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5 results on '"Alhassan, Robert Kaba"'

1. Health system barriers influencing timely breast cancer diagnosis and treatment among women in low and middle-income Asian countries: evidence from a mixed-methods systematic review.

Author

Afaya, Agani, Ramazanu, Sheena, Bolarinwa, Obasanjo Afolabi, Yakong, Vida Nyagre, Afaya, Richard Adongo, Aboagye, Richard Gyan, Daniels-Donkor, Silas Selorm, Yahaya, Ahmed-Rufai, Shin, Jinhee, Dzomeku, Veronica Millicent, Ayanore, Martin Amogre, and Alhassan, Robert Kaba

Subjects
CANCER diagnosis, MIDDLE-income countries, MEDICAL care, CANCER treatment, HEALTH information systems, MEDICAL care wait times
Abstract

Background: Globally, breast cancer is the most common cancer type and the leading cause of cancer mortality among women in developing countries. A high prevalence of late breast cancer diagnosis and treatment has been reported predominantly in Low- and Middle-Income Countries (LMICs), including those in Asia. Thus, this study utilized a mixed-methods systematic review to synthesize the health system barriers influencing timely breast cancer diagnosis and treatment among women in Asian countries. Methods: We systematically searched five electronic databases for studies published in English from 2012 to 2022 on health system barriers that influence timely breast cancer diagnosis and treatment among women in Asian countries. The review was conducted per the methodology for systematic reviews and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, while health system barriers were extracted and classified based on the World Health Organization (WHO)'s Health Systems Framework. The mixed-methods appraisal tool was used to assess the methodological quality of the included studies. Results: Twenty-six studies were included in this review. Fifteen studies were quantitative, nine studies were qualitative, and two studies used a mixed-methods approach. These studies were conducted across ten countries in Asia. This review identified health systems barriers that influence timely breast cancer diagnosis and treatment. The factors were categorized under the following: (1) delivery of health services (2) health workforce (3) financing for health (4) health information system and (5) essential medicines and technology. Delivery of health care (low quality of health care) was the most occurring barrier followed by the health workforce (unavailability of physicians), whilst health information systems were identified as the least barrier. Conclusion: This study concluded that health system factors such as geographical accessibility to treatment, misdiagnosis, and long waiting times at health facilities were major barriers to early breast cancer diagnosis and treatment among Asian women in LMICs. Eliminating these barriers will require deliberate health system strengthening, such as improving training for the health workforce and establishing more healthcare facilities. [ABSTRACT FROM AUTHOR]

Published
2022
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2. Decolonizing global health: an agenda for research.

Author

Zakumumpa, Henry, Diop, Nafissatou, and Alhassan, Robert Kaba

Subjects
WORLD health, DECOLONIZATION, MEDICAL care, COLLECTION agencies
Abstract

This editorial outlines the background to the BMC Health Services Research collection on decolonizing global health. The discourse on decolonizing global health is gaining increasing momentum. These persistent 'voices' have coalesced into a 'movement'. Several commentators have critiqued the way global health continues to be structured and practiced. The colonial roots of global health dominance have come under an unprecedentedly intense spotlight amid pressure for reform. [ABSTRACT FROM AUTHOR]

Published
2023
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3. Perceived needs of health tutors in rural and urban health training institutions in Ghana: Implications for health sector staff internal migration control.

Author

Alhassan, Robert Kaba, Beyere, Christopher B., Nketiah-Amponsah, Edward, and Mwini-Nyaledzigbor, Prudence P.

Subjects
*MEDICAL education, *RURAL health, *URBAN health, *HEALTH policy, *MEDICAL care
Abstract

Background: The population of Ghana is increasingly becoming urbanized with about 70% of the estimated 27 million people living in urban and peri-urban areas. Nonetheless, eight out of the ten regions in Ghana remain predominantly rural where only 32% of the national health sector workforce works. Moreover, the rural-urban disparities in the density of health tutors (staff responsible for pre-service training of health professionals) are enormous. This paper explores perceived needs of health tutors in rural and urban health training institutions in Ghana. Methods: This is a descriptive qualitative study conducted in the Greater Accra and Northern regions of Ghana. The Study used the deductive thematic and sub-thematic analysis approaches. Five health training institutions were randomly sampled, and 72 tutors engaged in separate focus group discussions with an average size of 14 participants per group in each training institution. Results: Perceived rural-urban disparities among health tutors were found in the payment of extra duty allowances; school infrastructure including libraries and internet connectivity; staff accommodation; and opportunities for scholarships and higher education. Health tutors in rural areas generally expressed more frustration with these work conditions than those in urban areas. Conclusions: There is the need to initiate and sustain work incentives that promote motivation of rural health tutors to control ongoing rural-urban migration of qualified staff. It is recommended the following incentives be prioritized to promote retention of qualified health tutors in rural health training schools: payment of research, book and rural allowances; early promotion of rural staff; prioritizing rural tutors for scholarships, and introduction of national best health tutor awards. [ABSTRACT FROM AUTHOR]

Published
2017
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4. Perspectives of frontline health workers on Ghana's National Health Insurance Scheme before and after community engagement interventions.

Author

Alhassan, Robert Kaba, Nketiah-Amponsah, Edward, Spieker, Nicole, Arhinful, Daniel Kojo, and Rinke de Wit, Tobias F.

Subjects
*NATIONAL health insurance, *MEDICAL care, *MEDICAL personnel, *DRUG accessibility, *HEALTH facilities, *MEDICAL care standards, *ATTITUDE (Psychology), *CLUSTER analysis (Statistics), *COMPARATIVE studies, *HEALTH insurance, *RESEARCH methodology, *MEDICAL cooperation, *NATIONAL health services, *SENSORY perception, *RESEARCH, *STATISTICAL sampling, *EVALUATION research, *RANDOMIZED controlled trials, *STANDARDS
Abstract

Background: Barely a decade after introduction of Ghana's National Health Insurance Scheme (NHIS), significant successes have been recorded in universal access to basic healthcare services. However, sustainability of the scheme is increasingly threatened by concerns on quality of health service delivery in NHIS-accredited health facilities coupled with stakeholders' discontentment with the operational and administrative challenges confronting the NHIS. The study sought to ascertain whether or not Systematic Community Engagement (SCE) interventions have a significant effect on frontline health workers' perspectives on the NHIS and its impact on quality health service delivery.Methods: The study is a randomized cluster trial involving clinical and non-clinical frontline health workers (n = 234) interviewed at baseline and follow-up in the Greater Accra and Western regions of Ghana. Individual respondents were chosen from within each intervention and control groupings. Difference-in-difference estimations and propensity score matching were performed to determine impact of SCE on staff perceptions of the NHIS. The main outcome measure of interest was staff perception of the NHIS based on eight (8) factor-analyzed quality service parameters.Results: Staff interviewed in intervention facilities appeared to perceive the NHIS more positively in terms of its impact on "availability and quality of drugs (p < 0.05)" and "workload on health staff/infrastructure" than those interviewed in control facilities (p < 0.1). Delayed reimbursement of service providers remained a key concern to over 70 % of respondents in control and intervention health facilities.Conclusion: Community engagement in quality service assessment is a potential useful strategy towards empowering communities while promoting frontline health workers' interest, goodwill and active participation in Ghana's NHIS. [ABSTRACT FROM AUTHOR]

Published
2016
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5. Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019

