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J Public Health Manag Pract ; 28(4 Suppl 4): S143-S150, 2022.
Article in English | MEDLINE | ID: covidwho-1865016


In Pierce County, Washington, 6 Communities of Focus face tough health disparities. To engage members of communities that have been marginalized for generations, Tacoma-Pierce County Health Department piloted participatory budgeting. Through this 5-step process, the health department and its partners make investments significant enough to bring community members to the table, codesign solutions, and put the final decision-making power to fund programs and services in their hands. Sharing power through this process is an innovative approach and has been adapted during the COVID-19 pandemic to build trust essential to resilience and recovery. After a series of successful projects bringing participatory budgeting to scale, the Public Health Centers for Excellence is piloting participatory policy making and disseminating both practices broadly.

COVID-19 , Population Health , Budgets , COVID-19/epidemiology , COVID-19/prevention & control , Community-Based Participatory Research , Humans , Pandemics/prevention & control , Policy Making
Nat Rev Drug Discov ; 21(4): 249, 2022 04.
Article in English | MEDLINE | ID: covidwho-1860313

Budgets , Humans , United States
Int J Environ Res Public Health ; 19(5)2022 03 05.
Article in English | MEDLINE | ID: covidwho-1732026


In the context of the COVID-19 pandemic, financial resources allocated to the health system have been refocused according to priority 0: fighting the pandemic. The main objective of this research is to identify the vulnerabilities affecting the health budget effort in the EU and in the Member States during the health crisis period. The analysis takes into account relevant statistical indicators both in terms of financial allocation to health and expenditure on health protection of the population in the Member States, with the effect being tracked even during the pandemic period. The novelty of the study is the identification of viable directions of intervention based on the structural determination of expenditures related to measures to combat the pandemic and making proposals for changes in public policies based on the determination of the effectiveness of budget allocations in health in relation to the proposed purpose. The main outcome of the study is the identification of the vulnerabilities and the projection of measures to mitigate them in the medium and long term.

COVID-19 , Pandemics , Budgets , COVID-19/epidemiology , Health Expenditures , Humans , Pandemics/prevention & control , SARS-CoV-2
Matern Child Nutr ; 18(2): e13253, 2022 04.
Article in English | MEDLINE | ID: covidwho-1714265


In India, 15 nutrition interventions are delivered and financed through the National Health Mission (NHM). Programmatic know-how, however, on tracking nutrition budgets in health sector plans is limited. Following the four phases of the budget cycle-planning, allocations, disbursements and expenditure, this paper presents a new method developed by the authors to track nutrition budgets within health sector plans. Using the example of the Anemia Mukt Bharat (AMB) or Anemia Free India strategy, it reports preliminary findings on the application of the first two phases of the method, that is, to track and act for improved planning and allocations, covering 12 states. The paper lists out the budget heads, cost norms and developed tools to plan adequately. Supportive action was undertaken through sharing trends and trainings for AMB's budgeting to create opportunities for improvements. It was observed that the AMB budget increased over 3 years despite the COVID situation. It increased from INR 6184 million in FY 2019-2020 to INR 6293 million, a 2% increase in FY 2020-2021, and to INR 7433 million, an 18% increase in FY 2021-2022. The difference in allocations and planned budgets were low (16%, 4% and 11%, respectively) while the difference in required budgets and planned budgets were significant but reduced consistently (41%, 31% and 22%, respectively). The paper concludes that the methods adopted for tracking and acting for improved nutrition budgets helped in informing national and state governments regarding yearly trends. Such methods can be effective and be developed for other nutrition interventions.

Anemia , COVID-19 , Budgets , Health Planning , Humans , India , Nutritional Status
Cad Saude Publica ; 38(2): e00164621, 2022.
Article in Portuguese | MEDLINE | ID: covidwho-1690641


This is a critical essay on policies for primary healthcare (PHC) adopted by the Jair Bolsonaro government in the Brazilian Unified National Health System (SUS), particularly in the first year of implementation of its new model for allocation of budget funds. The first part addresses the measures and effects of the first year, revealing the on-going process of valorization of an "operational SUS" as opposed to the principle of universality. The second part analyzes some evolving scenarios in the implementation of the new model for "financing" PHC in terms of losses and gains in funding, especially in two state capitals, São Paulo and Manaus, bearing a direct relationship to the problematic situation a year since the novel coronavirus pandemic struck. This exercise aims to relate the values in the Weighted Capitation Component for these municipalities, comparing the year 2019 (without the new model) to 2020 (one year after implementing the new model). The destruction of universality in the SUS via PHC continues in full sway, as the data show. If the situations in Manaus and São Paulo (with financial losses when compared to the funds received in 2019) in fact represent a trend, it is likely that the underfinancing produced by the new PHC allocation model will happen in other Brazilian cities in an unequal and combined pattern according to their realities.

