Health System Resources Research Articles

A Comparative Performance Analysis of Türkiye's Health System within OECD Countries

A country's health system stands as one of its most critical infrastructures, significantly influencing the well-being of its citizens. In line with the World Health Organization's (WHO) widely accepted definition, a country's health system involves all organizations, people, and actions whose primary purpose is to promote, restore, or maintain health (World Health Organization., 2007). As indicated in this definition, a health system carries characteristics of complex systems posing significant challenges in its management and maintenance. The complex nature of the health system also challenges the country's policymakers to improve the outcomes of the health system. Examining specific key performance indicators of the health system can assist policymakers in gaining deeper insights into its internal capacities and identifying areas for improvement. This paper provides a comparative performance analysis of Türkiye’s health system compared to other Organization for Economic Co-operation and Development (OECD) countries using selected key performance indicators of the health system's capacity and resources. The methodology involves a comprehensive review of existing literature, data collection and analysis, and performance evaluation using the Data Envelopment Analysis (DEA) technique. In this performance analysis, health systems capacity-related indicators, such as health expenditure, number of doctors, number of nurses, and number of hospital beds, are used as input variables, and life expectancy at birth and citizens’ satisfaction with the healthcare system are output variables. The analysis intends to identify best practices and potential areas for improvement within Türkiye’s health system by benchmarking insights from other OECD countries.

Uncovering the health system burden of pneumococcal infections in adult and elderly populations

Abstract Background Health system resources dedicated to vaccination and infectious disease prevention are often directed towards infants and children, through extensive childhood vaccination schedules. This focus has led to the near eradication of several preventable childhood diseases and had positive impacts on population health, but despite this track record of success, the ability of our health systems to make vaccinations accessible throughout the full life course has been less consistent. This project aims to address this issue by providing new data about the burden that pneumococcal infections, which are vaccine-preventable, have on adult and elderly populations. Methods This research aims to uncover the health system burden of invasive pneumococcal disease and pneumococcal pneumonia at all levels of the health system in 5 EU countries (Austria, Belgium, France, Italy & Portugal). This involves a survey of managers and care providers working in hospitals, long-term care facilities, and primary care centres who may be affected by the health system impacts of pneumococcal infections. The survey covers several dimensions of health service delivery to collect a broad range of data on existing disruptions. The survey was translated into the study country languages and its formulation was further validated through interviews with experts in each study country to ensure that it can capture context-specific health system insights. The data collected through this survey will be further enhanced through a series of in-depth interviews before being synthesised, analysed and eventually published in a detailed report. Results Data collection begins as of 15 May 2024, and full results are expected to be published and available for the EPH Conference in November 2024. The results of this research will offer valuable evidence to public health professionals, health managers and policy-makers across Europe who are working to improve life-course access to pneumococcal vaccination. Key messages • Effective vaccination programmes for adult and elderly populations require expanding focus beyond childhood. • Data about the health system burden of pneumococcal infections in adult and elderly populations improves evidence-based decision-making and public health services.

Provider costs of treating opioid dependence with extended-release buprenorphine in Australia.

The costs of providing medication-assisted treatment for opioid dependence can determine its scale of provision. To provide estimates of the costs of extended-release buprenorphine (BUP-XR), we performed a bottom-up costing analysis of provider operational treatment costs. Data were collected in a single-arm open label trial of BUP-XR injections conducted in specialist public drug treatment services and primary care private practices in three Australian states (the CoLAB study). The unit costs of resources used for each activity were combined with quantities used at each participating facility to arrive at the average annual cost per client. One hundred participants across the six health facility sites received monthly subcutaneous BUP-XR injections administered by a health-care practitioner. The average cost of providing 1 year of treatment per participant was $6656 ($6026-$8326). Screening cost (initial assessment and medical history) was $282 while monthly follow-up appointments cost $531 per client. The main cost driver was the monthly treatment costs accounting for 79% of the average annual client cost, with medication costs comprising 95% of this cost. With medication costs making up the largest proportion of treatment costs, treatment using BUP-XR has the potential to free up other health system resources, for example, staff time. The costs reported in this study can be used in an economic evaluation to estimate the net benefit or cost-effectiveness of BUP-XR especially when compared to other opioid agonist treatments.

