Investment In Health Systems Research Articles

Impact of the 100 days mission for vaccines on COVID-19: a mathematical modelling study

The COVID-19 pandemic has underscored the beneficial impact of vaccines. It also highlighted the need for future investments to expedite an equitable vaccine distribution. The 100 Days Mission aims to develop and make available a new vaccine against a future pathogen with pandemic potential within 100 days of that pathogen threat being recognised. We assessed the value of this mission by estimating the impact that it could have had on the COVID-19 pandemic. Using a previously published model of SARS-CoV-2 transmission dynamics fitted to excess mortality during the COVID-19 pandemic, we projected scenarios for three different investment strategies: rapid development and manufacture of a vaccine, increasing manufacturing capacity to eliminate supply constraints, and strengthening health systems to enable faster vaccine roll-outs and global equity. Each scenario was compared against the observed COVID-19 pandemic to estimate the public health and health-economic impacts of each scenario. If countries implemented non-pharmaceutical interventions (NPIs) as they did historically, the 100 Days Mission could have averted an estimated 8·33 million deaths (95% credible interval [CrI] 7·70-8·68) globally, mostly in lower-middle income countries. This corresponds to a monetary saving of US$14·35 trillion (95% CrI 12·96-17·87) based on the value of statistical life-years saved. Investment in manufacturing and health systems further increases deaths averted to 11·01 million (95% CrI 10·60-11·49). Under an alternative scenario whereby NPIs are lifted earlier on the basis of vaccine coverage, the 100 Days Mission alone could have reduced restrictions by 12 600 days (95% CrI 12 300-13 100) globally while still averting 5·76 million deaths (95% CrI 4·91-6·81). Our findings show the value of the 100 Days Mission and how these can be amplified through improvements in manufacturing and health systems equity. However, these investments must be enhanced by prioritising a more equitable global vaccine distribution. Schmidt Science Fellowship in partnership with the Rhodes Trust, WHO, UK Medical Research Council, Coalition for Epidemic Preparedness Innovations.

Where should health system investments be made to protect the mental health of healthcare workers?

Abstract Background This study explores trends and work-related determinants of mental health and wellbeing among health and care workers in Europe since the COVID-19 pandemic. The aim is to determine where investments can best be made to protect and support mental health and wellbeing among health and care workers to improve retention and recruitment. Methods Data are analysed from the National Health Service staff survey in England and the Health Service Executive ‘Your Opinion Counts’ survey in Ireland to explore trends in mental health and wellbeing and burnout. Evidence is then taken from a series of European Observatory policy briefs, based on expert-led literature reviews, to explore determinants of poor mental health and wellbeing and to identify potential areas for investment. Results Rates of burnout and poor mental health and wellbeing have increased in England and Ireland since the start of the pandemic among all professional groups. Workplace-based factors are important determinants of poor mental health and wellbeing, and can be grouped into: macro-level structural factors such as staff shortages, poor working conditions and low pay; meso-level organisational factors including poor leadership, and insufficient education, training and support; micro-level individual factors such as insufficient self-care or not seeking support. However, determinants at the micro-level, especially seeking support from others, are largely shaped by structural or organisational factors. Conclusions Increased financing to address structural and organisational determinants of mental health and wellbeing contributes to improved patient care, better staff experience, lower rates of absenteeism, and enhanced recruitment and retention. It is therefore one of the best health system investments that can be made.

The 2024 Public Health Emergency of International Concern: A Global Failure to Control Mpox.

On August 14, 2024, following a regional declaration by the Africa Centres for Disease Control and Prevention, the World Health Organization declared mpox a Public Health Emergency of International Concern, marking the second such declaration in two years. A series of outbreaks involving the more virulent clade I virus (compared to clade II, which caused a global outbreak in 2022), has now spread in 13 African countries, exposing the inadequacies of the public health infrastructure in these settings. There was significant investment during the 2022 global outbreak, but these efforts failed to address vaccine access and treatment in the Global South. Regulatory delays, unequal access to vaccines, and a lack of compassionate use treatments for severe cases have resulted in preventable cases and deaths, especially among vulnerable populations such as pregnant women, children, and the immunocompromised. The current outbreak also underscores critical knowledge gaps in our understanding of mpox, including its transmission, pathogenesis, and viral evolution. We join intensified calls for global solidarity and action to control mpox, emphasizing immediate containment measures and long-term local and international investment in African public health systems, to prevent future epidemics.

