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1.
Health Policy Plan ; 37(10): 1317-1327, 2022 Nov 14.
Article in English | MEDLINE | ID: covidwho-2017934

ABSTRACT

COVID-19 imposed unprecedented financing requirements on countries to rapidly implement effective prevention and control measures while dealing with severe economic contraction. The challenges were particularly acute for the 11 countries in the WHO South-East Asia Region (SEAR), home to the lowest average level of public expenditure on health of all WHO regions. We conducted a narrative review of peer-reviewed, grey literature and publicly available sources to analyse the immediate health financing policies adopted by countries in the WHO SEAR in response to COVID-19 in the first 12 months of the pandemic, i.e. from 1 March 2020 to 1 March 2021. Our review focused on the readiness of health systems to address the financial challenges of COVID-19 in terms of revenue generation, financial protection and strategic purchasing including public financial management issues. Twenty peer-reviewed articles were included, and web searches identified media articles (n = 21), policy reports (n = 18) and blog entries (n = 5) from reputable sources. We found that countries in the SEAR demonstrated great flexibility in responding to the COVID-19 pandemic, including exploring various options for revenue raising, removing financial barriers to care and rapidly adapting purchasing arrangements. At the same time, the pandemic exposed pre-existing health financing policy weaknesses such as underinvestment, inadequate regulatory capacity of the private health sector and passive purchasing, which should give countries an impetus for reform towards more resilient health systems. Further monitoring and evaluation are needed to assess the long-term implications of policy responses on issues such as government capacity for debt servicing and fiscal space for health and how they protect progress towards the objectives of universal health coverage.


Subject(s)
COVID-19 , Healthcare Financing , Humans , COVID-19/epidemiology , Pandemics , Health Policy , World Health Organization , Far East
2.
SSM Popul Health ; 19: 101141, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-1946622

ABSTRACT

Community health workers (CHWs) are the first point of contact with the primary health care system in many low- and middle-income countries and are situated to play a critical role in the public health response to the COVID-19 pandemic. The knowledge, attitude and practices of CHWs regarding COVID-19 may be influenced by their level of trust and participation in the community, collectively defined as their level of social capital. To assess whether social capital influences CHWs' knowledge, attitude and practices related to COVID-19, we conducted a web-based survey of CHWs (n = 478) in Malang district, Indonesia between October 2020 and January 2021. CHW social capital was measured using the Shortened Adapted Social Capital Assessment Tool. Multiple logistic regression results show that cognitive social capital was associated with higher self-reported knowledge of COVID-19, more confidence in answering COVID-related questions from the community and feeling safe from COVID-19 when working. Membership of community organisations was associated with a higher number of COVID-related tasks conducted. Thus, CHWs in Malang district with higher levels of cognitive social capital were more likely to be confident in their knowledge and ability to respond to COVID-19, and CHWs embedded in their community were more likely to be engaged in pandemic response duties. Our findings suggest that policies aimed at promoting CHW embeddedness, targeted recruitment and addressing training needs hold promise in strengthening the positive contribution of the community health workforce to the COVID-19 response.

3.
Contemp Clin Trials ; 118: 106794, 2022 07.
Article in English | MEDLINE | ID: covidwho-1850776

ABSTRACT

BACKGROUND: Practice-level quality improvement initiatives using rapidly advancing technology offers a multidimensional approach to reduce cardiovascular disease burden. For the "QUality improvement in primary care to prevent hospitalisations and improve Effectiveness and efficiency of care for people Living with heart disease" (QUEL) cluster randomised controlled trial, a 12-month quality improvement intervention was designed for primary care practices to use data and implement progressive changes using "Plan, Do, Study, Act" cycles within their practices with training in a series of interactive workshops. This protocol aims to describe the systematic methods to conduct a process evaluation of the data-driven intervention within the QUEL study. METHODS: A mixed-method approach will be used to conduct the evaluation. Quantitative data collected throughout the intervention period, via surveys and intervention materials, will be used to (1) identify the key elements of the intervention and how, for whom and in what context it was effective; (2) determine if the intervention is delivered as intended; and (3) describe practice engagement, commitment and capacity associated with various intervention components. Qualitative data, collected via semi-structured interviews and open-ended questions, will be used to gather in-depth understanding of the (1) satisfaction, utility, barriers and enablers; (2) acceptability, uptake and feasibility, and (3) effect of the COVID-19 pandemic on the implementation of the intervention. CONCLUSION: Findings from the evaluation will provide new knowledge on the implementation of a complex, multi-component intervention at practice-level using their own electronic patient data to enhance secondary prevention of cardiovascular disease. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR) number ACTRN12619001790134.


