Public policy lessons from the Covid-19 outbreak: How to deal with it in the post-pandemic world?

Using cumulative confirmed cases of Covid-19 covering 163 countries, this paper tests several hypotheses that have received extensive attention in the popular media and academic research during the ongoing coronavirus pandemic. Our goal is to identify lessons for designing better public health policies in the post-pandemic era based on the past 6 months' experiences of these 163 countries. Based on 2SLS regression, we derive the following lessons. First, providing universal health care is a significant public health strategy for countries to help deal with similar outbreaks in the future. Second, tackling air pollution is a win-win solution, not only for better preparedness against Covid-19 or other airborne diseases, but also for the environment and climate change. Third, lockdowns may help to reduce community spread, but its impact on reducing Covid-19 incidence is not statistically significant. Similarly, antimalarial drugs have no significant effect on reducing the spread of the disease. Fourth, countries should encourage home-based work as much as possible until some treatment or cure is found for the virus. Fifth, the lessons of past SARS experience helped contain the spread of the infection in East Asian countries; other countries must adjust their social and cultural life to the new normal: wearing masks, washing hands, and keeping a distance from others in public places.

Patient satisfaction with telemedicine in the Philippines during the COVID-19 pandemic: a mixed methods study.

BACKGROUND: The capacity to deliver essential health services has been negatively impacted by the COVID-19 pandemic, particularly due to lockdown restrictions. Telemedicine provides a safe, efficient, and effective alternative that addresses the needs of patients and the health system. However, there remain implementation challenges and barriers to patient adoption in resource-limited settings as in the Philippines. This mixed methods study aimed to describe patient perspectives and experiences with telemedicine services, and explore the factors that influence telemedicine use and satisfaction. METHODS: An online survey consisting of items adapted from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Clinician & Group Adult Visit Survey 4.0 (beta) and the Telehealth Usability Questionnaire (TUQ) was completed by 200 participants aged 18 to 65 years residing in the Philippines. A subsample of 16 participants was interviewed to provide further insights on their experiences. We used descriptive statistics to analyze survey data and thematically analyzed data from interviews guided by the principles of grounded theory. RESULTS: Participants were generally satisfied with telemedicine, and found it to be an efficient and convenient means of receiving healthcare. About 3 in 5 perceived telemedicine as affordable, with some finding telemedicine costs to be high and comparable to in-person consultations. Our results suggest that participants preferred telemedicine services, especially in cases where they feel that their condition is not urgent and does not need extensive physical examination. Safety against COVID-19, privacy, accessibility, and availability of multiple communication platforms contributed to patient satisfaction with telemedicine. Negative perceptions of patients on quality of care and service related to their telemedicine provider, inherent limitations of telemedicine in the diagnosis and management of patients, perceived high costs especially for mental health conditions, and poor connectivity and other technological issues were barriers to telemedicine use and satisfaction. CONCLUSION: Telemedicine is viewed as a safe, efficient, and affordable alternative to receiving care. Expectations of patients on costs and outcomes need to be managed by providers to increase satisfaction. Continued adoption of telemedicine will require improvements in technology infrastructure and technical support for patients, training and performance evaluation of providers to ensure quality of care and service, better patient communication to meet patient needs, and integration of telemedicine services in remote areas that have limited access to medical services. Telemedicine, to realize its full potential, should be centered in health equity - addressing patient barriers and needs, reducing health disparities across population groups and settings, and providing quality services to all.

Title: The policy environment of self-care: A case study of the Philippines.

Self-care is the ability and empowerment of individuals to maintain health through informed healthcare decisions, with or without the support of a health provider. High-income countries have made advances to its conceptualization, research, and institutionalization given its reported benefits to patients, the health system, and economy. A similar undertaking in low- and middle-countries (LMICs) with already fragile health systems is warranted as highlighted by the COVID-19 pandemic. Our paper therefore aimed to describe and analyze the policy environment of self-care using the Philippines as a case study, which may have relevance to other similar countries and settings that are transitioning towards Universal Health Care (UHC) to reform and strengthen their primary care systems. We conducted 13 key informant interviews and two focus group discussions among representatives from the government, the pharmaceutical retail/ industry, community retail pharmacy, primary health physicians and health workers, an infirmary administrator, and patients and/or patient advocates. We triangulated our qualitative data with findings from our policy review. We found a total of 13 relevant policies on self-care in the Philippines recently drafted and/or implemented from 2016 to 2021 that fall under the broad categories of unifying frameworks and roadmaps, capacity building and institutional streamlining, regulations, and disease guidelines. Our case study highlights the role of the UHC Law as a driver for self-care and patient empowerment towards better health outcomes with its passage resulting in the promulgation of self-care-related policies. Our findings also suggest that changes in the local policy and built environment, and the formal educational and health systems, are needed to foster a culture of responsible self-care. There are notable exemplars in advancing self-care in the region, including Thailand, from which LMICs like the Philippines can draw lessons to make progress on institutionalizing self-care and ultimately, realizing universal health coverage and Health For All.