High-risk human papillomavirus diversity among indigenous women of western Botswana with normal cervical cytology and dysplasia

BackgroundCervical cancer remains a public health problem despite heavy global investment in health systems especially in low-and-middle-income countries (LMIC). Prophylactic vaccines against the most commonly detected human papillomavirus (HPV) types in cervical cancers are available and decisions on the selection of vaccine design depends on the prevalence of high-risk (hr) HPV genotypes for a particular region. In 2015, Botswana adopted the use of a quadrivalent HPV vaccine as a primary prevention strategy. Secondary prevention includes cervical smear screening whose uptake remains notably low among indigenous and marginalized communities despite efforts to improve access.AimTo determine the prevalence of hrHPV genotypes and cervical lesions’ burden in women from the indigenous and marginalized communities of Botswana.MethodsThis prospective survey enrolled 171 non-HPV vaccinated women aged 21 years and older. Face-to-face interviews, Pap smear screening, hr-HPV and Human Immuno-deficiency virus (HIV) testing were carried out. Conventional Papanicolau smears were analyzed and cervical brushes were preserved for hrHPV testing using the Ampfire Multiplex HR-HPV protocol which detects the following genotypes: HPV 16, 18, 31, 35, 39, 45, 51, 52, 53, 56, 58, 59 and 68.ResultsIn this study, 168/171 (98.6%) of the women consented to HIV testing; 53/171 (31%) were living with HIV and self-reported enrolment on antiretroviral therapy. Among the women examined, 23/171 (13.5%) had cervical dysplasia with most presenting with Atypical Squamous Cells of Undetermined Significance 8/23 (35%), Low-Grade Squamous Intraepithelial Lesions 8/23 (35%), Atypical Squamous Cells-High Grade 4/23 (17%), Atypical Endocervical Cells 2/23 (9%) and Atypical Endocervical Cell favoring neoplasia 1/23(4%). However, no High-Grade Squamous Intraepithelial Lesions (HSIL) or squamous cell carcinoma (SCC) were detected. Overall hrHPV prevalence in this study was at 56/171 (32.7%). The most commonly detected hrHPV genotypes in women with cervical dysplasia were HPV39 (6.25%), HPV51 (14.5%), HPV52 (12.5%) and HPV56 (4%). Notably, HPV 16 and 18 were not found in women with cervical dysplasia.ConclusionsOur study provides valuable insights into the prevalence and distribution of hrHPV genotypes in indigenous and marginalized communities in Botswana, and the need for further investigation of their potential role in cervical carcinogenesis in this population. These results may also serve as baseline data to facilitate future evaluation of the HPV vaccine needs.

Effects of Health Investment on Poverty Reduction in Developing Countries like Brazil

Purpose: The aim of the study was to analyze the effects of health investment on poverty reduction in Developing Countries. Methodology: This study adopted a desk methodology. A desk study research design is commonly known as secondary data collection. This is basically collecting data from existing resources preferably because of its low cost advantage as compared to a field research. Our current study looked into already published studies and reports as the data was easily accessed through online journals and libraries. Findings: Health investment in developing countries has been shown to effectively reduce poverty. Improved healthcare access leads to better health outcomes, boosting productivity and household incomes while mitigating healthcare expenses. Quality healthcare services, including preventive measures, break the poverty cycle by enhancing overall well-being and productivity. Strengthening healthcare infrastructure enhances resilience to health crises, crucial for sustainable poverty reduction and socio-economic development in these regions. Unique Contribution to Theory, Practice and Policy: Health capital theory, social determinants of health theory & health capability approach may be used to anchor future studies on effects of health investment on poverty reduction in Developing Prioritization of investments in health systems strengthening, focusing on expanding access to essential healthcare services, improving healthcare quality, and promoting health equity. Recognition of health investment as a fundamental component of poverty reduction strategies, leading to increased government prioritization and allocation of resources to healthcare systems.

