The importance of non-communicable diseases (NCD) for the health status of Samoa’s population cannot be overstated - NCD causes are responsible for 7 of 10 pre-mature deaths with 3 of 10 due to cardiovascular causes alone1.
... Exibir mais + Many adults are hypertensive while rates of type diabetes and obesity are among the highest in the world and on an increasing trend. The 2013 Stepwise Approach to Surveillance (STEPS) survey found that 28.9 percent of the Samoa population are hypertensive, and 24.8 percent have diabetes. In response, the Government of Samoa has made NCD control and people, centered health services a priority in its Strategy for the Development of Samoa 2016/17-2019/20 and issued the National NCD Policy 2019-2023. In 2015, it contextualized and piloted WHO’s Package of Essential Non-communicable diseases (PEN) interventions and collected implementation experiences. The PEN Fa’a Samoa is oriented toward community participation and outreach services. It places emphasis on early detection of NCDs, effective referral and increasing population awareness of NCD risk factors. However four years after initiating PEN Fa’a Samoa program, it had only been rolled out to 17 out of total 431 villages in the country indicating the stagnant status of the screening. A World Bank study of NCD cost analysis in 2017 flagged low hypertension (HTN) treatment levels in Samoa as an issue of concern. The widespread HTN and the significant cardiovascular disease burden and high premature deaths suggest that the continuum of HTN care is sub-optimal in Samoa. To support the Government in improving NCD care, the World Bank joined the Ministry of Health (MOH) in 2018 to conduct a study on HTN and chronic care. The primary aim was to identify breakpoints and gaps in the continuum of HTN care and determine issues in chronic care and propose potential solutions. The study findings inform Samoa’s policy formulation, intervention implementation and the World Bank’s Samoa NCD control project. As the first in the Pacific Region to do an implementation cascade study, other Pacific Island Countries (PICs) may also draw on the findings of the study.
Exibir menos -
The Samoan Ministry of Health and the World Bank jointly conducted a cascade analysis to systematically identify the gaps and bottlenecks in the delivery of hypertension care (as a tracer condition for NCDs) and look at ways to address them.
... Exibir mais + The analysis looked at hypertension screening, diagnosis, treatment, and patient monitoring, and used blood pressure (BP) control as the indicator for treatment success. The study found that both the hypertension and obesity prevalence’s are still rising. There are large gaps in case finding as 39 percent of all hypertensive adults had not had a BP screen over 12 months. It also identified gaps in referral with 37 percent of hypertensive adults having been screened but not fully diagnosed. Among all the diagnosed hypertension patients in care, only one in 5 reached BP control, suggesting there are serious challenges with treatment. These gaps in care make Samoa’s hypertension cascade tumble: Overall, only 1 in 20 hypertensive adults benefits from effective treatment and reaches the BP target. Recommended actions fall into the areas of public awareness campaigns, service configuration at primary care facilities and in communities, recording and use of patient data, broadening of the scope of PEN Fa’a Samoa and scale-up, treatment adherence with a patient-centered care approach, and the continuous policy and program efforts required for addressing Samoa’s obesity and non-communicable disease epidemics.
Exibir menos -
South Africa remains a high-burden country for tuberculosis (TB) and multi-drug resistant TB (MDR-TB) with an underlying generalised HIV epidemic.
... Exibir mais + TB funding must therefore be allocated to interventions which provide high impact to prevent TB transmission, identify TB cases and treat them successfully. This report presents the findings from a pilot application of the Optima TB model in Gauteng Province, where many challenges remain to sustainably reduce TB. The modelling analysis focused on relevant intervention scenarios and optimal resource allocation to achieve the 2022 TB targets, using the mathematical optimisation feature of the tool. Findings suggest that further reductions in TB prevalence and deaths are possible through improved allocative efficiency. Several scenarios highlight opportunities especially in HIV negative populations by improving the TB care cascade with higher diagnosis rates, enhanced linkage to treatment and better MDR treatment outcomes using shorter drug regimens. The same budget allocated differently could, by 2022, reduce active TB infections by up to 40 and reduce TB deaths by up to 30 perent among HIV positive and HIV negative populations. The study provided valuable input into the refinement of the Optima TB model, especially for the HIV/TB co-epidemic setting. The model outputs support Gauteng's focus on improving the care cascade and innovating MDR-TB treatment.
