Universal Health Coverage in Francophone Sub-Saharan Africa: Assessment of Global Health Experts' Confidence in Policy Options

Many countries rely on standard recipes for accelerating progress toward universal health coverage (UHC). With limited generalizable empirical evidence, expert confidence and consensus plays a major role in shaping country policy choices. This article presents an exploratory attempt conducted between April and September 2016 to measure confidence and consensus among a panel of global health experts in terms of the effectiveness and feasibility of a number of policy options commonly proposed for achieving UHC in low- and middle-income countries, such as fee exemptions for certain groups of people, ring-fenced domestic health budgets, and public-private partnerships. To ensure a relative homogeneity of contexts, we focused on French-speaking sub-Saharan Africa. We initially used the Delphi method to arrive at expert consensus, but since no consensus emerged after 2 rounds, we adjusted our approach to a statistical analysis of the results from our questionnaire by measuring the degree of consensus on each policy option through 100 (signifying total consensus) minus the size of the interquartile range of the individual scores. Seventeen global health experts from various backgrounds, but with at least 20 years'experience in the broad region, participated in the 2 rounds of the study. The results provide an initial "mapping" of the opinions of a group of experts and suggest interesting lessons. For the 18 policy options proposed, consensus emerged only on strengthening the supply of quality primary health care services (judged as being effective with a confidence score of 79 and consensus score of 90), and on fee exemptions for the poorest (judged as being fairly easy to implement with a confidence score of 66 and consensus score of 85). For none of the 18 common policy options was there consensus on both potential effectiveness and feasibility, with very diverging opinions concerning 5 policy options. The lack of confidence and consensus within the panel seems to reflect the lack of consistent evidence on the proposed policy options. This suggests that experts' opinions should be framed within strengthened inclusive and "evidence-informed deliberative processes" where the trade-offs along the 3 dimensions of UHC—extending the population covered against health hazards, expanding the range of services and benefits covered, and reducing out-of-pocket expenditures—can be discussed in a transparent and contextualized setting.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Renforcement des systèmes de santé: Capitalisation des interventions de la Coopération Belge au Burundi, en RDC et au Rwanda

Actes de l'Atelier Régional Santé :Rubavu, Rwanda. Du 12 au 15 septembre 2011info:eu-repo/semantics/publishedL'Harmattan, Paris

Preliminary study of effects of anti GnRH vaccine on the germ line in 8 months Sarda rams

Several treatments can change reversibly (high and low temperatures and alteration of testosterone levels) or irreversibly (x-ray and chemotherapy) the structural morphology of the testis with alteration of spermatogenesis. The aim of this study was to evaluate the effects of an anti GnRH vaccine on germinal line and seminiferous epithelium in 8 months Sarda rams. The study was carried out using 10 Sarda rams divided into treated and control group. In both groups scrotal circumference and testosterone levels were measured weekly for 12 weeks and histological samples of the testes were collected. The results showed that scrotal circumferences and testosterone levels decreased in the treated group and the seminiferous tubules appeared depleted of the germinal line compared to the control group. The present study showed that the anti GNRH vaccine can be successfully used in rams to inhibit spermatogenesis

Long Way to Universal Health Coverage (UHC): Are Policy Dialogue Processes Appropriate to Negotiate Trade-Offs in Africa? The Cases of Benin and Senegal

