A cost-effectiveness analysis of the tuberculosis control procedures applied in the Cape Divisional Council area

Bibliography: leaves 215-226.This study evaluates the costs and effectiveness of preventive and curative procedures currently available for Tuberculosis (TB) control purposes. The procedures examined are as follows : i) BCG vaccinations; ii) Secondary chemoprophylaxis; iii) Health education; iv) Mass screening campaigns; v) Investigation of contacts of infectious TB cases and symptomatic persons, i.e. suspects; and vi) Treatment regimens for notified TB patients. The analysis is largely based on data from the records of 300 randomly selected TB patients, treated at clinics in the Cape Divisional Council area in 1983. The major finding of this study is that resources available for TB control should be reallocated in the direction of secondary chemoprophylaxis, BCG vaccination administration in the Black and Coloured populations, investigation of contacts and suspects, and ambulatory treatment of notified TB patients. Conversely, vaccinating the White population, mass screening campaigns and hospitalisation of TB patients should be given relatively less emphasis in the overall TB control programme. In addition, the proportion of patients confirmed as TB cases by means of bacteriological examinations should be increased to reduce misdiagnosis

Learning About Language Arts Instruction Through Collaboration

Donna\u27s voice shows the confidence she feels today; however, her metamorphosis did not happen overnight, nor did that of the six other teachers with whom she worked on a research project during the past three years. In this article, we describe how Donna and her colleagues learned more about language arts teaching through collaborative team work — research, and writing. We also discuss what this means for teachers who are trying to change their practices and the teacher educators trying to help

Who pays for health care in Ghana?

<p>Abstract</p> <p>Background</p> <p>Financial protection against the cost of unforeseen ill health has become a global concern as expressed in the 2005 World Health Assembly <it>resolution </it>(WHA58.33), which urges its member states to "plan the transition to universal coverage of their citizens". An important element of financial risk protection is to distribute health care financing fairly in relation to ability to pay. The distribution of health care financing burden across socio-economic groups has been estimated for European countries, the USA and Asia. Until recently there was no such analysis in Africa and this paper seeks to contribute to filling this gap. It presents the first comprehensive analysis of the distribution of health care financing in relation to ability to pay in Ghana.</p> <p>Methods</p> <p>Secondary data from the Ghana Living Standard Survey (GLSS) 2005/2006 were used. This was triangulated with data from the Ministry of Finance and other relevant sources, and further complemented with primary household data collected in six districts. We implored standard methodologies (including Kakwani index and test for dominance) for assessing progressivity in health care financing in this paper.</p> <p>Results</p> <p>Ghana's health care financing system is generally progressive. The progressivity of health financing is driven largely by the overall progressivity of taxes, which account for close to 50% of health care funding. The national health insurance (NHI) levy (part of VAT) is mildly progressive and formal sector NHI payroll deductions are also progressive. However, informal sector NHI contributions were found to be regressive. Out-of-pocket payments, which account for 45% of funding, are regressive form of health payment to households.</p> <p>Conclusion</p> <p>For Ghana to attain adequate financial risk protection and ultimately achieve universal coverage, it needs to extend pre-payment cover to all in the informal sector, possibly through funding their contributions entirely from tax, and address other issues affecting the expansion of the National Health Insurance. Furthermore, the pre-payment funding pool for health care needs to grow so budgetary allocation to the health sector can be enhanced.</p

What healthcare financing changes are needed to reach universal coverage in South Africa?

