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1. Private pharmacies as healthcare providers in Odisha, India: analysis and implications for universal health coverage

Author: Liana Woskie, Winnie Yip, Annie Haakenstad, Anuska Kalita, Bijetri Bose, and Jan E Cooper
Subjects: Medicine (General), R5-920, Infectious and parasitic diseases, RC109-216
Published: 2023
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2. Are rhetorical commitments to adolescents reflected in planning documents? An exploratory content analysis of adolescent sexual and reproductive health in Global Financing Facility country plans

Author: Asha S. George, Tanya Jacobs, Mary V. Kinney, Annie Haakenstad, Neha S. Singh, Kumanan Rasanathan, and Mickey Chopra
Subjects: Adolescent health, Health financing, World Bank, Global financing facility, Development assistance, Content analysis, Gynecology and obstetrics, RG1-991
Abstract: Abstract Background The Global Financing Facility (GFF) offers an opportunity to close the financing gap that holds back gains in women, children’s and adolescent health. However, very little work exists examining GFF practice, particularly for adolescent health. As momentum builds for the GFF, we examine initial GFF planning documents to inform future national and multi-lateral efforts to advance adolescent sexual and reproductive health. Methods We undertook a content analysis of the first 11 GFF Investment Cases and Project Appraisal Documents available on the GFF website. The countries involved include Bangladesh, Cameroon, Democratic Republic of Congo, Ethiopia, Guatemala, Kenya, Liberia, Mozambique, Nigeria, Tanzania and Uganda. Results While several country documents signal understanding and investment in adolescents as a strategic area, this is not consistent across all countries, nor between Investment Cases and Project Appraisal Documents. In both types of documents commitments weaken as one moves from programming content to indicators to investment. Important contributions include how teenage pregnancy is a universal concern, how adolescent and youth friendly health services and school-based programs are supported in several country documents, how gender is noted as a key social determinant critical for mainstreaming across the health system, alongside the importance of multi-sectoral collaboration, and the acknowledgement of adolescent rights. Weaknesses include the lack of comprehensive analysis of adolescent health needs, inconsistent investments in adolescent friendly health services and school based programs, missed opportunities in not supporting multi-component and multi-level initiatives to change gender norms involving adolescent boys in addition to adolescent girls, and neglect of governance approaches to broker effective multi-sectoral collaboration, community engagement and adolescent involvement. Conclusion There are important examples of how the GFF supports adolescents and their sexual and reproductive health. However, more can be done. While building on service delivery approaches more consistently, it must also fund initiatives that address the main social and systems drivers of adolescent health. This requires capacity building for the technical aspects of adolescent health, but also engaging politically to ensure that the right actors are convened to prioritize adolescent health in country plans and to ensure accountability in the GFF process itself.
Published: 2021
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3. Comprehensive Assessment of Health System Performance in Odisha, India

Author: Winnie Yip, Anuska Kalita, Bijetri Bose, Jan Cooper, Annie Haakenstad, William Hsiao, Liana Woskie, and Michael R. Reich
Subjects: Health policy reforms, health system, health system assessment, India, Odisha, Medicine (General), R5-920, Public aspects of medicine, RA1-1270
Abstract: ABSTRACTIndia has recently implemented several major health care reforms at national and state levels, yet the nation continues to face significant challenges in achieving better health system performance. These challenges are particularly daunting in India’s poorer states, like Odisha. The first step toward overcoming these challenges is to understand their root causes. Toward this end, the Harvard T.H. Chan School of Public Health conducted a comprehensive study in Odisha based on ten new field surveys of the system’s performance to provide a multi-perspective analysis. This article reports on the assessment of the performance of Odisha’s health system and the preliminary diagnosis of underlying causes of the strengths and challenges. This comprehensive health system assessment is aimed toward the overarching goals of informing and supporting efforts to improve the performance of health systems in Odisha and other similar contexts.
Published: 2022
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4. Disaggregating catastrophic health expenditure by disease area: cross-country estimates based on the World Health Surveys

Author: Annie Haakenstad, Matthew Coates, Andrew Marx, Gene Bukhman, and Stéphane Verguet
Subjects: Catastrophic health expenditure, Out-of-pocket spending, Financial risk protection, Universal health coverage, Illness-related impoverishment, Poverty, Medicine
Abstract: Abstract Background Financial risk protection (FRP) is a key objective of national health systems and a core pillar of universal health coverage (UHC). Yet, little is known about the disease-specific distribution of catastrophic health expenditure (CHE) at the national level. Methods Using the World Health Surveys (WHS) from 39 countries, we quantified CHE, or household health spending that surpasses 40% of capacity-to-pay by key disease areas. We restricted our analysis to households in which the respondent used health care in the last 30 days and categorized CHE into disease areas included as WHS response options: maternal and child health (MCH); high fever, severe diarrhea, or cough; heart disease; asthma; injury; surgery; and other. We compared disease-specific CHE estimates by income, pooled funding as a share of total health expenditure, share of the population affected by the different diseases, and poverty status. Results Across countries, an average of 45.1% of CHE cases could not be tied to a specific cause; 37.6% (95% UI 35.4–39.9%) of CHE cases were associated with high fever, severe cough, or diarrhea; 3.9% (3.0–4.9%) with MCH; and 4.1% (3.3–4.9%) with heart disease. Injuries constituted 5.2% (4.2–6.4%) of CHE cases. The distribution of CHE varied substantially by national income. A 10% increase in heart disease prevalence was associated with a 1.9% (1.3–2.4%) increase in heart disease CHE, an association stronger than any other disease area. Conclusions Our approach is comparable, comprehensive, and empirically based and highlights how financial risk protection may not be aligned with disease burden. Disease-specific CHE estimates can illuminate how health systems can target reform to best protect households from financial risk.
Published: 2019
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5. Health system strategies to increase HIV screening among pregnant women in Mesoamerica

Author: Charbel El Bcheraoui, Paola Zúñiga-Brenes, Diego Ríos-Zertuche, Erin B. Palmisano, Claire R. McNellan, Sima S. Desai, Marielle C. Gagnier, Annie Haakenstad, Casey Johanns, Alexandra Schaefer, Bernardo Hernandez, Emma Iriarte, and Ali H. Mokdad
Subjects: Human immunodeficiency virus, Antenatal care, HIV screening, Health care disparities, Central America, Mesoamerica, Computer applications to medicine. Medical informatics, R858-859.7, Public aspects of medicine, RA1-1270
Abstract: Abstract Background To propose health system strategies to meeting the World Health Organization (WHO) recommendations on HIV screening through antenatal care (ANC) services, we assessed predictors of HIV screening, and simulated the impact of changes in these predictors on the probability of HIV screening in Guatemala, Honduras, Mexico (State of Chiapas), Nicaragua, Panama, and El Salvador. Methods We interviewed a representative sample of women of reproductive age from the poorest Mesoamerican areas on ANC services, including HIV screening. We used a multivariate logistic regression model to examine correlates of HIV screening. First differences in expected probabilities of HIV screening were simulated for health system correlates that were associated with HIV screening. Results Overall, 40.7% of women were screened for HIV during their last pregnancy through ANC. This rate was highest in El Salvador and lowest in Guatemala. The probability of HIV screening increased with education, household expenditure, the number of ANC visits, and the type of health care attendant of ANC visits. If all women were to be attended by a nurse, or a physician, and were to receive at least four ANC visits, the probability of HIV screening would increase by 12.5% to reach 45.8%. Conclusions To meet WHO’s recommendations for HIV screening, special attention should be given to the poorest and least educated women to ensure health equity and progress toward an HIV-free generation. In parallel, health systems should be strengthened in terms of testing and human resources to ensure that every pregnant woman gets screened for HIV. A 12.5% increase in HIV screening would require a minimum of four ANC visits and an appropriate professional attendance of these visits.
Published: 2018
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6. The effect of facility-based antiretroviral therapy programs on outpatient services in Kenya and Uganda

Author: Alexandra Wollum, Emily Dansereau, Nancy Fullman, Jane Achan, Kelsey A. Bannon, Roy Burstein, Ruben O. Conner, Brendan DeCenso, Anne Gasasira, Annie Haakenstad, Michael Hanlon, Gloria Ikilezi, Caroline Kisia, Aubrey J. Levine, Samuel H. Masters, Pamela Njuguna, Emelda A. Okiro, Thomas A. Odeny, D. Allen Roberts, Emmanuela Gakidou, and Herbert C. Duber
Subjects: Antiretroviral therapy, HIV/AIDS, Health systems, Kenya, Uganda, Public aspects of medicine, RA1-1270
Abstract: Abstract Background Considerable debate exists concerning the effects of antiretroviral therapy (ART) service scale-up on non-HIV services and overall health system performance in sub-Saharan Africa. In this study, we examined whether ART services affected trends in non-ART outpatient department (OPD) visits in Kenya and Uganda. Methods Using a nationally representative sample of health facilities in Kenya and Uganda, we estimated the effect of ART programs on OPD visits from 2007 to 2012. We modeled the annual percent change in non-ART OPD visits using hierarchical mixed-effects linear regressions, controlling for a range of facility characteristics. We used four different constructs of ART services to capture the different ways in which the presence, growth, overall, and relative size of ART programs may affect non-ART OPD services. Results Our final sample included 321 health facilities (140 in Kenya and 181 in Uganda). On average, OPD and ART visits increased steadily in Kenya and Uganda between 2007 and 2012. For facilities where ART services were not offered, the average annual increase in OPD visits was 4·2% in Kenya and 13·5% in Uganda. Among facilities that provided ART services, we found average annual OPD volume increases of 7·2% in Kenya and 5·6% in Uganda, with simultaneous annual increases of 13·7% and 12·5% in ART volumes. We did not find a statistically significant relationship between annual changes in OPD services and the presence, growth, overall, or relative size of ART services. However, in a subgroup analysis, we found that Ugandan hospitals that offered ART services had statistically significantly less growth in OPD visits than Ugandan hospitals that did not provide ART services. Conclusions Our findings suggest that ART services in Kenya and Uganda did not have a statistically significant deleterious effects on OPD services between 2007 and 2012, although subgroup analyses indicate variation by facility type. Our findings are encouraging, particularly given recent recommendations for universal access to ART, demonstrating that expanding ART services is not inherently linked to declines in other health services in sub-Saharan Africa.
Published: 2017
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7. Tracking development assistance and government health expenditures for 35 malaria-eliminating countries: 1990–2017

Author: Rima Shretta, Brittany Zelman, Maxwell L. Birger, Annie Haakenstad, Lavanya Singh, Yingying Liu, and Joseph Dieleman
Subjects: Malaria, Elimination, Financing, Development assistance for health, Government health expenditure, Domestic expenditure, Arctic medicine. Tropical medicine, RC955-962, Infectious and parasitic diseases, RC109-216
Abstract: Abstract Background Donor financing for malaria has declined since 2010 and this trend is projected to continue for the foreseeable future. These reductions have a significant impact on lower burden countries actively pursuing elimination, which are usually a lesser priority for donors. While domestic spending on malaria has been growing, it varies substantially in speed and magnitude across countries. A clear understanding of spending patterns and trends in donor and domestic financing is needed to uncover critical investment gaps and opportunities. Methods Building on the Institute for Health Metrics and Evaluation’s annual Financing Global Health research, data were collected from organizations that channel development assistance for health to the 35 countries actively pursuing malaria elimination. Where possible, development assistance for health (DAH) was categorized by spend on malaria intervention. A diverse set of data points were used to estimate government health expenditure on malaria, including World Malaria Reports and government reports when available. Projections were done using regression analyses taking recipient country averages and earmarked funding into account. Results Since 2010, DAH for malaria has been declining for the 35 countries actively pursuing malaria elimination (from $176 million in 2010 to $62 million in 2013). The Global Fund to Fight AIDS, Tuberculosis and Malaria is the largest external financier for malaria providing 96% of the total external funding for malaria in 2013, with vector control interventions being the highest cost driver in all regions. Government expenditure on malaria, while increasing, has not kept pace with diminishing DAH or rising national GDP rates, leading to a potential gap in service delivery needed to attain elimination. Conclusion Despite past gains, total financing available for malaria in elimination settings is declining. Health financing trends suggest that substantive policy interventions will be needed to ensure that malaria elimination is adequately financed and that available financing is effectively targeted to interventions that provide the best value for money.
Published: 2017
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8. Supply-side interventions to improve health: Findings from the Salud Mesoamérica Initiative.

Author: Ali H Mokdad, Erin B Palmisano, Paola Zúñiga-Brenes, Diego Ríos-Zertuche, Casey K Johanns, Alexandra Schaefer, Sima S Desai, Annie Haakenstad, Marielle C Gagnier, Claire R McNellan, Danny V Colombara, Sonia López Romero, Leolin Castillo, Benito Salvatierra, Bernardo Hernandez, Miguel Betancourt-Cravioto, Ricardo Mujica-Rosales, Ferdinando Regalia, Roberto Tapia-Conyer, and Emma Iriarte
Subjects: Medicine, Science
Abstract: Results-based aid (RBA) is increasingly used to incentivize action in health. In Mesoamerica, the region consisting of southern Mexico and Central America, the RBA project known as the Salud Mesoamérica Initiative (SMI) was designed to target disparities in maternal and child health, focusing on the poorest 20% of the population across the region.Data were first collected in 365 intervention health facilities to establish a baseline of indicators. For the first follow-up measure, 18 to 24 months later, 368 facilities were evaluated in these same areas. At both stages, we measured a near-identical set of supply-side performance indicators in line with country-specific priorities in maternal and child health. All countries showed progress in performance indicators, although with different levels. El Salvador, Honduras, Nicaragua, and Panama reached their 18-month targets, while the State of Chiapas in Mexico, Guatemala, and Belize did not. A second follow-up measurement in Chiapas and Guatemala showed continued progress, as they achieved previously missed targets nine to 12 months later, after implementing a performance improvement plan.Our findings show an initial success in the supply-side indicators of SMI. Our data suggest that the RBA approach can be a motivator to improve availability of drugs and services in poor areas. Moreover, our innovative monitoring and evaluation framework will allow health officials with limited resources to identify and target areas of greatest need.
Published: 2018
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9. National health accounts data from 1996 to 2010: a systematic review

Author: Anthony L Bui, Rouselle F Lavado, Elizabeth K Johnson, Benjamin PC Brooks, Michael K Freeman, Casey M Graves, Annie Haakenstad, Benjamin Shoemaker, Michael Hanlon, and Joseph L Dieleman
Subjects: Public aspects of medicine, RA1-1270
Abstract: AbstractObjective:To collect, compile and evaluate publicly available national health accounts (NHA) reports produced worldwide between 1996 and 2010.Methods:We downloaded country-generated NHA reports from the World Health Organization global health expenditure database and the Organisation for Economic Co-operation and Development (OECD) StatExtract website. We also obtained reports from Abt Associates, through contacts in individual countries and through an online search. We compiled data in the four main types used in these reports: (i) financing source; (ii) financing agent; (iii) health function; and (iv) health provider. We combined and adjusted data to conform with OECD's first edition of A system of health accounts manual, (2000).Findings:We identified 872 NHA reports from 117 countries containing a total of 2936 matrices for the four data types. Most countries did not provide complete health expenditure data: only 252 of the 872 reports contained data in all four types. Thirty-eight countries reported an average not-specified-by-kind value greater than 20% for all data types and years. Some countries reported substantial year-on-year changes in both the level and composition of health expenditure that were probably produced by data-generation processes. All study data are publicly available at http://vizhub.healthdata.org/nha/.Conclusion:Data from NHA reports on health expenditure are often incomplete and, in some cases, of questionable quality. Better data would help finance ministries allocate resources to health systems, assist health ministries in allocating capital within the health sector and enable researchers to make accurate comparisons between health systems.
Published: 2015
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10. Tracking global expenditures on surgery: gaps in knowledge hinder progress

Author: Joseph L Dieleman, Gavin Yamey, Elizabeth K Johnson, Casey M Graves, Annie Haakenstad, and John G Meara
Subjects: Public aspects of medicine, RA1-1270
Published: 2015
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11. Missed Opportunities for Measles, Mumps, and Rubella (MMR) Immunization in Mesoamerica: Potential Impact on Coverage and Days at Risk.