Exibir menos -
In order to address the large and growing non-communicable disease (NCD) burden, Bangladesh’s public health system needs to change and innovate.
... Exibir mais + It needs to transition from a system designed for infectious disease and mother & child health to an integrated care system with focus on primary health care, out-patient and chronic care, as well as community health promotion. This report presents findings from an NCD cascade analysis, using hypertension as a tracer condition as well as type-2 diabetes, in order to determine the continuum of care for chronic NCDs in Bangladesh. The cascade findings are embedded in a review of the country’s policy and health care delivery environment for NCDs and a benchmarking assessment against similar economies and regional comparator countries. The report also presents promising practices and models of NCD and chronic care in Bangladesh and elsewhere. Based on the evidence reviewed and analyses conducted, the report provides recommendations for different aspects of NCD policy and programming. These are meant to provide input into the dialogue on how to improve NCD integrated care and outcomes in Bangladesh. The support is provided within the World Bank’s assistance to countries to strengthen NCD care through data-driven resource allocation and decision-making.
Exibir menos -
This report summarizes the findings of an allocative efficiency study of Romania's Tuberculosis (TB) response, which was conducted using the Optima-TB model.
... Exibir mais + The analysis was conducted to support Romania in its decision-making on strategic TB investments during the current National Strategic Plan for the Control of Tuberculosis in Romania (NSP, 2015‒20) and up to 2030. The analysis highlights the potential for Romania to maximize its impact on the TB response by reallocating spending on unnecessary hospitalization to increase the coverage of ambulatory care, treatment of drug-resistant TB and enhanced and active case finding in congregate community settings and high-risk areas.
Exibir menos -
The report summarizes the findings of an allocative and implementation efficiency analysis of Zimbabwe's HIV response across the care cascade, which was conducted using the Optima-HIV model.
... Exibir mais + The analysis was conducted to support Zimbabwe in its decision-making on strategic HIV investments, highlighting opportunities to maximise the impact of HIV financial resources in Zimbabwe through allocative and implementation efficiency gains.
Exibir menos -
Hypertension is one of the leading causes of preventable mortality in Ukraine. It is estimated that high systolic blood pressure was responsible for 42 percent of total deaths in 2016, which is among the highest rates in the world.
... Exibir mais + This report presents key findings from an analysis of the continuum of hypertension care in Ukraine, where the World Bank implements a technical assistance program to support reforms and governance in the health sector. The analysis found significant gaps in detection, treatment monitoring and treatment adherence in hypertension care. The largest breakpoints were blood pressure monitoring at the frequency recommended by the protocol (67 and 71 percent gap in compliance in Lviv and Poltava regions) and achieving normal blood pressure while on treatment (76 and 65 percent gap among patients with monitoring data in Lviv and Poltava regions). The analysis provided lessons with policy implications, including more systematic screening to detect hypertension early and link cases to effective treatment, and a monitoring focus on patients with stage 2 and 3 hypertension and those with co-morbidities like diabetes to prevent poor outcomes. Treatment for blood pressure control is cost-effective in all regions of the world, and in Ukraine improved hypertension care would save lives, reduce disability and save resources in health care.
Exibir menos -
Hypertension is one of the leading causes of preventable mortality in Ukraine. It is estimated that high systolic blood pressure was responsible for 42 percent of total deaths in 2016, which is among the highest rates in the world.
... Exibir mais + This report presents key findings from an analysis of the continuum of hypertension care in Ukraine, where the World Bank implements a technical assistance program to support reforms and governance in the health sector. The analysis found significant gaps in detection, treatment monitoring and treatment adherence in hypertension care. The largest breakpoints were blood pressure monitoring at the frequency recommended by the protocol (67 and 71 percent gap in compliance in Lviv and Poltava regions) and achieving normal blood pressure while on treatment (76 and 65 percent gap among patients with monitoring data in Lviv and Poltava regions). The analysis provided lessons with policy implications, including more systematic screening to detect hypertension early and link cases to effective treatment, and a monitoring focus on patients with stage 2 and 3 hypertension and those with co-morbidities like diabetes to prevent poor outcomes. Treatment for blood pressure control is cost-effective in all regions of the world, and in Ukraine improved hypertension care would save lives, reduce disability and save resources in health care.
