Health Budget Research Articles

Reduction in Behavior Problems with Increase in Communication Skills Through Augmentative and Alternative Communication among Special Needs Children

Cerebral Palsy is one of the most prevalent physical handicaps in children. Sensory-motor problems such as communication and cognitive impairment are major symptoms of cerebral palsy. In Pakistan, lack of interventions for cerebral palsy children exists due to low health budget. Consequently, CP children are facing difficulty in having the treatment. The present study aims to implement an augmentative and alternative communication (AAC) approach among nonverbal children with cerebral palsy living in Pakistan. Past research evidence has revealed the co-morbidity of communication problems with behavioral issues among cerebral palsy children. Keeping in view, the present study also aims to examine the behavioral issues of nonverbal children with cerebral palsy. For the said purpose, a pilot study employed the interventional research design (pre and post assessment) which was conducted in Pakistan. 10 nonverbal cerebral palsy children were selected from three different special needs centers by using non-probability sampling technique. Repeated measures, pre and post assessment t-test analysis was conducted to assess the impact of augmentative and alternative communication (AAC) intervention on the communication skills and behavioral problems of the participants. The results showed that AAC intervention has significantly improved the communication skills (t = -11.09, P < .001) and reduced the behavioral problems (t = 2.55, P <.005) of the participants which were nonverbal children with cerebral palsy. Thematic analysis on the open-ended questions from Pragmatic profile reported that participants have started to enjoy indoor and outdoor activities. After the intervention, significant improvement in communication has been observed in participants when they present needs/desire. Thus, this study recommends that implementation of AAC on cerebral palsy population would be effective in improving communication skills and reducing their behavioral problems.

Is government spending in the education and health sector necessary for human capital development?

This study intends to examine the impact of current health expenditure, domestic government health expenditure, government education expenditure, social protection, population growth, and foreign direct investment (FDI) on human capital formation in the context of Pakistan. This study utilized skill and health to measure human capital. The study utilized annual data for the period of 1990–2020 and data has been extracted from World Development Indicators (WDI) and World Bank. The study utilized auto-regressive distributed lag (ARDL) bound test to examine long-run co-integration among defined variables. Furthermore, the study employed ARDL Model to obtain long-run and short-run empirical estimates for modeled variables. The results of this study indicated that current health expenditure (CHE), domestic government health expenditure (DGHE), government education expenditures (GEE), foreign direct expenditure (FDI), and social protection program (SP) have a positive and significant association with human capital in term of primary, secondary, and tertiary education attainment and life expectancy at birth. Moreover, domestic government spending on health and education, and social protection program significantly decreases child mortality in Pakistan. Furthermore, this study found that population growth has a negative and significant association with primary attainment. The findings of this study suggest that the Government of Pakistan should allocate more of its budget for health, education, and social protection programs to uplift its human capital.

Projecting direct medical costs and productivity benefits of improving access to advanced therapy for rheumatoid arthritis: a projection modelling study

ABSTRACT Introduction: To ensure the sustainability of the AT access improvement, it is important that health system stakeholders have timely, analyzed information accessible for reference and decision-making support. In this study, we projected the direct costs required as well as the expected direct medical cost-offset and productivity benefits resulting from improving the disease control. Methods: We implemented a deterministic, prevalence-based mathematical model to project the annual cost of rheumatoid arthritis (RA) management within the public healthcare system in Malaysia. We also calculated the annual productivity loss due to uncontrolled RA in monetary value. Using the projection model, we compared the projected costs of the status quo scenario vs. several scenarios of improved advanced therapy (AT) access over a 5-year period. Results: We projected that between 10,765 and 11,024 RA patients in Malaysia over the period of 2020–2024 will need access to AT due to treatment failure with conventional synthetic disease modifying antirheumatic drugs (DMARDs). The projected net total medical cost under the status quo scenario were 163.5 million annually on average (approximately MYR 15,000 per patient per year). Cost related to health service utilization represented the heaviest component, amounting to 71.8% followed by drug cost (24.7%). Under the access improvement scenarios, drug cost constituted a higher proportion of the total medical, ranging from 25.6% to 30.4%. In contrast, the cost of health service utilization shown a reverse pattern (reducing to between 66.3% and 70.1%). Productivity costs were also expected to reduce as AT access improved leading to better outcomes. Treatment shifts to targeted synthetic DMARDs in anticipation of price adjustment appeared to have a cost saving advantage to the health system if all other parameters remain unchanged. Discussion: Improving AT access for RA patients towards the aspirational target appeared to be feasible given the current health budget in Malaysia. Broader socio-economic consequences of productivity and income loss should be included as an important part of the policy consideration. The financial implication of different AT utilization mixes and the anticipated price adjustment will likely result in some cost saving to the health system.