Assessing the effect of health system resources on HIV and tuberculosis programmes in Malawi: a modelling study

Assessing the effect of health system resources on HIV and tuberculosis programmes in Malawi: a modelling study

Evaluating Real World Health System Resource Utilization and Costs for a Risk-Based Breast Cancer Screening Approach in the Canadian PERSPECTIVE Integration and Implementation Project.

A prospective cohort study was undertaken within the PERSPECTIVE I&I project to evaluate healthcare resource utilization and costs associated with breast cancer risk assessment and screening and overall costs stratified by risk level, in Ontario, Canada. From July 2019 to December 2022, 1997 females aged 50 to 70 years consented to risk assessment and received their breast cancer risk level and personalized screening action plan in Ontario. The mean costs for risk-stratified screening-related activities included risk assessment, screening and diagnostic costs. The GETCOST macro from the Institute of Clinical Evaluative Sciences (ICES) assessed the mean overall healthcare system costs. For the 1997 participants, 83.3%, 14.4% and 2.3% were estimated to be average, higher than average, and high risk, respectively (median age (IQR): 60 [56-64] years). Stratification into the three risk levels was determined using the validated multifactorial CanRisk prediction tool that includes family history information, a polygenic risk score (PRS), breast density and established lifestyle/hormonal risk factors. The mean number of genetic counseling visits, mammograms and MRIs per individual increased with risk level. High-risk participants incurred the highest overall mean risk-stratified screening-related costs in 2022 CAD (±SD) at CAD 905 (±269) followed by CAD 580 (±192) and CAD 521 (±163) for higher-than-average and average-risk participants, respectively. Among the breast screening-related costs, the greatest cost burden across all risk groups was the risk assessment cost, followed by total diagnostic and screening costs. The mean overall healthcare cost per participant (±SD) was the highest for the average risk participants with CAD 6311 (±19,641), followed by higher than average risk with CAD 5391 (±8325) and high risk with CAD 5169 (±7676). Although high-risk participants incurred the highest risk-stratified screening-related costs, their costs for overall healthcare utilization costs were similar to other risk levels. Our study underscored the importance of integrating risk stratification as part of the screening pathway to support breast cancer detection at an earlier and more treatable stage, thereby reducing costs and the overall burden on the healthcare system.

Usability of APIMedOlder: A Web Application to Manage Potentially Inappropriate Medication in Older Adults.

Considering the increase in the proportion of the older population worldwide, the demand for health system resources also arises. These tools optimize clinical decision-making, thus avoiding iatrogenesis and thus contributing to a better quality of life for the older population. In response, we created an online web application, the APIMedOlder, that provides access to healthcare professionals to allow healthcare professionals to access potentially inappropriate medication identification criteria through a useful tool with a simplified profile, allowing its applicability in clinical practice. This study aims to assess the usability of the APIMedOlder online web application by healthcare professionals. A questionnaire, based on the System Usability Scale, was distributed among 15 healthcare professionals (five pharmacists, four physicians, three pharmacy technicians, and three nurses), to fully explore the website. Overall, healthcare professionals' evaluation of the usability of the APIMedOlder online web application was rated as "Best imaginable" (mean score of 87.17 points), with individual scores ranging from 75 to 100 points. Internal consistency of α = 0.881 (CI 95%: 0.766 - 0.953) was achieved. Specific questionnaire items contributing to this high score included ease of use, learning efficiency, and integration of functions. The overall evaluation of the developed tool was positive, with this online application being recognized as being easy to use and having well-integrated functions.

