中低收入国家的慢性病：背景、决定因素与卫生政策

近年来,中低收入国家慢性病不断上升的趋势及其产生的影响受到广泛关注,但有关这种上升趋势的解释和说明大多基于高收入国家的慢性病发展史,但其所经历的发展历程与中低收入国家并不完全相同.本文对这些差异进行评价,以更好地理解中低收入国家慢性病的流行趋势,并对慢性病决定因素的相关理论加以讨论,为慢性病的防控提供循证支持.此外,本文将慢性病防控政策看作是降低人口患病风险和个体易感性的重要干预手段,并讨论了中低收入国家需要开展的相关政策研究.在此基础上进一步强调了加强初级卫生保健改革的必要性,并将其作为降低慢性病流行趋势的一项重要政策.     

中低收入国家的卫生体系

<正>过去10年来,全球卫生开始逐渐意识到卫生体系的重要性,包括制度、组织和资源(人力、物力、财力)等与卫生服务提供有关的要素,以更好的满足人群需求。而中低收入国家的卫生体系尤为重要,但这些国家缺乏足够资金改善卫生基础设施,一些特定的疾病项目主要依赖外部资金支持,尤其是药物     

政策工具视角下2009—2019年国家卫生健康政策核心公文评述

目的 从政策工具视角探讨我国卫生健康政策存在的问题,以期为后续卫生健康政策制定与优化调整提供参考借鉴。方法 采用UCINET工具识别核心政策文本,运用RothwelI和Zegveld政策工具分类方法,对我国卫生健康政策核心文件进行编码分类和统计分析。结果 研究纳入62份核心政策文本,累计编码2 489条。其中环境型政策工具（70.23%）使用占比最高,供给型工具（27.80%）次之,应用最少的是需求型工具（1.97%）。结论 目前国家卫生健康政策制定有待优化:环境型工具使用呈现出强烈偏好,内部结构不均衡;供给型工具使用表现出一般偏好,部分环节薄弱;需求型工具使用偏好性弱,内部存在缺失问题。建议逐渐强化需求型工具功效,优化不同政策工具内部结构,注重政策工具均衡,增加政策拉力与推力,促进我国卫生健康事业高速高质发展。     

上海卫生政策情境分析研究设计

该文主要介绍了卫生政策情境分析方法 ,情境分析在卫生政策研究中的作用 ,上海卫生政策情境分析的理论模型及主要内容 ,以及研究的主要方法。     

系统综述在卫生政策分析中的应用

卫生政策问题分析和卫生政策制定中,越来越重视科学研究证据的使用。系统综述为从大量卫生政策研究中提取系统、全面和可靠的科学证据提供了很好的工具。随着系统综述方法学的发展,不同类型的系统综述可以为卫生政策问题的确定、卫生政策的制定、执行与评价等各类卫生政策问题提供证据支持。但卫生政策系统综述在综述问题类型的界定、原始研究的方法学质量评价以及结合背景因素解释研究结果方面,仍处于探索和发展之中。     

卫生政策研究成果应用的影响因素分析——基于对卫生政策研究者的调查

目的 从卫生政策研究者角度分析卫生政策研究成果应用的影响因素.方法 采用典型抽样方法,对57名研究者进行问卷调查,对7名研究者进行个人深入访谈.结果 课题执行者(研究机构及研究者)、决策者、课题执行者与决策者之间的合作及交流、研究课题类型及产出等会对卫生政策研究成果的应用产生影响.结论 应根据卫生发展需要选取研究课题、...     

卫生政策概念对国际卫生政策改革评估的影响

卫生政策概念模糊不清有三方面原因：１误解或领会错误;２某国因地制宜与不同地区建立的卫生保健制度被当作全国的制度来衡量其作用;３考虑卫生政策如何落实比其内容更为重视,本末倒置。     

基于政策工具的我国卫生信息化建设政策分析

目的 分析我国卫生信息化建设的政策工具应用及工具内部结构存在的问题,为卫生信息化建设相关政策的调整优化提供理论支持。方法 本研究采用Rothwell＆Zegveld 政策工具分类,对卫生信息化建设政策文件进行编码和频数统计分析。结果 本研究共收集42份我国中央政府颁布的卫生信息化建设相关政策文件,累计编码150条。卫生信息化建设政策综合运用了环境型、供给型和需求型三类政策工具,分别占68.0%、20.0%和12.0%。结论 我国卫生信息化建设政策以环境型政策工具为主,应加快供给型和需求型工具的制定,为卫生信息化建设提供动力。同时,需重视部门合作并细化政策条文,推动政策落实。     