Contextual Factors That Impact the Implementation of Patient Portals With a Focus on Older People in Acute Care Hospitals: Scoping Review

Older people are the highest users of health services but are less likely to use a patient portal than younger people. This scoping review aimed to identify and synthesize the literature on contextual factors that impact the implementation of patient portals in acute care hospitals and among older people. A scoping review was conducted according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. The following databases were searched from 2010 to June 2020: MEDLINE and Embase via the Ovid platform, CINAHL and PsycINFO via the EBSCO platform, and the Cochrane Library. Eligible reviews were published in English; focused on the implementation of tethered patient portals; included patients, health care professionals, managers, and budget holders; and aimed at identifying the contextual factors (ie, barriers and facilitators) that impact the implementation of patient portals. Review titles and abstracts and full-text publications were screened in duplicate. The study characteristics were charted by one author and checked for accuracy by a second author. The NASSS (Non-adoption, Abandonment, Scale-up, Spread, and Sustainability) framework was used to synthesize the findings. In total, 10 systematic reviews published between 2015 and 2020 were included in the study. Of these, 3 (30%) reviews addressed patient portals in acute care hospitals, and 2 (20%) reviews addressed the implementation of patient portals among older people in multiple settings (including acute care hospitals). To maximize the inclusion of the literature on patient portal implementation, we also included 5 reviews of systematic reviews that examined patient portals in multiple care settings (including acute care hospitals). Contextual factors influencing patient portal implementation tended to cluster in specific NASSS domains, namely the condition, technology, and value proposition. Certain aspects within these domains received more coverage than others, such as sociocultural factors and comorbidities, the usability and functionality aspects of the technology, and the demand-side value. There are gaps in the literature pertinent to the consideration of the provision of patient portals for older people in acute care hospitals, including the lack of consideration of the diversity of older adults and their needs, the question of interoperability between systems (likely to be important where care involves multiple services), the involvement of lay caregivers, and looking beyond short-term implementation to ways in which portal use can be sustained. We identified important contextual factors that impact patient portal implementation and key gaps in the literature. Future research should focus on evaluating strategies that address disparities in use and promote engagement with patient portals among older people in acute care settings.

Why falsified medicines reach patients: an analysis of political and economic factors in Romania

IntroductionTo protect patients against falsified medicines, countries around the world implement stringent regulations. Despite efforts to protect supply chains in the European Union (EU), authorities continue to find falsified medicine....

Physician workforce planning and boom-bust economic cycles: a retrospective on the Barer-Stoddart report.

In March 1990, the Federal/Provincial/Territorial Conference of Deputy Ministers of Health commissioned health economists Morris Barer and Greg Stoddart to report on medical resource policy. Facing recession and a public debt crisis, health ministers sought to reduce or restrain health budgets. With

Relations between indoor rehabilitation and basic health services in a developing country.

