Adjustments in purchasing arrangements to support the COVID-19 health sector response: evidence from eight middle-income countries.

The COVID-19 pandemic has triggered several changes in countries' health purchasing arrangements to accompany the adjustments in service delivery in order to meet the urgent and additional demands for COVID-19-related services. However, evidence on how these adjustments have played out in low- and middle-income countries is scarce. This paper provides a synthesis of a multi-country study of the adjustments in purchasing arrangements for the COVID-19 health sector response in eight middle-income countries (Armenia, Cameroon, Ghana, Kenya, Nigeria, Philippines, Romania and Ukraine). We use secondary data assembled by country teams, as well as applied thematic analysis to examine the adjustments made to funding arrangements, benefits packages, provider payments, contracting, information management systems and governance arrangements as well as related implementation challenges. Our findings show that all countries in the study adjusted their health purchasing arrangements to varying degrees. While the majority of countries expanded their benefit packages and several adjusted payment methods to provide selected COVID-19 services, only half could provide these services free of charge. Many countries also streamlined their processes for contracting and accrediting health providers, thereby reducing administrative hurdles. In conclusion, it was important for the countries to adjust their health purchasing arrangements so that they could adequately respond to the COVID-19 pandemic, but in some countries financing challenges resulted in issues with equity and access. However, it is uncertain whether these adjustments can and will be sustained over time, even where they have potential to contribute to making purchasing more strategic to improve efficiency, quality and equitable access in the long run.

HL7 in personal health system component's integration for mental health treatment / HL7 como componente de integração em Sistema de PEP para tratamento em Saúde Mental

Help4Mood is a project inside 7th European Framework Programme (FP7) for developing a computational distributed system to support remotely the treatment of patients with major depression at home. Core components are integrated with Health Level Seven (HL7) standard. One of the main goals of this system is to use the paradigm of a Virtual Agent to support the first symptoms of clinician alert of a patient, to interact with him an to prevent some causes of relapse. The system processes inputs from different devices (to monitor sleeping, eating and motor activity) in a decision support system, and the Virtual Agent interacts with the patient before clinical support from hospital is needed. The technical framework is using the open source HL7-standard-based healthcare integration engine, Mirth Connect, to interact with the different subsystems, analyze data and give different priorities for messages in queues. Particularly, the use of standard HL7 will contribute to interest in the project results and the potential impact through the development, dissemination and use, as stated in the analysis of the European commission.

Help4Mood é um projeto do 7 º Programa de Framework Europeu (FP7) para desenvolvimento de um sistema computacional distribuído para apoio remoto de tratamento domiciliar de pacientes com depressão. Os principais componentes são integrados com o padrão Health Level Seven (HL7). Um dos objetivos principais deste sistema é a utilização do paradigma de um agente virtual para apoiar os primeiros sintomas de alerta clínico de um paciente, interagirindo com ele de forma a impedir que algumas ocorrências de recaída. O sistema processa as entradas de dispositivos diferentes (para monitorar a dormir, comer e atividade motora) em um sistema de apoio à decisão, e o Agente Virtual interage com o paciente antes que o atendimento clínico hospitalar seja necessário. O framework usa o código-fonte ?open source? como motor de integração baseado no padrão HL7, chamado ?Mirth Connect? a fim de interagir com os diferentes subsistemas, analisar os dados, e dar prioridades diferentes para as mensagens enviadas. A utilização do padrão HL7, por certo, contribuirá para os resultados do projeto e o impacto potencial através do desenvolvimento, difusão e utilização, como referenciado na análise da Comissão Europeia do programa.

[Introduction of Aedes albopictus in Spain: a new challenge for public health]. / Llegada de Aedes albopictus a España, un nuevo reto para la salud pública.

INTRODUCTION: A spectacular increase was noticed in the number of consultations for insect bites at the Sant Cugat Primary Care Center (Barcelona, Spain). Subsequent study of the species in the area identified Aedes albopictus. OBJECTIVE: To analyze consultations for insect bites in this center (1998-2004). METHODS: A descriptive, cross sectional study with a 7-year retrospective review was performed. A total of 2,760 patients consulted. RESULTS: A continual increase in the number of consultations for insect bites was detected, reaching 16 consultations per 1,000 inhabitants. The mean age of the patients was 32 years and 62% were women. Seventy-one percent of the bites were located on the extremities and 19% were infected. Sixty-seven percent of the patients received systemic treatment. CONCLUSIONS: Primary care alerted the town council of the significant increase in consultations for insect bites. Patients consulting for this reason were predominantly young women who frequently received systemic treatment and showed a high percentage of local complications.

Llegada de Aedes albopictus a España, un nuevo reto para la salud pública / Introduction of Aedes albopictus in Spain: a new challenge for public health)

Introducción: En el Centro de Atención Primaria de Sant Cugat del Vallès (Barcelona) se detectó un espectacular aumento de consultas por picaduras de insectos. El posterior estudio de las especies del área permitió identificar a Aedes albopictus. Objetivo: Analizar las consultas por picaduras de insecto (1998-2004). Métodos: Estudio descriptivo transversal retrospectivo. Consultaron 2.760 pacientes durante el período 1998-2004. Resultados: Se detectó un continuo aumento de consultas por picaduras, hasta alcanzar las 16 consultas por 1.000 habitantes. Los pacientes tenían una media de edad de 32 años, y un 62% eran mujeres. El 71% de las lesiones se localizaron en las extremidades y se infectaron el 19% de ellas. El 67% de los pacientes recibió tratamiento sistémico. Conclusiones: La atención primaria alertó sobre el llamativo aumento de consultas por picaduras de insecto. El colectivo de pacientes que consultó por este motivo fue mayoritariamente femenino, joven, recibió con frecuencia tratamiento sistémico y presentó un elevado porcentaje de complicaciones locales

Introduction: A spectacular increase was noticed in the number of consultations for insect stings at the Sant Cugat Primary Care Center (Barcelona, Spain). Subsequent study of the species in the area identified Aedes albopictus. Objective: To analyze consultations for insect stings in this center (1998-2004). Methods: A descriptive, cross sectional study with a 7-year retrospective review was performed. A total of 2,760 patients consulted. Results: A continual increase in the number of consultations for insect stings was detected, reaching 16 consultations per 1,000 inhabitants. The mean age of the patients was 32 years and 62% were women. Seventy-one percent of the stings were located on the extremities and 19% were infected. Sixty-seven percent of the patients received systemic treatment. Conclusions: Primary care alerted the town council of the significant increase in consultations for insect stings. Patients consulting for this reason were predominantly young women who frequently received systemic treatment and showed a high percentage of local complications