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2.
Antimicrob Resist Infect Control ; 11(1): 34, 2022 02 14.
Article in English | MEDLINE | ID: covidwho-1679967

ABSTRACT

BACKGROUND: The current Coronavirus disease pandemic reveals political and structural inequities of the world's poorest people who have little or no access to health care and yet the largest burdens of poor health. This is in parallel to a more persistent but silent global health crisis, antimicrobial resistance (AMR). We explore the fundamental challenges of health care in humans and animals in relation to AMR in Tanzania. METHODS: We conducted 57 individual interviews and focus groups with providers and patients in high, middle and lower tier health care facilities and communities across three regions of Tanzania between April 2019 and February 2020. We covered topics from health infrastructure and prescribing practices to health communication and patient experiences. RESULTS: Three interconnected themes emerged about systemic issues impacting health. First, there are challenges around infrastructure and availability of vital resources such as healthcare staff and supplies. Second, health outcomes are predicated on patient and provider access to services as well as social determinants of health. Third, health communication is critical in defining trusted sources of information, and narratives of blame emerge around health outcomes with the onus of responsibility for action falling on individuals. CONCLUSION: Entanglements between infrastructure, access and communication exist while constraints in the health system lead to poor health outcomes even in 'normal' circumstances. These are likely to be relevant across the globe and highly topical for addressing pressing global health challenges. Redressing structural health inequities can better equip countries and their citizens to not only face pandemics but also day-to-day health challenges.


Subject(s)
Health Services Accessibility/standards , Poverty/statistics & numerical data , Public Health/standards , Social Determinants of Health/standards , Animals , COVID-19/epidemiology , COVID-19/prevention & control , Global Health/standards , Global Health/statistics & numerical data , Health Services Accessibility/economics , Health Services Accessibility/statistics & numerical data , Humans , Public Health/statistics & numerical data , Social Determinants of Health/economics , Social Determinants of Health/statistics & numerical data , Tanzania/epidemiology
8.
PLoS One ; 16(11): e0260142, 2021.
Article in English | MEDLINE | ID: covidwho-1526693

ABSTRACT

OBJECTIVE: To measure medicines' prices, availability, and affordability in Hanam, Vietnam. METHODS: The standardized methodology developed by the World Health Organization (WHO) and Health Action International was used to survey 30 essential medicines (EMs) in 30 public health facilities and 35 private medicine outlets in 2020. The availability of medicine was computed as the percentage of health facilities in which this medicine was found on the data-collection day. International reference prices (IRPs) from Management Sciences for Health (2015) were used to compute Median Price Ratio (MPR). The affordability of treatments for common diseases was computed as the number of days' wages of the lowest-paid unskilled government worker needed to purchase medicines prescribed at a standard dose. Statistic analysis was done using R software version 4.1.1. RESULTS: The mean availability of originator brands (OBs) and lowest-priced generics (LPGs) was 0.7%, 63.2% in the public sector, and 13.7%, 47.9% in the private sector, respectively. In private medicine outlets, the mean availability of both OBs and LPGs in urban areas was significantly higher than that in rural areas (p = 0.0013 and 0.0306, respectively). In the public sector, LPGs' prices were nearly equal to their IRPs (median MPRs = 0.95). In the private medicine outlets, OBs were generally sold at 6.24 times their IRPs while this figure for LPGs was 1.65. The affordability of LPGs in both sectors was good for all conditions, with standard treatments costing a day's wage or less. CONCLUSION: In both sectors, generic medicines were the predominant product type available. The availability of EMs was fairly high but still lower than WHO's benchmark. A national-scale study should be conducted to provide a comprehensive picture of the availability, prices, and affordability of EMs, thereby helping the government to identify the urgent priorities and improving access to EMs in Vietnam.


Subject(s)
Drugs, Essential/economics , Economics, Medical/trends , Health Services Accessibility/economics , Consumer Behavior , Costs and Cost Analysis , Cross-Sectional Studies , Drugs, Generic/economics , Economics, Medical/statistics & numerical data , Government , Health Facilities , Health Services Accessibility/trends , Humans , Medicine , Private Sector , Public Sector , Vietnam
9.
JAMA Netw Open ; 4(10): e2127369, 2021 10 01.
Article in English | MEDLINE | ID: covidwho-1453500

