Lancet Global Health Commission Research Articles

For and with people: announcing the Lancet Global Health Commission on people-centred care for universal health coverage and a call for commissioner nominations

For and with people: announcing the Lancet Global Health Commission on people-centred care for universal health coverage and a call for commissioner nominations

Current Neurosurgical Care in Ethiopia Using the Lens of the Lancet Global Health Commission on High-Quality Health Systems.

Neurosurgery is a rapidly developing specialty in Ethiopia. Previous global neurosurgery studies have highlighted the need for synchronizing workforce increase with improving quality, access, and capacity to provide neurosurgical care. To evaluate Ethiopia's neurosurgical system and highlight the critical interventions required for the sustained development of Ethiopian neurosurgery as part of a high-quality health system (HQHS). A comprehensive survey was sent to all practicing neurosurgeons. Public databases on Ethiopian census reports and current road infrastructure were used for spatial analysis of neurosurgical access. The survey response rate was 90% (45/50). Most respondents were men (95.6%), aged 30 to 40 years (82%), who worked at national referral hospitals (71%). The reported annual caseload per practicing neurosurgeon was >150 cases for 40% of urban and 20% of rural neurosurgeons. Head and spine neurotrauma and tumors were the most common neurosurgical indications. Computed tomography scanner was the most widely available diagnostic equipment (62%). 76% of respondents indicated the presence of postoperative rehabilitation care at their institutions. Thirteen percent and 27% of the nation lived within a 2-hour and 4-hour driving distance from a neurosurgical center, respectively. The results highlight the need for vital improvements in neurosurgical capacity to sustain progress toward HQHS. Promoting sustained development in all components of HQHS can be achieved by diversifying the workforce and training residency candidates committed to practicing in underserved regions. Additional strategies might include establishing a national registry for neurosurgical data and implementing policy changes conducive to improving perihospital care and other health system components.

Research Partnerships and Guidance in Academic Global Ophthalmology.

Research Partnerships and Guidance in Academic Global Ophthalmology.

Strengthening public health systems in China

Strengthening public health systems in China

Announcing the Lancet Global Health Commission on medical oxygen security

Medical oxygen is an essential health treatment for both acute and chronic conditions across all age groups. Strong medical oxygen systems save lives. Therefore, adequate access to safe, affordable, and appropriate medical oxygen services is crucial for improving population health and meeting the Sustainable Development Goal targets. However, severely limited or unreliable oxygen services have been a persistent issue in many low-income and middle-income countries (LMICs), particularly among small health facilities serving poor, rural, and otherwise marginalised populations.

Optimising child and adolescent health and development in the post-pandemic world

Our Series on optimising child and adolescent health and development follows on almost two decades after the original Lancet Series on child survival and its corresponding call for action. 1 The Bellagio Study group on Child SurvivalKnowledge into action for child survival. Lancet. 2003; 362: 323-327 Summary Full Text Full Text PDF PubMed Scopus (184) Google Scholar With less than 10 years left to meet the 2030 Sustainable Development Goals (SDGs), we are concerned that, once again, the world is failing its children. The evidence is strong and calls for change abound; however, effective actions are few and far between. Opportunities in crisis for optimising child health and developmentThe Lancet Series on optimising child and adolescent health and development1–4 arrives at the right time. For many years, the global health community has known that quality primary health care, including antenatal care, immunisation, and optimal nutrition, helps children survive past their fifth birthday and live healthy lives. Child survival has improved because of combined efforts in these areas; but the scale and scope of the global threats to child health and wellbeing, including conflicts, climate crises, and other humanitarian emergencies, all compounded by COVID-19, now put decades of progress at grave risk. Full-Text PDF Health and development from preconception to 20 years of age and human capitalOptimal health and development from preconception to adulthood are crucial for human flourishing and the formation of human capital. The Nurturing Care Framework, as adapted to age 20 years, conceptualises the major influences during periods of development from preconception, through pregnancy, childhood, and adolescence that affect human capital. In addition to mortality in children younger than 5 years, stillbirths and deaths in 5–19-year-olds are important to consider. The global rate of mortality in individuals younger than 20 years has declined substantially since 2000, yet in 2019 an estimated 8·6 million deaths occurred between 28 weeks of gestation and 20 years of age, with more than half of deaths, including stillbirths, occurring before 28 days of age. Full-Text PDF Effects of early-life poverty on health and human capital in children and adolescents: analyses of national surveys and birth cohort studies in LMICsThe survival and nutrition of children and, to a lesser extent, adolescents have improved substantially in the past two decades. Improvements have been linked to the delivery of effective biomedical, behavioural, and environmental interventions; however, large disparities exist between and within countries. Using data from 95 national surveys in low-income and middle-income countries (LMICs), we analyse how strongly the health, nutrition, and cognitive development of children and adolescents are related to early-life poverty. Full-Text PDF What can work and how? An overview of evidence-based interventions and delivery strategies to support health and human development from before conception to 20 yearsProgress has been made globally in improving the coverage of key maternal, newborn, and early childhood interventions in low-income and middle-income countries, which has contributed to a decrease in child mortality and morbidity. However, inequities remain, and many children and adolescents are still not covered by life-saving and nurturing care interventions, despite their relatively low costs and high cost-effectiveness. This Series paper builds on a large body of work from the past two decades on evidence-based interventions and packages of care for survival, strategies for delivery, and platforms to reach the most vulnerable. Full-Text PDF Improving health and social systems for all children in LMICs: structural innovations to deliver high-quality servicesDespite health gains over the past 30 years, children and adolescents are not reaching their health potential in many low-income and middle-income countries (LMICs). In addition to health systems, social systems, such as schools, communities, families, and digital platforms, can be used to promote health. We did a targeted literature review of how well health and social systems are meeting the needs of children in LMICs using the framework of The Lancet Global Health Commission on high-quality health systems and we reviewed evidence for structural reforms in health and social sectors. Full-Text PDF

