Determining the potential of mobilephone-based health interventions in Kumasi, Ghana

Background: Numerous reviews have reported generally positive outcomes of mobile phone-based health (mHealth) interventions in the sub-Saharan African countries, especially for people with non-communicable diseases. At the same time, the mHealth landscape is burdened by a lack of sustainability. A recently published review has identified several context factors that influence the successful implementation of mHealth. Therefore, the aim is to use these contextual factors to assess the potential for mHealth in a particular clinical setting.Design: The study used a cross-sectional, descriptive design.Setting: The clinical setting of the study was the ‘Komfo Anokye Teaching Hospital’ in Kumasi, Ghana.Participants: 150 patients attending the diabetes clinic were surveyed.Main outcome measures: Context factors that influence the perceived usefulness and ease of use of mHealth.Results: The survey revealed that patients at the diabetes centre had a positive attitude towards mobile phones, but also a low familiarity. Whereas patients faced several access barriers to care, most enabling resources for the successfuland sustainable implementation of mHealth interventions such as access to mobile phones and electricity were available.Conclusions: There is a high potential for mHealth in the setting of the diabetes clinic in Kumasi, Ghana.Keywords: Ghana, mHealth, Diabetes, potentialFunding: None Declare

Non-communicable diseases: mapping research funding organisations, funding mechanisms and research practices in Italy and Germany

Background Evidence shows that territorial borders continue to have an impact on research collaboration in Europe. Knowledge of national research structural contexts is therefore crucial to the promotion of Europe-wide policies for research funding. Nevertheless, studies assessing and comparing research systems remain scarce. This paper aims to further the knowledge on national research landscapes in Europe, focusing on non-communicable disease (NCD) research in Italy and Germany. Methods To capture the architecture of country-specific research funding systems, a three-fold strategy was adopted. First, a literature review was conducted to determine a list of key public, voluntary/private non-profit and commercial research funding organisations (RFOs). Second, an electronic survey was administered qualifying RFOs. Finally, survey results were integrated with semi-structured interviews with key opinion leaders in NCD research. Three major dimensions of interest were investigated – funding mechanisms, funding patterns and expectations regarding outputs. Results The number of RFOs in Italy is four times larger than that in Germany and the Italian research system has more project funding instruments than the German system. Regarding the funding patterns towards NCD areas, in both countries, respiratory disease research resulted as the lowest funded, whereas cancer research was the target of most funding streams. The most reported expected outputs of funded research activity were scholarly publication of articles and reports.TU Berlin, Open-Access-Mittel - 2017EC/FP7/602536/EU/ Mapping Chronic Non-Communicable Diseases Research Activities and their Impact/MAPPING_NC

Benefit Assessment and Reimbursement of Digital Health Applications: Concepts for Setting Up a New System for Public Coverage

In Germany, some digital health applications (DiHA) became reimbursable through the statutory health insurance system with the adoption of the Digital Healthcare Act in 2019. Approaches and concepts for the German care context were developed in an iterative process, based on existing concepts from international experience. A DiHA categorization was developed that could be used as a basis to enable the creation of a reimbursed DiHA repository, and to derive evidence requirements for coverage and reimbursement for each DiHA. The results provide an overview of a possible classification of DiHA as well as approaches to assessment and evaluation. The structure of remuneration and pricing in connection with the formation of groups is demonstrated

Costs of delivering human papillomavirus vaccination using a one- or two-dose strategy in Tanzania.