Author

William M. Gardner, Rawlance Ndejjo, Govinda Prasad Dhungana, Fereshteh Ansari, Kathleen Pillsbury Hopf, João Pedro Silva, M. Mofizul Islam, Cong Zhu, Abdul Hafiz, Irmina Maria Michalek, Syed Mohamed Aljunid, Leonardo Roever, Mustefa Glagn, Davood Anvari, Tessa M. Pilz, Sameer Vali Gopalani, Joel M. Francis, Man Mohan Mehndiratta, Rakhi Dandona, Abbas Sheikhtaheri, Mansour Ghafourifard, Simon Øverland, David Laith Rawaf, Jaykaran Charan, Akram Pourshams, Mostafa Dianatinasab, Morteza Mahmoudi, Alton Lu, Alyssa N. Sbarra, Lorainne Tudor Car, Franz Castro, Hafiz Ansar Rasul Suleria, Luca Ronfani, Marina Pinheiro, Mehran Asadi-Aliabadi, Maziar Moradi-Lakeh, Hoa Thi Do, Whitney L. Teagle, Sofia Androudi, Carl Abelardo T. Antonio, Myron Anthony Godinho, Bhaskaran Unnikrishnan, Oluchi Ezekannagha, Getinet Ayano, Seyyed Shamsadin Athari, Dimas Ria Angga Pribadi, Kyle E. Simpson, Muluken Bekele Sorrie, Vivekanand Jha, Chukwuma David Umeokonkwo, Akshaya Srikanth Bhagavathula, Cuong Tat Nguyen, Amr Hassan, Akine Eshete Abosetugn, Hailay Abrha Gesesew, Anna V. Korotkova, Brijesh Sathian, Marcello Tonelli, Olatunde Aremu, Mohammad Reza Salahshoor, Juan Jesus Carrero, Cameron J. Kneib, Ravi Prakash Jha, David H. Shaw, Hossein Samadi Kafil, Tanuj Kanchan, Khezar Hayat, Hamid Sharifi, Morteza Shamsizadeh, Muktar Omer Omer, Fatemeh Amiri, Hamidreza Pazoki Toroudi, David Edvardsson, Xiu Ju George Zhao, Hannah Han, Leticia Avila-Burgos, Adam E. Berman, Jemal Abdu Mohammed, Thomas Pilgrim, Leila Doshmangir, Mu'awiyyah Babale Sufiyan, David M. Pigott, Hadi Hassankhani, Beatriz Paulina Ayala Quintanilla, Teklemariam Gultie, Arash Ziapour, Seyed Sina Naghibi Irvani, Ilse N. Dippenaar, Jean Jacques Noubiap, Emmanuela Gakidou, Abiyu Mekonnen Gebrehiwot, Maha El Tantawi, Xuefeng Liu, Zulfiqar A. Bhutta, Keyghobad Ghadiri, João Mauricio Castaldelli-Maia, Behzad Karami Matin, Yunquan Zhang, Vera Marisa Costa, Iyad Sultan, Mostafa Hosseini, Abdulaziz Khalid Abu Haimed, Haidong Wang, Kaleab Alemayehu Zewdie, Celine M. Barthelemy, Hosna Janjani, Bartosz Miazgowski, Jobert Richie Nansseu, Arianna Maever L. Amit, John S. Ji, Ata Rafiee, Maria Inês Schmidt, Alireza Rafiei, Somayeh Bohlouli, Joana Morgado-da-Costa, Huong Lan Thi Nguyen, Pradyumna Agasthi, Tiffany K. Gill, Martin McKee, Khaled Khatab, Jae Il Shin, Animut Tagele Tamiru, Giancarlo Logroscino, Hassan Abolhassani, Syed Saoud Zaidi, Sivan Yegnanarayana Iyer Saraswathy, Garumma Tolu Feyissa, Ahmad Daryani, Ziyad Al-Aly, Gebreamlak Gebremedhn Gebremeskel, Michael T. Chung, Amirhossein Sahebkar, Mehedi Hasan, Saeed Shahabi, Diep Ngoc Nguyen, Yohannes Kinfu, Nicholas L S Roberts, Jagadish Rao Padubidri, Mika Shigematsu, Lucero Cahuana-Hurtado, Deepa Jahagirdar, Islam Y. Elgendy, Erkin M. Mirrakhimov, Tanvir M. Huda, Fakher Rahim, Dara K. Mohammad, Yingxi Zhao, Ruxandra Irina Negoi, Vinod C. Nayak, Reinhard Busse, Andrew T. Leever, Muhammad Aziz Rahman, Kathryn Mei Ming Lau, Stefania Mondello, Vivian Chia-Rong Hsieh, Kris J. Krohn, Reza Rawassizadeh, Vishnu Renjith, Jianing Ma, Moses K. Muriithi, Mark G. Shrime, Mayowa O. Owolabi, Nobuyuki Horita, Seyed Hossein Yahyazadeh Jabbari, Daniel Y. Cho, Miloje Savic, Moslem Soofi, Iqbal R. F. Elyazar, Freweini Gebrearegay G. Tela, Jonathan F. Mosser, Palash Chandra Banik, Andre Rodrigues Duraes, Yuan-Pang Wang, Natalie C. Galles, Rashid Abdi Guled, Abdallah M. Samy, Hadi Pourjafar, Roman Topor-Madry, Ayesha Humayun, Leila Zaki, Nuworza Kugbey, Maryam Khayamzadeh, Naznin Hossain, Jiregna Darega Gela, Jordi Alonso, Ruth W Kimokoti, A. A. Fomenkov, Jalal Arabloo, Aletta E. Schutte, Biruk Wogayehu Taddele, Teklehaimanot Gereziher Haile, Diego Augusto Santos Silva, Seyed Mohammad Kazem Aghamir, Maciej Banach, Deanna Anderlini, Moses J. Bockarie, Saleem Muhammad Rana, Randah R. Hamadeh, Farhad Islami, Olalekan A. Uthman, S. Mohammad Sajadi, Francisco Rogerlândio Martins-Melo, Shankar M Bakkannavar, Kairat Davletov, Soraya Seedat, Alan D. Lopez, Masoud Behzadifar, Benjamin B. Massenburg, Santosh Varughese, Ingan Ukur Tarigan, Amin Soheili, Félix Carvalho, Yun Jin Kim, Catalina Liliana Andrei, Caleb Mackay Salpeter Irvine, Mojgan Gitimoghaddam, G Anil Kumar, Rasmus J. Havmoeller, Hiroyasu Iso, Atte Meretoja, Yasir Waheed, João M. Furtado, Christian Razo, Neeti Kapoor, Mowafa Househ, Rajaa Al-Raddadi, Mohammad Khammarnia, Santi Martini, Feng Sha, Marco Vacante, Jacek A. Kopec, Hunduma Amensisa Bojia, Jacob Olusegun Olusanya, Kate E. LeGrand, Nikolay Ivanovich Briko, Robert S. Bernstein, Arun Balachandran, Davoud Adham, Ahad Bakhtiari, Shafiu Mohammed, Leake G. Gebremeskel, Smita Pakhale, Ejaz Ahmad Khan, Daniel Cury Ribeiro, Yousef Mohammad, Bernhard T. Baune, Azeem Majeed, Luis Camera, Mohammad Ali Jahani, Hasan Yusefzadeh, Rahman Shiri, Massimo Cirillo, Nikita Otstavnov, Vahid Yazdi-Feyzabadi, Paolo Lauriola, Irfan Ullah, Aruna M Kamath, Maryam Mirzaei, Zabihollah Yousefi, Iman El Sayed, Mohammad Farahmand, Yetunde O. John-Akinola, Khem Narayan Pokhrel, Felix Akpojene Ogbo, Megan Knight, Nelson