A Systematic Review of the Impact of Covid- 19 on Cancer Patients and Survivors from an Economic, Social and Psychological Perspective

Background: Cancer is one of the leading causes of death and has been found to have a significant associated economic burden. That cancer diagnosis comes with a financial burden on patients and survivors is known but little is known about the psychological and social impact of COVID-19 or how the resulting economic environment has exasperated this further. Aims of the Study: This systematic review examines the impact of COVID-19 on cancer patients and survivors from an economic, social and psychological perspective. Methods: A systematic review of the literature published between January 2020 and March 2021 was completed by searching electronic databases. The review protocol was registered on the PROSPERO database. Results were analysed using a thematic analysis approach. Results: A total of 55 articles were identified. Approximately 93% of the psychological studies reviewed reported increased anxiety, depression, psychological distress and worry in cancer patients. Evidence in 50% of social studies reviewed, showed that national stayat- home guidelines compounded and contributed to feelings of increased loneliness and social isolation. While the underlying economic conditions were found to impact health systems both positively and negatively with reports of a modified workflow and transitioning to telemedicine. Discussion and Limitations: National stay-at-home guidelines implemented to stop the spread of the virus and protect vulnerable populations were found to have a negative social effect on patients. Increased anxiety, depression, psychological distress and worry among cancer patients was found. Furthermore, there is evidence of socio-economic inequalities with certain subgroups more vulnerable to the economic strain caused by Covid-19 than others. Psychological strain and financial distress are side effects associated with cancer treatment but COVID-19 exasperated these side effects further. Many of the papers reviewed were reliant on single institutions and lack long term follow-up and in some cases data were only available for short periods which had negative implications on sample size. Implications for Healthcare Provision and Use: COVID-19 has reduced healthcare capacity, adversely impacting delivery and access to healthcare and causing a re-distribution of resources to meet with demand. In addition environmental considerations such as national and institutional COVID-19 guidelines and the reaction/ behaviour of patients to these guidelines will influence both demand and supply behaviour. The underlying economic conditions were found to impact health systems both positively and negatively with reports of a modified workflow and transitioning to telemedicine. Implications for Health Policy: The results provide reflections on how care for cancer patients undergoing treatment were affected by the pandemic. This informs continued plans for the implementation of the National Cancer Strategy and operationalisation plans for Ireland's blueprint for universal health care, Sláintecare. Implications for Future Research: Before COVID-19, studies were already shown to be lacking particularly on the financial burden of cancer on patients. The need for more studies in this area is paramount in order to fully understand the challenges that cancer patients face particularly because of COVID. The systematic review revealed few papers on survivors (two years post treatment)of cancer. The late effects of cancer and its treatment are well documented and extend further than active treatment and with only a few studies reporting on the psychological effects the true impact and risk to survivors is not yet fully understood.

HIV PREVENTION in VULNERABLE POPULATIONS: GENERATING EVIDENCE to REDUCE INEQUALITIES

The HIV epidemic in Latin America remains concentrated in large urban centers, with vulnerable populations suffering the highest burden, particularly MSM and transgender women. In the last 10 years, the number of new HIV infections remained high and stable, and although ART coverage led to a significant decrease in AIDS-related mortality, the decrease was lower in Latin America when compared to the other regions. Brazil accounts for more than one-third of the HIV burden of the region. It was the first low-/middle-income country to provide access to universal treatment to individuals living with HIV. Brazil's actions towards the AIDS crisis assumed a human rights-based approach, integrating both prevention and treatment efforts into its universal health care system. Brazil's civil society organizations play a crucial role in shaping the initial and ongoing response. Since 2014, a "Treat All" policy of providing antiretroviral treatment in addition to comprehensive services including HIV testing and laboratory monitoring, and pre-exposure prophylaxis has been in place. The impact of the policies on people living with HIV resulted in an improved quality of life and a decline in overall morbidity and mortality. Nonetheless, important challenges remain, including a high and stable HIV incidence among key populations, and a high prevalence of late treatment initiation and of early mortality from AIDS causes, impacting the multiple steps of the continuum of care. This presentation will (a) present recent epidemiologic data on the HIV epidemic in Latin America, (b) describe and detail the characteristics of the Brazilian response to the HIV epidemic and the current status of the epidemic in Brazil, and (c) share Brazil's contribution to cutting edge AIDS research and its impact on public health policies. The latter will focus on how the data emanating from research efforts have contributed to major innovations for the HIV prevention and care agenda. Areas highlighted include pMTCT, tuberculosis, ART strategies for treatment and prevention including pre-exposure prophylaxis, and vulnerable populations, particularly young MSM and transgender women, HPV, reproductive health, and COVID-19. These research advances were only made possible through close engagement with the community. It is through this strong community engagement that we aim to reduce stigma and discrimination while promoting human rights.