Experiences of individuals presenting to the emergency department for mental health reasons: A systematic mixed studies review.

Emergency departments the world over have seen substantial increases in the number of individuals presenting for mental health reasons. However, we have a limited understanding of their experiences of care. The aim of this review was to systematically examine and synthesise literature relating to the experiences of individuals presenting to emergency department for mental health reasons. We followed Pluye and Hong's seven-step approach to conducting a systematic mixed studies review. Studies were included if they investigated adult mental health experiences in emergency department from the users' perspective. Studies describing proxy, carer/family or care provider experiences were excluded. Sixteen studies were included. Thematic synthesis identified three themes and associated subthemes. Theme 1 - ED staff can make-or-break and ED experience - comprised: Feeling understood and heard; Engaging in judgement-free interactions; Receiving therapeutic support; Being actively and passively invalidated for presenting to the ED; and Once a psych patient, always a psych patient. Theme 2 - Being in the ED environment is counter-therapeutic - comprised: Waiting for an 'extremely' long time; and Lacking privacy. Theme 3 was Having nowhere else to go. The experiences described by individuals presenting to emergency department for mental health reasons were mostly poor. The results illustrate a need for increased mental health education and training for all emergency department staff. Employment of specialist and lived experience workers should also be prioritised to support more therapeutic relationships and emergency department environments. In addition, greater investment in mental health systems is required to manage the current crisis and ensure future sustainability.

The influence of economic policies on social environments and mental health.

Despite increased advocacy and investments in mental health systems globally, there has been limited progress in reducing mental disorder prevalence. In this paper, we argue that meaningful advancements in population mental health necessitate addressing the fundamental sources of shared distress. Using a systems perspective, economic structures and policies are identified as the potential cause of causes of mental ill-health. Neoliberal ideologies, prioritizing economic optimization and continuous growth, contribute to the promotion of individualism, job insecurity, increasing demands on workers, parental stress, social disconnection and a broad range of manifestations well-recognized to erode mental health. We emphasize the need for mental health researchers and advocates to increasingly engage with the economic policy discourse to draw attention to mental health and well-being implications. We call for a shift towards a well-being economy to better align commercial interests with collective well-being and social prosperity. The involvement of individuals with lived mental ill-health experiences, practitioners and researchers is needed to mobilize communities for change and influence economic policies to safeguard well-being. Additionally, we call for the establishment of national mental wealth observatories to inform coordinated health, social and economic policies and realize the transition to a more sustainable well-being economy that offers promise for progress on population mental health outcomes.

Data analysis based on COVID-19Important factors in the COVID-19 outbreak

Data analysis based on COVID-19Important factors in the COVID-19 outbreak

Dose the increasing burden of social endowment affect sustainable development of economy?

The rapid increase in the number of older people under the background of population aging has gradually changed the disease spectrum of society, making aging diseases more prevalent, and increasing the demand for health care services, medical and health services, and health insurance among older people, ultimately leading to increasing household and social spending on old age. This study is conducted to assess the impact of those spending burden on the sustainable development of economy and find out some practical and effective solutions. This paper constructs a theoretical model to illustrate the relationship between the old-age dependency ratio and the marginal product of capital (MPK), and then establishes a two-way fixed effect model based on transnational panel data of 81 countries from 1981 to 2017 to verify this relationship empirically. This paper finds that, after controlling a series of variables, an increased burden of old-age dependency leads to a decline in the MPK, a key macroeconomic variable and also a sustainable development criteria, but in which health care, health security systems, and technological innovation play a key and moderating role. The conclusion is also valid after tackling the problem of endogeneity with different methods, like two-stage least squares (TSLS) and the generalized methods of moments (GMM). Overall, before population aging, countries that are old-but-not-rich should encourage more supply-side investments in public health system or technological innovation, and adjust retirement system, or gradually encourage childbearing to strive for time and space for later sustainable development of public health system and economy.