Author: Ali H Mokdad, Marielle C Gagnier, K Ellicott Colson, Emily Dansereau, Paola Zúñiga-Brenes, Diego Ríos-Zertuche, Annie Haakenstad, Casey K Johanns, Erin B Palmisano, Bernardo Hernandez, and Emma Iriarte
Subjects: Medicine, Science
Abstract: BACKGROUND:Recent outbreaks of measles in the Americas have received news and popular attention, noting the importance of vaccination to population health. To estimate the potential increase in immunization coverage and reduction in days at risk if every opportunity to vaccinate a child was used, we analyzed vaccination histories of children 11-59 months of age from large household surveys in Mesoamerica. METHODS:Our study included 22,234 children aged less than 59 months in El Salvador, Guatemala, Honduras, Mexico, Nicaragua, and Panama. Child vaccination cards were used to calculate coverage of measles, mumps, and rubella (MMR) and to compute the number of days lived at risk. A child had a missed opportunity for vaccination if their card indicated a visit for vaccinations at which the child was not caught up to schedule for MMR. A Cox proportional hazards model was used to compute the hazard ratio associated with the reduction in days at risk, accounting for missed opportunities. RESULTS:El Salvador had the highest proportion of children with a vaccine card (91.2%) while Nicaragua had the lowest (76.5%). Card MMR coverage ranged from 44.6% in Mexico to 79.6% in Honduras while potential coverage accounting for missed opportunities ranged from 70.8% in Nicaragua to 96.4% in El Salvador. Younger children were less likely to have a missed opportunity. In Panama, children from households with higher expenditure were more likely to have a missed opportunity for MMR vaccination compared to the poorest (OR 1.62, 95% CI: 1.06-2.47). In Nicaragua, compared to children of mothers with no education, children of mothers with primary education and secondary education were less likely to have a missed opportunity (OR 0.46, 95% CI: 0.24-0.88 and OR 0.25, 95% CI: 0.096-0.65, respectively). Mean days at risk for MMR ranged from 158 in Panama to 483 in Mexico while potential days at risk ranged from 92 in Panama to 239 in El Salvador. CONCLUSIONS:Our study found high levels of missed opportunities for immunizing children in Mesoamerica. Our findings cause great concern, as they indicate that families are bringing their children to health facilities, but these children are not receiving all appropriate vaccinations during visits. This points to serious problems in current immunization practices and protocols in poor areas in Mesoamerica. Our study calls for programs to ensure that vaccines are available and that health professionals use every opportunity to vaccinate a child.
Published: 2015
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12. Comparative Estimates of Crude and Effective Coverage of Measles Immunization in Low-Resource Settings: Findings from Salud Mesoamérica 2015.

Author: K Ellicott Colson, Paola Zúñiga-Brenes, Diego Ríos-Zertuche, Carlos J Conde-Glez, Marielle C Gagnier, Erin Palmisano, Dharani Ranganathan, Gulnoza Usmanova, Benito Salvatierra, Austreberta Nazar, Ignez Tristao, Emmanuelle Sanchez Monin, Brent W Anderson, Annie Haakenstad, Tasha Murphy, Stephen Lim, Bernardo Hernandez, Rafael Lozano, Emma Iriarte, and Ali H Mokdad
Subjects: Medicine, Science
Abstract: Timely and accurate measurement of population protection against measles is critical for decision-making and prevention of outbreaks. However, little is known about how survey-based estimates of immunization (crude coverage) compare to the seroprevalence of antibodies (effective coverage), particularly in low-resource settings. In poor areas of Mexico and Nicaragua, we used household surveys to gather information on measles immunization from child health cards and caregiver recall. We also collected dried blood spots (DBS) from children aged 12 to 23 months to compare crude and effective coverage of measles immunization. We used survey-weighted logistic regression to identify individual, maternal, household, community, and health facility characteristics that predict gaps between crude coverage and effective coverage. We found that crude coverage was significantly higher than effective coverage (83% versus 68% in Mexico; 85% versus 50% in Nicaragua). A large proportion of children (19% in Mexico; 43% in Nicaragua) had health card documentation of measles immunization but lacked antibodies. These discrepancies varied from 0% to 100% across municipalities in each country. In multivariate analyses, card-positive children in Mexico were more likely to lack antibodies if they resided in urban areas or the jurisdiction of De Los Llanos. In contrast, card-positive children in Nicaragua were more likely to lack antibodies if they resided in rural areas or the North Atlantic region, had low weight-for-age, or attended health facilities with a greater number of refrigerators. Findings highlight that reliance on child health cards to measure population protection against measles is unwise. We call for the evaluation of immunization programs using serological methods, especially in poor areas where the cold chain is likely to be compromised. Identification of within-country variation in effective coverage of measles immunization will allow researchers and public health professionals to address challenges in current immunization programs.
Published: 2015
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13. Estimating the development assistance for health provided to faith-based organizations, 1990-2013.

Author: Annie Haakenstad, Elizabeth Johnson, Casey Graves, Jill Olivier, Jean Duff, and Joseph L Dieleman
Subjects: Medicine, Science
Abstract: Faith-based organizations (FBOs) have been active in the health sector for decades. Recently, the role of FBOs in global health has been of increased interest. However, little is known about the magnitude and trends in development assistance for health (DAH) channeled through these organizations.Data were collected from the 21 most recent editions of the Report of Voluntary Agencies. These reports provide information on the revenue and expenditure of organizations. Project-level data were also collected and reviewed from the Bill & Melinda Gates Foundation and the Global Fund to Fight AIDS, Tuberculosis and Malaria. More than 1,900 non-governmental organizations received funds from at least one of these three organizations. Background information on these organizations was examined by two independent reviewers to identify the amount of funding channeled through FBOs.In 2013, total spending by the FBOs identified in the VolAg amounted to US$1.53 billion. In 1990, FB0s spent 34.1% of total DAH provided by private voluntary organizations reported in the VolAg. In 2013, FBOs expended 31.0%. Funds provided by the Global Fund to FBOs have grown since 2002, amounting to $80.9 million in 2011, or 16.7% of the Global Fund's contributions to NGOs. In 2011, the Gates Foundation's contributions to FBOs amounted to $7.1 million, or 1.1% of the total provided to NGOs.Development assistance partners exhibit a range of preferences with respect to the amount of funds provided to FBOs. Overall, estimates show that FBOS have maintained a substantial and consistent share over time, in line with overall spending in global health on NGOs. These estimates provide the foundation for further research on the spending trends and effectiveness of FBOs in global health.
Published: 2015
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14. The complexity of resource allocation for health

Author: Joseph L Dieleman and Annie Haakenstad
Subjects: Public aspects of medicine, RA1-1270
Published: 2015
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15. Allocating development assistance for health

Author: Benjamin P C Brooks, BS, Dr. Joseph L Dieleman, PhD, Annie Haakenstad, MA, and Michael Hanlon, PhD
Subjects: Public aspects of medicine, RA1-1270
Abstract: Background: In the past decade, development assistance for health (DAH) distributed to developing countries grew at an annual rate of 11·6%, to a total of US$31·3 billion in 2013. Although this substantial rise in DAH is well documented, little has been done to quantify the determinants of its allocation. Methods: We derived estimates of total DAH received by recipient country during 5 year intervals from 1990–2010 from data published in the Institute for Health Metrics and Evaluation's Financing Global Health 2012 report. Disease burden information during the same period was available from the Global Burden of Disease Study 2010. Other country-level characteristics that might affect the allocation of aid, such as gross domestic product and quality of governance, were also included. We use linear regression to identify patterns that typify how DAH is allocated across countries and time. Findings: Income is associated with the allocation of DAH across countries but not across time, meaning that donors provide more health aid for low-income countries than for high-income countries, but an increase in a country's wealth with time does not mean it will receive less aid. Countries that are democratic and have civil or political rights receive more aid. Regarding disease burden, countries with a larger disease burden receive more DAH. A 10% increase in disease burden is associated with a 6% increase in DAH. Unlike gross domestic product, changes in disease burden within a country, over time, do affect DAH allocation; this is especially true for transparent and democratic countries. In these countries, a 10% increase in burden (which might be caused by disease epidemic or rising population) would result in up to a 30% increase in DAH. Lastly, DAH allocation is especially responsive to a recipient country's burden of HIV/AIDS. Interpretation: This analysis provides evidence that donors give less to high-income countries and more to democracies with increased disease burdens. However, when disease burden is examined in greater detail, the emergence of HIV/AIDS as a primary driver of aid allocation is interesting in view of the diverse set of priorities within the global health agenda. With the growth of DAH slowing due to the economic crisis and an increasing number of non-state organisations operating in global health, knowledge of which factors affect resource allocation at the aggregate level can inform discussions about whether resources are being distributed appropriately. Funding: The Bill & Melinda Gates Foundation.
Published: 2014
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16. Pharmaceutical availability across levels of care: evidence from facility surveys in Ghana, Kenya, and Uganda.

Author: Samuel H Masters, Roy Burstein, Brendan DeCenso, Kelsey Moore, Annie Haakenstad, Gloria Ikilezi, Jane Achan, Ivy Osei, Bertha Garshong, Caroline Kisia, Pamela Njuguna, Joseph Babigumira, Santosh Kumar, Michael Hanlon, and Emmanuela Gakidou
Subjects: Medicine, Science
Abstract: OBJECTIVE:In this study we use facility-level data from nationally representative surveys conducted in Ghana, Kenya, and Uganda to understand pharmaceutical availability within the three countries. METHODS:In 2012, we conducted a survey to capture information on pharmaceuticals and other facility indicators from over 200 facilities in each country. We analyze data on the availability of pharmaceuticals and quantify its association with various facility-level indicators. We analyze both availability of essential medicines, as defined by the various essential medicine lists (EMLs) of each respective country, and availability of all surveyed pharmaceuticals deemed important for treatment of various high-burden diseases, including those on the EMLs. RESULTS:We find that there is heterogeneity with respect to availability across the three countries with Ghana generally having better availability than Uganda and Kenya. To analyze the relationship between facility-level factors and pharmaceutical stock-out we use a binomial regression model. We find that the factors associated with stock-out vary by country, but across all countries both presence of a laboratory at the facility and presence of a vehicle at the facility are significantly associated with reduced stock-out. CONCLUSION:The results of this study highlight the poor availability of essential medicines across these three countries and suggest more needs to be done to strengthen the supply system so that stock remains uninterrupted.
Published: 2014
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17. Global fertility in 204 countries and territories, 1950-2021, with forecasts to 2100: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