Subject(s)
COVID-19 , Cardiovascular Diseases , Coronary Disease , Australia , COVID-19/prevention & control , Cardiovascular Diseases/prevention & control , Coronary Disease/prevention & control , Hospitalization , Humans , Pandemics , Quality Improvement , Randomized Controlled Trials as Topic
4.
Lancet Reg Health Southeast Asia ; 1: 100011, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1819560

ABSTRACT

Background: There is increasing evidence that the COVID-19 pandemic has impacted adversely on the provision of essential health services. The South East Asia region (SEAR) has experienced extremely high rates of COVID-19 infection, and continues to bear a significant proportion of communicable disease burden worldwide. Methods: We conducted a systematic literature review of quantitative evidence to estimate the impact of COVID-19 on the provision of essential prevention, detection, treatment, and management services for five high-burden infectious diseases across the SEAR. Findings: A total of 2338 studies were reviewed, and 12 studies were included in our analysis, covering six countries across the SEAR (Bhutan, Sri Lanka, Nepal, Myanmar, Thailand, and India) for three conditions of interest (HIV, TB, dengue fever). We identified significant disruption to TB testing (range=25% to 77.9%) and diagnoses (range=50% to 58%) in India, Nepal, and Indonesia; and similar disruptions were observed for screening, new diagnoses and commencing HIV treatment in India and Thailand. There was also drastically reduced case detection for dengue fever (range=75% to 90% disrupted) in Bhutan and Sri Lanka. No studies were identified for malaria nor hepatitis in any country, and nor for any service in the remaining six SEAR countries. Interpretation: We identified evidence of significant disruption to the prevention, diagnoses, treatment, and management of TB, HIV, and dengue fever due to the COVID-19 pandemic across multiple SEAR country settings. This has the potential to set back hard-fought gains in infectious disease control across the region. The lack of evidence for the impact of the pandemic on malaria and hepatitis services, and in the remaining six SEAR countries, is an important evidence gap that should be addressed in order to inform future policy for service protection and pandemic preparedness. Funding: This work was supported by the WHO Sri Lanka Country office.

5.
Lancet Reg Health Southeast Asia ; 1: 100010, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1819559

ABSTRACT

Background: COVID-19 has had a profound impact on the health systems of the 11 countries of the WHO South East Asia Region. We conducted a systematic review of studies that used quantitative and comparative approaches to assess the impact of the pandemic on the service provision of four noncommunicable diseases (NCDs) (cancer, cardiovascular disease, chronic respiratory diseases, and diabetes) in the region. Methods: A systematic search was conducted in PubMed, Embase, MedRxiv, and WHO COVID-19 databases in December 2021. The quality of studies was evaluated using the Joanna Briggs Institute Critical Appraisal Checklist and the ROBINS-I risk of bias tool. A narrative synthesis was conducted following the 'synthesis without meta-analysis' reporting guidelines. Findings: Two review authors independently screened 5,397 records with 31 studies included, 26 which were cross-sectional studies. Most studies (n=24, 77%) were conducted in India and 19 (61%) were single-site studies. Compared to a pre-pandemic period, 10/17 cancer studies found a >40% reduction in outpatient services, 9/14 cardiovascular disease found a reduction of 30% or greater in inpatient admissions and 2 studies found diagnoses and interventions for respiratory diseases reduced up to 78.9% and 83.0%, respectively. No eligible studies on the impact of COVID-19 on diabetes services were found. Interpretation: COVID-19 has substantially disrupted the provision of essential health services for NCDs in the WHO South East Asia Region, particularly cancer and cardiovascular disease. This is likely to have serious and potentially long-term downstream impacts on health and mortality of those living with or at risk of NCDs in the region. Funding: This work was supported by the WHO Sri Lanka Country Office.