中低收入国家卫生质量管理方法及启示

通过文献复习,介绍了部分中低收入国家提高卫生质量的几种管理方法:标准化临床评估法、医疗记录保存法、卫生项目认证法,并分析了其面临的挑战及未来的发展方向。提出了改善我国卫生质量管理的建议:建立专业的卫生质量管理组织、建立科学化的卫生质量评价流程、加强卫生质量管理信息化建设、促进卫生服务多主体监管等。     

中低收入国家中不安全流产并发症的治疗费用

<正>估计每年有520万妇女寻求治疗不安全流产带来的并发症,而估算不安全流产的地区性和全球性花费,从而为政策制定和卫生知识宣传提供依据近来也成了人们的关注点。一篇系统性综述评价了中低收入国家流产后保健成本研究的质量,并且描述了不同医疗条件下的单位成本。该文献共分析了21项研究。亚洲、欧洲和中东的研究一直就很少。研究显示成本水平的差异与所在地区、治疗方法、设备水平、病例严重程度以及报道该数据的研究是否为运筹学研究等相关。负压吸引术的平均估测成本比刮宫术(D&C)低225美元,这一结果支持了世界     

Influencing policy change: the experience of health think tanks in low- and middle-income countries

In recent years there has been a growth in the number of independent health policy analysis institutes in low- and middle-income countries which has occurred in response to the limitation of government analytical capacity and pressures associated with democratization. This study aimed to: (i) investigate the contribution made by health policy analysis institutes in low- and middle-income countries to health policy agenda setting, formulation, implementation and monitoring and evaluation; and (ii) assess which factors, including organizational form and structure, support the role of health policy analysis institutes in low- and middle-income countries in terms of positively contributing to health policy. Six case studies of health policy analysis institutes in Bangladesh, Ghana, India, South Africa, Uganda and Vietnam were conducted including two NGOs, two university and two government-owned policy analysis institutes. Case studies drew on document review, analysis of financial information, semi-structured interviews with staff and other stakeholders, and iterative feedback of draft findings. Some of the institutes had made major contributions to policy development in their respective countries. All of the institutes were actively engaged in providing policy advice and most undertook policy-relevant research. Relatively few were engaged in conducting policy dialogues, or systematic reviews, or commissioning research. Much of the work undertaken by institutes was driven by requests from government or donors, and the primary outputs for most institutes were research reports, frequently combined with verbal briefings. Several factors were critical in supporting effective policy engagement. These included a supportive policy environment, some degree of independence in governance and financing, and strong links to policy makers that facilitate trust and influence. While the formal relationship of the institute to government was not found to be critical, units within government faced considerable difficulties.     

Assessing capacity for health policy and systems research in low and middle income countries*

Background  

As demand grows for health policies based on evidence, questions exist as to the capacity of developing countries to produce the health policy and systems research (HPSR) required to meet this challenge.     

The Benin experience: How computational modeling can assist major vaccine policy changes in low and middle income countries

While scientific studies can show the need for vaccine policy or operations changes, translating scientific findings to action is a complex process that needs to be executed appropriately for change to occur. Our Benin experience provided key steps and lessons learned to help computational modeling inform and lead to major policy change. The key steps are: engagement of Ministry of Health, identifying in-country “champions,” directed and efficient data collection, defining a finite set of realistic scenarios, making the study methodology transparent, presenting the results in a clear manner, and facilitating decision-making and advocacy. Generating scientific evidence is one component of policy change. Enabling change requires orchestration of a coordinated set of steps that heavily involve key stakeholders, earn their confidence, and provide them with relevant information. Our Benin EVM + CCEM + HERMES Process led to a decision to enact major changes and could serve as a template for similar approaches in other countries.     

Exploring health systems research and its influence on policy processes in low income countries

Background  

The interface between research and policymaking in low-income countries is highly complex. The ability of health systems research to influence policy processes in such settings face numerous challenges. Successful analysis of the research-policy interface in these settings requires understanding of contextual factors as well as key influences on the interface. Future Health Systems (FHS): Innovations for Equity is a consortium conducting research in six countries in Asia and Africa. One of the three cross-country research themes of the consortium is analysis of the relationship between research (evidence) and policy making, especially their impact on the poor; insights gained in the initial conceptual phase of FHS activities can inform the global knowledge pool on this subject.     