Exibir menos -
Cervical cancer is an important disease in Ukraine: Among all cancers in females, it ranks 5th for incidence and 6th for mortality. While first year mortality shows some decline, progress in earlier detection has been very modest.
... Exibir mais + This report presents key findings from an analysis of the continuum of cervical cancer care in Ukraine, where the World Bank implements a technical assistance program to support reforms and governance in the health sector. The analysis determined the breakpoints in the care cascade from screening to long-term monitoring of cases, and identified opportunities for action. The screening gaps were 47 percent (Lviv Region) and 38 percent (Poltava Region). Due to Ukraine's cervical cancer screening eligibility from 18 years of age, screening has a low yield, and this is further reduced by the short screening intervals with almost half of the women screening at least once every year, leading to efficiency concerns. Among the diagnosed cervical cancer cases, treatment completion and negative outcomes were not sufficiently documented. Understanding of diagnosis and treatment gaps helps pinpoint solutions ranging from simplified decision-making for cancer treatment, to improved pharmaceutical supplies and access to diagnostic equipment. The analysis highlights the need for age- and risk-appropriate screening invitations and recall systems to increase the efficiency and effectiveness of the cervical cancer program in Ukraine.
Exibir menos -
Diabetes is the 7th most important cause of years lived with disability in Ukraine. Prevalence is estimated at 8.4 percent and there are over 1 million undiagnosed cases.
... Exibir mais + Expenditure for diabetes treatment is growing, in 2016, annual expenditure for diabetes was about 460 million US dollars. This report presents key findings from an analysis of the continuum of type-2 diabetes care in Ukraine, where the World Bank implements a technical assistance program to support reforms and governance in the health sector. The analysis determined the breakpoints in the care cascade from screening to sustained glucose control of diagnosed cases. Attainment of sustained glucose control was the largest breakpoint in the cascade in the two regions studied with 80 percent (Lviv Region) and 73 percent (Poltava Region) of HbA1C monitored cases not meeting the target. At the same time, there are high rates of hospital admissions in Ukraine due to diabetes. The analysis presents important lessons and policy implications for diabetes care. Diabetes screening needs to be strengthened and the PHC level needs to have the confidence, capacity and resources to manage diabetes patients as tasks are shifted from specialists to family doctors. The cascade framework offers an analysis approach to track change in the continuum of diabetes care as the PHC reform takes effect.
Exibir menos -
Diabetes is the 7th most important cause of years lived with disability in Ukraine. Prevalence is estimated at 8.4 percent and there are over 1 million undiagnosed cases.
... Exibir mais + Expenditure for diabetes treatment is growing, in 2016, annual expenditure for diabetes was about 460 million US dollars. This report presents key findings from an analysis of the continuum of type-2 diabetes care in Ukraine, where the World Bank implements a technical assistance program to support reforms and governance in the health sector. The analysis determined the breakpoints in the care cascade from screening to sustained glucose control of diagnosed cases. Attainment of sustained glucose control was the largest breakpoint in the cascade in the two regions studied with 80 percent (Lviv Region) and 73 percent (Poltava Region) of HbA1C monitored cases not meeting the target. At the same time, there are high rates of hospital admissions in Ukraine due to diabetes. The analysis presents important lessons and policy implications for diabetes care. Diabetes screening needs to be strengthened and the PHC level needs to have the confidence, capacity and resources to manage diabetes patients as tasks are shifted from specialists to family doctors. The cascade framework offers an analysis approach to track change in the continuum of diabetes care as the PHC reform takes effect.
Exibir menos -
Hypertension is a major driver of pre-mature death and disability in Tajikistan, a low-income country in Central Asia. The high burden of disease also results in significant health care expenditure and lost labour productivity.