O45 INDIVIDUAL VS. HEALTH SYSTEM FACTORS IN HYPERTENSION CONTROL PERFORMANCE: DISTRICT-LEVEL CARE CASCADE ANALYSIS

Background: High-quality health systems are crucial for achieving optimal health outcomes, particularly in managing chronic conditions like hypertension. Effective hypertension control reduces the risk of cardiovascular diseases (CVD). This study examines the relative importance of individual factors (social determinants of health, SDOH) versus health system factors in influencing the stages of the hypertension care cascade in Indonesia, focusing on the controlled rate as the endpoint. This study aims to analyze which factors impact the hypertension care cascade. Methods: The performance of 514 districts in Indonesia was analyzed using multivariate regression. Dependent variables included the percentages of individuals ever tested, diagnosed, treated, and controlled for hypertension. Independent variables encompassed healthcare resource availability, socioeconomic factors, and demographic factors. Results: The regression analysis revealed several key findings: The physician ratio positively and significantly impacted all stages of the care cascade, with coefficients increasing from 0.087 in testing to control 0.356 (p<0.01 for all). The midwife ratio positively influenced testing (0.072), diagnosis (0.135), and treatment (0.160) but not control (0.016, p>0.1). Conversely, Average years of schooling positively correlated with testing (0.111, p<0.05). GNI PPP per capita was positively associated with testing (0.235, p<0.01), diagnosis (0.189, p<0.05), and treatment (0.228, p<0.05), but not control (-0.253, p>0.1). Median age showed a strong positive association across all stages, with coefficients of 1.212 for testing, 1.443 for diagnosis, 1.509 for treatment, and 1.274 for control (p<0.01 for all). Regression shows a pattern that while individual SDOH significantly influenced the early stages of the care cascade (testing and diagnosis), these factors had minimal impact on the control rate. Instead, health system performance was particularly critical for achieving control. Conclusion: Individual SDOHs are more influential in the early stages of the care cascade, while health system factors are crucial for controlling hypertension. Efforts to improve hypertension management should focus on enhancing health system resources to achieve better control rates and reduce CVD risks.

Operationalizing the Behaviour Change Wheel and APEASE criteria to co-develop recommendations with stakeholders to address barriers to school-based immunization programs

Introduction: School-based immunization programs offer an accessible route to routine vaccines for students. During the COVID-19 pandemic, school closures to comply with public health measures had a drastic effect on school-based immunization program delivery and associated vaccine uptake. We sought to integrate findings from a mixed methods study to co-develop evidence-based and theory-informed recommendations with a diverse group of stakeholders (i.e., decision makers, healthcare providers, school staff, parents and adolescent students) to address barriers to new and existing school-based immunization programs. Methods: Findings from a mixed methods study were integrated using a joint display and narrative summary. These findings were mapped through the Behaviour Change Wheel, a series of tools designed to facilitate the development of behaviour change interventions. Draft recommendations were provided to previous mixed methods study participants who consented to participating in future phases of the research study (n = 26). Feedback was captured using a Likert-scale survey of acceptability, practicality, effectiveness, affordability, safety and equity (APEASE) criteria, with feedback and additional insights captured using open-ended textboxes. Data was used to revise and finalize recommendations. Results: Applying the Behaviour Change Wheel, we drafted 26 evidence-based, theory-informed recommendations to address barriers to school-based immunization programs. Participants (n = 16) provided feedback, with half of the recommendations scoring 80% or higher across all six APEASE criteria. The remaining 13 recommendations received a moderate score across one or more criteria. Stakeholders identified a high level of interest in expanding the use of e-consent forms, expanding programming to offer a meningitis B vaccine, and recommendations to ease student anxiety. Conclusion: We co-developed a range of recommendations to improve school-based immunization programs with stakeholders using data generated from a mixed methods study. Implementation of any single or combination of recommendations will need to be tailored to local clinic procedures, school system and health system resources.