J. Alvis-Zakzuk, Teferi Mekonnen, Iván Landires, Robert G. Weintraub, Chukwudi A Nnaji, Lauren E. Schaeffer, Paulo A. Lotufo, Mehdi Naderi, Tomislav Mestrovic, André Faro, Mohsen Bayati, Raffaele Palladino, Shahin Soltani, Vladimir Andreevich Korshunov, Birhanu Geta Meharie, Mihajlo Jakovljevic, Abdiwahab Hashi, Olatunji O. Adetokunboh, Dejana Braithwaite, Sergio I. Prada, Bárbara Niegia Garcia de Goulart, Reza Pourmirza Kalhori, Jee-Young Jasmine Choi, Ernoiz Antriyandarti, Ronny Westerman, Meghdad Pirsaheb, Paul S. F. Yip, Mehdi Mirzaei-Alavijeh, Gebremariam Woldu, Rashmi Gupta, Onome Bright Oghenetega, Shane D. Morrison, Inga Dora Sigfusdottir, Marcel Ausloos, Mehdi Hosseinzadeh, Marcos Roberto Tovani-Palone, K M Shivakumar, Alireza Ansari-Moghaddam, Archith Boloor, Aidin Abedi, Binyam Minuye Birihane, Mohammad Ali Mansournia, Nihad A. Almasri, Simachew Animen Bante, Carlo Eduardo Medina-Solís, Leeberk Raja Inbaraj, Edgar Denova-Gutiérrez, Antonio Biondi, Valentin Yurievich Skryabin, Srinivasa Vittal Katikireddi, Sarika Chaturvedi, Francesco Saverio Violante, Abhay Gaidhane, George A. Mensah, Naohiro Yonemoto, Ahmad Ghashghaee, Ebrahim Babaee, Saman Esmaeilnejad, Sharath Burugina Nagaraja, Avina Vongpradith, Javad Nazari, Amir Khater, Michael K. Hole, Ben Lacey, Razique Anwer, Łukasz Szumowski, Ai Koyanagi, Rajesh Sagar, Ali Rajabpour-Sanati, Seyed M Karimi, Yordanos Gizachew Yeshitila, Mona Pathak, Nithin Kumar, Masoud Foroutan, Mehdi Fazlzadeh, Anusha Ganapati Bhat, Abbas Mosapour, Kebede Deribe, Nermin Ghith, Vaman Kulkarni, Sanjay Zodpey, Asadollah Gholamian, Mohammed Shannawaz, Nancy Fullman, Benn Sartorius, Giulio Castelpietra, Ghulam Mustafa, Silvia Schiavolin, Nelson Alvis-Guzman, Jeffrey D. Stanaway, Rafael Lozano, Christopher J L Murray, Guoqing Hu, Andrew M. Briggs, Ashish Badiye, Yousef Khader, Masoud Moghadaszadeh, Rahmatollah Moradzadeh, Valery L. Feigin, Claudia I. Mastrogiacomo, Emma Smith, Yasser Vasseghian, Saeed Amini, Asif Hanif, Achala Upendra Jayatilleke, Maryam Adabi, Sarah Wulf Hanson, Bhaskar Thakur, Ravi Mehrotra, Virginia Núñez-Samudio, Lalit Dandona, Segun Emmanuel Ibitoye, Simon I. Hay, Kiirithio N. Ngari, Obinna Onwujekwe, Deborah Carvalho Malta, Lorenzo Monasta, Neda Kianipour, Khurshid Alam, Luisa Sorio Flor, Priya Rathi, Ali Bijani, Khalid A Altirkawi, Jaimie Adelson, Hamed Zandian, Frank Tanser, Dharmesh Kumar Lal, John Everett Mumford, Morteza Oladnabi, Telma Zahirian Moghadam, Rodrigo Sarmiento-Suárez, Masoud Moradi, Maseer Khan, Mohammad Ali Sahraian, Amy E. Peden, Dhirendra N Sinha, Shanshan Li, Shailesh Advani, Behshad Naghshtabrizi, Matilde Leonardi, Lope H Barrero, Nicholas Steel, Dinh-Toi Chu, Claudio Alberto Dávila-Cervantes, Pushpendra Singh, Adrian Otoiu, Fabrizio Tediosi, Yonas Getaye Tefera, Pawan Faris, George C. Patton, Christopher Troeger, Mohammed Madadin, Jeffrey V. Lazarus, Paul H. Lee, Mohammad Amin Bahrami, Wondimeneh Shibabaw Shiferaw, Emmanuel Wandera Okunga, Biniyam Sahiledengle Geberemariyam, Samer Hamidi, Young-Ho Khang, Rufus Akinyemi, Farhad Jadidi-Niaragh, Godfrey Mutashambara Rwegerera, Naser Mohammad Gholi Mezerji, Rupak Desai, Eduardo Bernabé, Jamal A. Yearwood, Nima Rezaei, Emerito Jose A. Faraon, Vasily Vlassov, Stanislav S. Otstavnov, Reed J D Sorensen, Elena V. Gnedovskaya, Johan Ärnlöv, Mukhammad David Naimzada, Tahereh Javaheri, Tamer H. Farag, Paolo Cortesi, Gbenga A. Kayode, Lucas Guimarães Abreu, Manu Raj Mathur, Getie Lake Aynalem, Narayanaswamy Venketasubramanian, Doris V.V. Ortega-Altamirano, Giorgia Giussani, Liliana G Ciobanu, Suraj Bhattarai, Basema Saddik, Mustafa Z. Younis, Ensiyeh Jenabi, Ira Martopullo, Mohamed M. Gad, Kanyin L. Ong, Addisu Melese, Fotis Topouzis, Hanne Christensen, In-Hwan Oh, Arash Sarveazad, Shuhei Nomura, Peter Memiah, Sergej M. Ostojic, Santosh Kumar Tadakamadla, Dinesh Bhandari, Ahmed Omar Bali, Farahnaz Joukar, Arielle Wilder Eagan, Emma Elizabeth Spurlock, Ferrán Catalá-López, Caroline Stein, Jonathan M. Kocarnik, Stephen S Lim, Siamak Sabour, Kelly Compton, Shoaib Hassan, Rannveig Sigurvinsdottir, Claudiu Herteliu, Aso Mohammad Darwesh, Muluken Altaye Ayza, Angela Y. Chang, Leila R Kalankesh, Rafael Alves Guimarães, Abdollah Mohammadian-Hafshejani, Lal B. Rawal, Soewarta Kosen, Degena Bahrey Tadesse, Theo Vos, Paula Moraga, Soheil Hassanipour, Abdelrahman Ibrahim Abushouk, Oladimeji Adebayo, Mikk Jürisson, Tuomo J. Meretoja, Ireneous N. Soyiri, Carlo La Vecchia, Khalil Eskandari, Aziz Sheikh, Jagdish Khubchandani, James Leigh, Morteza Arab-Zozani, Sheikh Mohammed Shariful Islam, Stefan Kohler, Olayinka Stephen Ilesanmi, Kazumasa Yamagishi, Michele Romoli, Jasvinder A. Singh, Neeraj Bedi, Ivo Iavicoli, Alyssa Pennini, Subas Neupane, Emmanuel Peprah, Sojib Bin Zaman, Marwa Rashad Salem, Mohammed Ibrahim Mohialdeen Gubari, Ramesh Holla, Bayisa Abdissa Baye, Robert Ancuceanu, Eduarda Fernandes, Chandrashekhar T Sreeramareddy, Ettore Beghi, Quique Bassat, B Reshmi, Masood Ali Shaikh, Ionut Negoi, Peter Azzopardi, Florian Fischer, Kerem