and Introduction: Physical rehabilitation is vital for patients to regain maximum function. Approximately 80% of people with a disability live in developing countries, where they face multiple challenges in rehabilitation. The goal of the study was to conduct an analysis of indoor rehabilitation programs based on the demographics and medical conditions of the admitted patients and to relate to the available basic health and rehabilitation facilities. This was a mixed method study conducted in an inpatient rehabilitation ward of a tertiary level academic university hospital in a developing country. All admitted patients who stayed for a period of minimum two weeks were included in the study. Demographic and clinical data were obtained by means of a retrospective medical record review utilizing a standardized data extraction form. The study was further strengthened by an online literature search for the available documents for analysis, relation, and discussion. Among the 1,309 admitted patients was male- female ratio was 10:7, with the majority (31.4%) cases falling between the ages of 46 and 60yrs. Rehabilitation outpatient department was the principal mode of admission (78%), and musculoskeletal and neurological conditions represented the maximum number (79.8%). Majority of patients (60.8%) were discharged home on completion of the rehabilitation program with a large number of patients who were absconded. Poor health budget allocation and lack of prioritization of the rehabilitation sector face multiple challenges, including the rehabilitation team functioning resources, space crisis for expansion which was further impacted by the COVID-19 pandemic. The country's current health-related rehabilitation process and socio-demographic variables have a negative relationship. There was a large number of missing data in the medical records and many patients were lost prematurely from the indoor rehabilitation program. Musculoskeletal disorders were common, and the majority of patients were discharged home once the program was completed.

National health systems strengthening as the primary strategy to achieve Universal Health Coverage in African countries

Africa is the second largest continent and has its socioeconomic and health peculiarities. Countries are faced with varying challenges towards its Universal Health Coverage (UHC) achievement and hence the region requires health system reforms to drive equitable and balanced medical services to its populace. The main objectives of the paper were to explore the complexities of the African health systems, subsequently highlighting major challenges to UHC and to provide a framework for strategic approaches to health system strengthening to ensure realization of UHC. Information presented in this paper was collected from published literature and reports on Rwanda, Kenya, Nigeria, Tanzania, Ghana, Tunisia, Democratic Republic of Congo, Zambia, Egypt and South Africa, amidst other African countries. The published literature points to the presence of a somewhat slow progress towards UHC or at least an existent knowledge of it. However, common challenges faced can be grouped into 1) Financial constraints which include low levels of government expenditure on health and increased out-of-pocket percentages, (2) Lack of coverage of key services which includes majorly immunization rates and existence of health insurance for citizens, (3) Input constraints ranging from drug availability to skilled healthcare workforce, information and research and (4) Lack of political support and commitment towards universal health coverage. To overcome the above-stated constraints, two broad groups of interventions were identified; General interventions largely focusing on reprioritization of health budget, quality and improved services, equipped facilities and efficient social protection systems; and Specific interventions which emphasizes the importance of eliminating shortage of health workers, ensuring availability of essential medicines/ products, embracing decentralization at supply chain management, validating data/ information system and advocacy for impactful health education/promotion. Although there will be strength and weakness for whatever reforms adopted, implementation is totally contextual and contingent upon countries' specific health system bottlenecks. Sources of Funding None Conflicts of Interest The authors declare no conflict of interest Acknowledgement We would like to thank Dr. AugustinoTing Mayai for assistance and mentorship

Asians Are Not Interchangeable.

To the Editor: As we celebrate Asian American and Pacific Islander Heritage Month (at the time of writing), we are compelled to address Liu and colleagues’ article by calling on medical schools across the nation to recognize the realities we face. 1 As 2 Asians in the United States, we repudiate the notion of an ethnic monolith deserving of hate by raising awareness of our distinct heritages and challenging the myth of the model minority, which assumes that all Asian American Pacific Islanders (AAPIs) are able to achieve high levels of success, because of their well-educated and hardworking nature. We are 2 AAPI physicians-in-training with unique backgrounds and experiences: Filipino-American and Hong Konger, Asian American and Asian Immigrant, native and non-native English speaker, united by this dialogue. We invite medical schools to join in this dialogue on anti-Asian hate, social invisibility, and the model minority myth by addressing the following 3 areas. First, we urge all medical schools to provide opportunities and scholarships for AAPI-related public health research. AAPI-health research is critically underfunded, comprising only 0.17% of the National Institutes of Health budget between 1992 and 2018. 1 This is exemplified by the shockingly low amount of clinical research dedicated to studying cancer in AAPIs. According to ClinicalTrials.gov, only 5 out of over 10,000 registered trials in January 2013 focused on cancer in AAPIs. 2 If research on the diseases that disproportionately affect AAPI individuals, such as liver and stomach cancers, remain underfunded, the research gap will only widen health disparities between AAPIs and the general U.S. population. Second, we ask medical schools to dismantle the barriers to success that AAPI individuals face by introducing inclusion efforts, mentorship, and career counseling. The “bamboo ceiling,” long-standing barriers in AAPI career advancement due to institutional racism, is especially salient in medicine. Compared with other ethnic groups, Asians experience a large disparity between the percentage of department chairs relative to the number of full-time faculty. 3 Third, we urge medical schools to overcome implicit bias and discrimination by integrating dialogue on the effects of anti-Asian hate within antiracism curriculum. Despite the success of AAPIs in medicine, we must not overlook the tragic history of anti-Asian sentiment in the United States, from the Chinese Exclusion Act of 1882, to the WWII Japanese internment camps, to the anti-Asian hate crimes that have risen in recent years. 1 These moments have had a profound impact on AAPIs, with race events since the COVID-19 pandemic as a particular concern for AAPI well-being and safety. As the fastest growing ethnicity group in the United States, 4 we urge all medical schools to proactively develop policies that demonstrate equity, justice, dignity, and respect toward the AAPI community.