How many people will live and die with serious illness in Ireland to 2040? Estimated needs and costs using microsimulation

As populations age, more people worldwide will live and die with serious illness like cancer, heart disease and dementia. Prior projections of serious illness prevalence and end-of-life care needs have typically used static population-level methods. We estimated future disease prevalence and healthcare costs by applying dynamic microsimulation models to high-quality individual-level panel data on older adults (aged 50 + ) in Ireland. We estimated that the number of people living and dying with serious illness will increase approximately 70 % over 20 years. Per-capita annual costs both at end of life and not at end of life increase substantially due to ageing populations and growing complexity. Total health system expenditures on care for people with serious illness are projected to double before accounting for rising cost of inputs in real terms. Decomposition of these estimates suggests that 39 % of additional costs are accounted for by rising absolute numbers of older people, 37 % by changing age distribution and growing life expectancy, and 23 % due to rising individual complexity including morbidity and functional limitations. Our results and methods will be of interest to other countries planning for the future population health needs, and formidable health system resources associated with these needs, in the coming years.

Implementation of WHO guidelines for cervical cancer screening, diagnosis and treatment: knowledge and perceptions of health providers from Argentina

BackgroundThe 2021 World Health Organization (WHO) guidelines on cervical cancer screening and treatment provide countries with evidence-based recommendations to accelerate disease elimination. However, evidence shows that health providers’ adherence to screening guidelines is low. We conducted a study in Argentina to analyze health providers’ knowledge and perceptions regarding the 2021 WHO Guidelines.MethodsA qualitative study was conducted based on individual, semi-structured interviews with health providers specializing in gynecology (n = 15). The themes explored were selected and analyzed using domains and constructs of the Consolidated Framework for Implementation Research.ResultsAlthough health providers perceive WHO as a reliable institution, they do not know the 2021 guidelines, its supporting evidence, and its elaboration process. Their clinical practice is mainly guided by local recommendations developed by national professional medical associations (PMAs). For interviewees, WHO guidelines should be disseminated through health authorities and national PMAs, mainly through in-service training. Health providers had a positive assessment regarding WHO Recommendation 1 (screen, triage, and treatment for women aged 30 + with HPV-testing every 5 to 10 years) and perceived a favorable climate for its implementation. HPV-testing followed by triage was considered a low-complexity practice, enabling a better detection of HPV, a better selection of the patients who will need diagnosis and treatment, and a more efficient use of health system resources. However, they suggested adapting this recommendation by removing screening interval beyond 5 years. WHO Recommendation 2 (screen-and-treat approach with HPV-testing for women aged 30 + every 5 to 10 years) was predominantly rejected by interviewees, was considered an algorithm that did not respond to women’s needs, and was not adequate for the Argentinean context. Regarding the HPV-test modality, clinician-collected tests were the preferred mode. Health providers considered that HPV self-collection should be used primarily among socially vulnerable women to increase screening coverage.ConclusionWHO guidelines should be widely disseminated among health providers, especially in settings that could benefit from a screen-and-treat approach. Identifying areas of partnership and collaboration with PMAs in implementing WHO guidelines is essential.

KPHA 2023 should explicitly include state accountability: Response to Fernandez et al.

The commentary "Public health ethics and the Kerala Public Health Act, 2023" published on January 27, 2024 in the Indian Journal of Medical Ethics (IJME) has received a response from members of the State Health Systems Resource Centre and Government Medical College, Malappuram, Kerala. They explain that the Kerala Public Health Act (KPHA) is a legal document and not required to explicitly include accountability mechanisms and social obligations of the state. Given the very real danger of state over-reach as was evident during the Covid pandemic, these checks and balances should, in fact, be non-negotiable. The position of KPHA on healthcare of migrant workers and patients with tuberculosis goes against existing public healthcare principles. There is therefore a need to revisit the Act to explicitly include state accountability.