6.
Lancet Reg Health West Pac ; 22: 100420, 2022 May.
Article in English | MEDLINE | ID: covidwho-1747700

ABSTRACT

Background: Pharmacists have been at the frontline of the COVID-19 response in Indonesia, providing medicines, advice, and referral services often in areas with limited healthcare access. This study aimed to explore their knowledge, attitudes, and practices during the pandemic, so that we can be better prepared for future emergencies. Methods: A cross-sectional online survey of community pharmacists and pharmacy technicians in Indonesia was conducted between July and August 2020. The dataset was analysed descriptively, and logistic regression was used to explore willingness to participate in COVID-19 interventions. Findings: 4716 respondents participated in the survey. Two-thirds (66·7%) reported knowing only "a little" about COVID-19 and around a quarter (26·6%) said they had not received any COVID-19 guidelines. Almost all were concerned about being infected (97·2%) and regularly took steps to protect themselves and their clients (87·2%). Stock-outs of Personal Protective Equipment (PPE) and other products (32·3%) was the main reason for not taking any precautions. Around a third (37·7%) mentioned having dispensed antibiotics to clients suspected of having COVID-19. To support COVID-19 response efforts, most respondents were willing to provide verbal advice to clients (97·8%), distribute leaflets to clients (97·7%), and participate in surveillance activities (88·8%). Older respondents, those identifying as male, and those working in smaller outlets were more willing to provide information leaflets. Those working in smaller outlets were also more willing to engage in outbreak surveillance. Interpretation: Drug retail outlets continue to operate at the frontline of disease outbreaks and pandemics around the world. These providers have an important role to play by helping to reduce the burden on facilities and providing advice and treatment. To fulfil this role, drug retail outlets require regular access to accurate guidelines and steady supplies of PPE. Calls for drug retail outlet staff to plat in response efforts including the provision of information to clients and surveillance could ease escalating pressures on the health system during future outbreaks. Funding: This study was funded by a grant from the Department of Foreign Affairs and Trade, Australia, under the Stronger Health Systems for Health Security Scheme.

7.
SSRN; 2022.
Preprint in English | SSRN | ID: ppcovidwho-330614

ABSTRACT

Background: The COVID-19 pandemic has had a profound impact on the 11 countries of the WHO South East Asia Region with substantial stress to health systems. We conducted a systematic review of studies that used quantitative and comparative approaches to assess the impact of the COVID-19 pandemic on the service provision of four NCDs (cancer, cardiovascular disease, chronic respiratory diseases, and diabetes) in the South East Asia region. Methods: A systematic search was conducted in PubMed, Embase, MedRxiv, and WHO COVID-19 databases in December 2020. The quality of included studies was evaluated using the Joanna Briggs Institute Critical Appraisal Checklist and the ROBINS-I risk of bias tool. A narrative synthesis was conducted following the ‘synthesis without meta-analysis’ reporting guidelines. The review was registered with PROSPERO (CRD42020187629) and reported according to PRISMA guidelines. Findings: Two review authors independently screened 5,397 records with 31 studies included, 26 which were cross-sectional in nature. The majority of studies (n=24, 77%) were conducted in India and 19 (61%) were single-site studies. 11/15 cancer studies examined disruptions to outpatient services, of which ten found a >40% reduction in service delivery post the onset of COVID-19 as compared to a pre-pandemic period. 10/12 cardiovascular disease studies examined disruptions to inpatient admissions, of which 9 found a reduction of 30% or greater compared to a pre-pandemic period. Two studies reported on disruption to respiratory disease services, finding a 78.9% reduction in diagnoses, and an 83% reduction in surgical management, respectively. Interpretation: This review provides evidence that the COVID-19 pandemic has substantially disrupted the provision of health services for multiple NCDs, and in particular - cancer and cardiovascular disease, across numerous countries in the region. This is likely to have serious and potentially long-term downstream impacts on health and mortality of those living with or at risk of NCDs in the region. Registration Details: The review was registered with PROSPERO (CRD42020187629) and reported according to PRISMA guidelines. Funding Information: This work was supported by the WHO Sri Lanka Country Office. TG is supported by a university post graduate award from the University of New South Wales. SJ and DP are both supported by NHMRC Principal Research fellowships. Declaration of Interests: The authors declare that they have no competing interests. Ethics Approval Statement: Ethical approval was not required for this review as all information collected was available in the public domain.