Shuval, Sorin Hostiuc, Hmwe H Kyu, Ver Bilano, Siddhesh Zadey, Davide Rasella, Vahid Alipour, Sowmya J. Rao, Radoslaw Sierpinski, Irina Filip, Michelle L. Bell, Malke Asaad, Ravensara S. Travillian, Christopher R. Cederroth, Rafael Tabarés-Seisdedos, Ashkan Afshin, Saqib Ali, Mahalaqua Nazli Khatib, Saad M.A. Dahlawi, Hedayat Abbastabar, Zahid A Butt, Sagun Paudel, Vahid Rashedi, B. Suresh Kumar Shetty, Thomas R. Hird, Shokofeh Maleki, Atif Amin Baig, Reza Heidari-Soureshjani, Shaun Wen Huey Lee, Jorge R. Ledesma, Ai-Min Wu, Fablina Sharara, Zemenu Tadesse Tessema, Ratilal Lalloo, Rohollah Kalhor, Rosario Cárdenas, Amir Radfar, Salime Goharinezhad, Fereshteh Mehri, Katarzyna Kissimova-Skarbek, Spencer A. Pease, Diana Silva, Amir Hossein Goudarzian, Samath D Dharmaratne, Darshan B B, Mariya Vladimirovna Titova, Dickson A. Amugsi, Lee Ling Lim, Agegnehu Bante, Charles D.A. Wolfe, Majid A Almadi, Seyed Mohammad Riahi, Nader Jahanmehr, Yuming Guo, Tauseef Ahmad, Platon D. Lopukhov, Takahiro Tabuchi, Nicholas J Kassebaum, Jacek Jerzy Jozwiak, Ritesh G. Menezes, Giovanni Damiani, Delia Hendrie, Mostafa Amini-Rarani, Sanjay Basu, Mohammad Hossein Bakhshaei, Gholamreza Roshandel, Borhan Mansouri, Enrico Rubagotti, Anurag Agrawal, Alireza Esteghamati, Paramjit Gill, Graeme J. Hankey, Mikhail Sergeevich Zastrozhin, Nima Hafezi-Nejad, Bruce Bartholow Duncan, Silvano Gallus, Jeevan Pereira, Ahamarshan Jayaraman Nagarajan, Giulia Carreras, Fariba Dorostkar, Pietro Ferrara, Andrea Farioli, Christoph Nowak, Ahmed I. Hasaballah, Vijay Kumar Chattu, Bolajoko O. Olusanya, Perminder S. Sachdev, Era Upadhyay, Tommi Vasankari, Susan M Sawyer, Adnan Kisa, Farshad Pourmalek, Kiomars Sharafi, Golnaz Heidari, Mohammad Abdollahi, Georges Nguefack-Tsague, Sajid Hameed, Sanni Yaya, Bach Xuan Tran, Ole Frithjof Norheim, Robert Kaba Alhassan, Morenike Oluwatoyin Folayan, Ismail Tareque, Phetole Walter Mahasha, Kewal Krishan, Soraya Siabani, Aleksandr Y. Aravkin, Helena Ullyartha Pangaribuan, Maryam Zamanian, Joshua A. Salomon, Bianca S. Zlavog, Vinay Nangia, Falk Schwendicke, Takeshi Fukumoto, Hung Chak Ho, Jordan Weiss, Maha Atout, Tariku Tesfaye Bekuma, Efat Mohamadi, Nikolaos Dervenis, Joan B. Soriano, Syed Amir Gilani, Victor Adekanmbi, Marina Karanikolos, Alberto Raggi, Michael R.M. Abrigo, Weijia Fu, Reza Shirkoohi, Aditya Prasad Dash, Peng Jia, Masoumeh Sadeghi, Ashraf Nabhan, Isabela M. Benseñor, Morteza Jafarinia, Joht Singh Chandan, Usman Iqbal, Amira Shaheen, Deepak Saxena, Lauren B. Wilner, Nataliya A. Foigt, Jeadran N. Malagón-Rojas, David C. Schwebel, Gail Davey, Milena Ilic, Josep Maria Haro, Peter Njenga Keiyoro, Stein Emil Vollset, Andrea Werdecker, Zahiruddin Quazi Syed, Yared Asmare Aynalem, Entezar Mehrabi Nasab, Yihun Mulugeta Alemu, Muhammad Ali, Mona M. Khater, Ehsan Sadeghi, Thirunavukkarasu Sathish, Pascual R. Valdez, Jennifer Rickard, Mark A. Stokes, Davide Sattin, Ewerton Cousin, Oliver J. Brady, Krittika Bhattacharyya, Mika Kivimäki, Andrew T Olagunju, Jost B. Jonas, Dian Kusuma, Goura Kishor Rath, Alberto Ortiz, Samad Azari, Nayu Ikeda, James L. Fisher, Peng Zheng, Elisabetta Pupillo, Pankaj Bhardwaj, Suzanne Lyn Barker-Collo, Riaz Uddin, Ester Cerin, Amir Taherkhani, Martin Amogre Ayanore, Richard G. Wamai, Anders Larsson, Josephine W. Ngunjiri, Hosni Salem, Hesham M. Al-Mekhlafi, Sharareh Eskandarieh, Taraneh Yousefinezhadi, Srikanta Banerjee, Yang Xie, Yuichiro Yano, Songhomitra Panda-Jonas, Themba G. Ginindza, Manasi Kumar, Babak Moazen, Bing-Fang Hwang, Cristiana Abbafati, Florentino Luciano Caetano dos Santos, Juan Sanabria, Milena Santric-Milicevic, Carla Sofia e.Sá Farinha, Samuel B. Albertson, Chieh Han, Parvaiz A Koul, Foad Abd-Allah, Mojisola Oluwasanu, Mihaela Hostiuc, Chinwe Juliana Iwu, Colm McAlinden, Mohsen Naghavi, Maarten J. Postma, Chhabi Lal Ranabhat, Jalil Jaafari, Walter Mendoza, Abdulaziz M. Almulhim, Magdalene K. Walters, Ali H. Mokdad, Andre M. N. Renzaho, Catherine M. Antony, Ken Lee Chin, Ali A. Asadi-Pooya, Daniel Diaz, Adrian Pana, Salman Rawaf, Gina Agarwal, Demelash Woldeyohannes Handiso, Savita Lasrado, Amir Almasi-Hashiani, Praveen Hoogar, Srinivasa Rao Bolla, Fares Alahdab, Om P Kurmi, Sonali Kochhar, Van C. Lansingh, François Alla, Ali Almasi, Till Bärnighausen, Michael A. Piradov, Zubair Kabir, Boris Bikbov, Philip B. Mitchell, Amin Mousavi Khaneghah, Yahya Safari, Anirudh Kotlo, Jan-Walter De Neve, Biagio Simonetti, Carlos A Castañeda-Orjuela, Kenji Shibuya, GBD 2019 Universal Health Coverage Collaborator, Violante FS, Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Value, Affordability and Sustainability (VALUE), Microbes in Health and Disease (MHD), Department of Public Health, University of Helsinki, Clinicum, Neurologian yksikkö, HUS Neurocenter, HUS Comprehensive Cancer Center, Helsinki University Hospital Area, GBD 2019 Universal Health Coverage Collaborators, Lozano, Rafael, Fullman, Nancy, Mumford, John Everett, Knight, Megan, Barthelemy, Celine M, Abbafati, Cristiana, Abbastabar, Hedayat, Abd-Allah, Foad, Abdollahi, Mohammad, Abedi, Aidin, Abolhassani, Hassan, Abosetugn, Akine