Public financing for primary health care is the key to universal health coverage and strengthening health security

Public financing for primary health care is the key to universal health coverage and strengthening health security

Commitment and innovation on the road to people-centred PHC financing

Commitment and innovation on the road to people-centred PHC financing

An assertive, practical, and substantive agenda to catalyse meaningful change

The Lancet Global Health Commission on financing primary health care1 combines a shared vision with practical guidance on how to align health financing with overall reform strategies that place primary care service delivery at the core. The Commission reinforces key messages that WHO has put forward on health financing reforms to enable progress towards universal health coverage (UHC). It then extends these by application to primary care as a critical service delivery element for the progressive realisation of UHC.

The Lancet Global Health Commission on global eye health: Vision beyond 2020

The Lancet Global Health Commission on global eye health: Vision beyond 2020

The economic and social costs of visual impairment and blindness in India.

To provide a current estimate of the economic and social costs (or welfare costs) of visual impairment and blindness in India. Using evidence from the recently conducted Blindness and Visual Impairment Survey across India, the Lancet Global Health Commission on Global Eye Health and other sources, we developed an economic model that estimates the costs of reduced employment, elevated mortality risk, education loss for children, productivity loss in employment, welfare loss for the unemployed, and caregiver costs associated with moderate and severe visual impairment (MSVI) and blindness. Probabilistic sensitivity analyses were also conducted by varying key parameters simultaneously. The costs of MSVI and blindness in India in 2019 are estimated at INR 1,158 billion (range: INR 947-1,427 billion) or $54.4 billion at purchasing power parity exchange rates (range: $44.5-67.0 billion), accounting for all six cost streams. The largest cost was for the loss of employment, whereas the the second largest cost was for caregiver time. A more conservative estimate focusing only on employment loss and elevated mortality risk yielded a cost of INR 504 billion (range: INR 348-621 billion) or $23.7 billion (range: $16.3-29.2 billion). Poor eye health imposes a non-trivial recurring cost to the Indian economy equivalent to 0.47% to 0.70% of GDP in the primary scenario, a substantial constraint on the country's growth aspirations. Furthermore, the absolute costs of poor eye health will increase over time as India ages and becomes wealthier unless further progress is made in reducing the prevalence of MSVI and blindness.

Introducing The Lancet Global Health Commission on financing primary health care: putting people at the centre

Introducing The Lancet Global Health Commission on financing primary health care: putting people at the centre

Patient and Family Engagement During Challenging Times: What Works and What Does Not?

A paradigm shift towards enhanced strategies to effectively engage patients and families in delivering safe and high-quality healthcare services was observed during recent times, particularly in the last decade. Immediately prior to the coronavirus disease 2019 (Covid-19) pandemic, the tri-institutional global healthcare quality reports from the National Academies of Sciences, Engineering, and Medicine, World Bank Group, and Lancet Global Health Commission reported the patient and family engagement measures used globally, highlighting the variations across the regions of the world. Through a pandemic for more than a year now, we aim to present the key lessons learned from practices and strategies to proactively engage patients and families. These strategies may continue to be implemented in the post-Covid-19 pandemic era to improve patient and family-centered care.

Global economic productivity losses from vision impairment and blindness.