Author: V Bhattacharjee, N, E Schumacher, A, Aali, A, Habtegiorgis Abate, Y, Abbasgholizadeh, R, Abbasian, M, Abbasi-Kangevari, M, Abbastabar, H, Abd ElHafeez, S, Abd-Elsalam, S, Abdollahi, M, Abdollahifar, M, Abdoun, M, Abdullahi, A, Abebe, M, Shawel Abebe, S, Abiodun, O, Abolhassani, H, Abolmaali, M, Abouzid, M, Beressa Aboye, G, Guimarães Abreu, L, Aberhe Abrha, W, M Abrigo, M, Abtahi, D, Abualruz, H, Abubakar, B, Abu-Gharbieh, E, Me Abu-Rmeileh, N, Girum Girum Adal, T, Molla Adane, M, Atanda Adeagbo Adeagbo, O, Adesoji Adedoyin, R, Adekanmbi, V, Aden, B, Victor Adepoju, A, O Adetokunboh, O, Bunmi Adetunji, J, Adedayo Adeyinka, D, Israel Adeyomoye, O, Estiningtyas Sakilah Adnani, Q, Adra, S, Felix Afolabi, R, Afyouni, S, Sohail Afzal, M, Afzal, S, Aghamiri, S, Agodi, A, Agyemang-Duah, W, Opoku Ahinkorah, B, J Ahlstrom, A, Ahmad, A, Ahmad, D, Ahmad, F, M Ahmad, M, Ahmad, S, Ahmad, T, Ahmed, A, Ahmed, H, A Ahmed, L, Saleh Ahmed, M, Anees Ahmed, S, Ajami, M, Aji, B, Taddesse Akalu, G, Akbarialiabad, H, Olusola Akinyemi, R, Ahmed Akkaif, M, Akkala, S, Al Hamad, H, Mahfuz Al Hasan, S, Al Qadire, M, Mohammed Ali Al-Ahdal, T, O Alalalmeh, S, A Alalwan, T, Al-Aly, Z, Alam, K, Mustafa Al-Amer, R, Mashhour Alanezi, F, M Alanzi, T, Albakri, A, Albashtawy, M, T AlBataineh, M, Alemi, H, Alemi, S, Mulugeta Alemu, Y, Al-Eyadhy, A, Ali Saeed Al-Gheethi, A, F Alhabib, K, Alhajri, N, Alhalaiqa Naji Alhalaiqa, F, Kaba Alhassan, R, Ali, A, Abdulqadir Ali, B, Ali, L, Usman Ali, M, Ali, R, Shujait Shujait Ali, S, Mohammad Alif, S, Aligol, M, Alijanzadeh, M, M Aljasir, M, Mohamed Aljunid, S, Al-Marwani, S, Uy Almazan, J, M Al-Mekhlafi, H, Almidani, O, A Alomari, M, Al-Omari, B, S Alqahtani, J, Yaseen Alqutaibi, A, M Al-Raddadi, R, Khalifah Al-Sabah, S, Altaf, A, A Al-Tawfiq, J, A Altirkawi, K, Oyine Aluh, D, Jawad Alvi, F, Alvis-Guzman, N, Alwafi, H, Mohammed Al-Worafi, Y, Aly, H, Aly, S, H Alzoubi, K, Kwabena Ameyaw, E, Tawfik Amin, T, Amindarolzarbi, A, Amini-Rarani, M, Amiri, S, Gyamfuah Ampomah, I, A Amugsi, D, Adeniyi Amusa, G, Ancuceanu, R, Anderlini, D, Prata Andrade, P, Liliana Andrei, C, Andrei, T, Anil, A, Anil, S, Ansar, A, Ansari-Moghaddam, A, M Antony, C, Antriyandarti, E, Anvari, S, Anwar, S, Anwer, R, Edward Anyasodor, A, Arabloo, J, Arabzadeh Bahri, R, A Arafa, E, Arafat, M, Margarida Araújo, A, Y Aravkin, A, Aremu, A, Aripov, T, Arkew, M, Armocida, B, Ärnlöv, J, Arooj, M, A Artamonov, A, Arulappan, J, Taiwo Aruleba, R, Arumugam, A, Asadi-Lari, M, Asemi, Z, Asgary, S, Asghariahmadabad, M, Asghari-Jafarabadi, M, Yesse Ashemo, M, Ashraf, M, Ashraf, T, O Asika, M, Shamsadin Athari, S, Moh'd Wahbi Atout, M, Atreya, A, Aujayeb, A, Ausloos, M, Avan, A, Mulat Aweke, A, Melaku Ayele, G, Mohammad Ayyoubzadeh, S, Azadnajafabad, S, S Azevedo, R, Y Azzam, A, Badar, M, D Badiye, A, Baghdadi, S, Bagheri, N, Bagherieh, S, Bahmanziari, N, Bai, R, Amin Baig, A, L Baker, J, T Bako, A, Kaur Bakshi, R, Balasubramanian, M, Constantin Baltatu, O, Bam, K, Banach, M, Bandyopadhyay, S, Banik, B, Chandra Banik, P, Bansal, H, Firat Baran, M, Barchitta, M, Bardhan, M, Bardideh, E, Lyn Barker-Collo, S, Winfried Bärnighausen, T, Barone-Adesi, F, Jawdat Barqawi, H, Barrow, A, Barteit, S, Basharat, Z, J Bashir, A, Akande Bashiru, H, Basiru, A, Diogo Basso, J, Basu, S, Mohammad Batiha, A, Batra, K, T Baune, B, Bayati, M, Begum, T, Behboudi, E, Hossein Behnoush, A, Beiranvand, M, Fernanda Bejarano Ramirez, D, Bekele, A, Assefa Belay, S, Iqbal Belgaumi, U, L Bell, M, Omolaja Bello, O, Beloukas, A, M Bensenor, I, Berezvai, Z, Yirga Berhie, A, C Bermudez, A, G Bettencourt, P, Srikanth Bhagavathula, A, Bhardwaj, N, Bhardwaj, P, V Bhardwaj, P, Bhaskar, S, Bhat, V, Kaur Bhatti, G, Singh Bhatti, J, S Bhatti, M, Bhatti, R, Biondi, A, Bisignano, C, Biswas, A, Kishore Biswas, R, R Bitra, V, Bjørge, T, Bliss, E, Kofi Boachie, M, Vasilica Bobirca, A, Bodolica, V, Olalekan Bodunrin, A, Ketema Bogale, E, Angaw Bogale, K, Bonakdar Hashemi, M, Bora Basara, B, Bouaoud, S, Braithwaite, D, Brauer, M, K Breitborde, N, Bryazka, D, B Bulamu, N, Buonsenso, D, Burkart, K, A Burns, R, Bustanji, Y, Shafique Butt, N, A Butt, Z, Luciano Caetano Dos Santos, F, Calina, D, R Campos-Nonato, I, Cao, F, Cao, S, Capodici, A, Carreras, G, Carugno, A, A Castañeda-Orjuela, C, Castelpietra, G, Sofia Cattaruzza, M, Caye, A, Cegolon, L, Cembranel, F, Cerin, E, Chadwick, J, Chahine, Y, Chakraborty, C, Chalek, J, Shi Kai Chan, J, Charalampous, P, Kumar Chattu, V, Chaturvedi, S, Paul Chavula, M, Chen, A, Chen, H, Chen, S, Chi, G, Chichagi, F, Chien, J, R Ching, P, S Cho, W, Choi, S, Chong, B, Chopra, H, Gajanan Choudhari, S, J Christopher, D, Chu, D, Sunday Chukwu, I, Chung, E, Chung, S, Cindi, Z, Cioffi, I, Ciuffreda, R, M Claro, R, Coberly, K, Columbus, A, Comfort, H, Conde, J, H Criqui, M, Cruz-Martins, N, Magali Cuadra-Hernández, S, Dadana, S, Dadras, O, Dahiru, T, Dai, Z, Dalton, B, Damiani, G, Mohammad Darwesh, A, K Das, J, Das, S, Dashti, M, Dastiridou, A, Alberto Dávila-Cervantes, C, Davletov, K, Tamire Debele, A, Debopadhaya, S, Delavari, S, Delgado-Enciso, I, Demeke, D, Hundessa Demessa, B, Deng, X, Denova-Gutiérrez, E, Deribe, K, Dervenis, N, Dineshbhai Desai, H, Desai, R, Gnana Chellaiyan Devanbu, V, Dhali, A, Dhama, K, Dhimal, M, R Dhulipala, V, Dias da Silva, D, Diaz, D, J Diaz, M, Dima, A, D Ding, D, Ashworth Dirac, M, Chi Do, T, Huynh Phuong Do, T, Bruneli do Prado, C, Dohare, S, Dong, W, D'Oria, M, Mombaque Dos Santos, W, Doshmangir, L, Kokou Dowou, R, Chelsea Dsouza, A, Larson Dsouza, H, Dsouza, V, Dube, J, Duprey, J, Rodrigues Duraes, A, Duraisamy, S, Christopher Durojaiye, O, Dutta, S, Dwyer-Lindgren, L, Agnieszka Dzianach, P, Marian Dziedzic, A, Ebrahimi, A, Atan Edinur, H, Edvardsson, K, Efendi, F, Andreas Eikemo, T, Ekholuenetale, M, El Tantawi, M, Mousaad Elemam, N, Metwally Tawfik ElGohary, G, Elhadi, M, Tesfaye Elilo, L, Abdelsadek Abdou Elmeligy, O, A Elmonem, M, Elshaer, M, Elsohaby, I, Emami Zeydi, A, Engelbert Bain, L, Eskandarieh, S, Esposito, F, Estep, K, Etaee, F, Fabin, N, Francis Fagbamigbe, A, Fahimi, S, Fakhri-Demeshghieh, A, Falzone, L, Faramarzi, A, Ezzat Mahmoud Faris, M, Farmer, S, Faro, A, Omolara Fasanmi, A, Fatehizadeh, A, Klau Fauk, N, Fazeli, P, L Feigin, V, Fereshtehnejad, S, Hamid Feroze, A, Ferrara, P, Ferreira, N, Fetensa, G, Filip, I, Fischer, F, Flavel, J, A Foigt, N, Oluwatoyin Folayan, M, Alekseevich Fomenkov, A, Foroutan, B, Foschi, M, Raphael Fowobaje, K, Louise Francis, K, Freitas, A, Fukumoto, T, E Fuller, J, Fux, B, Andras Gaal, P, A Gadanya, M, Motiramji Gaidhane, A, Galali, Y, Gallus, S, P Gandhi, A, Ganesan, B, Arfat Ganiyani, M, A Garcia-Gordillo, M, Garg, N, K Gautam, R, Gazzelloni, F, Olatunde Gbadamosi, S, W Gebregergis, M, Gebrehiwot, M, Brhane Gebremariam, T, B Gebremariam, T, Gebru Gebremeskel, T, Fikadu Geda, Y, Roxana Georgescu, S, Gerema, U, Geremew, H, Erena Getachew, M, W Gething, P, Ghasemi, M, Ghasempour Dabaghi, G, Ghasemzadeh, A, Ghassemi, F, Mohamed Ghazy, R, Ghimire, S, Gholamian, A, Gholamrezanezhad, A, Ghorbani, M, Gopal Ghoshal, A, Digambarrao Ghuge, A, Urievich Gil, A, K Gill, T, Giorgi, M, Girmay, A, C Glasbey, J, Göbölös, L, Goel, A, Golchin, A, Golechha, M, Goleij, P, Vali Gopalani, S, Goudarzi, H, C Goulart, A, Goyal, A, Matthew Graham, S, Grivna, M, Guan, S, Guarducci, G, Ibrahim Mohialdeen Gubari, M, Dechasa Gudeta, M, Guicciardi, S, Gulati, S, Gulisashvili, D, Asanga Gunawardane, D, Guo, C, Kumar Gupta, A, Gupta, B, Kumar Gupta, M, Gupta, M, Gupta, S, Bala Gupta, V, Kumar Gupta, V, Haakenstad, A, Habibzadeh, F, R Hadi, N, Haep, N, Hajibeygi, R, Haller, S, Halwani, R, R Hamadeh, R, M Hamdy, N, Hameed, S, Hamidi, S, Han, Q, J Handal, A, J Hankey, G, Nuruzzaman Haque, M, Maria Haro, J, I Hasaballah, A, Hasan, I, Jahid Hasan, M, M Mahmudul Hasan, S, Hasani, H, Saquib Hasnain, M, Hassan, A, Hassan, I, Hassanipour, S, Hassankhani, H, I Hay, S, J Hebert, J, E Hegazi, O, Heidari, M, Helfer, B, Hemmati, M, Yuliana Herrera-Serna, B, Herteliu, C, Hessami, K, Hezam, K, Hiraike, Y, Quoc Hoan, N, Holla, R, Horita, N, Mahbub Hossain, M, Bellal Hossain Hossain, M, Hosseinzadeh, H, Hosseinzadeh, M, Hostiuc, M, Hostiuc, S, Hsairi, M, Chia-Rong Hsieh, V, Hu, C, Huang, J, Mamun Huda, M, Humayun, A, Hussain, J, R Hussein, N, Huynh, H, Hwang, B, Emmanuel Ibitoye, S, Maria Iftikhar, P, Stephen Ilesanmi, O, M Ilic, I, D Ilic, M, Immurana, M, Raja Inbaraj, L, Iqbal, A, Rabiul Islam, M, Elkudssiah Ismail, N, Iso, H, Isola, G, Iwagami, M, Iyer, M, J, L, Jaafari, J, Jacob, L, Jadidi-Niaragh, F, Jaggi, K, Jahankhani, K, Jahanmehr, N, Jahrami, H, Jain, A, Jain, N, Abdulrahman Jairoun, A, Jakovljevic, M, Jamshidi, E, Javadov, S, Javaheri, T, Kumar Jayapal, S, Jayaram, S, Ha Jee, S, Jeganathan, J, K Jha, A, Prakash Jha, R, Jiang, H, Jokar, M, B Jonas, J, Joo, T, Joseph, N, Ehimwenma Joshua, C, Joukar, F, Jerzy Jozwiak, J, Jürisson, M, K, V, Kaambwa, B, Kabir, A, Kabir, H, Kabir, Z, Kalani, R, R Kalankesh, L, Kaliyadan, F, Kalra, S, Kamath, R, Kamath, S, Kanchan, T, Wedam Kanmiki, E, Kazeem Kanmodi, K, S, S, Kumar Kansal, S, S Kantar, R, Kapoor, N, Karajizadeh, M, Karami, M, M Karaye, I, Zaffar Kashoo, F, Kasraei, H, J Kassebaum, N, B Kassel, M, H Kauppila, J, Kazemi, F, Kazeminia, S, H Kempen, J, Shoshannah Kendal, E, Keshtkar, K, Keykhaei, M, Khajuria, H, Khalaji, A, Khalid, N, Ahmed Khalil, A, Khalilian, A, Khamesipour, F, Khan, A, Khan, I, Nuruzzaman Khan, M, Khan, M, Jobair Khan, M, Ab Khan, M, Khang, Y, Khanmohammadi, S, Khatab, K, Khavandegar, A, Reza Khayat Kashani, H, Fatima Khidri, F, Khormali, M, Ali Khosravi, M, Khosrowjerdi, M, Teklesilasie Kidane, W, Demelash Kifle, Z, Sojin Kim, J, Seo Kim, M, W Kimokoti, R, E Kinzel, K, Tsegay Kiross, G, Kisa, A, Kisa, S, Kolahi, A, Kompani, F, Koren, G, Korzh, O, Kosen, S, Lakshmi Koulmane Laxminarayana, S, Krishan, K, Krishna, V, Krishnamoorthy, V, Kuate Defo, B, M Kubeisy, C, Kucuk Bicer, B, Abdul Kuddus, M, Kuddus, M, Kuitunen, I, Kulimbet, M, Kumar, H, Kundu, S, Rotimi Kunle, K, P Kurmi, O, Kusnali, A, Kusuma, D, F Kyei, E, Kyriopoulos, I, La Vecchia, C, Lacey, B, Awwal Ladan, M, Laflamme, L, Lahariya, C, Teck Ching Lai, D, Kumar Lal, D, Lalloo, R, Lám, J, Lamnisos, D, Landires, I, Lanfranchi, F, Langguth, B, Laplante-Lévesque, A, Jane Larson, H, O Larsson, A, Lasrado, S, Latief, K, Latifinaibin, K, Khanh Dao Le, L, Huu Hanh Le, N, Diep Thanh Le, T, Ledda, C, Lee, M, H Lee, P, Won Lee, S, Han Lee, Y, Kiros Lema, G, Leong, E, L Lerango, T, Li, A, Li, M, Li, S, Li, W, Li, X, S Ligade, V, S Lim, S, Lin, R, A Lindstedt, P, Listl, S, Liu, G, Liu, J, Liu, X, Liu, Y, Llanaj, E, López-Bueno, R, D Lopukhov, P, Lorenzovici, L, A Lotufo, P, Lubinda, J, Lucchetti, G, Lugo, A, Lunevicius, R, Lv, H, Feei Ma, Z, Lynn Maass, K, Machoy, M, M Madureira-Carvalho, Á, Magdy Abd El Razek, M, A Maghazachi, A, Mahjoub, S, Adam Mahmoud, M, Majeed, A, N Malagón-Rojas, J, Malakan Rad, E, Malhotra, K, Azam Malik, A, Malik, I, Carvalho Malta, D, A Mamun, A, Manla, Y, Mansoori, Y, Mansour, A, Mansouri, B, Mansouri, Z, Ali Mansournia, M, C Maravilla, J, Marino, M, Marjani, A, Martinez, G, Martinez-Piedra, R, Rogerlândio Martins-Melo, F, Martorell, M, Maryam, S, Rillera Marzo, R, Masoudi, A, Mattumpuram, J, James Maude, R, Maugeri, A, A May, E, Mayeli, M, Mazaheri, M, J McGrath, J, Mckee, M, Laura Wensel McKowen, A, A McLaughlin, S, M McPhail, S, Mehra, R, Mehrabani-Zeinabad, K, Mehrabi Nasab, E, Mekene Meto, T, Alberto Mendez Mendez-Lopez, M, Mendoza, W, G Menezes, R, A Mensah, G, A Mentis, A, Ayoub Meo, S, Merati, M, Meretoja, A, J Meretoja, T, M Mersha, A, Mestrovic, T, Metanat, P, Chamila Dinushi Mettananda, K, Mettananda, S, Mhlanga, A, Mhlanga, L, Mi, T, Miazgowski, T, Micha, G, Maria Michalek, I, R Miller, T, Huu Nhat Minh, L, Mirghafourvand, M, M Mirrakhimov, E, Kiros Mirutse, M, Mirza, M, Mirzaei, R, Mishra, A, Misra, S, B Mitchell, P, Mittal, C, Moazen, B, Z Mohamed, A, Ismail Mohamed, A, Mohamed, J, H Mohamed, M, Saad Mohamed, N, Mohammad-Alizadeh-Charandabi, S, Mohammadi, S, Mohammadian-Hafshejani, A, Mohammed, M, Mohammed, S, H Mokdad, A, Mokhtarzadehazar, P, Molavi Vardanjani, H, Molinaro, S, Monasta, L, Ali Moni, M, Moradi, M, Moradi, Y, Moraga, P, Silveira Moreira, R, Morovatdar, N, Douglas Morrison, S, Morze, J, Mosapour, A, Mossialos, E, Motappa, R, Mousavi, P, Mousavi Khaneghah, A, Mpundu-Kaambwa, C, Mubarik, S, Muccioli, L, Mulita, F, Munjal, K, Murillo-Zamora, E, Musa, J, Musaigwa, F, Musina, A, Muthu, S, Muthupandian, S, Muzaffar, M, Myung, W, Jayaraman Nagarajan, A, Nagel, G, Naghavi, P, R Naik, G, Naik, G, David Naimzada, M, Nainu, F, Nangia, V, Narasimha Swamy, S, Ramos Nascimento, B, G Nascimento, G, Y Naser, A, Javad Nasiri, M, S Natto, Z, Nauman, J, Naveed, M, Prakash Nayak, B, C Nayak, V, Ndejjo, R, Onyinye Nduaguba, S, Negash, H, Tafere Negesse, C, Negoi, I, Irina Negoi, R, Aria Nejadghaderi, S, Nejjari, C, Nepal, S, Biresaw Netsere, H, Nguefack-Tsague, G, W Ngunjiri, J, H Nguyen, D, Thi Hien Nguyen, H, The Nguyen, P, P Nguyen, Q, Thanh Nguyen, V, Khan Niazi, R, T Nigatu, Y, Konstantinos Nikolouzakis, T, Nikoobar, A, Reza Nikpoor, A, A Nnaji, C, Achilles Nnyanzi, L, Ali Noman, E, Nomura, S, Noreen, M, Noroozi, N, Adaobi Nri-Ezedi, C, H Nunemo, M, Nuñez-Samudio, V, Nurrika, D, John Nutor, J, Oancea, B, O Obamiro, K, A Odetokun, I, Martina Odogwu, N, James O'Donnell, M, Ololade Odukoya, O, Sikiru Oguntade, A, Odhiambo Oguta, J, Oh, I, Reuben Okeke, S, Paul Okekunle, A, Christabel Okonji, O, Godwin Okwute, P, T Olagunju, A, O Olasupo, O, Idowu Olatubi, M, Maria Moraes Oliveira, G, Olubukunola Olusanya, B, Olusegun Olusanya, J, Olamilekan Oluwatunase, G, A Omar, H, Latif Omer, G, E Onwujekwe, O, Ordak, M, Ebere Orisakwe, O, N Orish, V, V Ortega-Altamirano, D, Ortiz, A, Ortiz-Prado, E, S Osman, W, Levi Osuagwu, U, Osuolale, O, Otoiu, A, S Otstavnov, S, Ouyahia, A, Ouyang, G, O Owolabi, M, Ozten, Y, P A, M, Taha Pahlevan Fallahy, M, Pan, F, 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Puvvula, Nameer Hashim Qasim, Ibrahim Qattea, Deepthi R, Mehrdad Rabiee Rad, Amir Radfar, Venkatraman Radhakrishnan, Pourya Raee, Hadi Raeisi Shahraki, Alireza Rafiei, Seyedeh Niloufar Rafiei Alavi, Cat Raggi, Pankaja Raghav Raghav, Fakher Rahim, Md Jillur Rahim, Md Mosfequr Rahman, Mohammad Hifz Ur Rahman, Mosiur Rahman, Muhammad Aziz Rahman, Vahid Rahmanian, Masoud Rahmati, Niloufar Rahnavard, Pramila Rai, Diego Raimondo, Ali Rajabpour-Sanati, Prashant Rajput, Prasanna Ram, Shakthi Kumaran Ramasamy, Juwel Rana, Kritika Rana, Shailendra Singh Rana, Chhabi Lal Ranabhat, Nemanja Rancic, Amey Rane, Shubham Ranjan, Chythra R Rao, Indu Ramachandra Rao, Deepthi Rapaka, Davide Rasella, Sina Rashedi, Vahid Rashedi, Mohammad-Mahdi Rashidi, Azad Rasul, Zubair Ahmed Ratan, Giridhara Rathnaiah Babu, Santosh Kumar Rauniyar, Nakul Ravikumar, David Laith Rawaf, Salman Rawaf, Reza Rawassizadeh, Bharat Rawlley, Murali Mohan Rama Krishna Reddy, Elrashdy Moustafa Mohamed Redwan, Giuseppe Remuzzi, Bhageerathy Reshmi, Nazila Rezaei, Aida Rezaei Nejad, Mohsen Rezaeian, Abanoub Riad, Mavra A Riaz, Jennifer Rickard, Reza Rikhtegar, Hannah Elizabeth Robinson-Oden, Célia Fortuna Rodrigues, Jefferson Antonio Buendia Rodriguez, Ravi Rohilla, Debby Syahru Romadlon, Luca Ronfani, Himanshu Sekhar Rout, Bedanta Roy, Nitai Roy, Priyanka Roy, Enrico Rubagotti, Guilherme de Andrade Ruela, Susan Fred Rumisha, Tilleye Runghien, Manjula S, Chandan S N, Aly M A Saad, Zahra Saadatian, Maha Mohamed Saber-Ayad, Morteza SaberiKamarposhti, Siamak Sabour, Fatos Sada, Basema Saddik, Bashdar Abuzed Sadee, Ehsan Sadeghi, Erfan Sadeghi, Mohammad Reza Saeb, Umar Saeed, Sher Zaman Safi, Dominic Sagoe, Manika Saha, Amirhossein Sahebkar, Soumya Swaroop Sahoo, Monalisha Sahu, Zahra Saif, Joseph W Sakshaug, Payman Salamati, Afeez Abolarinwa Salami, Mohamed A Saleh, Marwa Rashad Salem, Mohammed Z Y Salem, Sohrab Salimi, Sara Samadzadeh, Yoseph Leonardo Samodra, Vijaya Paul Samuel, Abdallah M Samy, Juan Sanabria, Nima Sanadgol, Francesca Sanna, Milena M Santric-Milicevic, Haaris Saqib, Sivan Yegnanarayana Iyer Saraswathy, Aswini Saravanan, Babak Saravi, Yaser Sarikhani, Tanmay Sarkar, Rodrigo Sarmiento-Suárez, Gargi Sachin Sarode, Sachin C Sarode, Arash Sarveazad, Brijesh Sathian, Thirunavukkarasu Sathish, Anudeep Sathyanarayan, Abu Sayeed, Md Abu Sayeed, Nikolaos Scarmeas, Winfried Schlee, Art Schuermans, David C Schwebel, Falk Schwendicke, Siddharthan Selvaraj, Pallav Sengupta, Subramanian Senthilkumaran, Sadaf G Sepanlou, Dragos Serban, Edson Serván-Mori, Yashendra Sethi, SeyedAhmad SeyedAlinaghi, Seyed Arsalan Seyedi, Allen Seylani, Mahan Shafie, Jaffer Shah, Pritik A Shah, Ataollah Shahbandi, Samiah Shahid, Moyad Jamal Shahwan, Ahmed Shaikh, Masood Ali Shaikh, Muhammad Aaqib Shamim, Mehran Shams-Beyranvand, Mohammad Anas Shamsi, Mohd Shanawaz, Abhishek Shankar, Mohammed Shannawaz, Medha Sharath, Sadaf Sharfaei, Amin Sharifan, Javad Sharifi-Rad, Manoj Sharma, Rajesh Sharma, Ujjawal Sharma, Vishal Sharma, Rajesh P Shastry, Amin Shavandi, David H Shaw, Amir Mehdi Shayan, Maryam Shayan, Amr Mohamed Elsayed Shehabeldine, Aziz Sheikh, Rahim Ali Sheikhi, Manjunath Mala Shenoy, Pavanchand H Shetty, Peilin Shi, Desalegn Shiferaw, Mika Shigematsu, Rahman Shiri, Reza Shirkoohi, Aminu Shittu, Velizar Shivarov, Farhad Shokraneh, Sina Shool, Seyed Afshin Shorofi, Kanwar Hamza Shuja, Kerem Shuval, Emmanuel Edwar Siddig, João Pedro Silva, Luís Manuel Lopes Rodrigues Silva, Soraia Silva, Biagio Simonetti, Anjali Singal, Abhinav Singh, Balbir Bagicha Singh, Jasvinder A Singh, Md Shahjahan Siraj, Georgia Smith, Bogdan Socea, Anton Sokhan, Ranjan Solanki, Shipra Solanki, Hamidreza Soleimani, Sameh S M Soliman, Yonatan Solomon, Yimeng Song, Reed J D Sorensen, Michael Spartalis, Chandrashekhar T Sreeramareddy, Vijay Kumar Srivastava, Muhammad Haroon Stanikzai, Vladimir I Starodubov, Antonina V Starodubova, Simona Cătălina Stefan, Paschalis Steiropoulos, Mark A Stokes, Vetriselvan Subramaniyan, Muhammad Suleman, Rizwan Suliankatchi Abdulkader, Abida Sultana, Jing Sun, Chandan Kumar Swain, Bryan L Sykes, Lukasz Szarpak, Mindy D Szeto, Miklós Szócska, Payam Tabaee Damavandi, Rafael Tabarés-Seisdedos, Ozra Tabatabaei Malazy, Seyed-Amir Tabatabaeizadeh, Shima Tabatabai, Karen M Tabb, Mohammad Tabish, Moslem Taheri Soodejani, Jabeen Taiba, Ardeshir Tajbakhsh, Iman M Talaat, Ashis Talukder, Mircea Tampa, Jacques Lukenze Tamuzi, Ker-Kan Tan, Haosu Tang, Derbie Alemu DA Tareke, Mengistie Kassahun Tariku, Vivian Y Tat, Seyed Mohammad Tavangar, Mojtaba Teimoori, Mohamad-Hani Temsah, Reem Mohamad Hani Temsah, Masayuki Teramoto, Dufera Rikitu Terefa, Riki Tesler, Enoch Teye-Kwadjo, Ramna Thakur, Pugazhenthan Thangaraju, Kavumpurathu Raman Thankappan, Rekha Thapar, Samar Tharwat, Rasiah Thayakaran, Nihal Thomas, Ales Tichopad, Jansje Henny Vera Ticoalu, Tenaw Yimer Tiruye, Mariya Vladimirovna Titova, Marcello Tonelli, Marcos Roberto Tovani-Palone, Eugenio Traini, Jasmine T Tran, Nghia Minh Tran, Indang Trihandini, Samuel Joseph Tromans, Thien Tan Tri Tai Truyen, Aristidis Tsatsakis, Evangelia Eirini Tsermpini, Munkhtuya Tumurkhuu, Stefanos Tyrovolas, Sayed Mohammad Nazim Uddin, Aniefiok John Udoakang, Arit Udoh, Atta Ullah, Saeed Ullah, Sana Ullah, Srikanth Umakanthan, Chukwuma David Umeokonkwo, Brigid Unim, Bhaskaran Unnikrishnan, Era Upadhyay, Jibrin Sammani Usman, Marco Vacante, Seyed Mohammad Vahabi, Asokan Govindaraj Vaithinathan, Rohollah Valizadeh, Jef Van den Eynde, Elena Varavikova, Orsolya Varga, Priya Vart, Shoban Babu Varthya, Tommi Juhani Vasankari, Balachandar Vellingiri, Deneshkumar Venugopal, Nicholas Alexander Verghese, Madhur Verma, Massimiliano Veroux, Georgios-Ioannis Verras, Dominique Vervoort, Jorge Hugo Villafañe, Manish Vinayak, Francesco S Violante, Mukesh Vishwakarma, Sergey Konstantinovitch Vladimirov, Vasily Vlassov, Bay Vo, Simona Ruxandra Volovat, Theo Vos, Isidora S Vujcic, Hatem A Wafa, Yasir Waheed, Elias Bekele Wakwoya, Cong Wang, Denny Wang, Fang Wang, Shu Wang, Yanzhong Wang, Yuan-Pang Wang, Paul Ward, Emebet Gashaw Wassie, Stefanie Watson, Marcia R Weaver, Kosala Gayan Weerakoon, Daniel J Weiss, Katherine M Wells, Yi Feng Wen, Ronny Westerman, Taweewat Wiangkham, Dakshitha Praneeth Wickramasinghe, Nuwan Darshana Wickramasinghe, Peter Willeit, Yohannes Addisu Wondimagegene, Felicia Wu, Juan Xia, Hong Xiao, Gelin Xu, Suowen Xu, Xiaoyue Xu, Ali Yadollahpour, Shirin Yaghoobpoor, Tina Yaghoobpour, Sajad Yaghoubi, Zwanden Sule Yahaya, Danting Yang, Lin Yang, Yuichiro Yano, Habib Yaribeygi, Pengpeng Ye, Renjulal Yesodharan, Subah Abderehim Yesuf, Saber Yezli, Amanuel Yigezu, Paul Yip, Dong Keon Yon, Naohiro Yonemoto, Yuyi You, Mustafa Z Younis, Zabihollah Yousefi, Chuanhua Yu, Yong Yu, Chun-Wei Yuan, Nima Zafari, Fathiah Zakham, Nazar Zaki, Giulia Zamagni, Milad Zandi, Ghazal G Z Zandieh, Moein Zangiabadian, Mikhail Sergeevich Zastrozhin, Haijun Zhang, Meixin Zhang, Yunquan Zhang, Chenwen Zhong, Juexiao Zhou, Bin Zhu, Lei Zhu, Magdalena Zielińska, Zhiyong Zou, Samer H Zyoud, Christopher J L Murray, Amanda E Smith, and Stein Emil Vollset
Abstract: Background: Accurate assessments of current and future fertility-including overall trends and changing population age structures across countries and regions-are essential to help plan for the profound social, economic, environmental, and geopolitical challenges that these changes will bring. Estimates and projections of fertility are necessary to inform policies involving resource and health-care needs, labour supply, education, gender equality, and family planning and support. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 produced up-to-date and comprehensive demographic assessments of key fertility indicators at global, regional, and national levels from 1950 to 2021 and forecast fertility metrics to 2100 based on a reference scenario and key policy-dependent alternative scenarios. Methods: To estimate fertility indicators from 1950 to 2021, mixed-effects regression models and spatiotemporal Gaussian process regression were used to synthesise data from 8709 country-years of vital and sample registrations, 1455 surveys and censuses, and 150 other sources, and to generate age-specific fertility rates (ASFRs) for 5-year age groups from age 10 years to 54 years. ASFRs were summed across age groups to produce estimates of total fertility rate (TFR). Livebirths were calculated by multiplying ASFR and age-specific female population, then summing across ages 10-54 years. To forecast future fertility up to 2100, our Institute for Health Metrics and Evaluation (IHME) forecasting model was based on projections of completed cohort fertility at age 50 years (CCF50; the average number of children born over time to females from a specified birth cohort), which yields more stable and accurate measures of fertility than directly modelling TFR. CCF50 was modelled using an ensemble approach in which three sub-models (with two, three, and four covariates variously consisting of female educational attainment, contraceptive met need, population density in
Published: 2024