ABSTRACT

Importance: Persons with kidney failure require treatment (ie, dialysis or transplantation) for survival. The burden of the COVID-19 pandemic and pandemic-related disruptions in care have disproportionately affected racial and ethnic minority and socially disadvantaged populations, raising the importance of understanding disparities in treatment initiation for kidney failure during the pandemic. Objective: To examine changes in the number and demographic characteristics of patients initiating treatment for incident kidney failure following the COVID-19 pandemic by race and ethnicity, county-level COVID-19 mortality rate, and neighborhood-level social disadvantage. Design, Setting, and Participants: This cross-sectional time-trend study used data from US patients who developed kidney failure between January 1, 2018, and June 30, 2020. Data were analyzed between January and July 2021. Exposures: COVID-19 pandemic. Main Outcomes and Measures: Number of patients initiating treatment for incident kidney failure and mean estimated glomerular filtration rate (eGFR) at treatment initiation. Results: The study population included 127 149 patients with incident kidney failure between January 1, 2018, and June 30, 2020 (mean [SD] age, 62.8 [15.3] years; 53 021 [41.7%] female, 32 932 [25.9%] non-Hispanic Black, and 19 835 [15.6%] Hispanic/Latino patients). Compared with the pre-COVID-19 period, in the first 4 months of the pandemic (ie, March 1 through June 30, 2020), there were significant decreases in the proportion of patients with incident kidney failure receiving preemptive transplantation (1805 [2.1%] pre-COVID-19 vs 551 [1.4%] during COVID-19; P < .001) and initiating hemodialysis treatment with an arteriovenous fistula (2430 [15.8%] pre-COVID-19 vs 914 [13.4%] during COVID-19; P < .001). The mean (SD) eGFR at initiation declined from 9.6 (5.0) mL/min/1.73 m2 to 9.5 (4.9) mL/min/1.73 m2 during the pandemic (P < .001). In stratified analyses by race/ethnicity, these declines were exclusively observed among non-Hispanic Black patients (mean [SD] eGFR: 8.4 [4.6] mL/min/1.73 m2 pre-COVID-19 vs 8.1 [4.5] mL/min/1.73 m2 during COVID-19; P < .001). There were significant declines in eGFR at initiation for patients residing in counties in the highest quintile of COVID-19 mortality rates (9.5 [5.0] mL/min/1.73 m2 pre-COVID-19 vs 9.2 [5.0] mL/min/1.73 m2 during COVID-19; P < .001), but not for patients residing in other counties. The number of patients initiating treatment for incident kidney failure was approximately 30% lower than projected in April 2020. Conclusions and Relevance: In this cross-sectional study of US adults, the COVID-19 pandemic was associated with a substantially lower number of patients initiating treatment for incident kidney failure and treatment initiation at lower levels of kidney function during the first 4 months, particularly for Black patients and people living in counties with high COVID-19 mortality rates.


Subject(s)
COVID-19 , Health Services Accessibility/trends , Healthcare Disparities/trends , Minority Groups , Renal Insufficiency/therapy , Social Class , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/mortality , Cross-Sectional Studies , Female , Health Services Accessibility/economics , Healthcare Disparities/economics , Healthcare Disparities/ethnology , Humans , Kidney Transplantation/economics , Kidney Transplantation/trends , Male , Middle Aged , Pandemics , Poisson Distribution , Renal Dialysis/economics , Renal Dialysis/trends , Renal Insufficiency/economics , Renal Insufficiency/ethnology , Residence Characteristics , United States/epidemiology , Vulnerable Populations , Young Adult
11.
Pan Afr Med J ; 39: 197, 2021.
Article in English | MEDLINE | ID: covidwho-1431149

ABSTRACT

The COVID-19 pandemic has changed the world in so many ways since 2019 when the first case was recorded. COVID-19 pandemic has impacted negatively on economy, health, education and infrastructure globally. COVID-19 vaccine was developed with the aim of stopping the pandemic and allowing the rebuilding of our societies and economies. The vaccine was rolled out in December 2020 and the distribution plan appears to be skewed in favour of high income countries. This paper highlights the need for consideration of the principles of equity and universal health coverage in the distribution plan of the vaccine. It emphasizes the need to ensure that the interests of citizens of developing and low income countries are well protected. The paper concludes that issues of disparity in economic status of countries entering agreement with the vaccine manufacturing companies, absence of logistic support among others should not be a barrier to ensuring equitable access to vaccine for all consistent with the sustainable development goal 3.7.


Subject(s)
COVID-19 Vaccines/supply & distribution , COVID-19/prevention & control , Healthcare Disparities/economics , Universal Health Insurance/economics , COVID-19 Vaccines/economics , Developing Countries , Drug Industry/economics , Global Health , Health Equity , Health Services Accessibility/economics , Humans , Socioeconomic Factors
12.
Health Serv Res ; 57(1): 15-26, 2022 02.
Article in English | MEDLINE | ID: covidwho-1405159

ABSTRACT

OBJECTIVE: To estimate the impact of the $600 per week Federal Pandemic Unemployment Compensation (FPUC) payments on health care services spending during the Covid pandemic and to investigate if this impact varied by state Medicaid expansion status. DATA SOURCES: This study leverages novel, publicly available data from Opportunity Insights capturing consumer credit and debit card spending on health care services for January 18-August 15, 2020 as well as information on unemployment insurance claims, Covid cases, and state policy changes. STUDY DESIGN: Using triple-differences estimation, we leverage two sources of variation-within-state change in the unemployment insurance claims rate and the introduction of FPUC payments-to estimate the moderating effect of FPUC on health care spending losses as unemployment rises. Results are stratified by state Medicaid expansion status. EXTRACTION METHODS: Not applicable. PRINCIPAL FINDINGS: For each percentage point increase in the unemployment insurance claims rate, health care spending declined by 1.0% (<0.05) in Medicaid expansion states and by 2.0% (<0.01) in nonexpansion states. However, FPUC partially mitigated this association, boosting spending by 0.8% (<0.001) and 1.3% (<0.05) in Medicaid expansion and nonexpansion states, respectively, for every percentage point increase in the unemployment insurance claims rate. CONCLUSIONS: We find that FPUC bolstered health care spending during the Covid pandemic, but that both the negative consequences of unemployment and moderating effects of federal income supports were greatest in states that did not adopt Medicaid expansion. These results indicate that emergency federal spending helped to sustain health care spending during a period of rising unemployment. Yet, the effectiveness of this program also suggests possible unmet demand for health care services, particularly in states that did not adopt Medicaid expansion.


