence about how to do so effectively. In India in 2016, only 62% of children had received a full course of basic vaccines. In response, in 2017–18 the government implemented Intensified Mission Indradhanush (IMI), a nationwide effort to improve coverage and equity using a campaign-style strategy. Campaign-style approaches to routine vaccine delivery like IMI, sometimes called ‘periodic intensification of routine immunization’ (PIRI), are widely used, but there is little robust evidence on their effectiveness. We conducted a quasi-experimental evaluation of IMI using routine data on vaccine doses delivered, comparing districts participating and not participating in IMI. Our sample included all districts that could be merged with India’s 2016 Demographic and Health Surveys data and had available data for the full study period. We used controlled interrupted time-series analysis to estimate the impact of IMI during the 4-month implementation period and in subsequent months. This method assumes that, if IMI had not occurred, vaccination trends would have changed in the same way in the participating and not participating districts. We found that, during implementation, IMI increased delivery of 13 infant vaccines, with a median effect of 10.6% (95% confidence interval 5.1% to 16.5%). We did not find evidence of a sustained effect during the 8 months after implementation ended. Over the 12 months from the beginning of implementation, we estimated reductions in the number of under-immunized children that were large but not statistically significant, ranging from 3.9% (−6.9% to 13.7%) to 35.7% (−7.5% to 77.4%) for different vaccines. The largest effects were for the first doses of vaccines against diphtheria-tetanus-pertussis and polio: IMI reached approximately one-third of children who would otherwise not have received these vaccines. This suggests that PIRI can be successful in increasing routine immunization coverage, particularly for early infant vaccines, but other approaches may be needed for sustained coverage improvements.

Visualizing the drivers of an effective health workforce: a detailed, interactive logic model

BackgroundA strong health workforce is a key building block of a well-functioning health system. To achieve health systems goals, policymakers need information on what works to improve and sustain health workforce performance. Most frameworks on health workforce planning and policymaking are high-level and conceptual, and do not provide a structure for synthesizing the growing body of empirical literature on the effectiveness of strategies to strengthen human resources for health (HRH). Our aim is to create a detailed, interactive logic model to map HRH evidence and inform policy development and decision-making.MethodsWe reviewed existing conceptual frameworks and models on health workforce planning and policymaking. We included frameworks that were: (1) visual, (2) comprehensive (not concentrated on specific outcomes or strategies), and (3) designed to support decision-making. We compared and synthesized the frameworks to develop a detailed logic model and interactive evidence visualization tool.ResultsTen frameworks met our inclusion criteria. The resulting logic model, available at hrhvisualizer.org, allows for visualization of high-level linkages as well as a detailed understanding of the factors that affect health workforce outcomes. HRH data and governance systems interact with the context to affect how human resource policies are formulated and implemented. These policies affect HRH processes and strategies that influence health workforce outcomes and contribute to the overarching health systems goals of clinical quality, responsiveness, efficiency, and coverage. Unlike existing conceptual frameworks, this logic model has been operationalized in a highly visual, interactive platform that can be used to map the research informing policies and illuminating their underlying mechanisms.ConclusionsThe interactive logic model presented in this paper will allow for comprehensive mapping of literature around effective strategies to strengthen HRH. It can aid researchers in communicating with policymakers about the evidence behind policy questions, thus supporting the translation of evidence to policy.

Ancillary benefits of seasonal influenza vaccination in middle-income countries

While seasonal influenza vaccines (SIV) remain the best method to prevent influenza-associated illnesses, implementing SIV programs may benefit countries beyond disease reduction, strengthening health systems and national immunization programs, or conversely, introduce new challenges. Few studies have examined perceived impacts of SIV introduction beyond disease reduction on health systems; understanding such impacts will be particularly salient in the context of COVID-19 vaccine introduction. We collected qualitative data from key informants—Partnership for Influenza Vaccine Introduction (PIVI) contacts in six middle-income PIVI vaccine recipient countries—to understand perceptions of ancillary benefits and challenges from SIV implementation. Respondents reported benefits associated with SIV introduction, including improved attitudes to SIV among risk groups (characterized by increased demand) and perceptions that SIV introduction improved relationships with other ministries and collaboration with mass media. Challenges included sustaining investment in SIV programs, as vaccine supply did not always meet coverage goals, and managing SIV campaigns.