18. Varied Health Spending Growth Across US States Was Associated With Incomes, Price Levels, And Medicaid Expansion, 2000–19

Author: Emily K. Johnson, Matthew A. Wojtesta, Sawyer W. Crosby, Herbert C. Duber, Eunice Jun, Haley Lescinsky, Phong Nguyen, Maitreyi Sahu, Azalea Thomson, Golsum Tsakalos, Maxwell S. Weil, Annie Haakenstad, Ali H. Mokdad, Christopher J. L. Murray, and Joseph L. Dieleman
Subjects: Health Policy
Published: 2022
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19. Measuring contraceptive method mix, prevalence, and demand satisfied by age and marital status in 204 countries and territories, 1970–2019: a systematic analysis for the Global Burden of Disease Study 2019

Author: Annie Haakenstad, Olivia Angelino, Caleb M S Irvine, Zulfiqar A Bhutta, Kelly Bienhoff, Corinne Bintz, Kate Causey, M Ashworth Dirac, Nancy Fullman, Emmanuela Gakidou, Thomas Glucksman, Simon I Hay, Nathaniel J Henry, Ira Martopullo, Ali H Mokdad, John Everett Mumford, Stephen S Lim, Christopher J L Murray, and Rafael Lozano
Subjects: Contraception, Contraceptive Agents, Marital Status, Pregnancy, Family Planning Services, Prevalence, Humans, Bayes Theorem, Female, General Medicine, Child, Global Burden of Disease
Abstract: Meeting the contraceptive needs of women of reproductive age is beneficial for the health of women and children, and the economic and social empowerment of women. Higher rates of contraceptive coverage have been linked to the availability of a more diverse range of contraceptive methods. We present estimates of the contraceptive prevalence rate (CPR), modern contraceptive prevalence rate (mCPR), demand satisfied, and the method of contraception used for both partnered and unpartnered women for 5-year age groups in 204 countries and territories between 1970 and 2019.We used 1162 population-based surveys capturing contraceptive use among women between 1970 and 2019, in which women of reproductive age (15-49 years) self-reported their, or their partner's, current use of contraception for family planning purposes. Spatiotemporal Gaussian process regression was used to generate estimates of the CPR, mCPR, demand satisfied, and method mix by age and marital status. We assessed how age-specific mCPR and demand satisfied changed with the Socio-demographic Index (SDI), a measure of social and economic development, using the meta-regression Bayesian, regularised, trimmed method from the Global Burden of Diseases, Injuries, and Risk Factors Study.In 2019, 162·9 million (95% uncertainty interval [UI] 155·6-170·2) women had unmet need for contraception, of whom 29·3% (27·9-30·6) resided in sub-Saharan Africa and 27·2% (24·4-30·3) resided in south Asia. Women aged 15-19 years (64·8% [62·9-66·7]) and 20-24 years (71·9% [68·9-74·2]) had the lowest rates of demand satisfied, with 43·2 million (95% UI 39·3-48·0) women aged 15-24 years with unmet need in 2019. The mCPR and demand satisfied among women aged 15-19 years were substantially lower than among women aged 20-49 years at SDI values below 60 (on a 0-100 scale), but began to equalise as SDI increased above 60. Between 1970 and 2019, the global mCPR increased by 20·1 percentage points (95% UI 18·7-21·6). During this time, traditional methods declined as a proportion of all contraceptive methods, whereas the use of implants, injections, female sterilisation, and condoms increased. Method mix differs substantially depending on age and geography, with the share of female sterilisation increasing with age and comprising more than 50% of methods in use in south Asia. In 28 countries, one method was used by more than 50% of users in 2019.The dominance of one contraceptive method in some locations raises the question of whether family planning policies should aim to expand method mix or invest in making existing methods more accessible. Lower rates of demand satisfied among women aged 15-24 years are also concerning because unintended pregnancies before age 25 years can forestall or eliminate education and employment opportunities that lead to social and economic empowerment. Policy makers should strive to tailor family planning programmes to the preferences of the groups with the most need, while maintaining the programmes used by existing users.BillMelinda Gates Foundation.
Published: 2022
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20. Quantifying the effects of the COVID-19 pandemic on gender equality on health, social, and economic indicators: a comprehensive review of data from March, 2020, to September, 2021