Management of hypertension in low and middle income countries: Challenges and opportunities

Hypertension is one of the most important risk factors for cardiovascular morbidity and mortality. More than a quarter of the global adult population (972 million) is currently hypertensive and almost three quarters (639 million) live in developing countries. Hypertension management therefore is of great public health importance in the developing world. In this paper, we review screening, diagnosis and management using lifestyle measures and pharmacotherapy given the resources of developed nations. We then discuss the barriers and challenges to implementing this approach and what can be done regarding prevention, screening, lifestyle modification and pharmacotherapy in developing countries. By adopting a comprehensive population based approach including policy level interventions directed at promoting lifestyle changes; a healthy diet (appropriate calories, low in saturated fats and salt additives and rich in fruits and vegetables), increased physical activity, and a smoke free environment, properly balanced with a high risk approach of cost effective clinical care, developing countries can effectively control hypertension and improve public health. Existing scientific knowledge regarding prevention, treatment and management should be harnessed as a health priority to reduce the disease burden associated with uncontrolled hypertension.     

The optimal number of routine vaccines to order at health clinics in low or middle income countries

In a low or middle income country, determining the correct number of routine vaccines to order at a health clinic can be difficult, especially given the variability in the number of patients arriving, minimal vaccination days and resource (e.g., information technology and refrigerator space) constraints. We developed a spreadsheet model to determine the potential impact of different ordering policies, basing orders on the arrival rates seen in the previous 1, 3, 6, or 12 sessions, or on long-term historical averages (where these might be available) along with various buffer stock levels (range: 5-50%). Experiments varied patient arrival rates (mean range: 1-30 per session), arrival rate distributions (Poisson, Normal, and Uniform) and vaccine vial sizes (range: 1-dose to 10-dose vials). It was found that when the number of doses per vial is small and the expected number of patients is low, the ordering policy has a more significant impact on the ability to meet demand. Using data from more prior sessions to determine arrival rates generally equates to a better ability to meet demand, although the marginal benefit is relatively small after more than 6 sessions are averaged. As expected, the addition of more buffer is helpful in obtaining better performance; however, this advantage also has notable diminishing returns. In general, the long-term demand rate, the vial sizes of the vaccines used and the method of determining the patient arrival rate all have an effect on the ability of a clinic to maximize the demand that is met.     

Cancer screening and early diagnosis in low and middle income countries

Limited health system capacities and competing health priorities in low and middle income countries (LMICs) necessitate a pragmatic approach to population-based cancer screening. Thus, the challenges faced by LMICs to implement a ‘western’ model of screening for common cancers and the possible means to overcome these challenges are presented. Breast cancer is the number one cancer with a rising trend in the majority of LMICs. Implementation of mass-scale mammography-based screening is not feasible and sustainable in most of them. While some LMICs have introduced breast cancer screening based on clinical breast examination (CBE), the programs need to be of appropriate quality. All LMICs should improve the capacity for early diagnosis of breast cancer along with other common cancers through community education, training of frontline health workers, facilitating prompt referrals and improving the infrastructure for cancer diagnosis and treatment. Resources permitting, the LMICs with high burden of cervical cancer may consider human papillomavirus (HPV) detection-based screening; a simple low-cost alternative is visual inspection with acetic acid (VIA). Regardless of the choice, a strong linkage should be established between screening and treatment with implementation of robust quality assurance. The few LMICs with a rising trend of colorectal cancers and adequate resources may implement demonstration projects to screen with fecal immunochemical tests (FIT). Oral cancer screening of habitual tobacco and/or alcohol users using oral visual examination (OVE) may be implemented in countries with high burden of the cancer, but primary prevention (i.e., tobacco/alcohol cessation) should be prioritized. Screenings for other cancers are not recommended for LMICs.     

Consumer-led demand side financing in health and education and its relevance for low and middle income countries

There is increasing awareness that supply subsidies for health and education services often fail to benefit those that are most vulnerable in a community. This recognition has led to a growing interest in and experimentation with, consumer-led demand side financing systems (CL-DSF). These mechanisms place purchasing power in the hands of consumers to spend on specific services at accredited facilities. International evidence in education and health sectors suggest a limited success of CL-DSF in raising the consumption of key services amongst priority groups. There is also some evidence that vouchers can be used to improve targeting of vulnerable groups. There is very little positive evidence on the effect of CL-DSF on service quality as a consequence of greater competition. Location of services relative to population means that areas with more provider choice, particularly in the private sector, tend to be dominated by higher and middle-income households. Extending CL-DSF in low-income countries requires the development of capacity in administering these financing schemes and also accrediting providers. Schemes could focus primarily on fixed packages of key services aimed at easily identifiable groups. Piloting and robust evaluation is required to fill the evidence gap on the impact of these mechanisms. Extending demand financing to less predictable services, such as hospital coverage for the population, is likely to require the development of a voucher scheme to purchase insurance. This suggests an already developed insurance market and is unlikely to be appropriate in most low-income countries for some time.