Eshete, Abreu, Lucas Guimarãe, Abrigo, Michael R M, Abu Haimed, Abdulaziz Khalid, Abushouk, Abdelrahman I, Adabi, Maryam, Adebayo, Oladimeji M, Adekanmbi, Victor, Adelson, 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Esteghamati, A, Ezekannagha, O, Farag, T, Farahmand, M, Faraon, E, Farinha, C, Farioli, A, Faris, P, Faro, A, Fazlzadeh, M, Feigin, V, Fernandes, E, Ferrara, P, Feyissa, G, Filip, I, Fischer, F, Fisher, J, Flor, L, Foigt, N, Folayan, M, Fomenkov, A, Foroutan, M, Francis, J, Fu, W, Fukumoto, T, Furtado, J, Gad, M, Gaidhane, A, Gakidou, E, Galles, N, Gallus, S, Gardner, W, Geberemariyam, B, Gebrehiwot, A, Gebremeskel, L, Gebremeskel, G, Gesesew, H, Ghadiri, K, Ghafourifard, M, Ghashghaee, A, Ghith, N, Gholamian, A, Gilani, S, Gill, P, Gill, T, Ginindza, T, Gitimoghaddam, M, Giussani, G, Glagn, M, Gnedovskaya, E, Godinho, M, Goharinezhad, S, Gopalani, S, Goudarzian, A, Goulart, B, Gubari, M, Guimarães, R, Guled, R, Gultie, T, Guo, Y, Gupta, R, Hafezi-Nejad, N, Hafiz, A, Haile, T, Hamadeh, R, Hameed, S, Hamidi, S, Han, C, Han, H, Handiso, D, Hanif, A, Hankey, G, Haro, J, Hasaballah, A, Hasan, M, Hashi, A, Hassan, S, Hassan, A, Hassanipour, S, Hassankhani, H, Havmoeller, R, Hay, S, Hayat, K, Heidari, G, Heidari-Soureshjani, R, Hendrie, D, Herteliu, C, Hird, T, Ho, H, Hole, M, Holla, R, Hollingsworth, B, Hoogar, P, Hopf, K, Horita, N, Hossain, N, Hosseini, M, Hosseinzadeh, M, Hostiuc, M, Hostiuc, S, Househ, M, Hsieh, V, Hu, G, Huda, T, Humayun, A, Hwang, B, Iavicoli, I, Ibitoye, S, Ikeda, N, Ilesanmi, O, Ilic, I, Ilic, M, Inbaraj, L, Iqbal, U, Irvani, S, Irvine, C, Islam, M, Islam, S, Islami, F, Iso, H, Iwu, C, Jaafari, J, Jadidi-Niaragh, F, Jafarinia, M, Jahagirdar, D, Jahani, M, Jahanmehr, N, Jakovljevic, M, Janjani, H, Javaheri, T, Jayatilleke, A, Jenabi, E, Jha, R, Jha, V, Ji, J, Jia, P, John-Akinola, Y, Jonas, J, Joukar, F, Jozwiak, J, Jürisson, M, Kabir, Z, Kalankesh, L, Kalhor, R, Kamath, A, Kanchan, T, Kapoor, N, Karami Matin, B, Karanikolos, M, Karimi, S, Kassebaum, N, Katikireddi, S, Kayode, G, Keiyoro, P, Khader, Y, Khammarnia, M, Khan, M, Khan, E, Khang, Y, Khatab, K, Khater, A, Khater, M, Khatib, M, Khayamzadeh, M, Khubchandani, J, Kianipour, N, Kim, Y, Kimokoti, R, Kinfu, Y, Kisa, A, Kissimova-Skarbek, K, Kivimäki, M, Kneib, C, Kocarnik, J, Kochhar, S, Kohler, S, Kopec, J, Korotkova, A, Korshunov, V, Kosen, S, Kotlo, A, Koul, P, Koyanagi, A, Krishan, K, Krohn, K, Kugbey, N, Kulkarni, V, Kumar, G, Kumar, N, Kumar, M, Kurmi, O, Kusuma, D, Kyu, H, La Vecchia, C, Lal, D, Lalloo, R, Landires, I, Lansingh, V, Larsson, A, Lasrado, S, Lau, K, Lauriola, P, Lazarus, J, Ledesma, J, Lee, P, Lee, S, Leever, A, Legrand, K, Leigh, J, Leonardi, M, Li, S, Lim, S, Lim, L, Liu, X, Logroscino, G, Lopez, A, Lopukhov, P, Lotufo, P, Lu, A, Ma, J, Madadin, M, Mahasha, P, Mahmoudi, M, Majeed, A, Malagón-Rojas, J, Maleki, S, Malta, D, Mansouri, B, Mansournia, M, Martini, S, Martins-Melo, F, Martopullo, I, Massenburg, B, Mastrogiacomo, C, Mathur, M, Mcalinden, C, Mckee, M, Medina-Solís, C, Meharie, B, Mehndiratta, M, Mehrabi Nasab, E, Mehri, F, Mehrotra, R, Mekonnen, T, Melese, A, Memiah, P, Mendoza, W, Menezes, R, Mensah, G, Meretoja, T, Meretoja, A, Mestrovic, T, Miazgowski, B, Michalek, I, Mirrakhimov, E, Mirzaei, M, Mirzaei-Alavijeh, M, Mitchell, P, Moazen, B, Moghadaszadeh, M, Mohamadi, E, Mohammad, Y, Mohammad, D, Mohammad Gholi Mezerji, N, Mohammadian-Hafshejani, A, Mohammed, S, Mohammed, J, Mokdad, A, Monasta, L, Mondello, S, Moradi, M, Moradi-Lakeh, M, Moradzadeh, R, Moraga, P, Morgado-da-Costa, J, Morrison, S, Mosapour, A, Mosser, J, Mousavi Khaneghah, A, Muriithi, M, Mustafa, G, Nabhan, A, Naderi, M, Nagarajan, A, Naghavi, M, Naghshtabrizi, B, Naimzada, M, Nangia, V, Nansseu, J, Nayak, V, Nazari, J, Ndejjo, R, Negoi, I, Negoi, R, Neupane, S, Ngari, K, Nguefack-Tsague, G, Ngunjiri, J, Nguyen, C, Nguyen, D, Nguyen, H, Nnaji, C, Nomura, S, Norheim, O, Noubiap, J, Nowak, C, Nunez-Samudio, V, Otoiu, A, Ogbo, F, Oghenetega, O, Oh, I, Okunga, E, Oladnabi, M, Olagunju, A, Olusanya, J, Olusanya, B, Oluwasanu, M, Omar Bali, A, Omer, M, Ong, K, Onwujekwe, O, Ortega-Altamirano, D, Ortiz, A, Ostojic, S, Otstavnov, N, Otstavnov, S, Øverland, S, Owolabi, M, Padubidri, J, Pakhale, S, Palladino, R, Pana, A, Panda-Jonas, S, Pangaribuan, H, Pathak, M, Patton, G, Paudel, S, Pazoki Toroudi, H, Pease, S, Peden, A, Pennini, A, Peprah, E, Pereira, J, Pigott, D, Pilgrim, T, Pilz, T, Pinheiro, M, Piradov, M, Pirsaheb, M, Pokhrel, K, Postma, M, Pourjafar, H, Pourmalek, F, Pourmirza Kalhori, R, Pourshams, A, Prada, S, Pribadi, D, Pupillo, E, Quazi Syed, Z, Radfar, A, Rafiee, A, Rafiei, A, Raggi, A, Rahim, F, Rahman, M, Rajabpour-Sanati, A, Rana, S, Ranabhat, C, Rao, S, Rasella, D, Rashedi, V, Rath, G, Rathi, P, Rawaf, S, Rawaf, D, Rawal, L, Rawassizadeh, R, Razo, C, Renjith, V, Renzaho, A, Reshmi, B, Rezaei, N, Riahi, S, Ribeiro, D, Rickard, J, Roberts, N, Roever, L, Romoli, M, Ronfani, L, Roshandel, G, Rubagotti, E, Rwegerera, G, Sabour, S, Sachdev, P, Saddik, B, Sadeghi, M, Sadeghi, E, Safari, Y, Sagar, R, Sahebkar, A, Sahraian, M, Sajadi, S, Salahshoor, M, Salem, M, Salem, H, Salomon, J, Samadi