Author: Luisa S Flor, Joseph Friedman, Cory N Spencer, John Cagney, Alejandra Arrieta, Molly E Herbert, Caroline Stein, Erin C Mullany, Julia Hon, Vedavati Patwardhan, Ryan M Barber, James K Collins, Simon I Hay, Stephen S Lim, Rafael Lozano, Ali H Mokdad, Christopher J L Murray, Robert C Reiner, Reed J D Sorensen, Annie Haakenstad, David M Pigott, and Emmanuela Gakidou
Subjects: Employment, Gender Equity, Male, COVID-19, Educational Status, Humans, Female, General Medicine, Pandemics
Abstract: Gender is emerging as a significant factor in the social, economic, and health effects of COVID-19. However, most existing studies have focused on its direct impact on health. Here, we aimed to explore the indirect effects of COVID-19 on gender disparities globally.We reviewed publicly available datasets with information on indicators related to vaccine hesitancy and uptake, health care services, economic and work-related concerns, education, and safety at home and in the community. We used mixed effects regression, Gaussian process regression, and bootstrapping to synthesise all data sources. We accounted for uncertainty in the underlying data and modelling process. We then used mixed effects logistic regression to explore gender gaps globally and by region.Between March, 2020, and September, 2021, women were more likely to report employment loss (26·0% [95% uncertainty interval 23·8-28·8, by September, 2021) than men (20·4% [18·2-22·9], by September, 2021), as well as forgoing work to care for others (ratio of women to men: 1·8 by March, 2020, and 2·4 by September, 2021). Women and girls were 1·21 times (1·20-1·21) more likely than men and boys to report dropping out of school for reasons other than school closures. Women were also 1·23 (1·22-1·23) times more likely than men to report that gender-based violence had increased during the pandemic. By September 2021, women and men did not differ significantly in vaccine hesitancy or uptake.The most significant gender gaps identified in our study show intensified levels of pre-existing widespread inequalities between women and men during the COVID-19 pandemic. Political and social leaders should prioritise policies that enable and encourage women to participate in the labour force and continue their education, thereby equipping and enabling them with greater ability to overcome the barriers they face.The BillMelinda Gates Foundation.
Published: 2022
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21. Measuring the availability of human resources for health and its relationship to universal health coverage for 204 countries and territories from 1990 to 2019 : a systematic analysis for the Global Burden of Disease Study 2019

Author: Annie Haakenstad, Caleb Mackay Salpeter Irvine, Megan Knight, Corinne Bintz, Aleksandr Y Aravkin, Peng Zheng, Vin Gupta, Michael R M Abrigo, Abdelrahman I Abushouk, Oladimeji M Adebayo, Gina Agarwal, Fares Alahdab, Ziyad Al-Aly, Khurshid Alam, Turki M Alanzi, Jacqueline Elizabeth Alcalde-Rabanal, Vahid Alipour, Nelson Alvis-Guzman, Arianna Maever L Amit, Catalina Liliana Andrei, Tudorel Andrei, Carl Abelardo T Antonio, Jalal Arabloo, Olatunde Aremu, Martin Amogre Ayanore, Maciej Banach, Till Winfried Bärnighausen, Celine M Barthelemy, Mohsen Bayati, Habib Benzian, Adam E Berman, Kelly Bienhoff, Ali Bijani, Boris Bikbov, Antonio Biondi, Archith Boloor, Reinhard Busse, Zahid A Butt, Luis Alberto Cámera, Ismael R Campos-Nonato, Rosario Cárdenas, Felix Carvalho, Collins Chansa, Soosanna Kumary Chattu, Vijay Kumar Chattu, Dinh-Toi Chu, Xiaochen Dai, Lalit Dandona, Rakhi Dandona, William James Dangel, Ahmad Daryani, Jan-Walter De Neve, Meghnath Dhimal, Isaac Oluwafemi Dipeolu, Shirin Djalalinia, Hoa Thi Do, Chirag P Doshi, Leila Doshmangir, Elham Ehsani-Chimeh, Maha El Tantawi, Eduarda Fernandes, Florian Fischer, Nataliya A Foigt, Artem Alekseevich Fomenkov, Masoud Foroutan, Takeshi Fukumoto, Nancy Fullman, Mohamed M Gad, Keyghobad Ghadiri, Mansour Ghafourifard, Ahmad Ghashghaee, Thomas Glucksman, Houman Goudarzi, Rajat Das Gupta, Randah R Hamadeh, Samer Hamidi, Josep Maria Haro, Edris Hasanpoor, Simon I Hay, Mohamed I Hegazy, Behzad Heibati, Nathaniel J Henry, Michael K Hole, Naznin Hossain, Mowafa Househ, Olayinka Stephen Ilesanmi, Mohammad-Hasan Imani-Nasab, Seyed Sina Naghibi Irvani, Sheikh Mohammed Shariful Islam, Mohammad Ali Jahani, Ankur Joshi, Rohollah Kalhor, Gbenga A Kayode, Nauman Khalid, Khaled Khatab, Adnan Kisa, Sonali Kochhar, Kewal Krishan, Barthelemy Kuate Defo, Dharmesh Kumar Lal, Faris Hasan Lami, Anders O Larsson, Janet L Leasher, Kate E LeGrand, Lee-Ling Lim, Narayan B Mahotra, Azeem Majeed, Afshin Maleki, Narayana Manjunatha, Benjamin Ballard Massenburg, Tomislav Mestrovic, GK Mini, Andreea Mirica, Erkin M Mirrakhimov, Yousef Mohammad, Shafiu Mohammed, Ali H Mokdad, Shane Douglas Morrison, Mohsen Naghavi, Duduzile Edith Ndwandwe, Ionut Negoi, Ruxandra Irina Negoi, Josephine W Ngunjiri, Cuong Tat Nguyen, Yeshambel T Nigatu, Obinna E Onwujekwe, Doris V Ortega-Altamirano, Nikita Otstavnov, Stanislav S Otstavnov, Mayowa O Owolabi, Abhijit P Pakhare, Veincent Christian Filipino Pepito, Norberto Perico, Hai Quang Pham, David M Pigott, Khem Narayan Pokhrel, Mohammad Rabiee, Navid Rabiee, Vafa Rahimi-Movaghar, David Laith Rawaf, Salman Rawaf, Lal Rawal, Giuseppe Remuzzi, Andre M N Renzaho, Serge Resnikoff, Nima Rezaei, Aziz Rezapour, Jennifer Rickard, Leonardo Roever, Maitreyi Sahu, Abdallah M Samy, Juan Sanabria, Milena M Santric-Milicevic, Sivan Yegnanarayana Iyer Saraswathy, Soraya Seedat, Subramanian Senthilkumaran, Edson Serván-Mori, Masood Ali Shaikh, Aziz Sheikh, Diego Augusto Santos Silva, Caroline Stein, Dan J Stein, Mariya Vladimirovna Titova, Stephanie M Topp, Marcos Roberto Tovani-Palone, Saif Ullah, Bhaskaran Unnikrishnan, Marco Vacante, Pascual R Valdez, Tommi Juhani Vasankari, Narayanaswamy Venketasubramanian, Vasily Vlassov, Theo Vos, Jamal Akeem Yearwood, Naohiro Yonemoto, Mustafa Z Younis, Chuanhua Yu, Siddhesh Zadey, Sojib Bin Zaman, Taddese Alemu Zerfu, Zhi-Jiang Zhang, Arash Ziapour, Sanjay Zodpey, Stephen S Lim, Christopher J L Murray, Rafael Lozano, Tampere University, and Clinical Medicine
Subjects: Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Pharmaceutical Preparations, Universal Health Insurance, Health Sciences, Workforce, Humans, Public Health, Global Health, Social Medicine and Epidemiology, General Medicine, Occupations, Hälsovetenskaper, 3121 Internal medicine, Global Health, Global Burden of Disease
Abstract: Background: Human resources for health (HRH) include a range of occupations that aim to promote or improve human health. The UN Sustainable Development Goals (SDGs) and the WHO Health Workforce 2030 strategy have drawn attention to the importance of HRH for achieving policy priorities such as universal health coverage (UHC). Although previous research has found substantial global disparities in HRH, the absence of comparable cross-national estimates of existing workforces has hindered efforts to quantify workforce requirements to meet health system goals. We aimed to use comparable and standardised data sources to estimate HRH densities globally, and to examine the relationship between a subset of HRH cadres and UHC effective coverage performance. Methods: Through the International Labour Organization and Global Health Data Exchange databases, we identified 1404 country-years of data from labour force surveys and 69 country-years of census data, with detailed microdata on health-related employment. From the WHO National Health Workforce Accounts, we identified 2950 country-years of data. We mapped data from all occupational coding systems to the International Standard Classification of Occupations 1988 (ISCO-88), allowing for standardised estimation of densities for 16 categories of health workers across the full time series. Using data from 1990 to 2019 for 196 of 204 countries and territories, covering seven Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) super-regions and 21 regions, we applied spatiotemporal Gaussian process regression (ST-GPR) to model HRH densities from 1990 to 2019 for all countries and territories. We used stochastic frontier meta-regression to model the relationship between the UHC effective coverage index and densities for the four categories of health workers enumerated in SDG indicator 3.c.1 pertaining to HRH: physicians, nurses and midwives, dentistry personnel, and pharmaceutical personnel. We identified minimum workforce density thresholds required to meet a specified target of 80 out of 100 on the UHC effective coverage index, and quantified national shortages with respect to those minimum thresholds. Findings: We estimated that, in 2019, the world had 104·0 million (95% uncertainty interval 83·5-128·0) health workers, including 12·8 million (9·7-16·6) physicians, 29·8 million (23·3-37·7) nurses and midwives, 4·6 million (3·6-6·0) dentistry personnel, and 5·2 million (4·0-6·7) pharmaceutical personnel. We calculated a global physician density of 16·7 (12·6-21·6) per 10 000 population, and a nurse and midwife density of 38·6 (30·1-48·8) per 10 000 population. We found the GBD super-regions of sub-Saharan Africa, south Asia, and north Africa and the Middle East had the lowest HRH densities. To reach 80 out of 100 on the UHC effective coverage index, we estimated that, per 10 000 population, at least 20·7 physicians, 70·6 nurses and midwives, 8·2 dentistry personnel, and 9·4 pharmaceutical personnel would be needed. In total, the 2019 national health workforces fell short of these minimum thresholds by 6·4 million physicians, 30·6 million nurses and midwives, 3·3 million dentistry personnel, and 2·9 million pharmaceutical personnel. Interpretation: Considerable expansion of the world's health workforce is needed to achieve high levels of UHC effective coverage. The largest shortages are in low-income settings, highlighting the need for increased financing and coordination to train, employ, and retain human resources in the health sector. Actual HRH shortages might be larger than estimated because minimum thresholds for each cadre of health workers are benchmarked on health systems that most efficiently translate human resources into UHC attainment. Anders O. Larsson ingår i gruppen GBD 2019 Human Resources for Health Collaborators
Published: 2022
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22. The Lancet NCDI Poverty Commission: bridging a gap in universal health coverage for the poorest billion

Author: Andrea B. Feigl, Stéphane Verguet, Rachel Nugent, Christopher Noble, Julie Makani, Kafui Adjaye-Gbewonyo, Maia Olsen, Alma J Adler, Fred Amegashie, Akshar Saxena, Annie Haakenstad, Nobhojit Roy, Katie Dain, Neil Gupta, Gisela Robles Aguilar, Anne E. Becker, Kibachio Joseph Muiruri Mwangi, Andrew P. Sumner, Nicole Bassoff, Solomon Tessema Memirie, Ole Frithjof Norheim, Zulfiqar A Bhutta, Adnan A. Hyder, Alexander Kintu, Peter Byass, Jean Roland Cadet, Abraham Haileamlak, Zoe Taylor Doe, Yogesh Jain, Majid Ezzati, Bashir Noormal, Lee A. Wallis, Jones Masiye, Amy McLaughlin, Andrew Marx, Jason Beste, Senendra Raj Upreti, Noel Kasomekera, Bhagawan Koirala, Indrani Gupta, Mamusu Kamanda, Humberto Nelson Muquingue, Ana Olga Mocumbi, Emily B Wroe, Dan Schwarz, Margaret E Kruk, Cristina Stefan, Gilles Francois Ndayisaba, Chelsea Clinton, Sarah Maongezi, Agnes Binagwaho, Kjell Arne Johansson, Leah N. Schwartz, Gladwell Gathecha, Wubaye Walelgne Dagnaw, Jonathan D. Shaffer, David A Watkins, Bongani M. Mayosi, Paul H. Park, Gary L. Gottlieb, Arielle Wilder Eagan, J. Jaime Miranda, Osman Sankoh, Mary Amuyunzu-Nyamongo, Nancy Charles Larco, Said Habib Arwal, Matthew M Coates, Rifat Atun, Chantelle Boudreaux, Mary T Mayige, Gene F. Kwan, Biraj Man Karmacharya, Gene Bukhman, Robles Aguilar, G, and Group, Lancet NCDI Poverty Commission Study
Subjects: education.field_of_study, Economic growth, Extreme poverty, medicine.medical_specialty, Poverty, business.industry, Public health, Population, The Lancet Commissions, General Medicine, Health Services Accessibility, Sierra leone, Epidemiological transition, HV, Social protection, RA0421, Universal Health Insurance, Political science, Health care, medicine, Humans, Noncommunicable Diseases, business, education
Abstract: On March 2–3, 2011—ahead of the first UN High-Level Meeting on NCDs—a conference hosted in Boston (MA, USA) focused on the NCDs of the world's poorest billion, whose poverty was embodied in young average age, low energy intake, and subsistence through physical labour.30 Participants at the Boston event argued that global thinking about NCDs had been too focused on a theory of epidemiological transition, which projected epidemics of chronic disease associated with development.31 This theory created a blind spot regarding the existence and pattern of non-infectious conditions before declines in infectious mortality (pre-transitional NCDIs). The poorest populations were still experiencing NCDIs as part of a nexus of hunger, toxic environments, infectious diseases, and lack of health care. The NCDIs that emerged under these circumstances were both more severe and more varied than could be captured by frameworks developed for other populations. In April, 2011, the WHO African Regional Office held a consultation of health ministers in Congo (Brazzaville).32 The Brazzaville Declaration on NCDs called for an expanded NCDI agenda addressing haemoglobinopathies (sickle cell disease), mental disorders, and violence and injury.32 Other prominent African health experts called for a 5 × 5 strategy inclusive of neuropsychiatric disorders and infectious risks.33, 34 In July, 2013, at a meeting in Rwanda, a group of NCD unit leaders from ten African ministries of health called for a complementary strategy for NCDIs.35 This NCDI equity agenda focused on policies and integrated health-sector interventions to eliminate deaths among the poorest children and young adults (aged
Published: 2021

23. Economic and social development along the urban–rural continuum: New opportunities to inform policy

Author: Andrea Cattaneo, Anjali Adukia, David L. Brown, Luc Christiaensen, David K. Evans, Annie Haakenstad, Theresa McMenomy, Mark Partridge, Sara Vaz, and Daniel J. Weiss
Subjects: Economics and Econometrics, Sociology and Political Science, Geography, Planning and Development, Building and Construction, Development
Published: 2022
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24. Economic and Social Development along the Urban-Rural Continuum: New Opportunities to Inform Policy

Author: Daniel J. Weiss, Luc Christiaensen, Mark D. Partridge, Annie Haakenstad, David K. Evans, Anjali Adukia, Andrea Cattaneo, Theresa McMenomy, David L. Brown, and Sara Vaz
Subjects: education.field_of_study, Geography, Food security, Operationalization, Poverty, Central place theory, Urbanization, Social change, Population, Regional science, Physical access, education
Abstract: The economic and social development of nations relies on their population having physical access to services and employment opportunities. For the vast majority of the 3.4 billion people living in rural locations, this largely depends on their access to urban centers of different sizes. Similarly, urban centers depend on their rural hinterlands. Building on the literature on functional areas/territories and the rural-urban continuum as well as insights from central place theory, this review paper advances the notion of catchment areas differentiated along an urban-to-rural continuum to capture these urban-rural interconnections. It further shows how a new, publicly available data set operationalizing this concept can shed new light on policy making across a series of development fields, including institutions and governance, urbanization and food systems, welfare and poverty, and access to health and education services. Together the insights support a more geographically nuanced perspective on development.
Published: 2021
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25. Examining the density in out-of-pocket spending share in the estimation of catastrophic health expenditures

Author: Carlos Riumallo-Herl, Annie Haakenstad, Stéphane Verguet, Abdulrahman Jbaily, Mizan Kiros, Applied Economics, and Tinbergen Institute
Subjects: Sustainable development, Estimation, Consumption (economics), medicine.medical_specialty, Family Characteristics, Health economics, Public economics, Health Policy, Public health, Financial risk, Economics, Econometrics and Finance (miscellaneous), Equity (finance), SDG 3 - Good Health and Well-being, Universal Health Insurance, medicine, Humans, Business, Health Expenditures, Catastrophic Illness, Poverty, Public finance
Abstract: Universal health coverage (UHC) aims to provide access to health services for all without financial hardship. Moving toward UHC while ensuring financial risk protection (FRP) from out-of-pocket (OOP) health expenditures is a critical objective of the Sustainable Development Goal for Health. In tracking country progress toward UHC, analysts and policymakers usually report on two summary indicators of lack of FRP: the prevalence of catastrophic health expenditures (CHE) and the prevalence of impoverishing health expenditures. In this paper, we build on the CHE indicator: we examine the distribution (density) of health OOP budget share as a way to capture both the magnitude and dispersion in the ratio of households’ OOP health expenditures relative to consumption or income at the population level. We illustrate our approach with country-specific examples using data from the World Health Organization’s World Health Surveys.
Published: 2021