Protecting Frontline Nurses: What will it take? A review of policy, practice and lessons learned from High Consequence Infectious Diseases like Ebola and COVID-19

The significance of failing to protect frontline health workers, especially nurses cannot be overstated. Inadequate personal protection, psychosocial support and emergency training put our frontline of defense in jeopardy. When comparing death by occupation early evidence showed that nurses constituted the largest percentage of health workforce deaths. Other severe consequences like high levels of resignation, burnout and other signs of mental distress are a warning that health systems require fundamental change to protect and retain our frontline of health security. This is equally true in settings with both high and lower resources. Those at the frontlines pay a heavy price responding to infectious disease outbreaks, but it does not have to be. This paper outlines key issues and potential strategies to ensure our health workers have the right environment, competence, tools, and support to protect themselves and society when needed most. Using an umbrella review, this paper sought to review the extant literature and identify the best way forward. Failure to learn from recent events such as the 2014-2016 West Africa Ebola outbreak and the COVID-19 pandemic could further exacerbate health worker shortages and our collective ability to prevent, detect and respond effectively. Protecting frontline health workers requires a multi-faceted approach including well-defined policies, adoption of best practices and continuous learning. The focus should move from broad policies and benchmarks to specific, tangible actions, including standard guidelines and protocols that use an All-Hazards Approach. Taking concrete steps to improve protection with national and local accountability that ensures adequate safety standards will be key. Moreover, continuous learning and investment in health system strengthening are needed. The return on investment in preparedness and protection are clear. COVID-19 has shown the devastating economic and social impact of failing to be prepared. Investment is needed in innovation, including new personal protective equipment (PPE) technology, resilient supply chains that move beyond “just-in time” procurements, and competency-based experiential learning that simulates complex emergencies, in “real world” settings as much as is possible. Learning from history, including nursing pioneers, is essential. Outbreaks begin in communities. Close community engagement and understanding of the social determinants of health for which those on the margins pay the heaviest price is central to nursing. Since this paper focuses on protection of frontline health workers, it would be remiss not to revisit nursing’s role in caregiving. This paper presents examples from 19th and 20th century nursing leaders who developed community- and person-centered models of care, led the development of hygiene and sanitation standards and examples which highlight the critical role of nurses at the frontlines. Nursing has historically been community- and person-centered. Serving as the communities’ first line of healthcare, nursing pioneers like Florence Nightengale and Lillian Wald offer guidance which is still valuable in our modern, highly connected world. Applying lessons from both our recent and past experiences to develop robust systems for health workforce protection and preparedness is a health security priority. Now, as COVID-19 becomes an endemic disease for which an effective vaccine is available, is the time to harness these lessons learned, develop more robust standards and accountability for emergency protection and health workforce protection, without which history will repeat itself.

Analysis of social investment in health systems reform: a case study of results-based financing in Marondera District, Zimbabwe.

suboptimal use of donor funds and poor health systems performance is rife across most developing countries; to address this, results-based financing (RBF) models were developed. However, it is imperative to explore the emic and context specific influence of results-based financing in health systems performance. This study therefore sought to explore the influence of results-based financing on health worker motivation and governance, temporal perspective, distributional principle, and policy coherence. Finally, the influence of results-based financing on interrelations across donors, technical partners, and health workers was explored. the study adopted a qualitative, exploratory, descriptive, phenomenological design using audio-recorded face-to-face semi-structured interviews to capture diverse perspectives from the remaining and available two health financing experts, two technical partner organization representatives, and six health workers who have been implementing results-based financing from 2011 to 2022 in the Marondera district of Zimbabwe. Data was transcribed and collectively analyzed using NVIVO software. improved staff motivation, better governance, health system development, equity, and policy consistency were attributable to results-based financing, notwithstanding several challenges including understaffing, increased workload, procurement red tape, financial rigidity, and delays in subsidy payments, which eroded gains of better performance. Additionally, a lack of continuum of care due to user fees faced by the poor at higher levels of care, and limited engagement between donors and healthcare facility workers were also observed. Conclusion: reinforcing pinpointed positives is vital for sustaining realized health gains; however, urgent attention is required to address the challenges to safeguard the milestones achieved thus far.