Does the Current Global Health Agenda Lack Vision?

<h3>Key Messages</h3> Despite the successes of the VISION 2020 global initiative, large economic and societal consequences still exist across the life span from vision impairment and blindness, which have not yet been addressed by the global health community. There remains a lack of reliable global data on vision health, especially in the case of childhood blindness and vision impairment. Historically, vision has been poorly represented in global health budgeting and finance, which objectively reflects its lack of prioritization on the overall global health agenda. We need greater investment in cost-effective strategies to prevent and treat a rapidly increasing global burden of ocular disease because of an aging and changing population.

Political economy analysis of sub-national health sector planning and budgeting: A case study of three counties in Kenya.

Devolution represented a concerted attempt to bring decision making closer to service delivery in Kenya, including within the health sector. This transformation created county governments with independent executive (responsible for implementing) and legislative (responsible for agenda-setting) arms. These new arrangements have undergone several growing pains that complicate management practices, such as planning and budgeting. Relatively little is known, however, about how these functions have evolved and varied sub-nationally. We conducted a problem-driven political economy analysis to better understand how these planning and budgeting processes are structured, enacted, and subject to change, in three counties. Key informant interviews (n = 32) were conducted with purposively selected participants in Garissa, Kisumu, and Turkana Counties; and national level in 2021, with participants drawn from a wide range of stakeholders involved in health sector planning and budgeting. We found that while devolution has greatly expanded participation in sub-national health management, it has also complicated and politicized decision-making. In this way, county governments now have the authority to allocate resources based on the preferences of their constituents, but at the expense of efficiency. Moreover, budgets are often not aligned with priority-setting processes and are frequently undermined by disbursements delays from national treasury, inconsistent supply chains, and administrative capacity constraints. In conclusion, while devolution has greatly transformed sub-national health management in Kenya with longer-term potential for greater accountability and health equity, short-to-medium term challenges persist in developing efficient systems for engaging a diverse array of stakeholders in planning and budgeting processes. Redressing management capacity challenges between and within counties is essential to ensure that the Kenya health system is responsive to local communities and aligned with the progressive aspirations of its universal health coverage movement.

TOWARDS INTEGRATING REHABILITATION INTO HEALTH SYSTEMS THROUGH PROFESSIONAL REGULATION

Strengthening rehabilitation in health systems and integrating rehabilitation across all levels of care depends on a mix of strategies, however all depend on an appropriately trained, resourced and organized workforce. Indeed, among the ten areas for action described in the World Health Organization 2030 initiative is developing a strong multidisciplinary rehabilitation workforce that is suitable for country context, and promoting rehabilitation concepts across all health workforce education. The rehabilitation workforce is constantly evolving as it strives to provide safe practices and treatment choices based on the best available evidence to improve function, promote independence and help people reach their maximum potential. However, barriers to this evolution include a lack of well-resourced training programs, variations in the competencies expected within the standard entry-level curriculum, limited opportunities for continuing professional development, geopolitical instability, competing demands for limited health budgets and persistent de-prioritization of rehabilitation.