26. Are rhetorical commitments to adolescents reflected in planning documents? An exploratory content analysis of adolescent sexual and reproductive health in Global Financing Facility country plans

Author: Mickey Chopra, Asha George, Mary V Kinney, Neha S. Singh, Kumanan Rasanathan, Tanya Jacobs, and Annie Haakenstad
Subjects: Male, medicine.medical_specialty, Adolescent, Service delivery framework, Social Determinants of Health, Adolescent health, Pregnancy, Political science, medicine, Healthcare Financing, Humans, World Bank, Global financing facility, Social determinants of health, Social determinants, Reproductive health, Health financing, Finance, Community engagement, business.industry, Public health, Research, Obstetrics and Gynecology, Capacity building, Gender, Gynecology and obstetrics, Development assistance, Multi-sectoral action, Reproductive Health, Reproductive Medicine, Project appraisal, RG1-991, Female, business, Content analysis
Abstract: Background The Global Financing Facility (GFF) offers an opportunity to close the financing gap that holds back gains in women, children’s and adolescent health. However, very little work exists examining GFF practice, particularly for adolescent health. As momentum builds for the GFF, we examine initial GFF planning documents to inform future national and multi-lateral efforts to advance adolescent sexual and reproductive health. Methods We undertook a content analysis of the first 11 GFF Investment Cases and Project Appraisal Documents available on the GFF website. The countries involved include Bangladesh, Cameroon, Democratic Republic of Congo, Ethiopia, Guatemala, Kenya, Liberia, Mozambique, Nigeria, Tanzania and Uganda. Results While several country documents signal understanding and investment in adolescents as a strategic area, this is not consistent across all countries, nor between Investment Cases and Project Appraisal Documents. In both types of documents commitments weaken as one moves from programming content to indicators to investment. Important contributions include how teenage pregnancy is a universal concern, how adolescent and youth friendly health services and school-based programs are supported in several country documents, how gender is noted as a key social determinant critical for mainstreaming across the health system, alongside the importance of multi-sectoral collaboration, and the acknowledgement of adolescent rights. Weaknesses include the lack of comprehensive analysis of adolescent health needs, inconsistent investments in adolescent friendly health services and school based programs, missed opportunities in not supporting multi-component and multi-level initiatives to change gender norms involving adolescent boys in addition to adolescent girls, and neglect of governance approaches to broker effective multi-sectoral collaboration, community engagement and adolescent involvement. Conclusion There are important examples of how the GFF supports adolescents and their sexual and reproductive health. However, more can be done. While building on service delivery approaches more consistently, it must also fund initiatives that address the main social and systems drivers of adolescent health. This requires capacity building for the technical aspects of adolescent health, but also engaging politically to ensure that the right actors are convened to prioritize adolescent health in country plans and to ensure accountability in the GFF process itself.
Published: 2021

27. Potential for additional government spending on HIV/AIDS in 137 low-income and middle-income countries: an economic modelling study

Author: Golsum Tsakalos, Tianchan Tao, Annie Haakenstad, Bianca S. Zlavog, Jennifer Kates, Adam Wexler, Mark Moses, Joseph L Dieleman, and Christopher J L Murray
Subjects: 0301 basic medicine, Economic growth, Epidemiology, Immunology, Developing country, HIV Infections, Article, 03 medical and health sciences, 0302 clinical medicine, Stochastic frontier analysis, Acquired immunodeficiency syndrome (AIDS), Virology, Global health, medicine, Humans, 030212 general & internal medicine, China, Developing Countries, Poverty, Government spending, Government, HIV, Low income and middle income countries, medicine.disease, 030112 virology, Infectious Diseases, Geography
Abstract: Summary Background Between 2012 and 2016, development assistance for HIV/AIDS decreased by 20·0%; domestic financing is therefore critical to sustaining the response to HIV/AIDS. To understand whether domestic resources could fill the financing gaps created by declines in development assistance, we aimed to track spending on HIV/AIDS and estimated the potential for governments to devote additional domestic funds to HIV/AIDS. Methods We extracted 8589 datapoints reporting spending on HIV/AIDS. We used spatiotemporal Gaussian process regression to estimate a complete time series of spending by domestic sources (government, prepaid private, and out-of-pocket) and spending category (prevention, and care and treatment) from 2000 to 2016 for 137 low-income and middle-income countries (LMICs). Development assistance data for HIV/AIDS were from Financing Global Health 2018, and HIV/AIDS prevalence, incidence, and mortality were from the Global Burden of Disease study 2017. We used stochastic frontier analysis to estimate potential additional government spending on HIV/AIDS, which was conditional on the current government health budget and other finance, economic, and contextual factors associated with HIV/AIDS spending. All spending estimates were reported in 2018 US$. Findings Between 2000 and 2016, total spending on HIV/AIDS in LMICs increased from $4·0 billion (95% uncertainty interval 2·9–6·0) to $19·9 billion (15·8–26·3), spending on HIV/AIDS prevention increased from $596 million (258 million to 1·3 billion) to $3·0 billion (1·5–5·8), and spending on HIV/AIDS care and treatment increased from $1·1 billion (458·1 million to 2·2 billion) to $7·2 billion (4·3–11·8). Over this time period, the share of resources sourced from development assistance increased from 33·2% (21·3–45·0) to 46·0% (34·2–57·0). Care and treatment spending per year on antiretroviral therapy varied across countries, with an IQR of $284–2915. An additional $12·1 billion (8·4–17·5) globally could be mobilised by governments of LMICs to finance the response to HIV/AIDS. Most of these potential resources are concentrated in ten middle-income countries (Argentina, China, Colombia, India, Indonesia, Mexico, Nigeria, Russia, South Africa, and Vietnam). Interpretation Some governments could mobilise more domestic resources to fight HIV/AIDS, which could free up additional development assistance for many countries without this ability, including many low-income, high-prevalence countries. However, a large gap exists between available financing and the funding needed to achieve global HIV/AIDS goals, and sustained and coordinated effort across international and domestic development partners is required to end AIDS by 2030. Funding The Bill & Melinda Gates Foundation.
Published: 2019

28. Disaggregating catastrophic health expenditure by disease area: cross-country estimates based on the World Health Surveys

Author: Matthew M Coates, Stéphane Verguet, Annie Haakenstad, Andrew Marx, and Gene Bukhman
Subjects: Male, Catastrophic health expenditure, Population, Poison control, lcsh:Medicine, Disease, Global Health, Financial risk protection, Occupational safety and health, 03 medical and health sciences, 0302 clinical medicine, Universal Health Insurance, Environmental health, Universal health coverage, Injury prevention, Health care, Prevalence, Humans, Medicine, 030212 general & internal medicine, Out-of-pocket spending, Catastrophic Illness, education, Poverty, Disease burden, education.field_of_study, integumentary system, business.industry, lcsh:R, General Medicine, Health Surveys, Illness-related impoverishment, Female, Health Expenditures, business, 030217 neurology & neurosurgery, Research Article
Abstract: Background Financial risk protection (FRP) is a key objective of national health systems and a core pillar of universal health coverage (UHC). Yet, little is known about the disease-specific distribution of catastrophic health expenditure (CHE) at the national level. Methods Using the World Health Surveys (WHS) from 39 countries, we quantified CHE, or household health spending that surpasses 40% of capacity-to-pay by key disease areas. We restricted our analysis to households in which the respondent used health care in the last 30 days and categorized CHE into disease areas included as WHS response options: maternal and child health (MCH); high fever, severe diarrhea, or cough; heart disease; asthma; injury; surgery; and other. We compared disease-specific CHE estimates by income, pooled funding as a share of total health expenditure, share of the population affected by the different diseases, and poverty status. Results Across countries, an average of 45.1% of CHE cases could not be tied to a specific cause; 37.6% (95% UI 35.4–39.9%) of CHE cases were associated with high fever, severe cough, or diarrhea; 3.9% (3.0–4.9%) with MCH; and 4.1% (3.3–4.9%) with heart disease. Injuries constituted 5.2% (4.2–6.4%) of CHE cases. The distribution of CHE varied substantially by national income. A 10% increase in heart disease prevalence was associated with a 1.9% (1.3–2.4%) increase in heart disease CHE, an association stronger than any other disease area. Conclusions Our approach is comparable, comprehensive, and empirically based and highlights how financial risk protection may not be aligned with disease burden. Disease-specific CHE estimates can illuminate how health systems can target reform to best protect households from financial risk. Electronic supplementary material The online version of this article (10.1186/s12916-019-1266-0) contains supplementary material, which is available to authorized users.
Published: 2019
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29. Tracking spending on malaria by source in 106 countries, 2000–16: an economic modelling study

Author: Seyyed Meysam Mousavi, Mina Anjomshoa, Tomislav Mestrovic, Joseph L Dieleman, Nancy Fullman, Christopher J L Murray, Molly R Nixon, Simon I. Hay, David M. Pigott, Tianchan Tao, Annie Haakenstad, Anton C Harle, Golsum Tsakalos, Shafiu Mohammed, Angela E Micah, Jessica Cohen, and Khanh Bao Tran
Subjects: Financing, Government, 030231 tropical medicine, Developing country, Global Health, Patient care, Drug Costs, Article, 03 medical and health sciences, 0302 clinical medicine, Malaria elimination, parasitic diseases, Global health, medicine, Humans, 030212 general & internal medicine, Socioeconomics, Developing Countries, Government spending, Government, medicine.disease, Malaria, Infectious Diseases, Models, Economic, Business, Tracking (education), Health Expenditures
Abstract: Background: Sustaining achievements in malaria control and making progress toward malaria elimination requires coordinated funding. We estimated domestic malaria spending by source in 106 countries that were malaria-endemic in 2000–16 or became malaria-free after 2000.Methods: We collected 36 038 datapoints reporting government, out-of-pocket (OOP), and prepaid private malaria spending, as well as malaria treatment-seeking, costs of patient care, and drug prices. We estimated government spending on patient care for malaria, which was added to government spending by national malaria control programmes. For OOP malaria spending, we used data reported in National Health Accounts and estimated OOP spending on treatment. Spatiotemporal Gaussian process regression was used to ensure estimates were complete and comparable across time and to generate uncertainty.Findings: In 2016, US$4·3 billion (95% uncertainty interval [UI] 4·2–4·4) was spent on malaria worldwide, an 8·5% (95% UI 8·1–8·9) per year increase over spending in 2000. Since 2000, OOP spending increased 3·8% (3·3–4·2) per year, amounting to $556 million (487–634) or 13·0% (11·6–14·5) of all malaria spending in 2016. Governments spent $1·2 billion (1·1–1·3) or 28·2% (27·1–29·3) of all malaria spending in 2016, increasing 4·0% annually since 2000. The source of malaria spending varied depending on whether countries were in the malaria control or elimination stage.Interpretation: Tracking global malaria spending provides insight into how far the world is from reaching the malaria funding target of $6·6 billion annually by 2020. Because most countries with a high burden of malaria are low income or lower-middle income, mobilising additional government resources for malaria might be challenging.
Published: 2019

30. Comparative health systems analysis of differences in the catastrophic health expenditure associated with non-communicable vs communicable diseases among adults in six countries

Author: Annie Haakenstad, Matthew Coates, Gene Bukhman, Margaret McConnell, and Stéphane Verguet
Subjects: Adult, Family Characteristics, Systems Analysis, Cost of Illness, Health Policy, Humans, Health Expenditures, Catastrophic Illness, Noncommunicable Diseases, Communicable Diseases
Abstract: The growing burden of non-communicable diseases (NCDs) in low- and middle-income countries may have implications for health system performance in the area of financial risk protection, as measured by catastrophic health expenditure (CHE). We compare NCD CHE to the CHE cases caused by communicable diseases (CDs) across health systems to examine whether: (1) disease burden and CHE are linked, (2) NCD CHE disproportionately affects wealthier households and (3) whether the drivers of NCD CHE differ from the drivers of CD CHE. We used the Study on Global Aging and Adult Health survey, which captured nationally representative samples of 44 089 adults in China, Ghana, India, Mexico, Russia and South Africa. Using two-part regression and random forests, we estimated out-of-pocket spending and CHE by disease area. We compare the NCD share of CHE to the NCD share of disability-adjusted life years (DALYs) or years of life lost to disability and death. We tested for differences between NCDs and CDs in the out-of-pocket costs per visit and the number of visits occurring before spending crosses the CHE threshold. NCD CHE increased with the NCD share of DALYs except in South Africa, where NCDs caused more than 50% of CHE cases but only 30% of DALYs. A larger share of households incurred CHE due to NCDs in the lowest than the highest wealth quintile. NCD CHE cases were more likely to be caused by five or more health care visits relative to communicable disease CHE cases in Ghana (P = 0.003), India (P = 0.004) and China (P = 0.093). Health system attributes play a key mediating factor in how disease burden translates into CHE by disease. Health systems must target the specific characteristics of CHE by disease area to bolster financial risk protection as the epidemiological transition proceeds.
Published: 2021

31. Tracking development assistance for health and for COVID-19: a review of development assistance, government, out-of-pocket, and other private spending on health for 204 countries and territories, 1990–2050