Chapter 11: Harnessing the Potential of Early Access: Advancing Timely Patient Access to Innovative Medicines in a Sustainable Way

The way medicines are developed, regulated and priced determines how quickly patients have access to safe, effective and affordable medicines. Patients are increasingly requesting access to investigational medicines and regulators are developing guidelines for additional data collection outside the clinical trial setting. Payors and healthcare policy makers worry about the rising prices of new medicines and are searching for effective policy instruments. Developing effective pharmaceutical policy requires a thorough understanding of the working of the medicine development ecosystem. Currently the smaller players are the drivers of discovery and innovation but are unable to compete in the approved medicine market as they lack the financial capacity to progress to the commercial phase, which limits competition and pricing pressure. Experimenting with innovative funding models for advanced therapy medicinal products, personalized treatments and medicines targeting (progressive) orphan diseases is expected to occur more frequently. One such model that supports smaller medicine developers, and helps them survive transitioning to the commercial stage, is the funding of early access programs. Countries with universal healthcare systems are well suited to experiment with an adaptive funding model for early access that includes pay-for-performance elements based on evolving real-world data and evaluation. Such an approach has the potential to contribute to universal access to new treatments in a sustainable way.

Response measures to COVID-19 in prisons and other detention centers.

PURPOSE: The purpose of this paper is to summarize activities being undertaken by the World Health Organization (WHO) Regional Office for Europe to prevent and control COVID-19 in and beyond prisons, activities specifically designed to increase information sharing and to support Member States, to comment on potential impacts of these initiatives at country-level responses and to underline the need for a rights-based approach to managing the pandemic, including the right to vaccination. DESIGN/METHODOLOGY/APPROACH: The Health in Prisons Programme (HIPP) of the WHO Regional Office for Europe worked with partner organizations to review regularly the evidence on best practices in prison health and use it to inform policy recommendations at the global level. HIPP issued overarching guidance and specific tools to support implementation of measures to prevent and control the spread of COVID-19 in prisons and other custodial settings. Moreover, to monitor the emergence of outbreaks, the HIPP developed a minimum data set for countries voluntarily to report COVID-19 cases and identify situations in need of direct support. FINDINGS: Since May 2020, the WHO has periodically received data from Member States, leading to the development of country-specific bulletins to support countries and, whenever appropriate, to organize virtual missions to further support ministries and public health bodies responsible for managing COVID-19 in prisons. ORIGINALITY/VALUE: The development of a specific set of indicators for prisons enables exploring data in a disaggregated manner. Monitoring response measures developed in prison enables judging their appropriateness to minimize the spread of SARS-CoV2 in prisons and alignment with guidance issued by the WHO.

Universal health care and political economy, neoliberalism and effects of COVID-19: A view of systems and complexity.

Sturmberg and Martin's application of systems and complexity theory to understanding Universal Health Care (UHC) and Primary Health Care (PHC) is evaluated in the light of the influence of political economy on health systems. Furthermore, the role that neoliberal approaches to governance have had in creating increased inequities is seen as a key challenge for UHC. COVID-19 has emphasized long standing discrepancies in health and these disadvantages require government will and cooperation together with adequate social services to redress these discrepancies in UHC.

Lives saved during economic downturns: Evidence from Australia.

Worldwide, countries have been restricting work and social activities to counter the emerging public health crisis due to the coronavirus pandemic. These measures have caused dramatic increases in unemployment. Some commentators argue that the "draconian measures" will do more harm than good due to the economic contraction, despite a large literature that finds mortality rates decline during recessions. We estimate the relationship between unemployment, a proxy for economic climate, and mortality in Australia, a country with universal health care. Using administrative time-series data on mortality by state, age, sex, and cause of death for 1979-2017, we find no relationship between unemployment and mortality on average. However, we observe beneficial health effects in economic downturns for young men, associated with a reduction in transport accidents. Our estimates imply 431 fewer deaths in 2020 if unemployment rates double as forecast. For the early 1980s, we find a procyclical pattern in infant mortality rates. However, this pattern disappears starting from the mid-1980s, coincident with the 1984 implementation of universal health care. Our results suggest that universal health care may insulate individuals from the health effects of macroeconomic fluctuations.