Realiza-se um ensaio crítico acerca das políticas adotadas pelo governo Jair Bolsonaro no âmbito da atenção primária à saúde (APS) no Sistema Único de Saúde (SUS), particularmente no tocante ao primeiro ano de implantação do seu novo modelo de alocação de recursos financeiros. A primeira parte aborda as medidas e os efeitos do primeiro ano, evidenciando a continuidade do processo de valorização de um "SUS operacional" em detrimento do princípio da universalidade. A segunda parte analisa alguns cenários de tendência da implantação do novo modelo de "financiamento" da APS, em termos de perdas e ganhos de recursos, especialmente, de duas capitais brasileiras, São Paulo e Manaus, que apresentam relação direta com a conjuntura problemática após um ano de pandemia do coronavírus. Para esse exercício, busca-se relacionar os valores do Componente de Capitação Ponderada desses municípios, comparando 2019 (ano sem o novo modelo) e 2020 (um ano de implantação do novo modelo). A destruição da universalidade no SUS via APS está seguindo seu curso, conforme os dados apontam. Se o que acontece em Manaus e São Paulo, com a existência de prejuízos financeiros em comparação aos recebimentos de 2019, de fato representa uma tendência, é provável que o processo de desfinanciamento produzido pelo novo modelo de alocação aconteça nos demais centros urbanos de forma desigual e combinada, segundo suas realidades.

Se realiza un ensayo crítico a cerca de las políticas adoptadas por el gobierno Jair Bolsonaro en el ámbito de la atención primaria en salud (APS) dentro del Sistema Único de Salud (SUS), particularmente en lo que se refiere al primer año de implantación de su nuevo modelo de asignación de recursos financieros. La primera parte aborda las medidas y los efectos del primer año, evidenciando la continuidad del proceso de valoración de un "SUS operacional", en detrimento del principio de la universalidad. La segunda parte analiza algunos escenarios de tendencia de la implantación del nuevo modelo de "financiación" de la APS, en términos de pérdidas y ganancias de recursos, especialmente, de dos capitales brasileñas, São Paulo y Manaos, que presentan una relación directa con la coyuntura problemática tras un año de pandemia del coronavirus. Para este ejercicio, se busca relacionar los valores del Componente de Capitación Ponderada de esos municipios, comparando 2019 (año sin el nuevo modelo) y 2020 (un año de implantación del nuevo modelo). La destrucción de la universalidad en el SUS -vía APS- está siguiendo su curso, conforme apuntan los datos. Si lo que sucede en Manaos y São Paulo, con la existencia de pérdidas financieras, representa una tendencia, en comparación con la asignación de recursos de 2019, es probable, de hecho, que el proceso de desfinanciación provocado por el nuevo modelo de asignación se produzca en los demás centros urbanos de forma desigual y combinada, según sus realidades.

COVID-19 , SARS-CoV-2 , Brazil , Budgets , Humans , Primary Health Care
Sci Rep ; 11(1): 19543, 2021 10 01.
Article in English | MEDLINE | ID: covidwho-1447319


The combination of machine learning (ML) and electronic health records (EHR) data may be able to improve outcomes of hospitalized COVID-19 patients through improved risk stratification and patient outcome prediction. However, in resource constrained environments the clinical utility of such data-driven predictive tools may be limited by the cost or unavailability of certain laboratory tests. We leveraged EHR data to develop an ML-based tool for predicting adverse outcomes that optimizes clinical utility under a given cost structure. We further gained insights into the decision-making process of the ML models through an explainable AI tool. This cohort study was performed using deidentified EHR data from COVID-19 patients from ProMedica Health System in northwest Ohio and southeastern Michigan. We tested the performance of various ML approaches for predicting either increasing ventilatory support or mortality. We performed post hoc analysis to obtain optimal feature sets under various budget constraints. We demonstrate that it is possible to achieve a significant reduction in cost at the expense of a small reduction in predictive performance. For example, when predicting ventilation, it is possible to achieve a 43% reduction in cost with only a 3% reduction in performance. Similarly, when predicting mortality, it is possible to achieve a 50% reduction in cost with only a 1% reduction in performance. This study presents a quick, accurate, and cost-effective method to evaluate risk of deterioration for patients with SARS-CoV-2 infection at the time of clinical evaluation.

Budgets , COVID-19/pathology , COVID-19/virology , Machine Learning , Outcome Assessment, Health Care , SARS-CoV-2/isolation & purification , Humans
Am J Nurs ; 121(9): 19-21, 2021 Sep 01.
Article in English | MEDLINE | ID: covidwho-1373672


The COVID-19 pandemic has revealed cracks in the nation's public health infrastructure.

COVID-19 , Public Health Administration/economics , Public Health Administration/standards , Budgets , Humans , United States/epidemiology , Workforce
Can J Public Health ; 112(2): 186-190, 2021 04.
Article in English | MEDLINE | ID: covidwho-1229505


Inspired by Fiset-Laniel et al.'s (2020) article entitled "Public health investments: neglect or wilful omission? Historical trends in Quebec and implications for Canada", we assessed public health investments since the establishment of the Nova Scotia provincial health authority in 2015. We analyzed Nova Scotia Department of Health and Wellness budgets from 2015-2016 to 2019-2020 and observed that less than 1% of funding was budgeted for public health annually, an amount well below the recommendation that 5-6% of healthcare funding be spent on public health. Healthcare spending has increased annually since 2015-2016, but proportions of funding to different programs and services have remained static. Specifically, we did not observe a change in investment in public health over time, suggesting that while the government does not necessarily spend too much or too little on healthcare, it spends far too little on public health. This chronic under-funding is problematic given the high rates of non-communicable diseases in Nova Scotia and health inequities experienced within the population. The 2020 COVID-19 pandemic has highlighted the importance of public health work, and the need for a pandemic recovery plan that prioritizes investment in all areas of public health in Nova Scotia.