Subject(s)
COVID-19/economics , Health Expenditures/statistics & numerical data , Health Services Accessibility/economics , Medicaid/economics , Unemployment/statistics & numerical data , COVID-19/epidemiology , Humans , Patient Protection and Affordable Care Act , United States
13.
Hastings Cent Rep ; 50(5): 3-4, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-1361187

ABSTRACT

Our health care system in the United States reflects the inequities that are part of the larger society, which is why our system for financing access to needed and effective health care is so complicated and unfair.


Subject(s)
African Americans , Anemia, Sickle Cell/ethnology , Health Services Accessibility/organization & administration , Health Status Disparities , Anemia, Sickle Cell/economics , COVID-19/ethnology , Health Services Accessibility/economics , Humans , Insurance Coverage/statistics & numerical data , Insurance, Health/statistics & numerical data , SARS-CoV-2 , United States
15.
PLoS Negl Trop Dis ; 15(8): e0009702, 2021 08.
Article in English | MEDLINE | ID: covidwho-1359097

ABSTRACT

BACKGROUND: Annually, about 2.7 million snakebite envenomings occur globally. Alongside antivenom, patients usually require additional care to treat envenoming symptoms and antivenom side effects. Efforts are underway to improve snakebite care, but evidence from the ground to inform this is scarce. This study, therefore, investigated the availability, affordability, and stock-outs of antivenom and commodities for supportive snakebite care in health facilities across Kenya. METHODOLOGY/PRINCIPAL FINDINGS: This study used an adaptation of the standardised World Health Organization (WHO)/Health Action International methodology. Data on commodity availability, prices and stock-outs were collected in July-August 2020 from public (n = 85), private (n = 36), and private not-for-profit (n = 12) facilities in Kenya. Stock-outs were measured retrospectively for a twelve-month period, enabling a comparison of a pre-COVID-19 period to stock-outs during COVID-19. Affordability was calculated using the wage of a lowest-paid government worker (LPGW) and the impoverishment approach. Accessibility was assessed combining the WHO availability target (≥80%) and LPGW affordability (<1 day's wage) measures. Overall availability of snakebite commodities was low (43.0%). Antivenom was available at 44.7% of public- and 19.4% of private facilities. Stock-outs of any snakebite commodity were common in the public- (18.6%) and private (11.7%) sectors, and had worsened during COVID-19 (10.6% versus 17.0% public sector, 8.4% versus 11.7% private sector). Affordability was not an issue in the public sector, while in the private sector the median cost of one vial of antivenom was 14.4 days' wage for an LPGW. Five commodities in the public sector and two in the private sector were deemed accessible. CONCLUSIONS: Access to snakebite care is problematic in Kenya and seemed to have worsened during COVID-19. To improve access, efforts should focus on ensuring availability at both lower- and higher-level facilities, and improving the supply chain to reduce stock-outs. Including antivenom into Universal Health Coverage benefits packages would further facilitate accessibility.


Subject(s)
Antivenins/therapeutic use , Equipment and Supplies, Hospital/statistics & numerical data , Health Services Accessibility/statistics & numerical data , Snake Bites/drug therapy , Antivenins/economics , COVID-19/epidemiology , Costs and Cost Analysis , Equipment and Supplies, Hospital/economics , Health Services Accessibility/economics , Humans , Kenya/epidemiology , Private Sector/economics , Private Sector/statistics & numerical data , Public Sector/economics , Public Sector/statistics & numerical data , Snake Bites/economics , Snake Bites/epidemiology
20.
Hastings Cent Rep ; 51(4): 7-8, 2021 07.
Article in English | MEDLINE | ID: covidwho-1306646

ABSTRACT

One of the biggest policy interventions during the last year of the COVID-19 pandemic was the Coronavirus Aid, Relief, and Economic Securities Act, instituting a novel form of economic relief similar to a universal basic income. The economic impact payments, colloquially known as "stimulus checks," were distributed based on the socioeconomic status of American citizens and legal residents and provided much-needed financial aid. However, the distribution of these payments paid little attention to other important factors that might determine the economic security of said individuals, such as race and gender. This article calls for policy-makers to pay particular attention to how structural inequity and discrimination based on identity could affect the efficacy of proposed policies and demonstrate an ethic of care informed by an understanding of intersectionality.


Subject(s)
COVID-19/economics , COVID-19/epidemiology , Cost of Illness , Economics, Behavioral/statistics & numerical data , Healthcare Financing/ethics , Health Behavior/ethics , Health Services Accessibility/economics , Humans , United Nations , United States
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