Governance framework for skilled health worker migration in Nigeria.

Governance framework for skilled health worker migration in Nigeria.</p

How Much Does a Verbal Autopsy Based Mortality Surveillance System Cost in Rural India?

<div><p>Objective</p><p>This paper aims to determine the cost of establishing and sustaining a verbal-autopsy based mortality surveillance system in rural India.</p><p>Materials and Methods</p><p>Deaths occurring in 45 villages (population 185,629) were documented over a 4-year period from 2003–2007 by 45 non-physician healthcare workers (NPHWs) trained in data collection using a verbal autopsy tool. Causes of death were assigned by 2 physicians for the first year and by one physician for the subsequent years. Costs were calculated for training of interviewers and physicians, data collection, verbal autopsy analysis, project management and infrastructure. Costs were divided by the number of deaths and the population covered in the year.</p><p>Results</p><p>Verbal-autopsies were completed for 96.7% (5786) of all deaths (5895) recorded. The annual cost in year 1 was INR 1,133,491 (USD 24,943) and the total cost per death was INR 757 (USD 16.66). These costs included training of NPHWs and physician reviewers Rs 67,025 (USD 1474), data collection INR 248,400 (USD 5466), dual physician review for cause of death assignment INR 375,000 (USD 8252), and project management INR 341,724 (USD 7520). The average annual cost to run the system each year was INR 822,717 (USD18104) and the cost per death was INR 549 (USD 12) for the next 3 years. Costs were reduced by using single physician review and shortened re-training sessions. The annual cost of running a surveillance system was INR 900,410 (USD 19814).</p><p>Discussion</p><p>This study provides detailed empirical evidence of the costs involved in running a mortality surveillance site using verbal-autopsy.</p></div

Start-up cost of the VA based mortality surveillance (2003–2004).

<p>Start-up cost of the VA based mortality surveillance (2003–2004).</p

Task Shifting for Non-Communicable Disease Management in Low and Middle Income Countries – A Systematic Review

<div><p>Background</p><p>One potential solution to limited healthcare access in low and middle income countries (LMIC) is task-shifting- the training of non-physician healthcare workers (NPHWs) to perform tasks traditionally undertaken by physicians. The aim of this paper is to conduct a systematic review of studies involving task-shifting for the management of non-communicable disease (NCD) in LMIC.</p><p>Methods</p><p>A search strategy with the following terms “task-shifting”, “non-physician healthcare workers”, “community healthcare worker”, “hypertension”, “diabetes”, “cardiovascular disease”, “mental health”, “depression”, “chronic obstructive pulmonary disease”, “respiratory disease”, “cancer” was conducted using Medline via Pubmed and the Cochrane library. Two reviewers independently reviewed the databases and extracted the data.</p><p>Findings</p><p>Our search generated 7176 articles of which 22 were included in the review. Seven studies were randomised controlled trials and 15 were observational studies. Tasks performed by NPHWs included screening for NCDs and providing primary health care. The majority of studies showed improved health outcomes when compared with usual healthcare, including reductions in blood pressure, increased uptake of medications and lower depression scores. Factors such as training of NPHWs, provision of algorithms and protocols for screening, treatment and drug titration were the main enablers of the task-shifting intervention. The main barriers identified were restrictions on prescribing medications and availability of medicines. Only two studies described cost-effective analyses, both of which demonstrated that task-shifting was cost-effective.</p><p>Conclusions</p><p>Task-shifting from physicians to NPHWs, if accompanied by health system re-structuring is a potentially effective and affordable strategy for improving access to healthcare for NCDs. Since the majority of study designs reviewed were of inadequate quality, future research methods should include robust evaluations of such strategies.</p></div

Cost for running the surveillance for subsequent years (2004–2007).

<p>Cost for running the surveillance for subsequent years (2004–2007).</p

Inclusion and Exclusion Criteria.

<p>Inclusion and Exclusion Criteria.</p

Overall design of the verbal autopsy based mortality surveillance system.

<p>Overall design of the verbal autopsy based mortality surveillance system.</p

The process of identifying relevant papers.

<p>The process of identifying relevant papers.</p

Studies included in the review.

<p>*Randomised Control Trial # Cluster Randomised Control Trial.</p

Additional file 1: of What is the optimal recall period for verbal autopsies? Validation study based on repeat interviews in three populations

List of target causes for the VA for adults, children and neonates. (DOCX 12 kb