Assessment of Urban ASHA workers: Unveiling Urban Dynamics

Background: The World Health Report highlighted the critical role of human resources in health systems, especially noting the human resource crisis in low-income countries due to various challenges such as migration and illness of health workers. The study aims to assess the performance of urban ASHA workers in Meerut and identify factors affecting their performance. Specific objectives include evaluating the delivery of essential services by ASHA workers and understanding the various individual, occupational, and environmental factors that influence their effectiveness. Methodology: The study was conducted with 40 ASHAs from the urban areas of Meerut. Data was collected through interviews using pretested schedules and performance assessments based on structured scales. Beneficiaries were also interviewed to gauge service delivery effectiveness. Chi-square and Fisher exact tests were used to analyze data and understand the association between various factors and ASHA performance. Results & Conclusion: The results were categorized into performance grades based on the ASHAs' scores, showing a distribution among different performance levels. Factors such as age, education, training frequency, occupation, and timely receipt of incentives were found to significantly affect the performance of ASHA workers. The study revealed that younger, better-educated, and regularly trained ASHAs with timely incentives showed better performance.

Evaluation of the Implementation of Integrated Primary Care for Patients with Type 2 Diabetes and Hypertension in Belgium, Cambodia, and Slovenia.

Integrated care of chronic patients improves quality of their management, but there is scarce evidence of its implementation in different healthcare settings. With this article, we wanted to determine the level of integrated care implementation in the management of T2D (diabetes) and HT (hypertension) in three different settings: Belgium, Slovenia, and Cambodia. This was an observational study with integrated approach. It was conducted in primary health care organisations in three countries. In each primary health care organisation, we aimed to include primary care workers that worked with Type 2 Diabetes (T2D) and hypertension (HT) patients. Data was collected with the Integrated Care Package (ICP) grid (consisting of six elements: identification, treatment, health education, self-management, caregiver collaboration, and care organisation). ICP is almost completely implemented without major differences within Slovenia. There is a considerable variability across practice types in Belgium. Implementation is constrained by health system resources in Cambodia. Some elements, especially identification, are better implemented then others, across health systems. Countries can enhance integrated care for chronic diseases by implementing central policies, standardized protocols, and local adaptation, addressing resource constraints, promoting systematic screening and health education, and providing training for healthcare workers, tailored to community needs, to improve patient outcomes and healthcare delivery.

Optimization of resources in intelligent electronic health systems based on internet of things to predict heart diseases via artificial neural network

As a paradigm shift in tandem with the expansion of ICT, smart electronic health systems hold great promise for enhancing healthcare delivery and illness prevention efforts. These systems acquire an in-depth understanding of patient health states through the real-time collection and analysis of medical data enabled by the Internet of Things (IoT) and machine learning. With the widespread use of cutting-edge artificial intelligence and machine learning techniques, predictive analytics in medicine can assist in making the shift from a reactive to a proactive healthcare strategy. With the ability to rapidly and precisely evaluate massive amounts of data, draw intelligent conclusions, and solve difficult issues, artificial neural networks could revolutionize several industries. Two cardiac illnesses were assessed in this study using a multilayer perceptron artificial neural network that incorporated a genetic algorithm and an error-back propagation mechanism. The ability of artificial neural networks to handle consecutive time series data is crucial for optimizing resources in smart electronic health systems, especially with the increasing volume of patient information and the broad use of electronic clinical records. This requires the creation of more accurate predictive models. Through the use of Internet of Things (IoT) sensors, the proposed system gathers data, which is then used to do predictive analytics on patient history-related electronic clinical data saved in the cloud. A smart healthcare system that uses Mu-LTM (multidirectional long-term memory) to accurately monitor and predict the risk of heart disease has a coverage error of 97.94 %, an accuracy of 97.89 %, a sensitivity of 97.96 %, and a specificity of 97.99 %. In comparison to other smart heart disease prediction systems, the F1-score of 97.95 % and precision of 97.71 % is very good.