Development of Thalassemia Medication Questionnaire (TMQ): An Instrument for Measuring Major Thalassemia Patients’ Knowledge and Practice Regarding their Medications

Background: Thalassemia is a congenital disease and Iran is as one of the countries in the thalassemia belt. It has a huge burden in Iranian national health budget. The aim of this study was to develop a questionnaire to assess the knowledge and practice of thalassemia patients toward their medications.&#x0D; Methods: This is a methodological research, which was done from April 2020 to November 2021 in Tehran, Iran, To develop a valid and reliable instrument for measuring major thalassemia patients’ knowledge and practice regarding their medications, a questionnaire based on three iron chelating medications (deferoxamine, deferiprone, and deferasirox) developed. This process done by holding several expert panel meetings. This questionnaire was consisting of some aspects such as: administration, self-monitoring, miss dose, common interactions, and adverse events. Content validity index (CVI) and internal consistency and reliability were calculated.&#x0D; Results: The CVI was as 0.76 for deferoxamine, 0.80 deferiprone and 0.88 for deferasirox questionnaire. Further analysis for internal consistency demonstrated satisfactory results with Cronbach’s alpha coefficients ranging from 0.743 to 0.781. Results showed Thalassemia Medication Questionnaire (TMQ) demonstrated acceptable validity and reliability for application.&#x0D; Conclusion: It was concluded that TMQ could be a useful instrument to measure knowledge and practice about iron chelation therapy. The reason is the diverse range of questions and the simplicity, validity, reliability, and the practicability.

Towards a framework for a collaborative support model to assist infection prevention and control programmes in low- and middle-income countries: a scoping review

Background: Infection prevention and control (IPC) in low- and middle-income countries (LMIC) is reported to be poorly supported because of limits in financial, human and physical resources and competing priorities in health budgets. As a result, there is often a role for external agencies to assist in strengthening IPC. While there are reports of how these partnerships have been put into practice, there are no reported frameworks or guidance documents to support the development of such relationships. Aim: The aim of this study is to identify the core elements of a collaborative support framework to assist LMIC in strengthening IPC. Methods: To achieve this, a systematic scoping review of available literature was conducted based on the guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA 2020). The databases MEDLINE, CINAHL, Embase and Scopus were utilised. The search strategy included different combinations of Medical Subject Heading (MeSH) terms, Emtree and keywords that are relevant to IPC collaboration in LMIC. Literature was limited to that published between 2005 and 2020 in the English language only. Results: Six core elements of comprehensive IPC collaborative support were identified with five IPC programme areas as minimum requirements, namely: 1) Collaborative Projects, 2) Policies and Procedures, 3) Training and Professional Development, 4) Surveillance Systems and 5) Assessment and Feedback. The last element, 6) Partnerships, was identified as an enabling factor. Conclusion: These six core elements should be considered when building a collaborative support model to assist IPC in LMIC.

The leading causes behind medico-legal claims and the use of mediation as a possible solution

Medico-legal claims in the South African health sector have noticeably increased since approximately 2007. This is significant as money spent from the public health budget on these claims is money which ought to have been spent on other healthcare priorities. As such, it becomes vital to understand why these claims have shown such drastic increases and what could be done to stem the rising tide. This article addresses two main themes: first, it explains the various causes for increased claims related to the medical field and broader possible solutions to this problem; secondly, mediation is proffered as a viable means of negating the negative impact of these claims on the health sector and budget. The conventional method of resolving medico-legal disputes is through adversarial court litigation. Litigation is expensive, time-consuming, complex and emotionally taxing, and the eventual outcome often fails to satisfy the needs of the litigants. Conventional civil dispute resolution exhibits little appreciation for, or consideration of, alternative and better-suited dispute resolution techniques and mechanisms. In this article we argue that mediation offers a viable alternative to resolve medico-legal issues. In essence, mediation is third-party (mediator) facilitated dispute resolution through negotiation. The process is less expensive, less time-consuming, uncomplicated, and party-oriented. In addition, it has the potential to enhance access to justice. However, to achieve this will require a change in legal culture.

Malaria elimination in Zanzibar: where next?