Author: Junaid Khan, Blake Angell, Marcel Ausloos, Catherine M. Antony, Elham Ehsani-Chimeh, Edgar Denova-Gutiérrez, Kewal Krishan, Mohamed Kamal Mesregah, Arrigo Francesco Giuseppe Cicero, Simona Cătălina Ştefan, Tanuj Kanchan, Maysaa El Sayed Zaki, Mohamed I Hegazy, Richard James Maude, Salman Rawaf, Viktória Szerencsés, Milena Santric-Milicevic, Martin McKee, Reza Rawassizadeh, Anton C Harle, Neda Milevska Kostova, Hamidreza Pazoki Toroudi, Saravanan Muthupandian, Mohammad Hifz Ur Rahman, Hassan Abolhassani, Christine Mpundu-Kaambwa, Atta Abbas Naqvi, John Dube, Habib Benzian, Cristiano Piccinelli, Kedir Hussein Abegaz, Mohammad Khammarnia, Carlo Eduardo Medina-Solís, Tanvir M. Huda, Fakher Rahim, Modhurima Moitra, Valentin Yurievich Skryabin, Emily Joy Callander, David Laith Rawaf, Saeed Shahabi, Mohsen Bayati, Raffaele Palladino, Shahin Soltani, Mohammad Ali Mansournia, Rafael Lozano, Himal Kandel, João Vasco Santos, MA Garcia-Gordillo, Savita Lasrado, Alexey V Breusov, Nicola Luigi Bragazzi, Deepak Dhamnetiya, Mohammad Amin Bahrami, Teroj Abdulrahman Mohamed, Reinhard Busse, Veer Bala Gupta, Ionut Negoi, Xiaochen Dai, Eun-Cheol Park, Trang Huyen Nguyen, Gulrez Shah Azhar, Annie Haakenstad, Asadollah Gholamian, Vafa Rahimi-Movaghar, Subramanian Senthilkumaran, Ismaeel Yunusa, Hubert Amu, G. K. Mini, Francesco Saverio Violante, Michael Abdelmasseh, Yun Jin Kim, Yousef Moradi, Nataliya Foigt, Afshin Maleki, Pavanchand H Shetty, Mesfin Agachew Woldekidan, Ramesh Holla, Mina Anjomshoa, Seyyed Meysam Mousavi, Azeem Majeed, Bright Opoku Ahinkorah, Hassan Magdy Abd El Razek, Avirup Guha, Telma Zahirian Moghadam, Olayinka Stephen Ilesanmi, Alessandro Arrigo, Neda Kianipour, Marcos Roberto Tovani-Palone, Mosiur Rahman, Tomas Y Ferede, Catalina Liliana Andrei, Alaa Makki, Joseph L Dieleman, Shuhei Nomura, Kanwar Hamza Shuja, Ileana Heredia-Pi, Mukhammad David Naimzada, Ali Kazemi Karyani, Chisom Joyqueenet Akunna, Souranshu Chatterjee, Yonas Akalu, Hanadi Al Hamad, Abdollah Mohammadian-Hafshejani, Hayley N Stutzman, Getinet Ayano, Atte Meretoja, Fahad Alanezi, Aravind Thavamani, Sonu Bhaskar, Claudiu Herteliu, Andreea Mirica, Masood Ali Shaikh, Soewarta Kosen, Nelson J. Alvis-Zakzuk, Emma Elizabeth Spurlock, Ferrán Catalá-López, Samath D Dharmaratne, Stany W. Lobo, Alemayehu Hailu, Sebastian Vollmer, Tarik Ahmed Rashid, Sheikh Mohammed Shariful Islam, Lalit Dandona, Farahnaz Joukar, Jacob Olusegun Olusanya, Befikadu Legesse Wubishet, Sezer Kisa, Songhomitra Panda-Jonas, Nasir Umar, Adrian Otoiu, Yonas Getaye Tefera, Harapan Harapan, Ivo Iavicoli, Jakub Morze, Mihajlo Jakovljevic, Nicholas J K Breitborde, Ian E Cogswell, Mehdi Hosseinzadeh, Sadia Bibi, Stefan Kohler, Florian Fischer, Jagdish Khubchandani, Justice Nonvignon, Salah Eddin Karimi, Yousef Khader, Jan-Walter De Neve, Stanislav S. Otstavnov, Ruoyan Tobe-Gai, Tommi Vasankari, Carlos A Castañeda-Orjuela, Nahlah Elkudssiah Ismail, Khezar Hayat, Chythra R Rao, Priya Rathi, Asma Tahir Awan, Jean Jacques Noubiap, Salime Goharinezhad, Ai Koyanagi, Rafael Tabarés-Seisdedos, Angela E Micah, Rakhi Dandona, Jaykaran Charan, Lorainne Tudor Car, Michael R.M. Abrigo, Kenji Shibuya, Aziz Sheikh, B Reshmi, Rovshan Khalilov, Haroon Ahmed, Andrea Werdecker, Alberto Freitas, Tara Ballav Adhikari, Vasily Vlassov, Risky Kusuma Hartono, Leila Keikavoosi-Arani, Gyu Ri Kim, Ana Laura Manda, Carlos Alberto Marrugo Arnedo, Obinna Onwujekwe, Van C. Lansingh, Miklós Szócska, Gelin Xu, Ted R. Miller, Saad M.A. Dahlawi, Till Bärnighausen, Jagadish Rao Padubidri, Bernhard T. Baune, Fatemeh Pashazadeh Kan, Juan Sanabria, Bruno Ramos Nascimento, Stefano Olgiati, Navid Rabiee, Mark G. Shrime, Mayowa O. Owolabi, V. E. Nwatah, Tesleem Kayode Babalola, Ranil Jayawardena, Robert Kaba Alhassan, Takeshi Fukumoto, Lucero Cahuana-Hurtado, Aparna Ichalangod Narayana, Mohammad Ali Sahraian, Atif Amin Baig, Carl Abelardo T. Antonio, Jost B. Jonas, Dian Kusuma, Priyanga Ranasinghe, Mikhail Sergeevich Zastrozhin, Ali Bijani, Arash Ziapour, Seyed Behzad Jazayeri, Francesco Sanmarchi, Seyed Sina Naghibi Irvani, Allen Seylani, Theo Vos, Tuomo J. Meretoja, Delia Hendrie, Mostafa Amini-Rarani, Manthan D Janodia, Sathish Kumar Jayapal, Sorin Hostiuc, Marjan Ajami, Ali Gholamrezanezhad, Muhammad Aqeel, Muhammed Magdy Abd El Razek, Shaun Wen Huey Lee, Rawlance Ndejjo, Maarten J. Postma, Luis Camera, Chhabi Lal Ranabhat, Sadaf G. Sepanlou, Adnan Kisa, Tahira Ashraf, Tudorel Andrei, Mohammad Ali Jahani, Virginia Bodolica, Chuanhua Yu, Moses K. Muriithi, Pascual R. Valdez, Paul S. F. Yip, Demetris Lamnisos, Amir Masoud Rahmani, Hamed Zandian, Anna Aleksandrovna Skryabina, Yeong Yeh Lee, Sana Salehi, Syed Mohamed Aljunid, Kyle E. Simpson, Sami Almustanyir Almustanyir, Bogdan Oancea, Biswa Prakash Nayak, Omid Dadras, Fariborz Mansour-Ghanaei, Turki Alanzi, Mahaveer Golechha, Bach Xuan Tran, Lal B. Rawal, Shoaib Hassan, Rahul R. Zende, Sandhya Neupane Kandel, Martin Amogre Ayanore, Adam E. Berman, Long Khanh Dao Le, Dragos Virgil Davitoiu, Adithi Shetty, Getinet Kassahun, Birhanu Wubale Yirdaw, Usha Ram, Linh Gia Vu, Emilie R Maddison, Yosef Alemayehu, Ali H. Mokdad, Tomislav Mestrovic, Mavra A Riaz, Muhammad Naveed, Koustuv Dalal, Syed Amir Gilani, Reza Malekzadeh, Nikha Bhardwaj, Desta Debalkie Atnafu, Rohollah Kalhor, Naohiro Yonemoto, Ahmad Ghashghaee, Andre M. N. Renzaho, Amadou Barrow, Christopher J L Murray, Budi Aji, Maitreyi Sahu, Sara D Friedman, Konrad Pesudovs, Robert Reiner, Mohammad Rifat Haider, Mustafa Z. Younis, Aidin Abedi, Sanjay Basu, Nancy Fullman, Darrah McCracken, Rajasekaran Koteeswaran, Falk Schwendicke, Ionela-Roxana Glavan, Mohamed H Hassanein, Sindhura Lakshmi Koulmane Laxminarayana, Javad Nazari, Khurshid Alam, Bulat Idrisov, Nelson Alvis-Guzman, Mokhtar Mohammadi, Golnaz Heidari, Asif Hanif, Ghozali Ghozali, Vijay Kumar Chattu, Leila Doshmangir, Simiao Chen, Maha El Tantawi, Stephen S Lim, Bay Vo, Deepak Saxena, Jasvinder A. Singh, Robert Ancuceanu, Yves Miel H Zuniga, Kamal Hezam, Andrew T Olagunju, Sheikh Jamal Hossain, Lindsey E Wallace, Dejana Braithwaite, Sergio I. Prada, Adolfo Martinez-Valle, Brandon Cunningham, Vivek Gupta, Joseph Salama, Rezaul Karim Ripon, Bing-Fang Hwang, Mokhtar Mahdavi, Tamás Joó, Cristiana Abbafati, Behzad Karami Matin, Tushar Garg, Cyrus Alinia, Yingxi Zhao, Richard G. Wamai, Satoshi Ezoe, Anders Larsson, Seyedeh Zahra Masoumi, Arokiasamy Perianayagam, Sharareh Eskandarieh, Maciej Banach, Billingsley Kaambwa, Nader Jahanmehr, Saeed Amini, Foluke Adetola Ojelabi, Nikolay Ivanovich Briko, Samer Hamidi, Gaetano Isola, Tahereh Javaheri, Gbenga A. Kayode, Nikita Otstavnov, Vahid Yazdi-Feyzabadi, David M. Pereira, Mansour Ghafourifard, Saira Afzal, Ravi Prakash Jha, Erkin M. Mirrakhimov, Ahamarshan Jayaraman Nagarajan, Giang Thu Vu, G Anil Kumar, Vahit Yigit, Farshad Farzadfar, Anasthasia Zastrozhina, Shafiu Mohammed, Leticia Avila-Burgos, Nastaran Barati, Morteza Arab-Zozani, Eduardo A. Undurraga, Muktar Beshir Ahmed, Mohamed M. Gad, Mikk Jürisson, Himanshu Khajuria, Anas M. Saad, Mohammad Rabiee, Abdallah M. Samy, Srinivas Goli, Roman Topor-Madry, Golsum Tsakalos, Mariam Molokhia, Biruk Wogayehu Taddele, Mohammad Ali Moni, E S Abhilash, Timur Aripov, Sepideh Ahmadi, Mehdi Sayyah, Jorge Hugo Villafañe, Peter Andras Gaal, Babayemi O Olakunde, Brijesh Sathian, Anayat Ullah, Ritesh G. Menezes, Samad Azari, Ahmed I. Hasaballah, Soosanna Kumary Chattu, Pankaj Bhardwaj, Sanni Yaya, Zhi-Jiang Zhang, Jalal Arabloo, Saif Ullah, Akshaya Srikanth Bhagavathula, Bahram Mohajer, Ekaterina Vladimirovna Glushkova, Vinay Nangia, Shrikant Pawar, Moslem Soofi, Antonio Reis de Sá-Junior, Simon I. Hay, Miloje Savic, 2. Global Burden of Disease 2020 Health Financing Collaborator Network, Cicero AFG, Network, Global Burden of Disease 2020 Health Financing Collaborator, Bill & Melinda Gates Foundation, Micah, A. E., Cogswell, I. E., Cunningham, B., Ezoe, S., Harle, A. C., Maddison, E. R., Mccracken, D., Nomura, S., Simpson, K. E., Stutzman, H. N., Tsakalos, G., Wallace, L. E., Zhao, Y., Zende, R. R., Abbafati, C., Abdelmasseh, M., Abedi, A., Abegaz, K. H., Abhilash, E. S., Abolhassani, H., Abrigo, M. R. M., Adhikari, T. B., Afzal, S., Ahinkorah, B. O., Ahmadi, S., Ahmed, H., Ahmed, M. B., Ahmed Rashid, T., Ajami, M., Aji, B., Akalu, Y., Akunna, C. J., Al Hamad, H., Alam, K., Alanezi, F. M., Alanzi, T. M., Alemayehu, Y., Alhassan, R. K., Alinia, C., Aljunid, S. M., Almustanyir, S. A., Alvis-Guzman, N., Alvis-Zakzuk, N. J., Amini, S., Amini-Rarani, M., Amu, H., Ancuceanu, R., Andrei, C. L., Andrei, T., Angell, B., Anjomshoa, M., Antonio, C. A. T., Antony, C. M., Aqeel, M., Arabloo, J., Arab-Zozani, M., Aripov, T., Arrigo, A., Ashraf, T., Atnafu, D. D., Ausloos, M., Avila-Burgos, L., Awan, A. T., Ayano, G., Ayanore, M. A., Azari, S., Azhar, G. S., Babalola, T. K., Bahrami, M. A., Baig, A. A., Banach, M., Barati, N., Barnighausen, T. W., Barrow, A., Basu, S., Baune, B. T., Bayati, M., Benzian, H., Berman, A. E., Bhagavathula, A. S., Bhardwaj, N., Bhardwaj, P., Bhaskar, S., Bibi, S., Bijani, A., Bodolica, V., Bragazzi, N. L., Braithwaite, D., Breitborde, N. J. K., Breusov, A. V., Briko, N. I., Busse, R., Cahuana-Hurtado, L., Callander, E. J., Camera, L. A., Castaneda-Orjuela, C. A., Catala-Lopez, F., Charan, J., Chatterjee, S., Chattu, S. K., Chattu, V. K., Chen, S., Cicero, A. F. G., Dadras, O., Dahlawi, S. M. A., Dai, X., Dalal, K., Dandona, L., Dandona, R., Davitoiu, D. V., De Neve, J. -W., de Sa-Junior, A. R., Denova-Gutierrez, E., Dhamnetiya, D., Dharmaratne, S. D., Doshmangir, L., Dube, J., Ehsani-Chimeh, E., El Sayed Zaki, M., El Tantawi, M., Eskandarieh, S., Farzadfar, F., Ferede, T. Y., Fischer, F., Foigt, N. A., Freitas, A., Friedman, S. D., Fukumoto, T., Fullman, N., Gaal, P. A., Gad, M. M., Garcia-Gordillo, M. A., Garg, T., Ghafourifard, M., Ghashghaee, A., Gholamian, A., Gholamrezanezhad, A., Ghozali, G., Gilani, S. A., Glavan, I. -R., Glushkova, E. V., Goharinezhad, S., Golechha, M., Goli, S., Guha, A., Gupta, V. B., Gupta, V. K., Haakenstad, A., Haider, M. R., Hailu, A., Hamidi, S., Hanif, A., Harapan, H., Hartono, R. K., Hasaballah, A. I., Hassan, S., Hassanein, M. H., Hayat, K., Hegazy, M. I., Heidari, G., Hendrie, D., Heredia-Pi, I., Herteliu, C., Hezam, K., Holla, R., Hossain, S. J., Hosseinzadeh, M., Hostiuc, S., Huda, T. M., Hwang, B. -F., Iavicoli, I., Idrisov, B., Ilesanmi, O. S., Irvani, S. S. N., Islam, S. M. S., Ismail, N. E., Isola, G., Jahani, M. A., Jahanmehr, N., Jakovljevic, M., Janodia, M. D., Javaheri, T., Jayapal, S. K., Jayawardena, R., Jazayeri, S. B., Jha, R. P., Jonas, J. B., Joo, T., Joukar, F., Jurisson, M., Kaambwa, B., Kalhor, R., Kanchan, T., Kandel, H., Karami Matin, B., Karimi, S. E., Kassahun, G., Kayode, G. A., Kazemi Karyani, A., Keikavoosi-Arani, L., Khader, Y. S., Khajuria, H., Khalilov, R., Khammarnia, M., Khan, J., Khubchandani, J., Kianipour, N., Kim, G. R., Kim, Y. J., Kisa, A., Kisa, S., Kohler, S., Kosen, S., Koteeswaran, R., Koulmane Laxminarayana, S. L., Koyanagi, A., Krishan, K., Kumar, G. A., Kusuma, D., Lamnisos, D., Lansingh, V. C., Larsson, A. O., Lasrado, S., Le, L. K. D., Lee, S. W. H., Lee, Y. Y., Lim, S. S., Lobo, S. W., Lozano, R., Magdy Abd El Razek, H., Magdy Abd El Razek, M., Mahdavi, M. M., Majeed, A., Makki, A., Maleki, A., Malekzadeh, R., Manda, A. L., Mansour-Ghanaei, F., Mansournia, M. A., Marrugo Arnedo, C. A., Martinez-Valle, A., Masoumi, S. Z., Maude, R. J., Mckee, M., Medina-Solis, C. E., Menezes, R. G., Meretoja, A., Meretoja, T. J., Mesregah, M. K., Mestrovic, T., Milevska Kostova, N., Miller, T. R., Mini, G. K., Mirica, A., Mirrakhimov, E. M., Mohajer, B., Mohamed, T. A., Mohammadi, M., Mohammadian-Hafshejani, A., Mohammed, S., Moitra, M., Mokdad, A. H., Molokhia, M., Moni, M. A., Moradi, Y., Morze, J., Mousavi, S. M., Mpundu-Kaambwa, C., Muriithi, M. K., Muthupandian, S., Nagarajan, A. J., Naimzada, M. D., Nangia, V., Naqvi, A. A., Narayana, A. I., Nascimento, B. R., Naveed, M., Nayak, B. P., Nazari, J., Ndejjo, R., Negoi, I., Neupane Kandel, S., Nguyen, T. H., Nonvignon, J., Noubiap, J. J., Nwatah, V. E., Oancea, B., Ojelabi, F. A. O., Olagunju, A. T., Olakunde, B. O., Olgiati, S., Olusanya, J. O., Onwujekwe, O. E., Otoiu, A., Otstavnov, N., Otstavnov, S. S., Owolabi, M. O., Padubidri, J. R., Palladino, R., Panda-Jonas, S., Park, E. -C., Pashazadeh Kan, F., Pawar, S., Pazoki Toroudi, H., Pereira, D. M., Perianayagam, A., Pesudovs, K., Piccinelli, C., Postma, M. J., Prada, S. I., Rabiee, M., Rabiee, N., Rahim, F., Rahimi-Movaghar, V., Rahman, M. H. U., Rahman, M., Rahmani, A. M., Ram, U., Ranabhat, C. L., Ranasinghe, P., Rao, C. R., Rathi, P., Rawaf, D. L., Rawaf, S., Rawal, L., Rawassizadeh, R., Reiner Jr, R. C., Renzaho, A. M. N., Reshmi, B., Riaz, M. A., Ripon, R. K., Saad, A. M., Sahraian, M. A., Sahu, M., Salama, J. S., Salehi, S., Samy, A. M., Sanabria, J., Sanmarchi, F., Santos, J. V., Santric-Milicevic, M. M., Sathian, B., Savic, M., Saxena, D., Sayyah, M., Schwendicke, F., Senthilkumaran, S., Sepanlou, S. G., Seylani, A., Shahabi, S., Shaikh, M. A., Sheikh, A., Shetty, A., Shetty, P. H., Shibuya, K., Shrime, M. G., Shuja, K. H., Singh, J. A., Skryabin, V. Y., Skryabina, A. A., Soltani, S., Soofi, M., Spurlock, E. E., Stefan, S. C., Szerencses, V., Szocska, M., Tabares-Seisdedos, R., Taddele, B. W., Tefera, Y. G., Thavamani, A., Tobe-Gai, R., Topor-Madry, R., Tovani-Palone, M. R., Tran, B. X., Tudor Car, L., Ullah, A., Ullah, S., Umar, N., Undurraga, E. A., Valdez, P. R., Vasankari, T. J., Villafane, J. H., Violante, F. S., Vlassov, V., Vo, B., Vollmer, S., Vos, T., Vu, G. T., Vu, L. G., Wamai, R. G., Werdecker, A., Woldekidan, M. A., Wubishet, B. L., Xu, G., Yaya, S., Yazdi-Feyzabadi, V., Yigit, V., Yip, P., Yirdaw, B. W., Yonemoto, N., Younis, M. Z., Yu, C., Yunusa, I., Zahirian Moghadam, T., Zandian, H., Zastrozhin, M. S., Zastrozhina, A., Zhang, Z. -J., Ziapour, A., Zuniga, Y. M. H., Hay, S. I., Murray, C. J. L., and Dieleman, J. L.
Subjects: Economic growth, Financing, Government, International Cooperation, HN, HM, Global Health, Gross domestic product, International Agencies/economics, 0302 clinical medicine, RA0421, Per capita, Global health, Healthcare Financing, 11 Medical and Health Sciences, 2. Zero hunger, COVID 19, develompment assistance, health financing, projection 1995-250, INCOME, COVID-19, Development assistance, Health financing, COVID-19/economics, 1. No poverty, Public Health, Global Health, Social Medicine and Epidemiology, Articles, General Medicine, 3. Good health, Government Programs, Health Expenditures/statistics & numerical data, 030220 oncology & carcinogenesis, Transparency (graphic), QR180, Economic Development, International development, Life Sciences & Biomedicine, medicine.medical_specialty, Government Programs/economics, Gross Domestic Product, Context (language use), 03 medical and health sciences, Medicine, General & Internal, General & Internal Medicine, medicine, Humans, Developing Countries/economics, Developing Countries, Government, Science & Technology, Public health, COVID-19, development assistance, global health, Global Burden of Disease 2020 Health Financing Collaborator Network, International Agencies, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Business, Global Health/economics, Health Expenditures, 030217 neurology & neurosurgery, RC, Financing, Government/economics
Abstract: Background The rapid spread of COVID-19 renewed the focus on how health systems across the globe are financed, especially during public health emergencies. Development assistance is an important source of health financing in many low-income countries, yet little is known about how much of this funding was disbursed for COVID-19. We aimed to put development assistance for health for COVID-19 in the context of broader trends in global health financing, and to estimate total health spending from 1995 to 2050 and development assistance for COVID-19 in 2020. Methods We estimated domestic health spending and development assistance for health to generate total health-sector spending estimates for 204 countries and territories. We leveraged data from the WHO Global Health Expenditure Database to produce estimates of domestic health spending. To generate estimates for development assistance for health, we relied on project-level disbursement data from the major international development agencies' online databases and annual financial statements and reports for information on income sources. To adjust our estimates for 2020 to include disbursements related to COVID-19, we extracted project data on commitments and disbursements from a broader set of databases (because not all of the data sources used to estimate the historical series extend to 2020), including the UN Office of Humanitarian Assistance Financial Tracking Service and the International Aid Transparency Initiative. We reported all the historic and future spending estimates in inflation-adjusted 2020 US$, 2020 US$ per capita, purchasing-power parity-adjusted US$ per capita, and as a proportion of gross domestic product. We used various models to generate future health spending to 2050. Findings In 2019, health spending globally reached $8. 8 trillion (95% uncertainty interval [UI] 8.7-8.8) or $1132 (1119-1143) per person. Spending on health varied within and across income groups and geographical regions. Of this total, $40.4 billion (0.5%, 95% UI 0.5-0.5) was development assistance for health provided to low-income and middle-income countries, which made up 24.6% (UI 24.0-25.1) of total spending in low-income countries. We estimate that $54.8 billion in development assistance for health was disbursed in 2020. Of this, $13.7 billion was targeted toward the COVID-19 health response. $12.3 billion was newly committed and $1.4 billion was repurposed from existing health projects. $3.1 billion (22.4%) of the funds focused on country-level coordination and $2.4 billion (17.9%) was for supply chain and logistics. Only $714.4 million (7.7%) of COVID-19 development assistance for health went to Latin America, despite this region reporting 34.3% of total recorded COVID-19 deaths in low-income or middle-income countries in 2020. Spending on health is expected to rise to $1519 (1448-1591) per person in 2050, although spending across countries is expected to remain varied. Interpretation Global health spending is expected to continue to grow, but remain unequally distributed between countries. We estimate that development organisations substantially increased the amount of development assistance for health provided in 2020. Continued efforts are needed to raise sufficient resources to mitigate the pandemic for the most vulnerable, and to help curtail the pandemic for all. For complete list of authors see http://dx.doi.org/10.1016/S0140-6736(21)01258-7
Published: 2021
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32. Examining the density in out-of-pocket spending share in the estimation of catastrophic health expenditures