The national health insurance proposed for South Africa aims to achieve a universal health system. The best way to identify the financing mechanism that is best suited to achieving this goal is to consider international evidence on funding in universal health systems. The evidence from Organisation for Economic Cooperation and Development countries and a number of middle-income countries that have achieved universal coverage clearly indicates that mandatory pre-payment financing mechanisms (i.e. general tax funding, in some cases supplemented by mandatory health insurance) must dominate, with a clearly specified, complementary role for voluntary or private health insurance

FAB:ulous! Family Literacy Nights: Learning to Listen to Families

This article describes our implementation of a program aimed at supporting families\u27 literacy through books and strategies and through capitalizing on what the families know and care about. We held several Family Literacy Nights in which we planned activities, workshops, and book give-aways around families\u27 interests, discerned during the first event. We struggled with simultaneously accomplishing our goals and those that reflected the families. In this article we share our successes as well as the lessons we learned about how to do this work

Changes in skeletal muscle gene expression following clenbuterol administration

BACKGROUND: Beta-adrenergic receptor agonists (BA) induce skeletal muscle hypertrophy, yet specific mechanisms that lead to this effect are not well understood. The objective of this research was to identify novel genes and physiological pathways that potentially facilitate BA induced skeletal muscle growth. The Affymetrix platform was utilized to identify gene expression changes in mouse skeletal muscle 24 hours and 10 days after administration of the BA clenbuterol. RESULTS: Administration of clenbuterol stimulated anabolic activity, as indicated by decreased blood urea nitrogen (BUN; P < 0.01) and increased body weight gain (P < 0.05) 24 hours or 10 days, respectively, after initiation of clenbuterol treatment. A total of 22,605 probesets were evaluated with 52 probesets defined as differentially expressed based on a false discovery rate of 10%. Differential mRNA abundance of four of these genes was validated in an independent experiment by quantitative PCR. Functional characterization of differentially expressed genes revealed several categories that participate in biological processes important to skeletal muscle growth, including regulators of transcription and translation, mediators of cell-signalling pathways, and genes involved in polyamine metabolism. CONCLUSION: Global evaluation of gene expression after administration of clenbuterol identified changes in gene expression and overrepresented functional categories of genes that may regulate BA-induced muscle hypertrophy. Changes in mRNA abundance of multiple genes associated with myogenic differentiation may indicate an important effect of BA on proliferation, differentiation, and/or recruitment of satellite cells into muscle fibers to promote muscle hypertrophy. Increased mRNA abundance of genes involved in the initiation of translation suggests that increased levels of protein synthesis often associated with BA administration may result from a general up-regulation of translational initiators. Additionally, numerous other genes and physiological pathways were identified that will be important targets for further investigations of the hypertrophic effect of BA on skeletal muscle

Promoting equitable access to health care for households

Funded by Rockefeller Foundation.Omnipraticien image by docnutpics shared under a CC-BY-NC-ND license.To develop an understanding of the dimensions of access to health care; Create greater awareness of health care access constraints from the household perspective; Promote critical evaluation of policy options to address access constraints in relation to equity goals; Promote and strengthen effective development and implementation of equitable health sector policies. The idea for developing this set of training materials arose from the ‘Affordability Ladder Program’ (ALPS). The ALPS initiative focused on the experience of households of illness and of seeking health care. As the name would suggest, a key focus of ALPS was that of affordability and other aspects of access to health care for households. The ALPS team recognised that almost all of the training materials presently available focus on illness and health services from the health system’s perspective, with little or no attention devoted to the perspective of households. In addition, few of the available materials focus explicitly on the issue of equity, which should be seen as a priority in the context of growing awareness of substantial inequities in existing health systems; the majority of training materials are presently directed towards efforts to promote efficiency of health services. This was seen as an important gap, in that health care managers and policy makers will be better placed to design and implement health care policies and detailed plans that meet population needs if they are aware of the experience of households and if equity is the ‘lens’ through which alternative policies are considered. Finally, despite access to health care being a key policy objective by many countries, there is a lack of clarity about how access is defined and what constitutes access. It is, thus, also important to explore the different aspects of access in greater detail so that equitable access can become a reality. On this basis, it was decided to develop a set of training materials that present participants with an equity ‘lens’ through which to view the challenges of promoting health system access, focusing attention on households’ experience of illness and health service access. TARGET GROUPS: The training materials can be used for a diverse set of target groups, but are primarily aimed at current and future health sector managers. It is also envisaged that the case studies can be used on an ad-hoc basis in post-graduate programs such as Masters in Public Health programs. CASE STUDY MATERIALS: Six case studies have been prepared for this course: *Experiences of households in Sri Lanka; *Availability of health services and resource allocation; *Affordability of drugs in the context of the World Trade Organisation (WTO); *Tax and insurance funding for health systems; *Health service acceptability issues; *Access board gam