1036. Reporting of SARS-CoV-2 testing results among PEPFAR and non-PEPFAR countries in Sub-Saharan Africa during the first year of the COVID-19 pandemic

Abstract Background The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) is the largest global health program dedicated to addressing a single disease. In its first ten years, PEPFAR invested one-fifth of country budgets on governance and health systems strengthening, including laboratories, surveillance networks, and long-term training of health care workers. In addition to furthering the HIV response and promoting the sustainability of health programs, it has been argued these investments built capacity to respond to novel public health threats such as SARS-CoV-2. Methods Testing data from 1/1/2020 through 2/17/2021 were downloaded from Our World in Data, an online database that collates information from national and international health agencies. These data were cross-referenced against publicly reported testing totals from Africa CDC and the World Health Organization. The data set did not include testing reported by governments through non-machine-readable formats such as social media or press releases. PEPFAR data were drawn from PEPFAR.gov. Results Of the 18 countries in sub-Saharan Africa (SSA) that reported testing data one year into the pandemic, 16 (88.9%) were PEPFAR countries (Table 1). Among PEPFAR countries in SSA, 16 of 27 countries (59.3%) reported SARS-CoV-2 tests performed, compared with 2 of 21 non-PEPFAR countries (9.5%, OR = 13.8). Among countries that reported testing, PEPFAR countries had a per-capita testing rate nearly 3 times that of non-PEPFAR countries (28.7 tests per 1,000 people vs. 9.6 tests per 1,000 people), suggesting greater testing capacity. PEPFAR countries reported higher COVID-19 case rates, likely due to increased testing, however this could also be due to regional differences in incidence (Table 2). Mean GDP per capita was 62% higher in non-PEPFAR SSA countries, making it unlikely that financial resources alone account for the observed differences.Figure 1.Countries that have received PEPFAR funding and countries that reported SARS-CoV-2 testing totals during the first year of the coronavirus pandemicTable 1.Reporting of SARS-CoV-2 testing in sub-Saharan Africa among PEPFAR and non-PEPFAR countries 1 year into the COVID-19 pandemicTable 2.COVID-19 indicators and characteristics of PEPFAR and non-PEPFAR countries in sub-Saharan Africa Conclusion PEPFAR countries in SSA were more likely than non-PEPFAR countries to report SARS-CoV-2 testing during the first year of the COVID-19 pandemic and also reported higher per-capita testing rates. This further supports anecdotal evidence that PEPFAR’s historical investments in health systems strengthened local capacity to respond to non-HIV public health emergencies such as COVID-19. Disclosures All Authors: No reported disclosures

Adapting Economic Evaluation Methods to Shifting Global Health Priorities: Assessing the Value of Health System Inputs

ObjectivesWe highlight the importance of undertaking value assessments for health system inputs if allocative efficiency is to be achieve with health sector resources, with a focus on low- and middle-income countries. However, methodological challenges complicated the application of current economic evaluation techniques to health system input investments. MethodsWe undertake a review of the literature to examine how assessments of investments in health system inputs have been considered to date, highlighting several studies that have suggested ways to address the methodological issues. Additionally, we surveyed how empirical economic evaluations of health system inputs have approached these issues. Finally, we highlight the steps required to move toward a comprehensive standardized framework for undertaking economic evaluations to make value assessments for investments in health systems. ResultsAlthough the methodological challenges have been illustrated, a comprehensive framework for value assessments of health system inputs, guiding the evidence required, does not exist. The applied literature of economic evaluations of health system inputs has largely ignored the issues, likely resulting in inaccurate assessments of cost-effectiveness. ConclusionsA majority of health sector budgets are spent on health system inputs, facilitating the provision of healthcare interventions. Although economic evaluation methods are a key component in priority setting for healthcare interventions, such methods are less commonly applied to decision making for investments in health system inputs. Given the growing agenda for investments in health systems, a framework will be increasingly required to guide governments and development partners in prioritizing investments in scarce health sector budgets.