Kafil, H, Samy, A, Sanabria, J, Santric-Milicevic, M, Saraswathy, S, Sarmiento-Suárez, R, Sarveazad, A, Sathian, B, Sathish, T, Sattin, D, Savic, M, Sawyer, S, Saxena, D, Sbarra, A, Schaeffer, L, Schiavolin, S, Schmidt, M, Schutte, A, Schwebel, D, Schwendicke, F, Seedat, S, Sha, F, Shahabi, S, Shaheen, A, Shaikh, M, Shamsizadeh, M, Shannawaz, M, Sharafi, K, Sharara, F, Sharifi, H, Shaw, D, Sheikh, A, Sheikhtaheri, A, Shetty, B, Shibuya, K, Shiferaw, W, Shigematsu, M, Shin, J, Shiri, R, Shirkoohi, R, Shivakumar, K, Shrime, M, Shuval, K, Siabani, S, Sierpinski, R, Sigfusdottir, I, Sigurvinsdottir, R, Silva, D, Silva, J, Simonetti, B, Simpson, K, Singh, J, Singh, P, Sinha, D, Skryabin, V, Smith, E, Soheili, A, Soltani, S, Soofi, M, Sorensen, R, Soriano, J, Sorrie, M, Soyiri, I, Spurlock, E, Sreeramareddy, C, Stanaway, J, Steel, N, Stein, C, Stokes, M, Sufiyan, M, Suleria, H, Sultan, I, Szumowski, Ł, Tabarés-Seisdedos, R, Tabuchi, T, Tadakamadla, S, Taddele, B, Tadesse, D, Taherkhani, A, Tamiru, A, Tanser, F, Tareque, M, Tarigan, I, Teagle, W, Tediosi, F, Tefera, Y, Tela, F, Tessema, Z, Thakur, B, Titova, M, Tonelli, M, Topor-Madry, R, Topouzis, F, Tovani-Palone, M, Tran, B, Travillian, R, Troeger, C, Tudor Car, L, Uddin, R, Ullah, I, Umeokonkwo, C, Unnikrishnan, B, Upadhyay, E, Uthman, O, Vacante, M, Valdez, P, Varughese, S, Vasankari, T, Vasseghian, Y, Venketasubramanian, N, Violante, F, Vlassov, V, Vollset, S, Vongpradith, A, Vos, T, Waheed, Y, Walters, M, Wamai, R, Wang, H, Wang, Y, Weintraub, R, Weiss, J, Werdecker, A, Westerman, R, Wilner, L, Woldu, G, Wolfe, C, Wu, A, Wulf Hanson, S, Xie, Y, Xu, R, Yahyazadeh Jabbari, S, Yamagishi, K, Yano, Y, Yaya, S, Yazdi-Feyzabadi, V, Yearwood, J, Yeshitila, Y, Yip, P, Yonemoto, N, Younis, M, Yousefi, Z, Yousefinezhadi, T, Yusefzadeh, H, Zadey, S, Zahirian Moghadam, T, Zaidi, S, Zaki, L, Zaman, S, Zamani, M, Zamanian, M, Zandian, H, Zastrozhin, M, Zewdie, K, Zhang, Y, Zhao, X, Zhao, Y, Zheng, P, Zhu, C, Ziapour, A, Zlavog, B, Zodpey, S, Murray, C, Tampere University, Health Sciences, 10922180 - Schutte, Aletta Elisabeth, Lozano, R., Fullman, N., Mumford, J. E., Knight, M., Barthelemy, C. M., Abbafati, C., Abbastabar, H., Abd-Allah, F., Abdollahi, M., Abedi, A., Abolhassani, H., Abosetugn, A. E., Abreu, L. G., Abrigo, M. R. M., Abu Haimed, A. K., Abushouk, A. I., Adabi, M., Adebayo, O. M., Adekanmbi, V., Adelson, J., Adetokunboh, O. O., Adham, D., Advani, S. M., Afshin, A., Agarwal, G., Agasthi, P., Aghamir, S. M. K., Agrawal, A., Ahmad, T., Akinyemi, R. O., Alahdab, F., Al-Aly, Z., Alam, K., Albertson, S. B., Alemu, Y. M., Alhassan, R. K., Ali, M., Ali, S., Alipour, V., Aljunid, S. M., Alla, F., Almadi, M. A. H., Almasi, A., Almasi-Hashiani, A., Almasri, N. A., Al-Mekhlafi, H. M., Almulhim, A. M., Alonso, J., Al-Raddadi, R. M., Altirkawi, K. A., Alvis-Guzman, N., Alvis-Zakzuk, N. J., Amini, S., Amini-Rarani, M., Amiri, F., Amit, A. M. L., Amugsi, D. A., Ancuceanu, R., Anderlini, D., Andrei, C. L., Androudi, S., Ansari, F., Ansari-Moghaddam, A., Antonio, C. A. T., Antony, C. M., Antriyandarti, E., Anvari, D., Anwer, R., Arabloo, J., Arab-Zozani, M., Aravkin, A. Y., Aremu, O., Arnlov, J., Asaad, M., Asadi-Aliabadi, M., Asadi-Pooya, A. A., Athari, S. S., Atout, M. M. W., Ausloos, M., Avila-Burgos, L., Ayala Quintanilla, B. P., Ayano, G., Ayanore, M. A., Aynalem, Y. A., Aynalem, G. L., Ayza, M. A., Azari, S., Azzopardi, P. S., B, D. B., Babaee, E., Badiye, A. D., Bahrami, M. A., Baig, A. A., Bakhshaei, M. H., Bakhtiari, A., Bakkannavar, S. M., Balachandran, A., Banach, M., Banerjee, S. K., Banik, P. C., Bante, A. B., Bante, S. A., Barker-Collo, S. L., Barnighausen, T. W., Barrero, L. H., Bassat, Q., Basu, S., Baune, B. T., Bayati, M., Baye, B. A., Bedi, N., Beghi, E., Behzadifar, M., Bekuma, T. T. T., Bell, M. L., Bensenor, I. M., Berman, A. E., Bernabe, E., Bernstein, R. S., Bhagavathula, A. S., Bhandari, D., Bhardwaj, P., Bhat, A. G., Bhattacharyya, K., Bhattarai, S., Bhutta, Z. A., Bijani, A., Bikbov, B., Bilano, V., Biondi, A., Birihane, B. M., Bockarie, M. J., Bohlouli, S., Bojia, H. A., Bolla, S. R. R., Boloor, A., Brady, O. J., Braithwaite, D., Briggs, A. M., Briko, N. I., Burugina Nagaraja, S., Busse, R., Butt, Z. A., Caetano dos Santos, F. L., Cahuana-Hurtado, L., Camera, L. A., Cardenas, R., Carreras, G., Carrero, J. J., Carvalho, F., Castaldelli-Maia, J. M., Castaneda-Orjuela, C. A., Castelpietra, G., Castro, F., Catala-Lopez, F., Cederroth, C. R., Cerin, E., Chandan, J. S., Chang, A. Y., Charan, J., Chattu, V. K., Chaturvedi, S., Chin, K. L., Cho, D. Y., Choi, J. -Y. J., Christensen, H., Chu, D. -T., Chung, M. T., Ciobanu, L. G., Cirillo, M., Compton, K., Cortesi, P. A., Costa, V. M., Cousin, E., Dahlawi, S. M. A., Damiani, G., Dandona, L., Dandona, R., Darega Gela, J., Darwesh, A. M., Daryani, A., Dash, A. P., Davey, G., Davila-Cervantes, C. A., Davletov, K., De