COVID-19 and care for patients with chronic kidney disease: Challenges and lessons.

The COVID-19 pandemic has blurred the traditional distinction between communicable diseases (CD) and noncommunicable diseases (NCDs). The manifestations of COVID-19 range from an asymptomatic carrier state to fatal multiorgan failure. While initial reports did not report significant effects on the kidneys, it is now well established that kidney involvement (acute kidney injury, urinary abnormalities, tubular function defects) in COVID-19 is common and it is also associated with poorer outcomes. At the same time, care for patients with existing chronic kidney disease (CKD) has suffered during this pandemic and those with CKD are considered to have higher risk for severity of COVID-19 symptoms. Widespread lockdowns have affected the delivery of health care to patients with CKD, including those on dialysis or on transplant wait-lists. The pandemic has reinforced the need for accessible home-based therapies and highlighted the value of teleconsultation and remote monitoring technologies. COVID-19 has revealed the poor emergency preparedness by health systems around the world. It has underscored glaring inequities in availability of diagnostic tests and essential medications, including that for dialysis. In response, there has been increasing recognition of the necessity of universal health coverage and in prioritizing vaccine distribution to serve the most vulnerable, including those with kidney failure. The COVID-19 pandemic has also reaffirmed the role of the environment and eco-systems contributing to both CDs and NCDs. Attention to universal health coverage through a One Health approach is needed to prevent global health crises and prevent further kidney dysfunction and failure.

Sláintecare implementation status in 2020: Limited progress with entitlement expansion.

The Sláintecare report developed by political consensus sets out a ten year plan for achieving Universal Health Care (UHC) in Ireland. This paper evaluates the design and progress of the report to mid 2020, but with some reflection on the new COVID 19 era, particularly as it relates to the expansion of entitlements to achieve UHC. The authors explore how close Sláintecare is to the UHC ideal. They also review the phased strategy of implementation in Sláintecare that utilises a systems-thinking approach with interlinkages between entitlements, funding, capacity and implementation. Finally the authors review the Sláintecare milestones against the reality of implementation since the publication of the report in 2017, cognisant of government policy and practice. Some of the initial assumptions around the context of Sláintecare were not realised and there has been limited progress made toward expanding entitlements, and certainly short of the original plan. Nevertheless there have been positive developments in that there is evidence that Government's Implementation Strategy and Action Plans are focussing on reforming a complex adaptive system rather than implementing a blueprint with such initiatives as integrated care pilots and citizen engagement. The authors find that this may help the system change but it risks losing some of the essential elements of entitlement expansion in favour of organisational change.

The Role of Telemedicine in Addressing Access to Sexual and Reproductive Health Services in sub-Saharan Africa during the COVID-19 Pandemic.

The outbreak of COVID-19 threatens continued access to non-urgent healthcare including sexual and reproductive health (SRH) services. With the epicentre of the outbreak projected to shift to sub-Saharan Africa (SSA) after making significant impact in China, Europe, USA, and South America, it is necessary for countries in this region to begin to plan for how to tackle a rapid surge in cases. Health facilities are already being primed for increased presentation of COVID-19 cases. As countries prepare, they also need to consider how non-urgent services will not be interrupted. Estimates of a potential disruption in access to long and short acting contraceptives for up to 12 months will result in an additional 15 million unintended pregnancies and additional 28,000 maternal deaths. Thus, effort must be made to ensure that the gains made in SRH outcomes over several years are not lost. The potential of utilizing telemedicine to continue to offer healthcare services to the population for non-urgent care needs to be considered. It will not only provide for continued access to important services that can be delivered remotely but will reduce the risks of COVID-19 infection for both the client and the health workers.

Policy Decisions and Use of Information Technology to Fight COVID-19, Taiwan.

Because of its proximity to and frequent travelers to and from China, Taiwan faces complex challenges in preventing coronavirus disease (COVID-19). As soon as China reported the unidentified outbreak to the World Health Organization on December 31, 2019, Taiwan assembled a taskforce and began health checks onboard flights from Wuhan. Taiwan's rapid implementation of disease prevention measures helped detect and isolate the country's first COVID-19 case on January 20, 2020. Laboratories in Taiwan developed 4-hour test kits and isolated 2 strains of the coronavirus before February. Taiwan effectively delayed and contained community transmission by leveraging experience from the 2003 severe acute respiratory syndrome outbreak, prevalent public awareness, a robust public health network, support from healthcare industries, cross-departmental collaborations, and advanced information technology capacity. We analyze use of the National Health Insurance database and critical policy decisions made by Taiwan's government during the first 50 days of the COVID-19 outbreak.