The negative impact of global health worker migration, and how it can be addressed

International migration of healthcare workers is well established and has become a means of maintaining service quality in many high income countries. In recent years, there has been a dramatic increase in recruitment of health personnel who have been trained abroad, including from the poorest countries in the world. In this article, using General Medical Council (GMC) data, we chart the growth in numbers of international staff working in the United Kingdom, where since 2018, over half of all new GMC registrations have been of doctors trained abroad. There is evidence that this migration of health staff results in poorer health service provision in low and middle income countries, as well as substantial economic impacts in these countries that have invested in training their health workforce. Recruiting governments have argued that remittances compensate for the loss of personnel, and that training opportunities can enable skills transfer to countries with weaker health systems. However, we found that the costs to the source countries dwarfed remittances, and that only a tiny fraction of people who move to take up posts in wealthier countries ever return to their countries of origin to work. We conclude that in addition to the investment in health systems (and workforce development) in low and middle income countries as part of Official Development Assistance for Health, there is an urgent need to increase training of nurses and doctors so that damaging migration is no longer relied upon to fill gaps in healthcare personnel.

Private equity investment in Germany's primary care sector

Abstract Background A major reform of the primary care sector in Germany that included a new law on health system financing in 2004 introduced new tools to be used by “entrepreneurial doctors”. These new tools provided opportunities for corporate investments into primary care, including through private equity funds (PEFs). Since then, there has been a stark increase of private investments. Methods A review of academic and grey literature, media reports and relevant organizational websites. Results Investments by PEFs in Ambulatory Health Care Centres (in German: Medizinische Versorgungszentren, MVZs) have increased continuously in recent years, and latest estimates suggest that in 2020 about 750 of overall 3800 MVZs were owned by PEFs. However, exact and robust data on how many MVZs are owned by PEFs do not exist, as there are no (legal) requirements for disclosures of these investment and ownership structures in Germany. Often, investors are located in tax havens, making the identification of ownership difficult. In addition, a PEF investing into an MVZ may include one health care facility, several dozens or over 100, depending on how well developed the network is (sometimes including long-term care facilities), further complicating an understanding of ownership status. The public debate on private equity investments in Germany's health system has been intensifying in recent years and a number of concerns have been raised, leading to calls by medical chambers for stricter regulation. Federal Minister of Health, Karl Lauterbach, announced in late 2022 that a law prohibiting private equity acquisitions of MVZs would be forthcoming in 2023. Conclusions The involvement of PEFs in Germany's ambulatory health care centres has increased substantially in recent years, leading to increasing public concerns and calls for stricter regulation.

Annual incidence and fatality rates of notifiable infectious diseases in southeast China from 1950 to 2022 and relationship to socioeconomic development.

Over the past 70 years, China has advanced significantly in the prevention and treatment of infectious diseases while simultaneously undergoing a socioeconomic transformation, making it a useful source of data for analysing relationships between public health policy and the control of infectious diseases. We collected data on the incidence of notifiable infectious diseases and associated fatalities in Jiangsu province in southeast China from the Provincial Center for Disease Control and Prevention, Provincial Institute of Parasitic Diseases, and the Nationwide Notifiable Infectious Diseases Reporting Information System. We compared data from different historical periods using descriptive statistical methods, joinpoint regression, and correlation analysis. During 1950-2022, 75 754 008 cases of 46 notifiable infectious diseases were reported in Jiangsu, with an average annual incidence was 1679.49 per 100 000 population and a fatality rate of 1.82 per 1000 persons. The incidence of classes A-B decreased (average annual percent change (AAPC) = -2.1) during the entire study period, while the incidence of class C increased (AAPC = 10.8) after 2004. The incidence of intestinal diseases (AAPC = -4.4) and vector-borne and zoonotic diseases (AAPC = -8.1) decreased rapidly, while the incidence of sexually transmitted and blood-borne diseases (AAPC = 1.8) increased. The number of medical and health institutions and the per capita gross domestic product correlated negatively with the annual incidence of diseases in classes A-B, but not with fatality rates. Although the annual incidence of many severe infectious diseases has decreased in Jiangsu since 1950, the incidence of sexually transmitted and blood-borne diseases increased. Socioeconomic growth and sustainable investment in health systems are associated with better control of infectious diseases.