8.
SSRN; 2022.
Preprint in English | SSRN | ID: ppcovidwho-330606

ABSTRACT

Background: The South East Asia region (SEAR) has experienced extremely high rates of COVID-19 infection, and continues to bear a significant proportion of communicable disease burden worldwide. We conducted a systematic literature review of quantitative evidence to estimate the impact of COVID-19 on the provision of essential prevention, detection, treatment, and management services for 5 high-burden infectious diseases across the SEAR. Methods: A systematic search was conducted in PubMed, Embase, MedRxiv, and WHO COVID-19 databases in December 2020. A narrative synthesis was conducted following the ‘synthesis without meta-analysis’ reporting guidelines. The review was registered with PROSPERO (CRD42020187629) and reported according to PRISMA guidelines. Findings: A total of 2338 studies were reviewed, and of these, 9 studies were included in our analysis. Included studies covered 6 countries across the SEA region (Bhutan, Sri Lanka, Nepal, Myanmar, Thailand, and India) for three conditions of interest (HIV, TB, Dengue fever). We identified significant disruption to TB testing (range=25% to 77.9% disrupted) and diagnoses (range=50% to 58% disrupted) in India, Nepal, and Indonesia;and similar disruptions were observed for screening, new diagnoses and commencing HIV treatment in India and Thailand. There was also drastically reduced case detection for Dengue Fever (range=75% to 90% disrupted) in Bhutan and Sri Lanka. Interpretation: We identified evidence of significant disruption to the prevention, diagnoses, treatment, and management of TB, HIV, and Dengue Fever due to the COVID-19 pandemic across numerous SEAR country settings. This has the potential to set back hard-fought gains in infectious disease control across the region. The lack of evidence for the impact of the pandemic on malaria and hepatitis services, and in the remaining 6 SEAR countries, is an important evidence gap that should be addressed in order to inform future policy for service protection and pandemic preparedness. Registration Details: The review was registered with PROSPERO (CRD42020187629) and reported according to PRISMA guidelines. Funding Information: This work was supported by the WHO Sri Lanka Country office. TG is supported by a University Postgraduate Award from the University of New South Wales. SJ is supported by a NHMRC Principal Research Fellowship. Declaration of Interests: The authors declare that they have no competing interests. Ethics Approval Statement: Ethical approval was not required for this review as all information collected was available in the public domain.