A Comparative Assessment of Access to Healthcare of People Living in Ekiti and Kogi States of Nigeria

Aim: To undertake a comparative assessment of healthcare access of people in Ekiti and Kogi States of Nigeria. This further provided hard data for health program development towards attainment of universal health coverage and health sustainable development goal.&#x0D; Study Design: A comparative research design was employed using questionnaire for data collection.&#x0D; Place and Duration of the Study: The study was conducted in Ekiti and Kogi States of Nigeria representing Southern and Northern parts of the nation. The fieldwork was conducted in October and December 2019.&#x0D; Methodology: Multistage sampling technique was used starting from random selection of one local government area from each of the three senatorial districts in the two states. From each of the local government areas, five political wards were randomly selected from the existing number of wards. From the selected wards, equal number of 144 sampled respondents were contacted for the structured interviews to make 856 administered copies of questionnaire.&#x0D; Results: Most of the respondents could identify available health care facilities in their environment. However about 70 percent patronized secondary health facilities in Ekiti State while tertiary health facilities were visited mostly in Kogi State. Costs of health care is higher in Kogi compared to Ekiti State. 49% of Ekiti have a challenge in paying for treatment compared to 69% in Kogi State while from the two states, only about 19% have health insurance coverage. Respondents in Ekiti State experience strike actions of health workers than those in Kogi State. On appropriateness, Ekiti state has better scores while Kogi State has better score in acceptability.&#x0D; Conclusion: Pronounced challenge to healthcare access is unaffordability of health care as a result of very low health insurance scheme coverage in the two states through Ekiti State has better indicators of quality healthcare.

Impact of National Health Mission of India on Infant and Maternal Mortality: A Logical Framework Analysis

Background: Since independence, life expectancy has increased substantially in India, but the goal of health-for-all has not been achieved yet. Hence, National Rural Health Mission was launched in 2005, and several strategies were implemented to strengthen the health system. Impact evaluation of the mission was done to learn lessons for future health planning. Materials and Methods: Logical evaluation framework was used to examine input, output and impact indicators systematically using time series data from Health Management Information System, National Family Health Surveys, National Sample Surveys and Sample Registration Scheme. Findings: After launch of the mission, fund allocation has increased nearly five times. The number of auxiliary nurse midwives has doubled, and the number of nurses has trebled. The number of accredited social health activists has increased to about one million. Institutional deliveries have increased from 38.7% in 2005–2006 to 78.9% in 2015–2016. Full immunisation coverage has increased from 43.5% to 62%. Oral rehydration solution (ORS) use in childhood diarrhoea has increased from 26% to 51%. Infant mortality rate has declined from 58 in 2005 to 33 per 1,000 live births in 2017 and maternal mortality ratio has also registered a decline from 254 in 2004–2006 to 122/100000 live births in 2015–2017. However, out-of-pocket health expenditure continues to be fairly high (69.3% of the total expenditure on health). Conclusions: Though National Health Mission has made a significant impact, the goal of universal care coverage is not yet fully achieved. Hence, capacity of health system needs to be trebled by a substantial increase in fund allocation.

Managing Health at District Level: A Framework for Enhancing Programme Implementation in India

COVID-19 pandemic has brought to the fore the need for a strong health system for the social protection of people and to improve health programme implementation in the coming years. India has made great progress in health over the past 50 years; however, despite the progress made, it is faced with several challenges. While infectious diseases remain an unfinished agenda, chronic non-communicable diseases (NCDs) are rising and are now the leading cause of mortality in the country. This is further compounded by the prevailing inequalities in access to quality health care among population groups including those living in remote rural areas. To achieve Universal Health Coverage and Sustainable Development Goals by 2030, India in 2017 revised its National Health Policy and committed itself to attain the highest possible level of good health and well-being, through preventive and promotive health interventions. While policies are enunciated and plans are formulated, the implementation at ground level is at best tardy and lack lustre As an administrative unit for programme implementation, a district has a key role to play in implementing national programmes and in delivery of basic health services to the people. They are strategically placed to plan, organise and lead efforts meant to deliver primary health care services through better management of existing resources and by fully engaging all relevant stakeholders in contributing towards achievement of national health goals and in responding to a public health emergency such as Covid-19. Planning and managing health problems need an improved and responsive health governance. Strategic planning, monitoring and evaluation require integration and coordination of various health programmes including dealing with health crises, fostering inter-sectoral involvement and engagement of the community as a key actor. Efforts are needed to ensure that services reach the most vulnerable and marginalised sections of the society. Adequate governance support at district level through a whole-of-society approach is essential to bridge the health inequities and ensure equitable access to health services.