The numerous stakeholders involved in the development of universal health coverage (UHC) policies are likely to have diverging interests about which dimensions to prioritize, hence the importance of ensuring an effective and transparent policy dialogue. This paper aims to investigate whether or not UHC policy dialogue processes are functioning well in Benin and Senegal. Based on a literature review, we have identified a number of characteristics guaranteeing the quality of policy dialogue processes, which we have integrated into an analytical grid. The quality criteria identified were classified along four dimensions: stakeholder participation, dialogue/negotiation process, quality of situation analysis and decision criteria, and results from the negotiation process. Based on data collected through documentary review, interviews, an electronic survey and the authors’ own experience, we applied that analytical grid to the cases of Benin and Senegal. In both countries, the policy dialogue processes are largely imperfect in terms of many of the quality criteria identified. Decisions were made under strong political leadership, ensuring government coordination and ownership, and strong emphasis has been put on expanding financial risk protection. Yet, both countries perform poorly in a number of dimensions, especially with regards to conflicts of interest, transparency and accountability. None of them has really institutionalized a UHC policy dialogue process, and the UHC policymaking processes have actually bypassed existing health sector coordination mechanisms. The two countries perform well regarding the quality of situation analysis. A small (in the case of Benin) or broader (in the case of Senegal) governmental coalition managed to impose its views, given insufficient stakeholder participation. Policy networks were particularly influential in Senegal. Overall, there are important gaps that reduce the quality of UHC policy dialogue processes, hence explaining the weaknesses in their results in terms of transparency and accountability. Our analytical framework enables us to identify rooms for improvement with regard to country-led negotiation processes relating to UHC.Les nombreux acteurs impliqués dans l’élaboration des politiques de couverture santé universelle (CSU) sont susceptibles d’avoir des intérêts divergents sur les dimensions à privilégier, d’où l’importance de garantir un dialogue politique efficace et transparent. Ce papier de recherche a pour but d’examiner si les processus de dialogue politique sur la CSU fonctionnent ou non bien au Bénin et au Sénégal. Sur la base d’une revue de la littérature, nous avons identifié un certain nombre de caractéristiques garantissant la qualité des processus de dialogue politique, que nous avons intégrées dans une grille d’analyse. Les critères de qualité identifiés ont été classés selon quatre dimensions : la participation des parties prenantes, le processus de dialogue/négociation, la qualité de l’analyse de la situation et les critères de décision, et les résultats du processus de négociation. Sur la base des données recueillies par le biais d’une revue documentaire, d’entretiens, d’une enquête électronique et de l’expérience des auteurs, nous avons appliqué cette grille d’analyse aux cas du Bénin et du Sénégal. Dans ces deux pays, les processus de dialogue politique sont largement imparfaits en ce qui concerne bon nombre des critères de qualité identifiés. Les décisions ont été prises sous un leadership politique fort, assurant la coordination et l’appropriation par le gouvernement, et l’accent a été mis sur l’élargissement de la protection contre les risques financiers. Pourtant, les deux pays affichent de piètres performances dans un certain nombre de domaines, notamment en ce qui concerne les conflits d’intérêts, la transparence et la redevabilité. Aucun d’entre eux n’a réellement institutionnalisé un processus de dialogue politique en vue de la CSU, et les processus d’élaboration des politiques de CSU ont en fait contourné les mécanismes de coordination existants dans le secteur de la santé. Les deux pays obtiennent de bons résultats en ce qui concerne la qualité de l’analyse de la situation. Une petite coalition gouvernementale (dans le cas du Bénin) ou plus large (dans le cas du Sénégal) a réussi à imposer ses vues, compte tenu de la participation insuffisante des parties prenantes. Les réseaux politiques ont été particulièrement influents au Sénégal. Dans l’ensemble, il existe des lacunes importantes qui réduisent la qualité des processus de dialogue politique sur la CSU, ce qui explique les faiblesses de leurs résultats en termes de transparence et de redevabilité. Notre cadre analytique nous permet d’identifier les possibilités d’amélioration des processus de négociation menés par les pays en matière de CSU.ARC Effi-Sant

Long Way to Universal Health Coverage (UHC): Are Policy Dialogue Processes Appropriate to Negotiate Trade-Offs in Africa? The Cases of Benin and Senegal