9.
JAMA Netw Open ; 5(3): e220773, 2022 03 01.
Article in English | MEDLINE | ID: covidwho-1718200

ABSTRACT

Importance: Women with recent gestational diabetes (GDM) have increased risk of developing type 2 diabetes. Objective: To investigate whether a resource-appropriate and context-appropriate lifestyle intervention could prevent glycemic deterioration among women with recent GDM in South Asia. Design, Setting, and Participants: This randomized, participant-unblinded controlled trial investigated a 12-month lifestyle intervention vs usual care at 19 urban hospitals in India, Sri Lanka, and Bangladesh. Participants included women with recent diagnosis of GDM who did not have type 2 diabetes at an oral glucose tolerance test (OGTT) 3 to 18 months postpartum. They were enrolled from November 2017 to January 2020, and follow-up ended in January 2021. Data were analyzed from April to July 2021. Interventions: A 12-month lifestyle intervention focused on diet and physical activity involving group and individual sessions, as well as remote engagement, adapted to local context and resources. This was compared with usual care. Main Outcomes and Measures: The primary outcome was worsening category of glycemia based on OGTT using American Diabetes Association criteria: (1) normal glucose tolerance to prediabetes (ie, impaired fasting glucose or impaired glucose tolerance) or type 2 diabetes or (2) prediabetes to type 2 diabetes. The primary analysis consisted of a survival analysis of time to change in glycemic status at or prior to the final patient visit, which occurred at varying times after 12 months for each patient. Secondary outcomes included new-onset type 2 diabetes and change in body weight. Results: A total of 1823 women (baseline mean [SD] age, 30.9 [4.9] years and mean [SD] body mass index, 26.6 [4.6]) underwent OGTT at a median (IQR) 6.5 (4.8-8.2) months postpartum. After excluding 160 women (8.8%) with type 2 diabetes, 2 women (0.1%) who met other exclusion criteria, and 49 women (2.7%) who did not consent or were uncontactable, 1612 women were randomized. Subsequently, 11 randomized participants were identified as ineligible and excluded from the primary analysis, leaving 1601 women randomized (800 women randomized to the intervention group and 801 women randomized to usual care). These included 600 women (37.5%) with prediabetes and 1001 women (62.5%) with normoglycemia. Among participants randomized to the intervention, 644 women (80.5%) received all program content, although COVID-19 lockdowns impacted the delivery model (ie, among 644 participants who engaged in all group sessions, 476 women [73.9%] received some or all content through individual engagement, and 315 women [48.9%] received some or all content remotely). After a median (IQR) 14.1 (11.4-20.1) months of follow-up, 1308 participants (81.2%) had primary outcome data. The intervention, compared with usual care, did not reduce worsening glycemic status (204 women [25.5%] vs 217 women [27.1%]; hazard ratio, 0.92; [95% CI, 0.76-1.12]; P = .42) or improve any secondary outcome. Conclusions and Relevance: This study found that a large proportion of women in South Asian urban settings developed dysglycemia soon after a GDM-affected pregnancy and that a lifestyle intervention, modified owing to the COVID-19 pandemic, did not prevent subsequent glycemic deterioration. These findings suggest that alternate or additional approaches are needed, especially among high-risk individuals. Trial Registration: Clinical Trials Registry of India Identifier: CTRI/2017/06/008744; Sri Lanka Clinical Trials Registry Identifier: SLCTR/2017/001; and ClinicalTrials.gov Identifier: NCT03305939.


Subject(s)
Diabetes Mellitus, Type 2/prevention & control , Diabetes, Gestational/prevention & control , Diet , Exercise , Glycemic Control/methods , Life Style , Postpartum Period , Adult , Bangladesh , Blood Glucose , Diabetes Mellitus, Type 2/ethnology , Diabetes, Gestational/ethnology , Female , Glucose Tolerance Test , Humans , India , Pregnancy , Sri Lanka , Survival Analysis , Treatment Outcome , Urban Population
11.
BMJ Glob Health ; 6(10)2021 10.
Article in English | MEDLINE | ID: covidwho-1505066

ABSTRACT

BACKGROUND: Of the estimated 10 million people affected by (TB) each year, one-third are never diagnosed. Delayed case detection within the private healthcare sector has been identified as a particular problem in some settings, leading to considerable morbidity, mortality and community transmission. Using unannounced standardised patient (SP) visits to the pharmacies, we aimed to evaluate the performance of private pharmacies in the detection and treatment of TB. METHODS: A cross-sectional study was undertaken at randomly selected private pharmacies within 40 districts of Vietnam. Trained actors implemented two standardised clinical scenarios of presumptive TB and presumptive multidrug-resistant TB (MDR-TB). Outcomes were the proportion of SPs referred for medical assessment and the proportion inappropriately receiving broad-spectrum antibiotics. Logistic regression evaluated predictors of SPs' referral. RESULTS: In total, 638 SP encounters were conducted, of which only 155 (24.3%) were referred for medical assessment; 511 (80·1%) were inappropriately offered antibiotics. A higher proportion of SPs were referred without having been given antibiotics if they had presumptive MDR-TB (68/320, 21.3%) versus presumptive TB (17/318, 5.3%; adjusted OR=4.8, 95% CI 2.9 to 7.8). Pharmacies offered antibiotics without a prescription to 89.9% of SPs with presumptive TB and 70.3% with presumptive MDR-TB, with no clear follow-up plan. CONCLUSIONS: Few SPs with presumptive TB were appropriately referred for medical assessment by private pharmacies. Interventions to improve appropriate TB referral within the private pharmacy sector are urgently required to reduce the number of undiagnosed TB cases in Vietnam and similar high-prevalence settings.


Subject(s)
Pharmacies , Pharmacy , Tuberculosis , Cross-Sectional Studies , Humans , Tuberculosis/diagnosis , Tuberculosis/drug therapy , Tuberculosis/epidemiology , Vietnam/epidemiology
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