Neve, J. -W., Denova-Gutierrez, E., Deribe, K., Dervenis, N., Desai, R., Dharmaratne, S. D., Dhungana, G. P., Dianatinasab, M., Dias da Silva, D., Diaz, D., Dippenaar, I. N., Do, H. T., Dorostkar, F., Doshmangir, L., Duncan, B. B., Duraes, A. R., Eagan, A. W., Edvardsson, D., El Sayed, I., El Tantawi, M., Elgendy, I. Y., Elyazar, I. R., Eskandari, K., Eskandarieh, S., Esmaeilnejad, S., Esteghamati, A., Ezekannagha, O., Farag, T., Farahmand, M., Faraon, E. J. A., Farinha, C. S. E. S., Farioli, A., Faris, P. S., Faro, A., Fazlzadeh, M., Feigin, V. L., Fernandes, E., Ferrara, P., Feyissa, G. T., Filip, I., Fischer, F., Fisher, J. L., Flor, L. S., Foigt, N. A., Folayan, M. O., Fomenkov, A. A., Foroutan, M., Francis, J. M., Fu, W., Fukumoto, T., Furtado, J. M., Gad, M. M., Gaidhane, A. M., Gakidou, E., Galles, N. C., Gallus, S., Gardner, W. M., Geberemariyam, B. S., Gebrehiwot, A. M., Gebremeskel, L. G., Gebremeskel, G. G., Gesesew, H. A., Ghadiri, K., Ghafourifard, M., Ghashghaee, A., Ghith, N., Gholamian, A., Gilani, S. A., Gill, P. S., Gill, T. K., Ginindza, T. G., Gitimoghaddam, M., Giussani, G., Glagn, M., Gnedovskaya, E. V., Godinho, M. A., Goharinezhad, S., Gopalani, S. V., Goudarzian, A. H., Goulart, B. N. G., Gubari, M. I. M., Guimaraes, R. A., Guled, R. A., Gultie, T., Guo, Y., Gupta, R., Hafezi-Nejad, N., Hafiz, A., Haile, T. G., Hamadeh, R. R., Hameed, S., Hamidi, S., Han, C., Han, H., Handiso, D. W., Hanif, A., Hankey, G. J., Haro, J. M., Hasaballah, A. I., Hasan, M. M., Hashi, A., Hassan, S., Hassan, A., Hassanipour, S., Hassankhani, H., Havmoeller, R. J., Hay, S. I., Hayat, K., Heidari, G., Heidari-Soureshjani, R., Hendrie, D., Herteliu, C., Hird, T. R., Ho, H. C., Hole, M. K., Holla, R., Hoogar, P., Hopf, K. P., Horita, N., Hossain, N., Hosseini, M., Hosseinzadeh, M., Hostiuc, M., Hostiuc, S., Househ, M., Hsieh, V. C. -R., Hu, G., Huda, T. M., Humayun, A., Hwang, B. -F., Iavicoli, I., Ibitoye, S. E., Ikeda, N., Ilesanmi, O. S., Ilic, M. D., Inbaraj, L. R., Iqbal, U., Irvani, S. S. N., Irvine, C. M. S., Islam, M. M., Islam, S. M. S., Islami, F., Iso, H., Iwu, C. J., Jaafari, J., Jadidi-Niaragh, F., Jafarinia, M., Jahagirdar, D., Jahani, M. A., Jahanmehr, N., Jakovljevic, M., Janjani, H., Javaheri, T., Jayatilleke, A. U., Jenabi, E., Jha, R. P., Jha, V., Ji, J. S., Jia, P., John-Akinola, Y. O., Jonas, J. B., Joukar, F., Jozwiak, J. J., Jurisson, M., Kabir, Z., Kalankesh, L. R., Kalhor, R., Kamath, A. M., Kanchan, T., Kapoor, N., Karami Matin, B., Karanikolos, M., Karimi, S. M., Kassebaum, N. J., Katikireddi, S. V., Kayode, G. A., Keiyoro, P. N., Khader, Y. S., Khammarnia, M., Khan, M., Khan, E. A., Khang, Y. -H., Khatab, K., Khater, A. M., Khater, M. M., Khatib, M. N., Khayamzadeh, M., Khubchandani, J., Kianipour, N., Kim, Y. J., Kimokoti, R. W., Kinfu, Y., Kisa, A., Kissimova-Skarbek, K., Kivimaki, M., Kneib, C. J., Kocarnik, J. M., Kochhar, S., Kohler, S., Kopec, J. A., Korotkova, A. V., Korshunov, V. A., Kosen, S., Kotlo, A., Koul, P. A., Koyanagi, A., Krishan, K., Krohn, K. 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Subjects
Index (economics), Servicios de Salud, SUSTAINABLE DEVELOPMENT GOALS, 030204 cardiovascular system & hematology, universal health coverage, sustaibale develpment goal, global burden of disease, performance, systematic analysis, Global Burden of Disease, 0302 clinical medicine, Universal Health Insurance, RA0421, 11. Sustainability, Per capita, Medical economics, Disease, 030212 general & internal medicine, 10. No inequality, 11 Medical and Health Sciences, effective coverage of health services, GBD 2019 Universal Health Coverage Collaborators, education.field_of_study, Public health, Medical care, Sjúkdómar, 4. Education, 1. No poverty, Health coverage, Public Health, Global Health, Social Medicine and Epidemiology, General Medicine, Hälsovetenskaper, 3142 Public health care science, environmental and occupational health, Health services, 3. Good health, Global burden of disease, Health Expenditures, Humans, World Health Organization, Purchasing power parity, Scale (social sciences), Lýðheilsa, universal health coverag, CANCER SURVIVAL, ACCESS, Human, Heilsuhagfræði, medicine.medical_specialty, Health coverage, GBD, GBD, Universal health, GBD 2019, Population, Health expenditures, 3122 Cancers, Population health, 03 medical and health sciences, Health systems, Heilbrigðisvísindi, SDG 3 - Good Health and Well-being, General & Internal Medicine, Development economics, Health Sciences, medicine, Heilbrigðisstefna, Alþjóðaheilbrigðisstofnunin, QUALITY, Global Burden of Disease Study, education, PROGRESS, Disease burden, Health services accessibility, CARE, Heilbrigðisþjónusta, purl.org/pe-repo/ocde/ford#3.02.00 [https], Health Expenditure, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, 3121 General medicine, internal medicine and other clinical medicine, Morbility, Administración de los Servicios de Salud, Medical policy, Business, Heilbrigðiskerfi
Abstract