Essential cancer medicines: adding feasibility to the magnitude of clinical benefit value chain

Cancer is a global public health problem, requiring efficient health system investments to deliver sustainable impact on population health. Access to medicines is a critical component of health systems, having a crucial role in delivering therapeutic benefits. Since 1977, the World Health Organization (WHO) has published a Model List of Essential Medicines (EML) that includes key health interventions for the prevention and control of conditions of public health relevance. Essential medicines are selected for inclusion in the EML based on the evidence of efficacy, safety, therapeutic value, and the potential to impact population health. With the rapid changes in the therapeutic landscape of cancer treatment with new medicine approvals, there is a critical need to select and prioritise specific cancer interventions based on their intrinsic value. The European Society for Medical Oncology (ESMO) has developed a decisional methodology based on a threshold with a minimum set of technical specifications and a consensus-based procedure for decisions to select candidate cancer medicines to be submitted to the WHO for consideration for the WHO EML. ESMO recognises the WHO EML as an important reference guide for medicines that all countries should include in their national EMLs. Cancer medicines on the WHO EML are used in the treatment of the majority of cancers, and are recommended in the evidence-based ESMO Clinical Practice Guidelines that medical oncologists use to treat patients. ESMO's submissions to the WHO EML in 2019 and 2021 and their respective outcomes are presented in the manuscript. Due to the rising costs associated with newly available therapies, structured, reproducible, and field-tested tools to evaluate the added clinical benefit from these therapies need to be implemented in pre-selecting potential candidate medicines to be included in the WHO EML. ESMO is proud to collaborate closely with WHO on this important global public health initiative.

Impact of health and safety management implementation on cost performance of construction projects in Abuja, Nigeria

Construction activities lack understanding of health and safety management implementation and perceived safety cost as a burden. Stakeholders, especially contractors within the construction industry believe that investment in health and safety management system increases overall construction cost, and therefore, tend to neglect relevant accident prevention activities on construction sites. Therefore, this study has the following objectives: it assesses the impact of health and safety management implementation on cost performance of construction projects in Abuja, Nigeria; identifies health and safety management practices adopted by construction sites and to assess the cost implication associated with the implementation of health and safety management practices within the selected construction sites. Data were collected using structured questionnaires and analyzed using simple percentile and mean item score. The study identifies 35 elements of health and safety management implementation on cost performance of construction sites, under 4 major components out of which safety manager on site with the mean score 4.51, onsite safety inspection 4.25, safety helmet 3.95 and tool – box talk 3.89 were the most important under each component of health and safety management system. The result reveals that the cost of implementing health and safety programme is a major challenge facing Nigerian contractors and companies in terms of high-cost involvement in the area of injuries and hazard on site. This tends to increase the overall cost of the project. Therefore, the paper recommends that adequate cost control measures be adopted to checkmate health and safety expenditure during construction process instead of total avoidance of health and safety programme.

Building Integrated Testing Programs for Infectious Diseases.

In the past two decades, testing services for diseases such as HIV, TB and malaria have expanded dramatically. Investments in testing capacity and supportive health systems have often been disease specific, resulting in siloed testing programs with suboptimal capacity, reduced efficiency, and limited ability to introduce additional tests or respond to new outbreaks. Emergency demand for SARS-CoV2 testing overcame these silos and demonstrated the feasibility of integrated testing. Moving forward, an integrated public laboratory infrastructure that services multiple diseases, including SARS-CoV-2, influenza, HIV, TB, hepatitis, malaria, sexually transmitted diseases, and other infections will help improve universal healthcare delivery and pandemic preparedness. However, integrated testing faces many barriers including poorly aligned health systems, funding and policies. Strategies to overcome these include greater implementation of policies that support multi-disease testing and treatment systems, diagnostic network optimization, bundled test procurement, and more rapid spread of innovation and best practices across disease programs.

Getting Further Faster: Illuminating Opportunities for Health Departments to Support Community-Driven Social Determinants of Health Interventions.

Getting Further Faster: Illuminating Opportunities for Health Departments to Support Community-Driven Social Determinants of Health Interventions.