“The reasons you believe …”: An exploratory study of text driven evidence gathering and prediction from first responder records justifying state authorised intervention for mental health episodes

Objective First responders’ mandatory reports of mental health episodes requiring emergency hospital care contain rich information about patients and their needs. In Queensland (Australia) much of the information contained in Emergency Examination Authorities (EEAs) remains unused. We propose and demonstrate a methodology to extract and translate vital information embedded in reports like EEAs and to use it to investigate the extreme propensity of incidence of serious mental health episodes.Methods The proposed method integrates clinical, demographic, spatial and free text information into a single data collection. The data is subjected to exploratory analysis for spatial pattern recognition leading to an observational epidemiology model for the association of maximum spatial recurrence of EEA episodes.Results Sentiment analysis revealed that among EEA presentations hospital and health service (HHS) region #4 had the lowest proportion of positive sentiments (18 %) compared to 33 % for HHS region #1 pointing to spatial differentiation of sentiments immanent in mandated free text which required more detailed analysis.At the postcode geographical level, we found that variation in maximum spatial recurrence of EEAs was significantly positively associated with spatial range of sentiments (0.29, p < 0.001) and the postcode-referenced sex ratio (0.45, p = 0.01). The volatility of sentiments significantly correlated with extremes of recurrence of EEA episodes. The predicted (probabilistic) incidence rate when mapped reflected this correlation.Conclusions The paper demonstrates the efficacy of integrating, machine extracted, human sentiments (as potential surrogates) with conventional exposure variables for evidence-based methods for mental health spatial epidemiology.Such insights from informatics-driven epidemiological observations may inform the strategic allocation of health system resources to address the highest levels of need and to improve the standard of care for mental patients while also enhancing their safe and humane treatment and management.

Differences between parents' and paediatricians' perceptions of mild respiratory infections in childhood: contrast study.

Mild respiratory infections are a common reason for consultation in paediatrics, both in the emergency department and in primary care clinics. These conditions, mostly viral and self-limiting, have a significant impact on the healthcare system, school and work absenteeism, and family routines. Despite being common and banal illnesses from a medical perspective, they involve a significant concern in families. The main objective of the contrast study was to compare the perceptions of parents and paediatricians regarding mild respiratory infections in childhood and their impact on family conciliation. Two online, cross-sectional surveys were conducted among Spanish paediatricians and parents with children aged 6 months to 12 years, involving 504 paediatricians and 1,447 families, with questions on attitudes towards visits to the paediatric consultation, care burden of minor pathologies, work, and family conciliation, and treatment and prevention of these illnesses. Results showed significant differences in paediatricians' and parents' perceptions in many aspects. According to 34.5% of paediatricians and 27% of parents, families regularly go to the paediatrician without a scheduled visit. Only 4% of parents report having self-medicated their child, while paediatricians raise this percentage significantly to 48%. Regarding the question: "it is normal for a child to have an average of 4 colds a year," only 25.5% of the surveyed families "strongly agree" unlike to 70.2% of paediatricians. 72.8% of paediatricians "strongly agree" with: "in my opinion, it is good for children to get sick to improve their immune system" reduced to 45.9% of parents. Consultations for minor pathologies represent a "high workload" for 60.9% of paediatricians, while this opinion is agreed by only 18.9% of the parents. Mild respiratory infections in childhood are perceived differently by paediatricians and parents. While paediatricians perceive them as a common and manageable phenomenon, parents tend to show higher concern and demand for medical attention. This study underlines the need to improve communication between paediatricians and parents to align perceptions, optimise the use of the health system resources, and improve the efficiency in the management of these common paediatric illnesses.

