Résumé
Objectives: The objective of this study is to measure the national impact of COVID-19 on cervical cancer screening rates in Colombia in five of its geographic regions to inform future health policy decision making. Method(s): This study utilized a quasi-experimental interrupted time-series design to examine changes in trends for the number of cervical cancer screenings performed in five geographic regions of Colombia. Result(s): In the rural region of Vichada, we found the lowest incidence of cervical cancer screenings, totaling at 3,771 screenings. In Cundinamarca, the region which hosts the capital city, a total of 1,213,048 cervical cancer screenings were performed. The researcher measured the impact on cervical cancer screenings in December 2021 against the counterfactual. This impact was ~269 cases that were not performed in December 2021 as a result of the COVID-19 pandemic compared to the counterfactual. In Cundinamarca, unlike other regions, we observed a stagnant pre-pandemic trend, a sharp drop in screenings in March 2020, and an immediate upward trend starting in April 2020. In the month of April 2020, compared to the counterfactual, there were 27,359 screenings missed, and by the month of December 2021, there were only 5,633 cervical cancer screenings missed. Conclusion(s): The region of Cundinamarca's sharp climb back to pre-pandemic screening levels could signal the relatively stronger communication system in the region, and especially in the capital district of Bogota, in re-activating the economy. This can serve as an example of what should be implemented in other regions to improve cervical cancer screening rates. Areas for further research include the examination of social determinants of health, such as the breakdown of the type of insurance screened patients hold (public versus private), zone (urban versus rural), insurance providers of those screened, ethnicities of the patients screened, and percentage of screenings that resulted in early detection of cervical cancer.Copyright © 2023
Résumé
Objectives: The study aims to determine the influence of the efficiency of the cervical cancer program on the budget execution during the COVID-19 pandemic years 2020- 2021. Method(s): Estimating the screened women and using a micro-costing analysis to estimate the cost of treating precancerous lesions and cervical cancer in the pandemic and a non-pandemic scenario during 2020 -2021. Finally, the estimation of the budget execution for the cervical cancer program led by the Ministry of Health in the pandemic and non-pandemic scenarios. The estimation in the study was through two scenarios determined, the pandemic and non-pandemic scenarios during the years 2020 and 2021. After that, it was determined the number of screened and non-screened women. The next step was the cost estimation of the low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesions (HSIL), and cervical cancer at different stages. Therefore, this information is necessary for the Peruvian Ministry of Health to provide healthcare services to patients who did not get screened in the years 2020 and 2021. Result(s): The non-pandemic scenario would be spent USD 33,547,185 and USD 37,428,997 in 2020 and 2021, respectively. Conversely, in the pandemic scenario, spent USD 9,934,440 and USD 23,762,073 by 2020 and 2021. Therefore, by 2020 must be spent 68.7% of the budget, but only had been spent 20.3%. Moreover, in 2021, only 46.7% of the budget was spent when it should be 73.6% of the total budget. Therefore, USD 39,496,476 and USD 27,114,114 were not executed in 2020 and 2021, respectively. Conclusion(s): A total of USD 66,610,590 was the non-executed budget for the cervical program and needs to be reallocated in the following years to provide healthcare services to the women who did not get access to screening and treatment.Copyright © 2023
Résumé
Objectives: The G20 proclaimed that Value-Based Healthcare (VBHC) offers the best approach to sustain and improve healthcare services after the pandemic. Value-Based Procurement (VBP) enables the implementation of VBHC by considering total cost of care and health outcomes to support better purchasing decisions. This poster advocates for a broader adoption of VBP in Latin America (LA). Methods: We conducted semi-structured interviews with six experts from academia, government, industry and multilateral organizations. A standardized questionnaire was used to identify case studies, key success factors and hurdles for implementation of VBP in LA. Experts provided supporting literature that was further expanded using the snowball technique. Results: We identified three examples: (1) Integrated Renal Care Services (Colombia), where the High Cost Account defines and record clinical outcomes financially rewarding those outperformers;(2) Vaccines value-based recommendation (Argentina, Brazil, Colombia), where a National Vaccine Advisory Committee selects the vaccine to be procured informed by a cost-effectiveness analysis;and (3) Diabetes Type 1 care model (Brazil), in a public-private collaboration defines and gather outcomes to support a value-based tender for 2022. Common key success factors include multi-stakeholder alignment on value attributes;monitoring and reporting performance indicators and the training of stakeholders. Hurdles identified included lack of IT infrastructure, price-based procurement mandates and institutional misalignment (finance, procurement, health agencies). Conclusions: Traditional procurement approaches undermine value realization from healthcare investments. Although we focused in 3 cases involving public funding, there are more examples in the private sector which demonstrate the feasibility and sustainability of a VBP approach. Education and mentoring to develop local expertise are key to strengthen decision makers’ confidence in advancing VBP, while multilateral organizations could play a role in capacity building and institutional alignment. With the ongoing COVID-19 pandemic, the importance of better purchasing decisions is clearer than ever.