The numerous stakeholders involved in the development of universal health coverage (UHC) policies are likely to have diverging interests about which dimensions to prioritize, hence the importance of ensuring an effective and transparent policy dialogue. This paper aims to investigate whether or not UHC policy dialogue processes are functioning well in Benin and Senegal. Based on a literature review, we have identified a number of characteristics guaranteeing the quality of policy dialogue processes, which we have integrated into an analytical grid. The quality criteria identified were classified along four dimensions: stakeholder participation, dialogue/negotiation process, quality of situation analysis and decision criteria, and results from the negotiation process. Based on data collected through documentary review, interviews, an electronic survey and the authors’ own experience, we applied that analytical grid to the cases of Benin and Senegal. In both countries, the policy dialogue processes are largely imperfect in terms of many of the quality criteria identified. Decisions were made under strong political leadership, ensuring government coordination and ownership, and strong emphasis has been put on expanding financial risk protection. Yet, both countries perform poorly in a number of dimensions, especially with regards to conflicts of interest, transparency and accountability. None of them has really institutionalized a UHC policy dialogue process, and the UHC policymaking processes have actually bypassed existing health sector coordination mechanisms. The two countries perform well regarding the quality of situation analysis. A small (in the case of Benin) or broader (in the case of Senegal) governmental coalition managed to impose its views, given insufficient stakeholder participation. Policy networks were particularly influential in Senegal. Overall, there are important gaps that reduce the quality of UHC policy dialogue processes, hence explaining the weaknesses in their results in terms of transparency and accountability. Our analytical framework enables us to identify rooms for improvement with regard to country-led negotiation processes relating to UHC.Les nombreux acteurs impliqués dans l’élaboration des politiques de couverture santé universelle (CSU) sont susceptibles d’avoir des intérêts divergents sur les dimensions à privilégier, d’où l’importance de garantir un dialogue politique efficace et transparent. Ce papier de recherche a pour but d’examiner si les processus de dialogue politique sur la CSU fonctionnent ou non bien au Bénin et au Sénégal. Sur la base d’une revue de la littérature, nous avons identifié un certain nombre de caractéristiques garantissant la qualité des processus de dialogue politique, que nous avons intégrées dans une grille d’analyse. Les critères de qualité identifiés ont été classés selon quatre dimensions :la participation des parties prenantes, le processus de dialogue/négociation, la qualité de l’analyse de la situation et les critères de décision, et les résultats du processus de négociation. Sur la base des données recueillies par le biais d’une revue documentaire, d’entretiens, d’une enquête électronique et de l’expérience des auteurs, nous avons appliqué cette grille d’analyse aux cas du Bénin et du Sénégal. Dans ces deux pays, les processus de dialogue politique sont largement imparfaits en ce qui concerne bon nombre des critères de qualité identifiés. Les décisions ont été prises sous un leadership politique fort, assurant la coordination et l’appropriation par le gouvernement, et l’accent a été mis sur l’élargissement de la protection contre les risques financiers. Pourtant, les deux pays affichent de piètres performances dans un certain nombre de domaines, notamment en ce qui concerne les conflits d’intérêts, la transparence et la redevabilité. Aucun d’entre eux n’a réellement institutionnalisé un processus de dialogue politique en vue de la CSU, et les processus d’élaboration des politiques de CSU ont en fait contourné les mécanismes de coordination existants dans le secteur de la santé. Les deux pays obtiennent de bons résultats en ce qui concerne la qualité de l’analyse de la situation. Une petite coalition gouvernementale (dans le cas du Bénin) ou plus large (dans le cas du Sénégal) a réussi à imposer ses vues, compte tenu de la participation insuffisante des parties prenantes. Les réseaux politiques ont été particulièrement influents au Sénégal. Dans l’ensemble, il existe des lacunes importantes qui réduisent la qualité des processus de dialogue politique sur la CSU, ce qui explique les faiblesses de leurs résultats en termes de transparence et de redevabilité. Notre cadre analytique nous permet d’identifier les possibilités d’amélioration des processus de négociation menés par les pays en matière de CSU.info:eu-repo/semantics/publishe

Breakthrough Cancer Pain: Preliminary Data of The Italian Oncologic Pain Multisetting Multicentric Survey (IOPS-MS)

Introduction: An ongoing national multicenter survey [Italian Oncologic Pain multiSetting Multicentric Survey (IOPS-MS)] is evaluating the characteristics of breakthrough cancer pain (BTP) in different clinical settings. Preliminary data from the first 1500 cancer patients with BTP enrolled in this study are presented here. Methods: Thirty-two clinical centers are involved in the survey. A diagnosis of BTP was performed by a standard algorithm. Epidemiological data, Karnofsky index, stage of disease, presence and sites of metastases, ongoing oncologic treatment, and characteristics of background pain and BTP and their treatments were recorded. Background pain and BTP intensity were measured. Patients were also questioned about BTP predictability, BTP onset (≤10 or >10 min), BTP duration, background and BTP medications and their doses, time to meaningful pain relief after BTP medication, and satisfaction with BTP medication. The occurrence of adverse reactions was also assessed, as well as mucosal toxicity. Results: Background pain was well controlled with opioid treatment (numerical rating scale 3.0 ± 1.1). Patients reported 2.5 ± 1.6 BTP episodes/day with a mean intensity of 7.5 ± 1.4 and duration of 43 ± 40 min; 977 patients (65.1%) reported non-predictable BTP, and 1076 patients (71.7%) reported a rapid onset of BTP (≤10 min). Higher patient satisfaction was reported by patients treated with fast onset opioids. Conclusions: These preliminary data underline that the standard algorithm used is a valid tool for a proper diagnosis of BTP in cancer patients. Moreover, rapid relief of pain is crucial for patients’ satisfaction. The final IOPS-MS data are necessary to understand relationships between BTP characteristics and other clinical variables in oncologic patients. Funding: Molteni Farmaceutici, Italy