Long-term survival for lymphoid neoplasms and national health expenditure (EUROCARE-6): a retrospective, population-based study

Management of lymphoid malignancies requires substantial health system resources. Total national health expenditure might influence population-based lymphoid malignancy survival. We studied the long-term survival of patients with 12 lymphoid malignancy types and examined whether different levels of national health expenditure might explain differences in lymphoid malignancy prognosis between European countries and regions. For this observational, retrospective, population-based study, we analysed the EUROCARE-6 dataset of patients aged 15 or older diagnosed between 2001 and 2013 with one of 12 lymphoid malignancies defined according to International Classification of Disease for Oncology (third edition) and WHO classification, and followed up to 2014 (Jan 1, 2001-Dec 31, 2014). Countries were classified according to their mean total national health expenditure quartile in 2001-13. For each lymphoid malignancy, 5-year and 10-year age-standardised relative survival (ASRS) was calculated using the period approach. Generalised linear models indicated the effects of age at diagnosis, gender, and total national health expenditure on the relative excess risk of death (RER). 82 cancer registries (61 regional and 21 national) from 27 European countries provided data eligible for 10-year survival estimates comprising 890 730 lymphoid malignancy cases diagnosed in 2001-13. Median follow-up time was 13 years (IQR 13-14). Of the 12 lymphoid malignancies, the 10-year ASRS in Europe was highest for hairy cell leukaemia (82·6% [95% CI 78·9-86·5) and Hodgkin lymphoma (79·3% [78·6-79·9]) and lowest for plasma cell neoplasms (29·5% [28·9-30·0]). RER increased with age at diagnosis, particularly from 55-64 years to 75 years or older, for all lymphoid malignancies. Women had higher ASRS than men for all lymphoid malignancies, except for precursor B, T, or natural killer cell, or not-otherwise specified lymphoblastic lymphoma or leukaemia. 10-year ASRS for each lymphoid malignancy was higher (and the RER lower) in countries in the highest national health expenditure quartile than in countries in the lowest quartile, with a decreasing pattern through quartiles for many lymphoid malignancies. 10-year ASRS for non-Hodgkin lymphoma, the most representative class for lymphoid malignancies based on the number of incident cases, was 59·3% (95% CI 58·7-60·0) in the first quartile, 57·6% (55·2-58·7) in the second quartile, 55·4% (54·3-56·5) in the third quartile, and 44·7% (43·6-45·8) in the fourth quartile; with reference to the European mean, the RER was 0·80 (95% CI 0·79-0·82) in the first, 0·91 (0·90-0·93) in the second, 0·94 (0·92-0·96) in the third, and 1·45 (1·42-1·48) in the fourth quartiles. Total national health expenditure is associated with geographical inequalities in lymphoid malignancy prognosis. Policy decisions on allocating economic resources and implementing evidence-based models of care are needed to reduce these differences. Italian Ministry of Health, European Commission, Estonian Research Council.

A mixed methods evaluation of the impact of ECHO® telementoring model for capacity building of community health workers in India

IntroductionIndia has the largest cohort of community health workers with one million Accredited Social Health Activists (ASHAs). ASHAs play vital role in providing health education and promoting accessible health care services in the community. Despite their potential to improve the health status of people, they remain largely underutilized because of their limited knowledge and skills. Considering this gap, Extension for Community Healthcare Outcomes (ECHO)® India, in collaboration with the National Health System Resource Centre (NHSRC), implemented a 15-h (over 6 months) refresher training for ASHAs using a telementoring interface. The present study intends to assess the impact of the training program for improving the knowledge and skills of ASHA workers.MethodsWe conducted a pre–post quasi-experimental study using a convergent parallel mixed-method approach. The quantitative survey (n = 490) assessed learning competence, performance, and satisfaction of the ASHAs. In addition to the above, in-depth interviews with ASHAs (n = 12) and key informant interviews with other stakeholders (n = 9) examined the experience and practical applications of the training. Inferences from the quantitative and qualitative approaches were integrated during the reporting stage and presented using an adapted Moore’s Expanded Outcomes Framework.ResultsThere was a statistically significant improvement in learning (p = 0.038) and competence (p = 0.01) after attending the training. Participants were satisfied with the opportunity provided by the teleECHO™ sessions to upgrade their knowledge. However, internet connectivity, duration and number of participants in the sessions were identified as areas that needed improvement for future training programs. An improvement in confidence to communicate more effectively with the community was reported. Positive changes in the attitudes of ASHAs towards patient and community members were also reported after attending the training. The peer-to-peer learning through case-based discussion approach helped ensure that the training was relevant to the needs and work of the ASHAs.ConclusionsThe ECHO Model ™ was found effective in improving and updating the knowledge and skills of ASHAs across different geographies in India. Efforts directed towards knowledge upgradation of ASHAs are crucial for strengthening the health system at the community level. The findings of this study can be used to guide future training programs.Trial registration The study has been registered at the Clinical Trials Registry, India (CTRI/2021/10/037189) dated 08/10/2021.