Publisher's version (útgefin grein), Background Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. Methods Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (>= 65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0-100 based on the 2.5th and 97.5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target-1 billion more people benefiting from UHC by 2023-we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. Findings Globally, performance on the UHC effective coverage index improved from 45.8 (95% uncertainty interval 44.2-47.5) in 1990 to 60.3 (58.7-61.9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2.6% [1.9-3.3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010-2019 relative to 1990-2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0.79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach $1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388.9 million (358.6-421.3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3.1 billion (3.0-3.2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968.1 million [903.5-1040.3]) residing in south Asia. Interpretation The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people-the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close-or how far-all populations are in benefiting from UHC., Lucas Guimaraes Abreu acknowledges support from Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior -Brasil (Capes) -Finance Code 001, Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq) and Fundacao de Amparo a Pesquisa do Estado de Minas Gerais (FAPEMIG). Olatunji O Adetokunboh acknowledges South African Department of Science & Innovation, and National Research Foundation. Anurag Agrawal acknowledges support from the Wellcome Trust DBT India Alliance Senior Fellowship IA/CPHS/14/1/501489. Rufus Olusola Akinyemi acknowledges Grant U01HG010273 from the National Institutes of Health (NIH) as part of the H3Africa Consortium. Rufus Olusola Akinyemi is further supported by the FLAIR fellowship funded by the UK Royal Society and the African Academy of Sciences. Syed Mohamed Aljunid acknowledges the Department of Health Policy and Management, Faculty of Public Health, Kuwait University and International Centre for Casemix and Clinical Coding, Faculty of Medicine, National University of Malaysia for the approval and support to participate in this research project. Marcel Ausloos, Claudiu Herteliu, and Adrian Pana acknowledge partial support by a grant of the Romanian National Authority for Scientific Research and Innovation, CNDSUEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084. Till Winfried Barnighausen acknowledges support from the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award, funded by the German Federal Ministry of Education and Research. Juan J Carrero was supported by the Swedish Research Council (2019-01059). Felix Carvalho acknowledges UID/MULTI/04378/2019 and UID/QUI/50006/2019 support with funding from FCT/MCTES through national funds. Vera Marisa Costa acknowledges support from grant (SFRH/BHD/110001/2015), received by Portuguese national funds through Fundacao para a Ciencia e a Tecnologia (FCT), IP, under the Norma TransitA3ria DL57/2016/CP1334/CT0006. Jan-Walter De Neve acknowledges support from the Alexander von Humboldt Foundation. Kebede Deribe acknowledges support by Wellcome Trust grant number 201900/Z/16/Z as part of his International Intermediate Fellowship. Claudiu Herteliu acknowledges partial support by a grant co-funded by European Fund for Regional Development through Operational Program for Competitiveness, Project ID P_40_382. Praveen Hoogar acknowledges the Centre for Bio Cultural Studies (CBiCS), Manipal Academy of Higher Education(MAHE), Manipal and Centre for Holistic Development and Research (CHDR), Kalghatgi. Bing-Fang Hwang acknowledges support from China Medical University (CMU108-MF-95), Taichung, Taiwan. Mihajlo Jakovljevic acknowledges the Serbian part of this GBD contribution was co-funded through the Grant OI175014 of the Ministry of Education Science and Technological Development of the Republic of Serbia. Aruna M Kamath acknowledges funding from the National Institutes of Health T32 grant (T32GM086270). Srinivasa Vittal Katikireddi acknowledges funding from the Medical Research Council (MC_UU_12017/13 & MC_UU_12017/15), Scottish Government Chief Scientist Office (SPHSU13 & SPHSU15) and an NRS Senior Clinical Fellowship (SCAF/15/02). Yun Jin Kim acknowledges support from the Research Management Centre, Xiamen University Malaysia (XMUMRF/2018-C2/ITCM/0001). Kewal Krishan acknowledges support from the DST PURSE grant and UGC Center of Advanced Study (CAS II) awarded to the Department of Anthropology, Panjab University, Chandigarh, India. Manasi Kumar acknowledges support from K43 TW010716 Fogarty International Center/NIMH. Ben Lacey acknowledges support from the NIHR Oxford Biomedical Research Centre and the BHF Centre of Research Excellence, Oxford. Ivan Landires is a member of the Sistema Nacional de InvestigaciA3n (SNI), which is supported by the Secretaria Nacional de Ciencia Tecnologia e Innovacion (SENACYT), Panama. Jeffrey V Lazarus acknowledges support by a Spanish Ministry of Science, Innovation and Universities Miguel Servet grant (Instituto de Salud Carlos III/ESF, European Union [CP18/00074]). Peter T N Memiah acknowledges CODESRIA; HISTP. Subas Neupane acknowledges partial support from the Competitive State Research Financing of the Expert Responsibility area of Tampere University Hospital. Shuhei Nomura acknowledges support from the Ministry of Education, Culture, Sports, Science, and Technology of Japan (18K10082). Alberto Ortiz acknowledges support by ISCIII PI19/00815, DTS18/00032, ISCIII-RETIC REDinREN RD016/0009 Fondos FEDER, FRIAT, Comunidad de Madrid B2017/BMD-3686 CIFRA2-CM. These funding sources had no role in the writing of the manuscript or the decision to submit it for publication. George C Patton acknowledges support from a National Health & Medical Research Council Fellowship. Marina Pinheiro acknowledges support from FCT for funding through program DL 57/2016 -Norma transitA3ria. Alberto Raggi, David Sattin, and Silvia Schiavolin acknowledge support by a grant from the Italian Ministry of Health (Ricerca Corrente, Fondazione Istituto Neurologico C Besta, Linea 4 -Outcome Research: dagli Indicatori alle Raccomandazioni Cliniche). Daniel Cury Ribeiro acknowledges support from the Sir Charles Hercus Health Research Fellowship -Health Research Council of New Zealand (18/111). Perminder S Sachdev acknowledges funding from the NHMRC Australia. Abdallah M Samy acknowledges support from a fellowship from the Egyptian Fulbright Mission Program. Milena M Santric-Milicevic acknowledges support from the Ministry of Education, Science and Technological Development of the Republic of Serbia (Contract No. 175087). Rodrigo Sarmiento-Suarez acknowledges institutional support from University of Applied and Environmental Sciences in Bogota, Colombia, and Carlos III Institute of Health in Madrid, Spain. Maria Ines Schmidt acknowledges grants from the Foundation for the Support of Research of the State of Rio Grande do Sul (IATS and PrInt) and the Brazilian Ministry of Health. Sheikh Mohammed Shariful Islam acknowledges a fellowship from the National Heart Foundation of Australia and Deakin University. Aziz Sheikh acknowledges support from Health Data Research UK. Kenji Shibuya acknowledges Japan Ministry of Education, Culture, Sports, Science and Technology. Joan B Soriano acknowledges support by Centro de Investigacion en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Rafael Tabares-Seisdedos acknowledges partial support from grant PI17/00719 from ISCIII-FEDER. Santosh Kumar Tadakamadla acknowledges support from the National Health and Medical Research Council Early Career Fellowship, Australia. Marcello Tonelli acknowledges the David Freeze Chair in Health Services Research at the University of Calgary, AB, Canada., "Peer Reviewed"

Published
2020

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