... Exibir mais + Therefore, there is an urgent need to strengthen service delivery systems through early detection of high blood pressure, prompt diagnosis, sustained treatment maintenance, and the attainment of blood pressure control. The Ministry of Health and Social Protection and the World Bank undertook implementation research to identify effective and context-appropriate solutions for improving hypertension services. The assessment used the cascade framework to describe drop-offs along the continuum of care, collected patient and health care provider perspectives on the causes of discontinuities, used routine data from participating facilities in a Bank-supported operation, and drew on the international literature on chronic care interventions. The report presents feasible and cost-effective recommendations that, if adopted, can strengthen current programs and policies to address the growing burden of hypertension in Tajikistan.
Exibir menos -
Hypertension is a major driver of pre-mature death and disability in Tajikistan, a low-income country in Central Asia. The high burden of disease also results in significant health care expenditure and lost labour productivity.
... Exibir mais + Therefore, there is an urgent need to strengthen service delivery systems through early detection of high blood pressure, prompt diagnosis, sustained treatment maintenance, and the attainment of blood pressure control. The Ministry of Health and Social Protection and the World Bank undertook implementation research to identify effective and context-appropriate solutions for improving hypertension services. The assessment used the cascade framework to describe drop-offs along the continuum of care, collected patient and health care provider perspectives on the causes of discontinuities, used routine data from participating facilities in a Bank-supported operation, and drew on the international literature on chronic care interventions. The report presents feasible and cost-effective recommendations that, if adopted, can strengthen current programs and policies to address the growing burden of hypertension in Tajikistan.
Exibir menos -
In 2014, city leaders from around the world endorsed the Paris Declaration on fast-track cities, pledging to achieve the 2020 and 2030 human immunodeficiency virus (HIV) targets championed by Joint United Nations Program on HIV and acquired immunodeficiency syndrome (AIDS) (UNAIDS).
... Exibir mais + The City of Johannesburg - one of South Africa’s metropolitan municipalities and also a health district - has over 600,000 people living with HIV (PLHIV), more than any other city worldwide. The authors estimate what it will take in terms of programmatic targets and costs for the City of Johannesburg to meet the fast-track targets and demonstrate the impact that this will have. The authors applied the optima HIV epidemic and resource allocation model to demographic, epidemiological, and behavioral data on 26 sub-populations in Johannesburg. Plausible scale-ups of other proven interventions ((voluntary medical male circumcision (VMMC), condom distribution, and female sex workers (FSW) strategies) can yield additional reductions in new infections (between 4 and 15 percent), and in overall treatment investment needs. Scaling up VMMC in line with national targets is found to be cost-effective in the medium term. The scale-up in testing and treatment programs over this decade has been rapid, but these efforts must be doubled to reach 2020 targets. Strategic investments in proven interventions will help Johannesburg achieve the treatment targets and be on track to end AIDS by 2030.
Exibir menos -
Many new HIV cases are lost to follow-up before they can be enrolled in care and treatment programs. This report summarises a proof-of-concept evaluation of a mHealth intervention which aims to improve linkage of newly diagnosed HIV cases to care.
... Exibir mais + The design was a randomised controlled multi-center trial enrolling consenting patients in clinics in Inner-city Johannesburg. The trial developed and tested the “SmartLink” app which is designed to make laboratory data directly available to patients via a secure account and send them appointment reminder and notifications on their smartphone. The primary endpoint was linkage to care in the first 8 months after diagnosis, as evidenced by a HIV-related laboratory test. The report provides the key findings on phone ownership of the target group, and which demographics can best be reached via apps and data-based communication (which is cheaper and offers more scope than text messaging). The app worked best in younger HIV patients under 30 years of age, who had their linkage to HIV care improved by 20 percent through the app. This younger age group is difficult to reach with traditional interventions, and reacted positively to a technology solution. The unique feature of this custom-made app (sending real-time CD4/VL test data from the laboratory database to HIV clients) is highly scalable among smartphone owners.
Exibir menos -
This report summarizes findings from a mathematical modelling study to examine the patterns of HIV acquisition and transmission in Zimbabwe during the period from 2000 to 2017 and to predict future trends to 2030 This study was conducted in preparation for the planned analyses to identify opportunities for optimizing HIV resource allocation and improving implementation efficiency of core components as part of the HIV response in Zimbabwe.
