HOW THE COVID PANDEMIC HAS INFLUENCED THE PROCESS OF PRIMARY HEALTH CARE REFORM PRIORITY SETTING: A CASE STUDY FROM PAKISTAN

Background: Primary health care is a critical component of health systems, but there is a relative paucity of information on the indirect impact the COVID pandemic may have on primary health care systems in low and low-middle income countries using a policy process lens. Objective: This case study from Khyber Pakhtunkhwa in Pakistan is of a PHC reform agenda from 2020-2023 and aims to contribute to the understanding of the varying effects that the wide-ranging shock of COVID had on prioritization processes within primary healthcare reforms in the province, and early implementation of that reform. Methods and conceptual framework: This analysis draws on 14 in-depth semi-structured interviews from key officials across the provincial government and the wider policy community, complemented with a document analysis. Results were analyzed using health systems themes drawing from a resilient health systems framework, coupled with a process tracing approach to describe the reform process. The outputs of reform analysis were then examined through a modified multiple streams framework/policy feedback theory framework to describe how well the framework could describe the drivers of the reform. Results: The health systems analysis illustrates the breadth of health systems components relevant during the pandemic. Process tracing describes how a reactive public sector primary health care agenda pre-pandemic driven by external priorities evolved into a new reform agenda after the emergency phase of the COVID response. This evolution was contributed to by an increased ability to influence the allocation of resources due to increased political power from perceived successful management of the pandemic amongst health system leadership, a wider appreciation for gaps in health system performance, and sharing of learnings from the reform experience of the neighboring province of Punjab. Conclusion: This case study illustrates the mechanics of how a ‘window of opportunity’ for reform in in LMIC primary health care systems may have been opened due to the COVID pandemic, and how understanding the experience within the system of the pandemic could help inform a reform agenda using policy frameworks to help understand drivers of reform

The inclusion of diagnostics in national health insurance schemes in Cambodia, India, Indonesia, Nepal, Pakistan, Philippines and Viet Nam

The Lancet Commission on Diagnostics highlighted a huge gap in access to diagnostic testing even for basic tests, particularly at the primary care level, and emphasised the need for countries to include diagnostics as part of their universal health coverage benefits packages. Despite the poor state of diagnostic-related services in low-income and middle-income countries (LMICs), little is known about the extent to which diagnostics are included in the health benefit packages. We conducted an analysis of seven Asian LMICs - Cambodia, India, Indonesia, Nepal, Pakistan, Philippines, Viet Nam - to understand this issue. We conducted a targeted review of relevant literature and applied a health financing framework to analyse the benefit packages available in each government-sponsored scheme. We found considerable heterogeneity in country approaches to diagnostics. Of the seven countries, only India has developed a national essential diagnostics list. No country presented a clear policy rationale on the inclusion of diagnostics in their scheme and the level of detail on the specific diagnostics which are covered under the schemes was also generally lacking. Government-sponsored insurance expansion in the eligible populations has reduced the out-of-pocket health payment burden in many of the countries but overall, there is a lack of access, availability and affordability for diagnostic-related services

The governance of personal data for COVID-19 response: perspective from the access to COVID-19 tools accelerator

COVID-19 is the world’s first digital pandemic. Digital tools and technologies have been developed to track and trace the spread of the virus, screen for infection, and the pandemic has accelerated the use of digital technology in the delivery of healthcare. The continued development of these tools and technologies, the monitoring of the virus and the development of new tests, treatments and vaccines are dependent on the collection of and access to vast amounts of personal data. This includes clinical data, epidemiological data and public health data that may be collected from laboratories, medical records, wearables and smartphone apps. Previous public health emergencies (PHEs) have demonstrated the importance in making this data available, and early in the COVID-19 pandemic, there were calls for making all kinds of data, including clinical trial data, routine surveillance data, genetic sequencing, and data on the ongoing monitoring of disease control programmes, openly and rapidly available. As part of this, personal data on age, race, sex, health, ethnic group, and socioeconomic factors have been shared. This has helped led to the rapid development of COVID-19 interventions. It has also enabled the better understanding of factors contributing to difference in infection rates and effectiveness of tests, treatments, and vaccines. However, the use of this particularly sensitive data can infringe upon individual and group privacy, increase the risks of individual and group stigma and discrimination, and it may negatively impact already vulnerable, marginalised or minority populations. [...

Optimal use of COVID-19 Ag-RDT screening at border crossings to prevent community transmission: A modeling analysis.

Countries around the world have implemented restrictions on mobility, especially cross-border travel to reduce or prevent SARS-CoV-2 community transmission. Rapid antigen testing (Ag-RDT), with on-site administration and rapid turnaround time may provide a valuable screening measure to ease cross-border travel while minimizing risk of local transmission. To maximize impact, we developed an optimal Ag-RDT screening algorithm for cross-border entry. Using a previously developed mathematical model, we determined the daily number of imported COVID-19 cases that would generate no more than a relative 1% increase in cases over one month for different effective reproductive numbers (Rt) and COVID-19 prevalence within the recipient country. We then developed an algorithm-for differing levels of Rt, arrivals per day, mode of travel, and SARS-CoV-2 prevalence amongst travelers-to determine the minimum proportion of people that would need Ag-RDT testing at border crossings to ensure no greater than the relative 1% community spread increase. When daily international arrivals and/or COVID-19 prevalence amongst arrivals increases, the proportion of arrivals required to test using Ag-RDT increases. At very high numbers of international arrivals/COVID-19 prevalence, Ag-RDT testing is not sufficient to prevent increased community spread, especially when recipient country prevalence and Rt are low. In these cases, Ag-RDT screening would need to be supplemented with other measures to prevent an increase in community transmission. An efficient Ag-RDT algorithm for SARS-CoV-2 testing depends strongly on the epidemic status within the recipient country, volume of travel, proportion of land and air arrivals, test sensitivity, and COVID-19 prevalence among travelers

Assistive technology policy: a position paper from the first global research, innovation, and education on assistive technology (GREAT) summit

creased awareness, interest and use of assistive technology (AT) presents substantial opportunities for many citizens to become, or continue being, meaningful participants in society. However, there is a significant shortfall between the need for and provision of AT, and this is patterned by a range of social, demographic and structural factors. To seize the opportunity that assistive technology offers, regional, national and sub-national assistive technology policies are urgently required. This paper was developed for and through discussion at the Global Research, Innovation and Education on Assistive Technology (GREAT) Summit; organized under the auspices of the World Health Organization’s Global Collaboration on Assistive Technology (GATE) program. It outlines some of the key principles that AT polices should address and recognizes that AT policy should be tailored to the realities of the contexts and resources available. AT policy should be developed as a part of the evolution of related policy across a number of different sectors and should have clear and direct links to AT as mediators and moderators for achieving the Sustainable Development Goals. The consultation process, development and implementation of policy should be fully inclusive of AT users, and their representative organizations, be across the lifespan, and imbued with a strong systems-thinking ethos. Six barriers are identified which funnel and diminish access to AT and are addressed systematically within this paper. We illustrate an example of good practice through a case study of AT services in Norway, and we note the challenges experienced in less wellresourced settings. A number of economic factors relating to AT and economic arguments for promoting AT use are also discussed. To address policy-development the importance of active citizenship and advocacy, the need to find mechanisms to scale up good community practices to a higher level, and the importance of political engagement for the policy process, are highlighted. Policy should be evidenceinformed and allowed for evidence-making; however, it is important to account for other factors within the given context in order for policy to be practical, authentic and actionable