Towards universal health coverage in the WHO African Region: assessing health system functionality, incorporating lessons from COVID-19

The move towards universal health coverage is premised on having well-functioning health systems, which can assure provision of the essential health and related services people need. Efforts to define ways...

Radiation treatment planning study to investigate feasibility of delivering Immunotherapy in Combination with Ablative Radiosurgery to Ultra-High DoSes (ICARUS).

PurposeImmune checkpoint inhibitors improve survival in metastatic diseases for some cancers. Multisite SBRT with pembrolizumab (SBRT + Pembro) was shown to be safe with promising local control using biologically effective doses (BEDs) = 95–120 Gy. Increased BED may improve response rate; however, SBRT doses are limited by surrounding organs at risk (OARs). The purpose of this work was to develop and validate methods for safe delivery of ultra‐high doses of radiation (BED10 > 300) to be used in future clinical trials.Methods and MaterialsThe radiation plans from 15 patients enrolled on a phase I trial of SBRT + pembro were reanalyzed. Metastatic disease sites included liver (8/15), inguinal region (1/15), pelvis (2/15), lung (1/15), abdomen (1/15), spleen (1/15), and groin (1/15). Gross tumor volumes (GTVs) ranged from 80 to 708 cc. Following the same methodology used in the Phase I trial on which these patients were treated, GTVs > 65 cc were contracted to a 65 cc subvolume (SubGTV) resulting in only a portion of the GTV receiving prescription dose. Volumetric modulated arc therapy (VMAT) was used to plan treatments BED10 = 360 Gy. Plans utilizing both 6FFF and 10FFF beams were compared to clinical plans delivering BED10 = 112.50 Gy. The target primary goal was V100% > 95% with a secondary goal of V70% > 99% and OAR objectives per the trial. To demonstrate feasibility, plans were delivered to a diode array phantom and evaluated for fidelity using gamma analysis.ResultsAll 30 plans met the secondary coverage goal and satisfied all OAR constraints. The primary goal was achieved in 12/15 of the 6FFF plans and 13/15 of the 10FFF plans. Average gamma analysis passing rate using criteria of 3% dose difference and 3, 2, and 1 mm were 99.1 ± 1.0%, 98.5 ± 1.6%, and 95.1 ± 3.8%, respectively.ConclusionNovel VMAT planning approaches with clinical treatment planning software and linear accelerators prove capable of delivering radiation doses in excess of 360 Gy BED10 to tumor subvolumes, while maintaining safe OAR doses.

The challenges of payment for performance under Brazil's PMAQ

In 2020, the Brazilian Unified Health System (Sistema Único de Saúde; SUS) celebrated 30 years. However, adequate government funding allocation to continue supporting SUS's universal health coverage goal remains a challenge to be addressed.1 Payment for performance (P4P) was the strategy proposed to strengthen primary health care with the implementation of Brazil's National Programme for Improving Primary Care Access and Quality (PMAQ), a federal public policy that started in 2011, with three rounds completed in 2019.

Archive-based multi-criteria Artificial Bee Colony algorithm for whole test suite generation

Testing an object-oriented software is harder than testing a structural program due to inheritance, states, behaviour of different objects, association, and polymorphism properties of the object-oriented software, which is established based on classes. The classes should be carefully tested using predefined test cases to optimize coverage goals. Because generating test cases manually is labour-intensive, search-based software testing methods that maximize coverage criteria by a search algorithm can be used to generate test cases automatically. Artificial Bee Colony (ABC) algorithm is a powerful search tool that performs balanced exploration and exploitation. In this study, two new multi-criteria and combinatorial ABC algorithms using mutation and crossover operators are proposed to generate a test suite that maximizes a fitness function combining various goals for object-oriented software. First, an archive-based ABC algorithm is proposed to keep covered targets in the archive to use available search resource efficiently. Second, the archive-based ABC algorithm is improved to bring more diversity in the population. To investigate the effect of the archive, the basic ABC algorithm and the archive-based ABC algorithms are compared on a set of classes from SF110 corpus. To validate efficiency of the proposed methods, they are compared to state-of-the-art evolutionary test suite generators and random testing methodology on the classes divided into difficulty levels based on their weight method class values. The experimental results reveal that introducing an archive into the ABC algorithm provides fast convergence compared to the basic ABC and the improved archive-based ABC produces higher coverage for the problems with both low and high difficulty levels.