What Does the End of Africa's Boom Mean for Universal Health Coverage?

Achieving universal health coverage by 2030, as stated in UN Global Goal 3, will require substantial increases in health spending and the proportion funded through taxation or social insurance to make health care affordable for all. Not only will institutions need to be established to ensure sustainable arrangements for social finance, it will also be vital to ensure that health financing is resilient to economic and other shocks if Global Goal 3 is to be realised. This presents a major challenge in Africa, where an economic downturn is projected in a number of resource-dependent countries, such as Mozambique and Guinea Bissau and where countries such as Sierra Leone have weakened health systems. The response to these challenges by governments and development partners, will have important effects on how well people, and the health services on which they rely, cope in the short term and longer-term evolution of health coverage

Universal Health Coverage, Economic Slowdown and System Resilience: Africa’s Policy Dilemma

Achieving universal health coverage (UHC) has become a dominant global health policy preoccupation during the last decade, advocating ambitious healthcare coverage goals, increases in health funding and financial pooling mechanisms for social protection; As many commodity-dependent African economies are presently experiencing a marked slowdown and international assistance is becoming more volatile, there seems to be a growing divide between UHC principles and policy-makers’ everyday concerns in the field; In order to keep inspiring health development in Africa, UHC thinking and international health support need to take into account the continent’s non-linear growth pattern and the need to ensure that its health systems are resilient to external shocks; Drawing from past mistakes and from the continent’s reaction to past crises, a number of macro, meso and micro policies can be identified to strengthen the UHC concept, and reconcile its aspirations with Africa’s current economic outlook.Achieving universal health coverage (UHC) has become a dominant policy reoccupation within the global health community. For Africa, progress towards UHC involves ambitious goals for expanding access to a range of effective health services, a substantial increase in health expenditure, and establishing a greater reliance on prepayment and pooling mechanisms to finance healthcare. This paper argues that if the continent is to remain committed to the concept of UHC, the associated policies and financial tenets need to incorporate the nature of Africa’s non-linear, fragile growth

Purchasing power of civil servant health workers in Mozambique

Background: Health workers ’ purchasing power is an important consideration in the development of strategies for health workforce development. This work explores the purchasing power variation of Mozambican public sector health workers, between 1999 and 2007. In general, the calculated purchasing power increased for most careers under study, and the highest percentage increase was observed for the lowest remuneration careers, contributing in this way for a relative reduction in the difference between the higher and the lower salaries. Methods: This was done through a simple and easy-to-apply methodology to estimate salaries ’ capitalization rate, by means of the accumulated inflation rate, after taking wage revisions into account. All the career categories in the Ministry of Health and affiliated public sector institutions were considered. Results: Health workers ’ purchasing power is an important consideration in the development of strategies for health workforce development. This work explores the purchasing power variation of Mozambican public sector health workers, between 1999 and 2007. In general, the calculated purchasing power increased for most careers under study, and the highest percentage increase was observed for the lowest remuneration careers, contributing in this way for a relative reduction in the difference between the higher and the lower salaries. Conclusion: These results seem to contradict a commonly held assumption that health sector pay has deteriorated over the years, and with substantial damage for the poorest. Further studies appear to be needed to design a more accurate methodology to better understand the evolution and impact of public sector healt

Rosetta: a container-centric science platform for resource-intensive, interactive data analysis

Rosetta is a science platform for resource-intensive, interactive data analysis which runs user tasks as software containers. It is built on top of a novel architecture based on framing user tasks as microservices - independent and self-contained units - which allows to fully support custom and user-defined software packages, libraries and environments. These include complete remote desktop and GUI applications, besides common analysis environments as the Jupyter Notebooks. Rosetta relies on Open Container Initiative containers, which allow for safe, effective and reproducible code execution; can use a number of container engines and runtimes; and seamlessly supports several workload management systems, thus enabling containerized workloads on a wide range of computing resources. Although developed in the astronomy and astrophysics space, Rosetta can virtually support any science and technology domain where resource-intensive, interactive data analysis is required

Costing the scaling-up of human resources for health: lessons from Mozambique and Guinea Bissau

<p>Abstract</p> <p>Introduction</p> <p>In the context of the current human resources for health (HRH) crisis, the need for comprehensive Human Resources Development Plans (HRDP) is acute, especially in resource-scarce sub-Saharan African countries. However, the financial implications of such plans rarely receive due consideration, despite the availability of much advice and examples in the literature on how to conduct HRDP costing. Global initiatives have also been launched recently to standardise costing methodologies and respective tools.</p> <p>Methods</p> <p>This paper reports on two separate experiences of HRDP costing in Mozambique and Guinea Bissau, with the objective to provide an insight into the practice of costing exercises in information-poor settings, as well as to contribute to the existing debate on HRH costing methodologies. The study adopts a case-study approach to analyse the methodologies developed in the two countries, their contexts, policy processes and actors involved.</p> <p>Results</p> <p>From the analysis of the two cases, it emerged that the costing exercises represented an important driver of the HRDP elaboration, which lent credibility to the process, and provided a financial framework within which HRH policies could be discussed. In both cases, bottom-up and country-specific methods were designed to overcome the countries' lack of cost and financing data, as well as to interpret their financial systems. Such an approach also allowed the costing exercises to feed directly into the national planning and budgeting process.</p> <p>Conclusions</p> <p>The authors conclude that bottom-up and country-specific costing methodologies have the potential to serve adequately the multi-faceted purpose of the exercise. It is recognised that standardised tools and methodologies may help reduce local governments' dependency on foreign expertise to conduct the HRDP costing and facilitate regional and international comparisons. However, adopting pre-defined and insufficiently flexible tools may undermine the credibility of the costing exercise, and reduce the space for policy negotiation opportunities within the HRDP elaboration process.</p