OBJECTIVE: As part of the Dose Reduction Immunobridging and Safety Study of Two HPV Vaccines in Tanzanian Girls (DoRIS; NCT02834637), the current study is one of the first to evaluate the financial and economic costs of the national rollout of an HPV vaccination program in school-aged girls in sub-Saharan Africa and the potential costs associated with a single dose HPV vaccine program, given recent evidence suggesting that a single dose may be as efficacious as a two-dose regimen. METHODS: The World Health Organization's (WHO) Cervical Cancer Prevention and Control Costing (C4P) micro-costing tool was used to estimate the total financial and economic costs of the national vaccination program from the perspective of the Tanzanian government. Cost data were collected in 2019 via surveys, workshops, and interviews with local stakeholders for vaccines and injection supplies, microplanning, training, sensitization, service delivery, supervision, and cold chain. The cost per two-dose and one-dose fully immunized girl (FIG) was calculated. RESULTS: The total financial and economic costs were US$10,117,455 and US$45,683,204, respectively, at a financial cost of $5.17 per two-dose FIG, and an economic cost of$23.34 per FIG. Vaccine and vaccine-related costs comprised the largest proportion of costs, followed by service delivery. In a one-dose scenario, the cost per FIG reduced to $2.51 (financial) and$12.18 (economic), with the largest reductions in vaccine and injection supply costs, and service delivery. CONCLUSIONS: The overall cost of Tanzania's HPV vaccination program was lower per vaccinee than costs estimated from previous demonstration projects in the region, especially in a single-dose scenario. Given the WHO Strategic Advisory Group of Experts on Immunization's recent recommendation to update dosing schedules to either one or two doses of the HPV vaccine, these data provide important baseline data for Tanzania and may serve as a guide for improving coverage going forward. The findings may also aid in the prioritization of funding for countries that have not yet added HPV vaccines to their routine immunizations

Wirksam und benötigt, aber nicht genutzt: Warum schaffen es digitale Gesundheitsanwendungen in Afrika nicht in die Regelversorgung?

Gedruckt erschienen im Universitätsverlag der TU Berlin, ISBN 978-3-7983-3052-8 (ISSN 2197-8123).Reviews have shown that mobile phone-based health interventions (mHealth interventions) are capable of improving health outcomes of patients in Africa, particularly for patients with chronic diseases such as non-communicable diseases (NCDs). But currently, most mHealth interventions are stopped after the pilot and the funding of the donors has ceased. The aim is to identify the reasons for the lacking integration of mHealth interventions against NCDs in sub Saharan African health systems. 10 countries from sub-Saharan Africa (SSA) were selected for the analysis. For the assessment a catalogue of indicators was developed. Data for the indicators was gathered from various sources: databases, literature reviews and expert interviews. mHealth against NCDs is still in its infancy. Inhibiting factors for the further uptake of mHealth are the lack of specific action points by the governments, the missing attention paid to the rising burden of NCDs, the non-utilization of the full potential of mHealth, the lack of financial incentives and standardized workshops/guidelines and lack of good governance. The access to mobile phones is also inhibited by the poor electricity infrastructure. Enabling factors in many countries are numerous published eHealth strategies, constantly improving legislative frameworks (such as data protection laws) and a growing technology start-up ecosystem.Reviews haben gezeigt, dass Mobiltelefon-basierte Gesundheitsinterventionen (mHealth Interventionen) in der Lage sind klinische Outcomes von Patienten in Afrika zu verbessern; insbesondere von Patienten mit chronischen Erkrankungen wie zum Beispiel nicht übertragbaren Krankheiten (NCDs). Jedoch bleiben die meisten mHealth Interventionen in der Projektphase und werden häufig, nachdem die Finanzierung der Geldgeber aufhört, gestoppt. Ziel dieser Arbeit ist es deswegen, die Ursachen für die mangelnde Integration von mHealth Interventionen gegen NCDs in die afrikanischen Gesundheitssysteme zu identifizieren. Für die Analyse wurden 10 Länder aus sub-Sahara Afrika (SSA) ausgewählt. Für die Bewertung wurde ein Katalog von Indikatoren entwickelt. Die Daten für die Indikatoren wurden aus verschiedenen Quellen gesammelt: Datenbanken, Literaturrecherchen und Experteninterviews. Hemmende Faktoren für eine flächendeckende Verbreitung sind unter anderem das Fehlen spezifischer Zielvorgaben durch die Regierungen, die fehlende Berücksichtigung von NCDs in den verschiedenen Digitalstrategien, die Nichtausschöpfung des vollen Potenzials von mHealth, das Fehlen von finanziellen Anreizen und standardisierten Workshops/Richtlinien, sowie mangelnde Good Governance. Außerdem wird der Zugang zu Mobiltelefonen durch die schlechte Elektrizitäts-Infrastruktur behindert. Fördernde Faktoren sind die zahlreichen eHealth-Strategien, die sich ständig verbessernden gesetzliche Rahmenbedingungen (z.B. Datenschutzgesetze) und die wachsenden Start-up-Ökosysteme