BackgroundIn the absence of accessible, good quality eye health services and inclusive environments, vision loss can impact individuals, households and communities in many ways, including through increased poverty, reduced quality of life and reduced employment. We aimed to estimate the annual potential productivity losses associated with reduced employment due to blindness and moderate and severe vision impairment (MSVI) at a regional and global level.MethodsWe constructed a model using the most recent economic, demographic (2018) and prevalence (2020) data. Calculations were limited to the working age population (15–64 years) and presented in 2018 US Dollars purchasing power parity (ppp). Two separate models, using Gross Domestic Product (GDP) and Gross National Income (GNI), were calculated to maximise comparability with previous estimates.FindingsWe found that 160.7 million people with MSVI or blindness were within the working age and estimated that the overall relative reduction in employment by people with vision loss was 30.2%. Globally, using GDP we estimated that the annual cost of potential productivity losses of MSVI and blindness was $410.7 billion ppp (range $322.1 - $518.7 billion), or 0.3% of GDP. Using GNI, overall productivity losses were estimated at $408.5 billion ppp (range $320.4 - $515.9 billion), 0.5% lower than estimates using GDP.InterpretationThese findings support the view that blindness and MSVI are associated with a large economic impact worldwide. Reducing and preventing vision loss and developing and implementing strategies to help visually impaired people to find and keep employment may result in significant productivity gainsFundingMJB is supported by the Wellcome Trust (207472/Z/17/Z). JR's appointment at the University of Auckland is funded by the Buchanan Charitable Foundation, New Zealand. The Lancet Global Health Commission on Global Eye Health was supported by grants from The Queen Elizabeth Diamond Jubilee Trust, Moorfields Eye Charity (GR001061), NIHR Moorfields Biomedical Research Centre, The Wellcome Trust, Sightsavers, The Fred Hollows Foundation, The SEVA Foundation, The British Council for the Prevention of Blindness and Christian Blind Mission. The funders had no role in the design, conduct, data analysis of the study, or writing of the manuscript.

Ageing and vision loss: looking to the future

Ageing and vision loss: looking to the future

Eye health and the Decade of Action for the Sustainable Development Goals

Eye health and the Decade of Action for the Sustainable Development Goals

The role of evaluation in iterative learning and implementation of quality of care interventions

ABSTRACT Background: The Lancet Global Health Commission (LGHC) has argued that quality of care (QoC) is an emergent property that requires an iterative process to learn and implement. Such iterations are required given that health systems are complex adaptive systems. Objective: This paper explores the multiple roles that evaluations need to play in order to help with iterative learning and implementation. We argue evaluation needs to shift from a summative focus toward an approach that promotes learning in complex systems. A framework is presented to help guide the iterative learning, and includes the dimensions of clinical care, person-centered care, continuum of care, and ‘more than medicine. Multiple roles of evaluation corresponding to each of the dimensions are discussed. Methods: This paper is informed by reviews of the literature on QoC and the roles of evaluation in complex systems. The proposed framework synthesizes the multiple views of QoC. The recommendations of the roles of evaluation are informed both by review and experience in evaluating multiple QoC initiatives. Results: The specific roles of different evaluation approaches, including summative, realist, developmental, and participatory, are identified in relationship to the dimensions in our proposed framework. In order to achieve the potential of LGHC, there is a need to discuss how different evaluation approaches can be combined in a coherent way to promote iterative learning and implementation of QoC initiatives. Conclusion: One of the implications of the QoC framework discussed in the paper is that time needs to be spent upfront in recognizing areas in which knowledge of a specific intervention is not complete at the outset. This, of course, implies taking stock of areas of incompleteness in knowledge of context, theory of change, support structures needed in order for the program to succeed in specific settings. The role of evaluation should not be limited to only providing an external assessment, but an important goal in building evaluation capacity should be to promote adaptive management among planners and practitioners. Such iterative learning and adaptive management are needed to achieve the goals of sustainable development goals.

Associations between vision impairment and driving and the effectiveness of vision-related interventions: protocol for a systematic review and meta-analysis

IntroductionDriving is one of the main modes of transport with safe driving requiring a combination of visual, cognitive and physical skills. With population ageing, the number of people living with...

Estimating the global cost of vision impairment and its major causes: protocol for a systematic review.

IntroductionVision impairment (VI) places a burden on individuals, health systems and society in general. In order to support the case for investing in eye health services, an updated cost of illness study that measures the global impact of VI is necessary. To perform such a study, a systematic review of the literature is needed. Here we outline the protocol for a systematic review to describe and summarise the costs associated with VI and its major causes.Methods and analysisWe will systematically search in Medline (Ovid) and the Centre for Reviews and Dissemination database which includes the National Health Service Economics Evaluation Database. No language or geographical restriction will be applied. Additional literature will be identified by reviewing the references in the included studies and by contacting field experts. Grey literature will be considered. The review will include any study published from 1 January 2000 to November 2019 that provides information about costs of illness, burden of disease and/or loss of well-being in participants with VI due to an unspecified cause or due to one of the seven leading causes globally.Two reviewers will independently screen studies and extract relevant data from included studies. Methodological quality of economic studies will be assessed based on the British Medical Journal checklist for economic submissions adapted to costs of illness studies. This protocol has been prepared following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocols and has been published prospectively in Open Science Framework.Ethics and disseminationFormal ethical approval is not required, as primary data will not be collected in this review. The findings of this study will be disseminated through peer-reviewed publications, stakeholder meetings and inclusion in the ongoing Lancet Global Health Commission on Global Eye Health.Registration detailshttps://osf.io/9au3w (DOI 10.17605/OSF.IO/6F8VM).

Eye health and quality of life: an umbrella review protocol

IntroductionVision impairment and eye disease are major global health concerns and have been associated with increased morbidity and mortality, and lower quality of life. Quality of life, whether generic, vision-specific...