RéSUMé: Inspirés par l'article de Fiset-Laniel et coll. (2020) intitulé « Public health investments: neglect or wilful omission? Historical trends in Quebec and implications for Canada ¼, nous avons évalué les investissements en santé publique depuis la fondation de l'autorité sanitaire provinciale de la Nouvelle-Écosse en 2015. Nous avons analysé les budgets du ministère de la Santé et du Mieux-Être de la Nouvelle-Écosse de 2015−2016 à 2019−2020 et nous avons observé que moins de 1 % du financement était prévu pour la santé publique annuellement, un montant bien inférieur à la recommandation que 5−6 % du financement pour les soins de santé soit dépensé sur la santé publique. Les dépenses de santé ont augmenté annuellement depuis 2015−2016, mais les proportions du financement consacrés à différents programmes et services ont demeuré statiques. Spécifiquement, nous n'avons pas observé de changement dans l'investissement en santé publique au fil du temps, indiquant que tandis que le gouvernement ne dépense pas nécessairement trop ou trop peu sur les soins de santé, il dépense bien trop peu sur la santé publique. Ce sous-financement chronique est problématique étant donné les hauts taux de maladies non transmissibles en Nouvelle-Écosse et les inégalités en matière de santé qui existent au sein de la population. La pandémie de la COVID-19 de 2020 a souligné l'importance du travail lié à la santé publique, ainsi que la nécessité d'un plan de rétablissement suite à une pandémie qui priorise l'investissement dans tous les domaines de santé publique en Nouvelle-Écosse.

Budgets/trends , Financing, Government/economics , Public Health/economics , COVID-19 , Health Status Disparities , Humans , Noncommunicable Diseases/epidemiology , Nova Scotia/epidemiology
Rev. adm. pública (Online) ; 55(1): 140-150, Jan.-Feb. 2021. tab, graf
Article in English | WHO COVID, LILACS (Americas) | ID: covidwho-1159421


Abstract Given the lack of governmental guidelines, this paper identifies and analyzes the statistical determinants associated with receiving the onetime monetary transfer in El Salvador ($300 dollars) as an economic measure to face the COVID-19 pandemic. A logistic regression was implemented (whether received the transfer or not) based on a probabilistic sample (n=1222) of surveyed people throughout the country. Independent variables were selected drawing upon key characteristics employed internationally in monetary transfers: age, gender, rural area, employment, family income, and education. The text identifies a statistically significant and negative relation between receiving the monetary transfer and two variables: family income and educational level. The need to increase coverage of the program is addressed as well as the importance of considering age, gender, rural areas, and employment as criteria for selecting the beneficiaries in such economic measures.

Resumo Dada a ausência de diretrizes governamentais, o texto apresenta uma análise exploratória e identifica quais são os fatores estatísticos determinantes que explicam a transferência única de renda ($300 dólares) como medida econômica para enfrentar a pandemia gerada pela COVID-19 em El Salvador. Para tal fim, utiliza-se uma análise estatística de regressão logística (receber ou não a ajuda) com base em uma amostra probabilística de respondentes em todo o país (n=1222). Como variáveis independentes emprega-se caraterísticas importantes utilizadas em programas de transferência de renda em todo o mundo: Idade, gênero, zona de procedência, emprego e renda familiar e nível educacional. O presente texto identifica que existe uma relação inversa e estatisticamente significativa entre essa ajuda pública com a renda familiar e o nível educacional. Finalmente, discute-se a necessidade de ampliação do programa econômico e a importância de considerar características como idade, gênero, zona de procedência e emprego nesse tipo de políticas econômicas.

Resumen Ante la falta de lineamientos gubernamentales, el presente texto muestra un análisis exploratorio e identifica cuáles han sido los determinantes estadísticos asociados a la recepción de la transferencia monetaria única ($300 dólares) como medida económica para enfrentar la pandemia de COVID-19 en El Salvador. Para tal efecto, se utiliza un análisis estadístico de regresión logística (recibir la ayuda o no) con base en una muestra probabilística de encuestados en todo el país (n=1222). Como variables independientes se emplean características cruciales utilizadas en programas de transferencias monetarias a nivel internacional: Edad, género, lugar de origen, empleo, ingresos familiares y nivel educacional. El presente texto identifica que existe una relación inversa y estadísticamente significativa entre la asignación de esa ayuda pública, los ingresos familiares y el nivel educacional. Finalmente, se discute la necesidad de ampliación del programa y la importancia de considerar aspectos como edad, género, lugar de origen y empleo en ese tipo de políticas económicas.

Humans , Male , Female , Public Policy , Budgets , Coronavirus Infections , Economics