Payment methods for hospital stays with a large variability in the care process : Short Report

43 p.ill.,SHORT REPORT 1 -- 1. INTRODUCTION 3 -- 1.1. BACKGROUND. 3 -- 1.2. RESEARCH QUESTIONS AND SCOPE OF THE STUDY 5 -- 1.3. METHODS 6 -- 2. INTERNATIONAL COMPARISON OF EXCLUSION MECHANISMS 7 -- 2.1. DENMARK. 11 -- 2.2. ENGLAND 12 -- 2.3. ESTONIA 13 -- 2.4. FRANCE. 14 -- 2.5. GERMANY. 15 -- 2.6. USA – MEDICARE PART A 16 -- 3. HOSPITAL PAYMENT METHODS IN BELGIUM FOR COMPLEX OR DIFFICULT TO STANDARDISE CARE 17 -- 3.1. REDUCING VARIABILITY UNDER DRG-BASED HOSPITAL PAYMENT 17 -- 3.2. HOW ARE BELGIAN HOSPITALS PAID FOR STAYS WITH A LARGE VARIABILITY IN THE CARE PROCESS? 18 -- 3.2.1. Hospital revenue sources 18 -- 3.2.2. Adjustments to the DRG system: B2-points are weighted.19 -- 3.2.3. Adjustments at the margin of DRG-based hospital payment: outlier payments, supplementary points and payments for services relevant for several DRGs 20 -- 3.2.4. Payment methods outside of DRG-based hospital payment 23 -- 4. PAYMENT MECHANISMS FOR PARTICULAR AREAS OF CARE 25 -- 4.1. CANCER TREATMENT 27 -- 4.2. SPECIALISED PAEDIATRICS 27 -- 4.3. SEVERE BURNS 28 -- 4.4. NEUROLOGICAL DISEASES. 28 -- 4.5. INTENSIVE CARE UNIT 29 -- 4.6. DIALYSIS 30 -- 4.7. ORGAN MANAGEMENT AND TRANSPLANTATIONS 30 -- 4.8. DIAGNOSTIC IMAGING SERVICES AND RADIOTHERAPY 31 -- 5. DISCUSSION 31 -- 5.1. IMPORTANCE OF PATH DEPENDENCY 31 -- 5.2. A CLOSE LINK WITH THE CORE PAYMENT METHOD. 31 -- 5.3. STEERING CARE CAN LOWER HIGH VARIABILITY 32 -- 5.4. OUTLIER PAYMENTS 33 -- 5.5. A WIDE DIVERSITY OF PAYMENT METHODS FOR HIGHLY VARIABLE, COMPLEX OR RARE CARE 33 -- 5.6. NO CLEAR DEFINITION OF EXCLUSION CRITERIA 34 -- 5.7. BELGIUM: FRAGMENTED PAYMENT SYSTEM BUT COMPARABLE INSTRUMENTS AS ABROAD EXIST TO DEAL WITH VARIABILITY 34 -- 5.8. WHICH POLICY CONCLUSIONS CAN BE DRAWN FROM THIS STUDY? 35 -- RECOMMENDATIONS 37 -- REFERENCES 4

Financement des séjours hospitaliers pour les soins à haute variabilité : Synthèse