... Exibir mais + These analyses were carried out using the Optima HIV model.
Exibir menos -
Breast cancer is the leading cancer in Ukrainian females, however, there is evidence of progress with earlier detection and decreased first year mortality after diagnosis from 14.5 percent in 2000 to 9.7 percent in 2015.
... Exibir mais + This report presents key findings from an analysis of the continuum of breast cancer care in Ukraine, where the World Bank implements a technical assistance program to support reforms and governance in the health sector. The analysis determined the breakpoints in the breast cancer care cascade from screening to long-term monitoring of cancer cases, and identified opportunities for action. It was found that the breast cancer screening gaps were 64 perent (Lviv Region) and 39 percent (Poltava Region). At least 3 of 10 positive screens were followed up with diagnostic tests. Among the diagnosed cases, negative outcomes (death, loss to care, treatment refusal, and withdrawal from treatment) were poorly documented, as was treatment completion. Understanding of diagnosis and treatment gaps and delays from cascade analysis helps identify solutions ranging from simplified decision-making for cancer treatment, to improved pharmaceutical supplies and access to diagnostic equipment. The analysis highlighted the need for age- and risk-appropriate screening invitations and recall systems for an improved and more efficient breast cancer program in Ukraine.
Exibir menos -
With limited funds available, meeting global health targets requires countries to both mobilize and prioritize their health spending. Within this context, countries have recognized the importance of allocating funds for HIV as efficiently as possible to maximize impact.
... Exibir mais + Over the past six years, the governments of twenty-three countries in Africa, Asia, Eastern Europe and Latin America have used the Optima HIV tool to estimate the optimal allocation of HIV resources. Each study commenced with a request by the national government for technical assistance in conducting an HIV allocative efficiency study using Optima HIV. Each study team validated the required data, calibrated the Optima HIV epidemic model to produce HIV epidemic projections, agreed on cost functions for interventions, and used the model to calculate the optimal allocation of available funds to best address national strategic plan targets. From a review and analysis of these twenty-three country studies, we extract common themes around the optimal allocation of HIV funding in different epidemiological contexts. The optimal distribution of HIV resources depends on the amount of funding available and the characteristics of each country’s epidemic, response and targets. Universally, the modelling results indicated that scaling up treatment coverage is an efficient use of resources. There is scope for efficiency gains by targeting the HIV response towards the populations and geographical regions where HIV incidence is highest. Across a range of countries, the model results indicate that a more efficient allocation of HIV resources could reduce cumulative new HIV infections by an average of eighteen percent over the years to 2020 and twenty-five percent over the years to 2030, along with an approximately twenty-five percent reduction in deaths for both timelines. However, in most countries this would still not be sufficient to meet the targets of the national strategic plan, with modelling results indicating that budget increases of up to one hundred and eighty-five percent would be required. Greater epidemiological impact would be possible through better targeting of existing resources, but additional resources would still be required to meet targets. Allocative efficiency models have proven valuable in improving the HIV planning and budgeting process.
Exibir menos -
This report describes the short-term outcomes of an evaluation study for five different HIV cohorts using routinely collected data. The evaluation study is a collaboration between the National Department of Health of South Africa, the National Health Laboratory Service (NHLS) and the World Bank.
... Exibir mais + Boston University/Health Economics and Epidemiology Research Office (HE2RO) is the academic partner in the evaluation. The overall aims of the evaluation are to assess the impact of South Africa`s Adherence Guideline interventions on HIV patients’ treatment outcomes; estimate the costs of the interventions; and describe the cascade of care for TB, hypertension, and diabetes at the same clinics. The short-term endpoints reported on herein concern ART initiation among FTIC eligible patients, ARV medication pick-up among AC and DMD eligible patients, retention in care among TRIC eligible patients, and viral load suppression among EAC eligible patients. The final outcomes of this evaluation will be reported on separately, once patients have been follow-up for one year and routine data on viral load suppression and retention in care become available
Exibir menos -