Context matters (but how and why?) A hypothesis-led literature review of performance based financing in fragile and conflict-affected health systems

** From PLOS via Jisc Publications Router. ** History: received 11-07-2017; collection 2018; accepted 20-03-2018; epub 03-04-2018. ** Licence for this article: http://creativecommons.org/licenses/by/4.0/Performance-based financing (PBF) schemes have been expanding rapidly across low and middle income countries in the past decade, with considerable external financing from multilateral, bilateral and global health initiatives. Many of these countries have been fragile and conflict-affected (FCAS), but while the influence of context is acknowledged to be important to the operation of PBF, there has been little examination of how it affects adoption and implementation of PBF. This article lays out initial hypotheses about how FCAS contexts may influence the adoption, adaption, implementation and health system effects of PBF. These are then interrogated through a review of available grey and published literature (140 documents in total, covering 23 PBF schemes). We find that PBF has been more common in FCAS contexts, which were also more commonly early adopters. Very little explanation of the rationale for its adoption, in particular in relation with the contextual features, is given in programme documents. However, there are a number of factors which could explain this, including the greater role of external actors and donors, a greater openness to institutional reform, and lower levels of trust within the public system and between government and donors, all of which favour more contractual approaches. These suggest that rather than emerging despite fragility, conditions of fragility may favour the rapid emergence of PBF. We also document few emerging adaptations of PBF to humanitarian settings and limited evidence of health system effects which may be contextually driven, but these require more in-depth analysis. Another area meriting more study is the political economy of PBF and its diffusion across contexts.sch_iih13pub5303pub4 [e0195301

Why do some physicians in Portuguese-speaking African countries work exclusively for the private sector? Findings from a mixed-methods study

Despite the growing interest in the private health sector in low- and middle-income countries, little is known about physicians working outside the public sector. The present work adopts a mixed-methods approach to explore characteristics, working patterns, choices, and motivations of the physicians working exclusively for the private sector in the capital cities of Cape Verde, Guinea Bissau, and Mozambique. The paper's objective is to contribute to the understanding of such physicians, ultimately informing the policies regulating the medical profession in low- and middle-income countries

Lower mortality rate in elderly patients with community-onset pneumonia on treatment with aspirin

BACKGROUND: Pneumonia is complicated by high rate of mortality and cardiovascular events (CVEs). The potential benefit of aspirin, which lowers platelet aggregation by inhibition of thromboxane A2 production, is still unclear. The aim of the study was to assess the impact of aspirin on mortality in patients with pneumonia. METHODS AND RESULTS: Consecutive patients admitted to the University-Hospital Policlinico Umberto I (Rome, Italy) with community-onset pneumonia were recruited and prospectively followed up until discharge or death. The primary end point was the occurrence of death up to 30 days after admission; the secondary end point was the intrahospital incidence of nonfatal myocardial infarction and ischemic stroke. One thousand and five patients (age, 74.7±15.1 years) were included in the study: 390 were receiving aspirin (100 mg/day) at the time of hospitalization, whereas 615 patients were aspirin free. During the follow-up, 16.2% of patients died; among these, 19 (4.9%) were aspirin users and 144 (23.4%; P<0.001) were aspirin nonusers. Overall, nonfatal CVEs occurred in 7% of patients, 8.3% in nonaspirin users, and 4.9% in aspirin users (odds ratio, 1.77; 95% confidence interval, 1.03 to 3.04; P=0.040). The Cox regression analysis showed that pneumonia severity index (PSI), severe sepsis, pleural effusion, and PaO(2)/FiO(2) ratio <300 negatively influenced survival, whereas aspirin therapy was associated with improved survival. Compared to patients receiving aspirin, the propensity score adjusted analysis confirmed that patients not taking aspirin had a hazard ratio of 2.07 (1.08 to 3.98; P=0.029) for total mortality. CONCLUSIONS: This study shows that chronic aspirin use is associated with lower mortality rate within 30 days after hospital admission in a large cohort of patients with pneumonia

Hospitalization for pneumonia is associated with decreased 1-year survival in patients with type 2 diabetes results from a prospective cohort study

Diabetes mellitus is a frequent comorbid conditions among patients with pneumonia living in the community. The aim of our study is to evaluate the impact of hospitalization for pneumonia on early (30 day) and late mortality (1 year) in patients with type 2 diabetes mellitus. Prospective comparative cohort study of 203 patients with type 2 diabetes hospitalized for pneumonia versus 206 patients with diabetes hospitalized for other noninfectious causes from January 2012 to December 2013 at Policlinico Umberto I (Rome). Enrolled patients were followed up to discharge and up to 1 year after initial hospital admission or death. Overall, 203 patients with type 2 diabetes admitted to hospital for pneumonia were compared to 206 patients with type 2 diabetes admitted for other causes (39.3% decompensated diabetes, 21.4% cerebrovascular diseases, 9.2% renal failure, 8.3% acute myocardial infarction, and 21.8% other causes). Compared to control patients, those admitted for pneumonia showed a higher 30-day (10.8% vs 1%, P&lt;0.001) and 1-year mortality rate (30.3% vs 16.8%, P&lt;0.001). Compared to survivors, nonsurvivor patients with pneumonia had a higher incidence of moderate to severe chronic kidney disease, hemodialysis, and malnutrition were more likely to present with a mental status deterioration, and had a higher number of cardiovascular events during the follow-up period. Cox regression analysis found age, Charlson comorbidity index, pH&lt;7.35 at admission, hemodialysis, and hospitalization for pneumonia as variables independently associated with mortality. Hospitalization for pneumonia is associated with decreased 1-year survival in patients with type 2 diabetes, and appears to be a major determinant of long-term outcome in these patients