36 p.ill.,Dans sa réforme du financement des hôpitaux, la ministre de la Santé Maggie De Block prévoit de répartir les séjours hospitaliers en trois « clusters » en fonction de la variabilité des soins, chaque cluster bénéficiant d’une forme de financement différente. C’est dans cette optique qu’elle a demandé au Centre fédéral d’expertise des Soins de Santé (KCE) d'analyser la manière dont d’autres pays financent les soins à haute variabilité. Mais étant donné que le choix d’un tel financement est lié aux priorités et aux politiques de chaque pays, il n'est pas possible de transposer telle quelle une méthode de financement étrangère au système belge. Il faut donc d’abord poser des choix politiques nécessaires. Le KCE recommande de commencer par une étude « proof of concept » consistant à développer un financement tenant compte de la variabilité, par exemple pour la prise en charge de l'AVC, pour laquelle un modèle organisationnel a déjà été choisi par les autorités.PRÉFACE. 1 -- SYNTHÈSE . 2 -- 1. INTRODUCTION 4 -- 1.1. CONTEXTE. 4 -- 1.2. QUESTIONS DE RECHERCHE ET PORTÉE DE L’ÉTUDE. 6 -- 2. COMMENT LES AUTRES PAYS FINANCENT-ILS LES SOINS À HAUTE VARIABILITÉ ? 7 -- 2.1. APERÇU DES MÉCANISMES D’EXCLUSION. 7 -- 2.2. TROIS TYPES DE MÉCANISMES POUR DIMINUER LA VARIABILITÉ.10 -- 2.2.1. Adaptations régulières du système de DRG proprement dit 10 -- 2.2.2. Mécanismes en marge du système de DRG 10 -- 2.2.3. Mécanismes extérieurs au système de DRG 12 -- 3. COMMENT SONT FINANCÉS LES SOINS À HAUTE VARIABILITÉ DANS LES HÔPITAUX BELGES ?. 12 -- 3.1. SOURCES DE FINANCEMENT DES HÔPITAUX BELGES 12 -- 3.2. ADAPTATION AU NIVEAU DU SYSTÈME DE DRG PROPREMENT DIT : PONDÉRATION DES POINTS B2 13 -- 3.2.1. L’activité justifiée, pierre angulaire du financement par pathologie en Belgique 13 -- 3.2.2. Adaptation du système de DRG par la pondération du nombre de lits justifiés par service.14 -- 3.3. FINANCEMENT EN MARGE DU SYSTÈME DRG : OUTLIERS, POINTS SUPPLÉMENTAIRES ET SERVICES OU PRODUITS SPÉCIFIQUES 14 -- 3.3.1. Financement des outliers et des groupes résiduels .14 -- 3.3.2. Points supplémentaires pour des services spécifiques 15 -- 3.3.3. Points supplémentaires pour les hôpitaux avec un profil d’activité ou de soins infirmiers plus intensif 15 -- 3.3.4. Remboursement de médicaments et dispositifs médicaux onéreux/nouveaux/spécifiques.17 -- 3.3.5. Autres mécanismes ciblant la pharmacie, l’hôpital de jour et les patients à faible statut socio-économique 17 -- 3.4. FINANCEMENT EN-DEHORS DU SYSTÈME DE DRG POUR CERTAINS HÔPITAUX OU DÉPARTEMENTS. 18 -- 4. MÉCANISMES DE FINANCEMENT UTILISÉS DANS DES DOMAINES DE SOINS SPÉCIFIQUES 21 -- 4.1. TRAITEMENTS ONCOLOGIQUES . 21 -- 4.2. SOINS PÉDIATRIQUES SPÉCIALISÉS 22 -- 4.3. GRANDS BRÛLÉS 23 -- 4.4. MALADIES NEUROLOGIQUES 23 -- 4.5. LES SERVICES DES SOINS INTENSIFS 24 -- 4.6. DIALYSE. 25 -- 4.7. GESTION DES ORGANES ET TRANSPLANTATIONS 25 -- 4.8. IMAGERIE DIAGNOSTIQUE ET RADIOTHÉRAPIE 26 -- 5. DISCUSSION 26 -- 5.1. UNE GRANDE DISPARITÉ DANS LES MÉCANISMES D’EXCLUSION.26 -- 5.2. DIFFÉRENTES APPROCHES POUR LE FINANCEMENT DES OUTLIERS 27 -- 5.3. DIFFICILE DE TIRER DES ENSEIGNEMENTS DES EXEMPLES ÉTRANGERS .27 -- RECOMMANDATIONS 31 -- RÉFÉRENCES 3

