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Two decades ago, the genocide against the Tutsis in Rwanda led to the deaths of 1 million people, and the displacement of millions more. Injury and trauma were followed by the effects of a devastated health system and economy. In the years that followed, a new course set by a new government set into motion equity-oriented national policies focusing on social cohesion and people-centred development. Premature mortality rates have fallen precipitously in recent years, and life expectancy has doubled since the mid-1990s. Here we reflect on the lessons learned in rebuilding Rwanda's health sector during the past two decades, as the country now prepares itself to take on new challenges in health-care delivery.

In order to accurately monitor CO2 concentration based on the non-dispersive infrared technique, a novel flat conical chamber CO2 gas sensor is proposed and investigated by simulation analysis and experimental verification. First, the optical design software and computational fluid dynamics method are utilized to theoretically investigate the relationship between the energy distribution, absorption efficiency of infrared radiation, and chamber size. The simulation results show that the chamber length has an optimal value of 8 cm when the cone angle is 5° and the diameter of the detection surface is 1 cm, which makes infrared absorption efficiency optimal. Then, the flat conical chamber CO2 gas sensor system is developed, calibrated, and tested. The experimental results indicate that the sensor can accurately detect CO2 gas concentrations in the range of 0–2000 ppm at 25 °C. It is found that the absolute error of calibration is within 10 ppm, and the maximum repeatability and stability errors are 5.5 and 3.5%, respectively. Finally, the genetic neural network algorithm is presented to compensate for the output concentration of the sensor to solve the problem of temperature drift. Experimental results demonstrate that the relative error of the compensated CO2 concentration is varied from −0.85 to 2.32%, which is significantly reduced. The study has reference significance for the structural optimization of the infrared CO2 gas sensor and the improvement of the measurement accuracy. [ABSTRACT FROM AUTHOR]

There is incontrovertible evidence that early learning opportunities shape long-term development and health. Nevertheless, early childhood care and education (ECCE) is not expressly mentioned as part of the right to education in the Convention on the Rights of the Child, the International Covenant on Economic, Social and Cultural Rights, and the Convention on the Rights of Persons with Disabilities. This paper argues that the right to education can nevertheless be regarded as including ECCE. We examine the treaties, General Comments, and 264 Concluding Observations by relevant UN monitoring bodies, covering 152 countries from 2015 to 2020, to determine whether the right to ECCE is regarded as part of States' obligations and the content of the duty. These demonstrate consistently that States must provide affordable, accessible, quality, inclusive ECCE, with adequate resources. We argue that monitoring committees should draw these obligations together in one General Comment, thereby improving States' accountability and guiding the delivery of ECCE. [ABSTRACT FROM AUTHOR]

Author(s): Chunling Lu 1,2,3,*, Zhihui Li 4, Vikram Patel 2 Summary points One-quarter of disability-adjusted life years (DALYs) for mental disorders and substance abuse is borne by those 24 years [...]

The Chinese government is in the process of providing health insurance to the uninsured rural population by expanding the rural Cooperative Medical System (CMS) to every rural county. Using the China Health Surveillance Baseline Survey in 2001, we conducted a case study on two CMS pilot programs and investigated whether or not enrolling in these CMS pilot programs has led to an increase in health care utilization and a decrease in the likelihood of catastrophic health spending for rural residents. Matched data sets are produced using propensity score and the instrumental variable (IV) method is used. We have found that the CMS pilot programs have had a significant and positive effect on the probability of seeking medical care and the number of visits. However, the CMS programs did not seem to have had a significant impact on households' out-of-pocket health expenditure and on reducing catastrophic spending. The findings generated from the matched data are consistent with those obtained from the full set of data and those obtained from the IV method, (JEL 118), I. INTRODUCTION China's rural health care system has undergone a significant transformation since the late 1970s, when China embarked on the process of moving from a planned to market economy. [...]