Factors Affecting the Availability and Utilization of Essential Medicines in India: A Systematic Review

ABSTRACT Essential medicines or drugs are recognized as highly cost-effective components within contemporary healthcare, demonstrating significant potential for improving health outcomes. The provision of essential medicines directly impacts the functioning of healthcare facilities, resulting in financial hardship. This review aims to fill knowledge gaps by examining obstacles hindering access and utilization of essential medicines in India. This study conducted a comprehensive evidence synthesis, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, to analyse articles on the availability and utilization of essential medicines in India. The search strategy included various databases and keywords. Published, peer-reviewed articles focusing on the National/ State List of Essential Medicines and meeting specific criteria were considered. Data items included essential medicines, drug availability, utilization, and challenges. Data was extracted, synthesized, and analysed using thematic framework analysis. Out of 1,129 articles, 11 were selected for review. Studies consistently highlighted the inadequate availability of essential medicines in different Indian states. Availability of essential medicines varies in the range of 17-51 percent across major states of India. Stock-outs of medicines vary from 4 to 14 weeks. Governance issues including differential procurement mechanisms across states of India, hinder seamless availability of essential medicines. Other challenges included distribution and purchasing system inefficiencies, governance-related issues, and facility/ user-level challenges impacting drug utilization. Disruptions in utilization were observed due to improper prescription practices and non-availability of affordable options. Accessibility and affordability also affected drug utilization. Issues with supply chain management and conflicting guidelines further contributed to the obstacles faced in ensuring availability and utilization of essential medicines in India. Ensuring the availability, accessibility, and affordability of essential medicines is of utmost importance. The public health system needs to strengthen its procurement and distribution management. Strengthening the logistics support for an efficient supply of essential medicines will reduce the time lag in receipt of drugs. Guidelines on essential drugs prepared by the National Health System Resource Centre need to be strictly adhered to and monitored in inventory management system. There is an urgent need to develop a sustainable model for achieving uniformity in the availability and utilization of essential medicines in India.

Current situation of full vaccination with basic vaccines in children under 1 year old in Vietnam during 2017 - 2022

A cross-sectional study in 63 provinces/cities in Vietnam (2017 - 2022) was conducted to describe the current situation of full vaccination with basic vaccines in children under 1 year old in Vietnam during 2017 - 2022. The study results showed that the proportion of full vaccination with basic vaccines in children under 1 year old during 2017 - 2022 was 93.1%, still not reached the target of ≥ 95%, and decreased to only 90.7% in the 2020 - 2022 period, when Vietnam was under pressure from the COVID-19 pandemic. There were differences in this proportion between regions/areas and between times before or during the COVID-19 epidemic. It is necessary to increase attention and investment in the expanded vaccination activities, providing adequate vaccines, supplies and equipment, as well as improving the quality of human resources in the preventive health system to meet the increasing needs of child health protection, be ready to adapt to other difficulties that may be encountered in the future.