In 2018, Zanzibar developed a national malaria strategic plan IV (2018-2023) to guide elimination of malaria by 2023. We assessed progress in the implementation of malaria activities as part of the end-term review of the strategic plan. The review was done between August and October 2022 following the WHO guideline to assess progress made towards malaria elimination, effectiveness of the health systems in delivering malaria case management; and malaria financing. A desk review examined available malaria data, annual work plans and implementation reports for evidence of implemented malaria activities. This was complemented by field visits to selected health facilities and communities by external experts, and interviews with health management teams and inhabitants to authenticate desk review findings. A steady increase in the annual parasite incidence (API) was observed in Zanzibar, from 2.7 (2017) to 3.6 (2021) cases per 1,000 population with marked heterogeneity between areas. However, about 68% of the detected malaria cases were imported into Zanzibar. Malaria case follow-up and investigation increased from <70% in 2017 to 94% and 96% respectively, in 2021. The review noted a 3.7-fold increase of the health allocation in the country's budget, from 31.7 million USD (2017/18) to 117.3 million USD (2022/23) but malaria allocation remained low (<1%). The varying transmission levels in the islands suggest a need for strategic re-orientation of the elimination attempts from a national-wide to a sub-national agenda. We recommend increasing malaria allocation from the health budget to ensure sustainability of malaria elimination interventions.

Status of mental health in South Asian countries

Status of mental health in South Asian countries

The Influences of Community Health Resources in Lower Income Countries and Responsibilities of Community Health Nurses

Community refers to the geographical area where every people share the same geographical region, same facilities and same health care facilities. Community health refers to the in total health of the whole community people. Community health nurse are the one who is the part of community health team and played a vital role in the public health care. Who is consider as human resources for health care system. Without human resources providing health care is not possible so sufficient amount of human resources is most important as well as material resources. Health resources includes several things like drug, equipment, diagnostic tool etc. But lower income countries are having the problem of low health budget which is directly effecting the health resources and health facilities. When facilities are less, resources are minimal community health care need will be not fulfilling. It will increase morbidity and mortality ratios in the country. So, Health resources is vital for every health care which should be in a sufficient amount to promote patient condition and prevention of several communicable diseases in the low income countries. Keywords: Community, Community health, Community health nurse, Prevention, Promotion.

Assessing the Effects of the COVID-19 Pandemic on the Evolution and Efficiency of Health Expenditure in Eastern European Countries

In the global context of the COVID-19 pandemic, economic and social systems were shaken to their foundations, in the sense that many businesses had to close or suspend their activities, which also had a negative impact on the quality of life of the population, both from a medical and economic perspective. Thus, like other countries around the world, Eastern European countries that are members of the European Union (EU) community have also faced such economic and health problems, which have led to multiple crisis situations that have not been managed in the most optimal, efficient and targeted way to meet the real needs of the population, generating discontent and protests among them. In view of these issues, the aim of this paper is to identify the main factors impacting on the evolution of health budget expenditures allocated to the management of the COVID-19 crisis in Eastern European countries and the efficiency of the allocation of these costs. Keywords: Eastern Europe, health expenditure, GDP, COVID-19

Does green finance and ICT matter for sustainable development: role of government expenditure and renewable energy investment.

Green financing and renewable energy growth are commonly influenced by public expenditure on health and R&D; however, data supporting this claim is scarce, especially in the 65 countries that are part of the Belt and Road Initiative (BRI). The study applied Augmented Mean Group (AMG) analysis on panel data from 2005 to 2018 for BRI nations to look at the interplay between R&D and health budgets, GDP growth, FDI, carbon emissions, green finance, and renewable energy deployment. This study uses the two models for green finance and renewable energy development. In the light of the first model, economic growth, public expenditures on health and R&D, and foreign direct investment cause to increase the level of green finance in BRI economies, while the emissions cause to reduce the level of green finance. Similarly, renewable energy development uses another explained variable by this study and found the positive contribution of growth, public expenditures, and FDI inflows to renewable energy development. In contrast, environmental pollution decreases the level of renewable energy development. In order to obtain the desired level of green finance and renewable energy development, policies are suggested by the study.