Die Bekämpfung von chronischen Krankheiten in Afrika : die Wirksamkeit, der Bedarf und die Implementierung von mobilfunk-gestützten Gesundheitsinterventionen gegen nicht-übertragbare Krankheiten in Subsahara Afrika

This dissertation deals with mobile phone-based health interventions (mHealth interventions) against chronic Non-Communicable Diseases (NCDs) in the poorest region of the world: Sub-Saharan Africa (SSA). First, a systematic review of randomized controlled trials in low-income countries was conducted in order to analyze the efficacy of mHealth interventions against NCDs. A 'Realist Review' was then used to identify factors influencing the 'perceived user-friendliness and usefulness' of mHealth interventions against NCDs in SSA. These factors were translated into a questionnaire to determine the potential for mHealth interventions in a particular region. Subsequently, 150 patients with Diabetes at the Diabetes Clinic of the ‘Komfo Anokye Teaching Hospital’ in Kumasi, Ghana were interviewed using the questionnaire. In a further part, the need for mHealth interventions was considered and the current self-management behavior of people from SSA with Diabetes was evaluated through a systematic review. In the last part of the work, the current implementation of mHealth against NCDs in African health systems was investigated. A framework consisting of 18 parameters was developed based on the Building Block concept of the World Health Organization (WHO). The parameters of this framework were then evaluated in 10 representative SSA countries.Diese Dissertation beschäftigt sich mit mobilfunk-gestützten Gesundheitsinterventionen (mHealth Interventionen) gegen chronische, nicht-übertragbare Krankheiten (NCDs) in der ärmsten Region der Welt: Subsahara Afrika (SSA). Es wurde zunächst eine Analyse der Wirksamkeit von mHealth Interventionen gegen NCDs anhand einer systematischen Übersichtsarbeit von bisher durchgeführten randomisiert kontrollierten Studien in einkommensschwachen Ländern durchgeführt. Mit Hilfe eines ‚Realist Review‘ wurden dann Faktoren identifiziert, welche die ‚wahrgenommene Benutzerfreundlichkeit und Nützlichkeit‘ von mHealth Interventionen gegen NCDs in SSA beeinflussen. Diese Faktoren wurden in einen Fragebogen überführt, mit Hilfe dessen das Potential für mHealth Interventionen in einer bestimmten Region ermittelt werden kann. Anschließend wurden 150 PatientInnen mit Diabetes an der Diabetes-Klinik des ‚Komfo Anokye Teaching Hospital‘ in Kumasi, Ghana mit Hilfe des Fragebogens befragt. In einem weiteren Teil wurde der Bedarf von mHealth Interventionen betrachtet und durch eine systematische Übersichtsarbeit das derzeitige Selbstmanagementverhalten von Menschen mit Diabetes aus SSA bewertet. Im letzten Teil der Arbeit wurde schließlich die derzeitige Implementierung von mHealth gegen NCDs in den afrikanischen Gesundheitssystemen ermittelt. Dazu wurde ein Framework bestehend aus 18 Parametern auf Grundlage des ‚Building Block‘ Konzepts der Weltgesundheitsorganisation (WHO) entwickelt. Diese Framework-Parameter wurden dann in 10 repräsentativen SSA-Ländern bewertet