The structure and financing of South African health services: future options

The current period of fundamental political change in South Africa offers a window of opportunity for the implementation of transformative health policies. The South African health system is presently characterised by considerable fragmentation of health service provision and administration, with associated inefficiencies. There is a wide degree of consensus amongst different political and health-related organisations that this can best be addressed by unifying the myriad of public sector health departments into a single National Health Service. While there would be overall policy formation, strategic planning and health service coordination at the national level, there would also be significant decentralisation of responsibility to the provincial and district levels. The major challenge for a future “Government of National Unity” will be to redress the gross inequalities in the current health system. It will need to investigate possible ways of resolving the maldistribution of resources between the public and private sectors, to reduce geographical and “racial” disparities in health service provision, and to address the financial barriers to obtaining health care for lower income groups. As there will be competing claims on the limited resources that will be available to the newly elected democratic government, alternative source of finance for health services are currently being investigated. These include increased excise on tobacco and alcohol products, increased user fees at public sector hospitals for patients who have medical insurance cover, and the possible implementation of a National Health Insurance system. The latter option is supported by many groups in South Africa, and is seen as an important mechanism for addressing the current cost spiral in the private health sector. There are unlikely to be any easy or short-term solutions to the many problems confronting the South African health system. However, if the political will to achieve a just and equitable health system is sustained, significant gains can be made during this transitional period.inequality, reform

Should countries implementing an artemisinin-based combination malaria treatment policy also introduce rapid diagnostic tests?

BACKGROUND: Within the context of increasing antimalarial costs and or decreasing malaria transmission, the importance of limiting antimalarial treatment to only those confirmed as having malaria parasites becomes paramount. This motivates for this assessment of the cost-effectiveness of routine use of rapid diagnostic tests (RDTs) as an integral part of deploying artemisinin-based combination therapies (ACTs). METHODS: The costs and cost-effectiveness of using RDTs to limit the use of ACTs to those who actually have Plasmodium falciparum parasitaemia in two districts in southern Mozambique were assessed. To evaluate the potential impact of introducing definitive diagnosis using RDTs (costing $0.95), five scenarios were considered, assuming that the use of definitive diagnosis would find that between 25$1.77 per adult treatment and artemether-lumefantrine (AL) costing $2.40 per adult treatment, as well as the option of restricting RDT use to only those older than six years. Sensitivity analyses considered lower cost ACTs and RDTs and different population age distributions. RESULTS: Compared to treating patients on the basis of clinical diagnosis, the use of RDTs in all clinically diagnosed malaria cases results in cost savings only when 29$2.12. When more than 29% of clinically diagnosed cases are malaria test positive, the incremental cost per malaria positive patient treated is less than US$1. When relatively less expensive ACTs are introduced (e.g. current WHO preferential price for AL of$1.44 per adult treatment), the RDT price to the healthcare provider should be $0.65 or lower for RDTs to be cost saving in populations with between 30 and 52% of clinically diagnosed malaria cases being malaria test positive. CONCLUSION: While the use of RDTs in all suspected cases has been shown to be cost-saving when parasite prevalence among clinically diagnosed malaria cases is low to moderate, findings show that targeting RDTs at the group older than six years and treating children less than six years on the basis of clinical diagnosis is even more cost-saving. In semi-immune populations, young children carry the highest risk of severe malaria and many healthcare providers would find it harder to deny antimalarials to those who test negative in this age group