Objective To investigate the effect of survey design, specifically the number of items and recall period, on estimates of household out-of-pocket and catastrophic expenditure on health. Methods We used results from two surveys--the World Health Survey and the Living Standards Measurement Study--that asked the same respondents about health expenditures in different ways. Data from the World Health Survey were used to compare estimates of average annual out-of-pocket spending on health care derived from a single-item and from an eight-item measure. This was done by calculating the ratio of the average obtained with the single-item measure to that obtained with the eight-item measure. Estimates of catastrophic spending from the two measures were also compared. Data from the Living Standards Measurement Study from three countries (Bulgaria, Jamaica and Nepal) with different recall periods and varying numbers of items in different modules were used to compare estimates of average annual out-of-pocket spending derived using various methods. Findings In most countries, a lower level of disaggregation (i.e. fewer items) gave a lower estimate for average health spending, and a shorter recall period yielded a larger estimate. However, when the effects of aggregation and recall period are combined, it is difficult to predict which of the two has the greater influence. Conclusion The magnitude of both out-of-pocket and catastrophic spending on health is affected by the choice of recall period and the number of items. Thus, it is crucial to establish a method to generate valid, reliable and comparable information on private health spending. Objectif Etudier l'effet du type d'enquete, et en particulier du nombre de postes de depense examines et de la periode de rappel, sur les estimations des debours directs et des depenses catastrophiques en faveur de la sante des menages. Methodes Nous avons utilise les resultats de deux enquetes l'Enquete sur-la sante dans le monde et la Living Standards Measurement Study--ayant interroge les memes personnes a propos de leurs depenses de sante, mais de manieres differentes. Les donnees provenant de l'Enquete sur la sante dans le monde ont servi a comparer les estimations des debours directs annuels moyens des menages pour la sante, obtenues par une methode de mesure ne considerant qu'un poste de depense et par une methode prenant en compte huit postes. Cette comparaison a ete effectuee en determinant le rapport de la moyenne obtenue par la premiere methode de mesure a celle fournie par la seconde methode. Nous avons egalement compare des estimations des depenses catastrophiques etablies a partir de ces deux methodes de mesure. Nous avons utilise des donnees de la Living Standards Measurement Study pour trois pays (Bulgarie, Jamaique et Nepal), correspondant a differentes periodes de rappel et a un nombre variable de categories de depenses, et relevees dans le cadre de divers modules d'enquete, pour comparer les estimations des debours directs annuels moyens obtenues par plusieurs methodes. Resultats Dans la plupart des pays, un niveau plus faible de desagregation (c'est-a-dire la prise en compte d'un nombre moindre de postes de depense) a conduit a une estimation plus basse des depenses de sante moyennes et une periode de rappel plus breve a abouti a une estimation plus elevee. Cependant, lorsque les effets de la desagregation et de la periode de rappel se combinent, il est difficile de predire quel facteur s'exerce le plus fortement. Conclusion L'ampleur des debours directs et des depenses catastrophiques pour la sante des menages est influencee par le choix de la periode de rappel et du nombre de postes de depense consideres. Il est donc essentiel de definir une methode pour generer des donnees valides, fiables et comparables sur les depenses de sante des privees. Objetivo Investigar el efecto del diseno de las encuestas, especificamente del numero de parametros y del periodo de rememoracion, en las estimaciones del gasto directo (de bolsillo) y los gastos catastroficos de los hogares en salud. Metodos Utilizamos los resultados de dos encuestas -la Encuesta Mundial de Salud y el Estudio de medicion de los niveles de vida- en las que se formulaban preguntas planteadas de distinta manera a las mismas personas sobre los gastos en salud. Los datos de la Encuesta Mundial de Salud se usaron para comparar las estimaciones del gasto directo anual medio en salud obtenidas a partir de un solo parametro y a partir de ocho parametros. El resultado se expreso como la razon entre la media obtenida con un solo parametro y la obtenida midiendo los ocho parametros. Se compararon asimismo las estimaciones de los gastos catastroficos que arrojaron esos dos metodos de medicion. Los datos del Estudio de medicion de los niveles de vida de tres paises (Bulgaria, Jamaica y Nepal) con distintos periodos de rememoracion y distinto numero de parametros en diferentes modulos se usaron para comparar las estimaciones del gasto directo anual medio obtenidas con diversos metodos. Resultados En la mayoria de los paises, un menor grado de desglose (esto es, menos parametros de valoracion) implicaba una estimacion menor del gasto sanitario medio, y un periodo de rememoracion mas corto arrojaba una estimacion mayor. No obstante, si se combinan los efectos de la agregacion y del periodo de rememoracion, resulta dificil predecir cual de los dos influye mas. Conclusion La magnitud de ambos, los gastos directos y los gastos catastroficos en salud, depende del periodo de rememoracion elegido y del numero de parametros empleado. Asi pues, es fundamental establecer un metodo que genere informacion valida, fiable y comparable sobre el gasto sanitario privado., Line traduction en francais de ce resume figure a la fin de l'article. Al final del articulo se facilita una traduccion al espanol. [TEXT NOT REPRODUCIBLE IN ASCII.] Introduction Valid, [...]

We use 1996 Medical Expenditure Panel Survey to examine the demand response of ambulatory medical services to demand-side cost sharing under managed health care and find that demand response to a coinsurance rate is less than that under conventional plans. To address the selection problem, only respondents who were offered a single insurance plan from private establishments are studied. Our results show that managed care, relying on different approaches to ration, has blunted demand response. This suggests that in a managed care context, increasing demand-side cost sharing will reduce costs to plans mainly by shifting costs to enrollees. (JEL I11), I. INTRODUCTION Demand response is one of the most venerable topics in health economics. Zeckhauser (1970) related demand response to optimal (second-best) health insurance showing that a greater demand response [...]

Objective: Telepsychiatry involves use of telecommunications technology to deliver psychiatric care and offers promise to reduce costs and increase access to mental health services. This systematic review examined cost reporting of telepsychiatry programmes for mental healthcare.Methods: We systematically searched electronic databases for studies reporting costs, including economic evaluations such as cost-effectiveness analyses, or costs of developing telepsychiatry programmes for clinical care of mental disorders. Included studies enrolled participants with mental disorders and involved telepsychiatry for depression, anxiety disorders, serious mental illnesses including schizophrenia spectrum disorders and bipolar disorder, post-traumatic stress disorder, dementia or epilepsy.Results: Twenty-six unique studies met inclusion criteria (17,967 participants), with most targeting depression (n = 7; 27%), general mental disorders and screening (n = 7; 27%), child mental health (n = 4; 15%) and geriatric mental health (n = 4; 15%). Nearly all studies (n = 25; 96%) compared telepsychiatry programme costs with either standard in-person consultation or usual care, with 15 (60%) reporting that telepsychiatry programmes were less expensive, and 8 (32%) showing telepsychiatry programmes were more expensive. Three studies reported cost-effectiveness analyses, favouring telepsychiatry programmes, but at highly elevated cost-effectiveness thresholds. Few studies reported costs of developing or delivering telepsychiatry programmes.Conclusion: Costs of telepsychiatry programmes varied widely, with substantial heterogeneity in how costs were defined and reported. Some programmes cost less than in-person services while others cost more. Therefore, rigorous cost-effectiveness studies following established standards in economic evaluation are needed to inform implementation and sustainability of these programmes in health systems. [ABSTRACT FROM AUTHOR]