Author: Abdulrahman Jbaily, Annie Haakenstad, Mizan Kiros, CJ (Carlos) Riumallo Herl, S Verguet, Abdulrahman Jbaily, Annie Haakenstad, Mizan Kiros, CJ (Carlos) Riumallo Herl, and S Verguet
Abstract: Universal health coverage (UHC) aims to provide access to health services for all without financial hardship. Moving toward UHC while ensuring financial risk protection (FRP) from out-of-pocket (OOP) health expenditures is a critical objective of the Sustainable Development Goal for Health. In tracking country progress toward UHC, analysts and policymakers usually report on two summary indicators of lack of FRP: the prevalence of catastrophic health expenditures (CHE) and the prevalence of impoverishing health expenditures. In this paper, we build on the CHE indicator: we examine the distribution (density) of health OOP budget share as a way to capture both the magnitude and dispersion in the ratio of households’ OOP health expenditures relative to consumption or income at the population level. We illustrate our approach with country-specific examples using data from the World Health Organization’s World Health Surveys.
Published: 2021
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33. Is the Glass Half-Full or Half-Empty? A Content Analysis of Adolescent Sexual and Reproductive Health in Global Financing Facility Country Plans

Author: Mickey Chopra, Annie Haakenstad, Neha S. Singh, Asha George, Mary V Kinney, Tanya Jacobs, and Kumanan Rasanathan
Subjects: business.industry, Content analysis, Political science, Socioeconomics, business, Reproductive health
Abstract: Background: The Global Financing Facility (GFF) offers an opportunity to close the financing gap that holds back gains in women, children’s and adolescent health is recognised as a key priority by the GFF leadership. However, very little work exists examining GFF practice. As momentum builds for the GFF, we examine the initial efforts of the GFF in addressing adolescent health.Methods: We undertook a content analysis of the first 10 GFF Investment Cases and Project Appraisal Documents available on the GFF website. The countries involved include Bangladesh, Cameroon, Democratic Republic of Congo, Ethiopia, Guatemala, Kenya, Liberia, Mozambique, Nigeria, Tanzania and Uganda. Results: While several country documents signal understanding and investment in adolescent health as a strategic area, this is not consistent across all countries, nor between Investment Cases and Project Appraisal Documents. In both types of documents commitments weaken as one moves from programming content to indicators to investment. Important contributions include how teenage pregnancy is a universal concern, how adolescent and youth friendly health services and school-based programs are supported in several country documents, how gender is noted as a key social determinant critical for mainstreaming across the health system, alongside the importance of multi-sectoral collaboration, and the acknowledgement of adolescent rights. Weaknesses include the lack of comprehensive analysis of adolescent health needs, inconsistent investments in adolescent friendly health services and school based programs, missed opportunities in not supporting multi-component and multi-level initiatives to change gender norms involving adolescent boys in addition to adolescent girls, and neglect of governance approaches to broker effective multi-sectoral collaboration, community engagement and adolescent involvement. Conclusion: There are important examples of how the GFF supports adolescent health as a priority area. However, more can be done. While building on service delivery approaches more consistently, it must also fund initiatives that address the main social and systems drivers of adolescent health. This requires capacity building for the technical aspects of adolescent health, but also engaging politically to ensure that the right actors are convened to prioritize adolescent health in country plans and to ensure accountability in the GFF process itself.
Published: 2020
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34. The financing gaps framework: using need, potential spending and expected spending to allocate development assistance for health

Author: Jesse B. Bump, Tara Templin, Stephen S Lim, Joseph L Dieleman, and Annie Haakenstad
Subjects: International Cooperation, resource allocation, 030204 cardiovascular system & hematology, Global Health, 03 medical and health sciences, 0302 clinical medicine, 11. Sustainability, Global health, Humans, 030212 general & internal medicine, 10. No inequality, Empirical evidence, Developing Countries, Budget constraint, Finance, Sustainable development, Flexibility (engineering), Government, business.industry, Health Policy, Financing, Organized, 1. No poverty, International health, Original Articles, Sustainability, aid, Business, Delivery of Health Care, Overseas development assistance
Abstract: As growth in development assistance for health levels off, development assistance partners must make allocation decisions within tighter budget constraints. Furthermore, with the advent of comprehensive and comparable burden of disease and health financing estimates, empirical evidence can increasingly be used to direct funding to those most in need. In our ‘financing gaps framework’, we propose a new approach for harnessing information to make decisions about health aid. The framework was designed to be forward-looking, goal-oriented, versatile and customizable to a range of organizational contexts and health aims. Our framework brings together expected health spending, potential health spending and spending need, to orient financing decisions around international health targets. As an example of how the framework could be applied, we develop a case study, focused on global goals for child health. The case study harnesses data from the Global Burden of Disease 2013 Study, Financing Global Health 2015, the WHO Global Health Observatory and National Health Accounts. Funding flows are tied to progress toward the Sustainable Development Goal’s target for reductions in under-five mortality. The flexibility and comprehensiveness of our framework makes it adaptable for use by a diverse set of governments, donors, policymakers and other stakeholders. The framework can be adapted to short‐ or long‐run time frames, cross‐country or subnational scales, and to a number of specific health focus areas. Depending on donor preferences, the framework can be deployed to incentivize local investments in health, ensuring the long-term sustainability of health systems in low- and middle-income countries, while also furnishing international support for progress toward global health goals.
Published: 2018

35. US Health Care Spending by Race and Ethnicity, 2002-2016

Author: Sawyer W Crosby, Annie Haakenstad, Ali H. Mokdad, Kirstin W. Scott, Golsum Tsakalos, Christopher J L Murray, Gregory A. Roth, Ian Pollock, Maitreyi Sahu, Angela Liu, Laura Dwyer-Lindgren, Carina Chen, Joseph L Dieleman, and Darrah McCracken
Subjects: education.field_of_study, business.industry, Population, Ethnic group, General Medicine, Disease, Health care, Pacific islanders, Medicine, National Health Interview Survey, Medical prescription, education, business, Medical Expenditure Panel Survey, Original Investigation, Demography
Abstract: IMPORTANCE: Measuring health care spending by race and ethnicity is important for understanding patterns in utilization and treatment. OBJECTIVE: To estimate, identify, and account for differences in health care spending by race and ethnicity from 2002 through 2016 in the US. DESIGN, SETTING, AND PARTICIPANTS: This exploratory study included data from 7.3 million health system visits, admissions, or prescriptions captured in the Medical Expenditure Panel Survey (2002-2016) and the Medicare Current Beneficiary Survey (2002-2012), which were combined with the insured population and notified case estimates from the National Health Interview Survey (2002; 2016) and health care spending estimates from the Disease Expenditure project (1996-2016). EXPOSURE: Six mutually exclusive self-reported race and ethnicity groups. MAIN OUTCOMES AND MEASURES: Total and age-standardized health care spending per person by race and ethnicity for each year from 2002 through 2016 by type of care. Health care spending per notified case by race and ethnicity for key diseases in 2016. Differences in health care spending across race and ethnicity groups were decomposed into differences in utilization rate vs differences in price and intensity of care. RESULTS: In 2016, an estimated $2.4 trillion (95% uncertainty interval [UI], $2.4 trillion-$2.4 trillion) was spent on health care across the 6 types of care included in this study. The estimated age-standardized total health care spending per person in 2016 was $7649 (95% UI, $6129-$8814) for American Indian and Alaska Native (non-Hispanic) individuals; $4692 (95% UI, $4068-$5202) for Asian, Native Hawaiian, and Pacific Islander (non-Hispanic) individuals; $7361 (95% UI, $6917-$7797) for Black (non-Hispanic) individuals; $6025 (95% UI, $5703-$6373) for Hispanic individuals; $9276 (95% UI, $8066-$10 601) for individuals categorized as multiple races (non-Hispanic); and $8141 (95% UI, $8038-$8258) for White (non-Hispanic) individuals, who accounted for an estimated 72% (95% UI, 71%-73%) of health care spending. After adjusting for population size and age, White individuals received an estimated 15% (95% UI, 13%-17%; P
Published: 2021
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36. Barriers and facilitators for institutional delivery among poor Mesoamerican women: a cross-sectional study

Author: Danny V. Colombara, Bernardo Hernández, Paola Zúñiga-Brenes, Marielle C. Gagnier, Jennifer Nelson, Claire R. McNellan, Casey K. Johanns, Erin B. Palmisano, Ali H. Mokdad, Alexandra Schaefer, Sima S. Desai, Emma Iriarte, Diego Ríos-Zertuche, and Annie Haakenstad
Subjects: Adult, Economic growth, Adolescent, Cost effectiveness, Cross-sectional study, Population, Prenatal care, Health Services Accessibility, 03 medical and health sciences, 0302 clinical medicine, Health facility, Pregnancy, Environmental health, Humans, Medicine, Maternal Health Services, 030212 general & internal medicine, Quality of care, education, Poverty, Quality of Health Care, education.field_of_study, business.industry, 030503 health policy & services, Health Policy, Attendance, Central America, Consumer Behavior, Middle Aged, Delivery, Obstetric, Travel time, Cross-Sectional Studies, Female, Health Facilities, 0305 other medical science, business
Abstract: Professional skilled care has shown to be one of the most promising strategies to reduce maternal mortality, and in-facility deliveries are a cost-effective way to ensure safe births. Countries in Mesoamerica have emphasized in-facility delivery care by professionally skilled attendants, but access to good-quality delivery care is still lacking for many women. We examined the characteristics of women who had a delivery in a health facility and determinants of the decision to bypass a closer facility and travel to a distant one. We used baseline information from the Salud Mesoamerica Initiative (SMI). Data were collected from a large household and facilities sample in the poorest quintile of the population in Guatemala, Honduras and Nicaragua. The analysis included 1592 deliveries. After controlling for characteristics of women and health facilities, being primiparous (RR = 1.15, 95% CI 1.10, 1.21), being literate (RR = 1.24, 95% CI 1.04, 1.48), having antenatal care (RR = 1.68, 95% CI 1.24, 2.27), being informed of the need for having a C-section (RR = 1.07, 95% CI 1.02, 1.11) and travel time to the closest facility totaling 1-2 h vs under 30 min (RR = 0.88, 95% CI 0.77, 0.99) were associated with in-health facility deliveries. In Guatemala, increased availability of medications and equipment at a distant facility was strongly associated with bypassing the closest facility in favor of a distant one for delivery (RR = 2.10, 95% CI 1.08, 4.07). Our study showed a strong correlation between well-equipped facilities and delivery attendance in poor areas of Mesoamerica. Indeed, women were more likely to travel to more distant facilities if the facilities were of higher level, which scored higher on our capacity score. Our findings call for improving the capacity of health facilities, quality of care and addressing cultural and accessibility barriers to increase institutional delivery among the poor population in Mesoamerica.
Published: 2017
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37. Rural-urban disparities in colonoscopies after the elimination of patient cost-sharing by the Affordable Care Act

Author: Annie Haakenstad, Lydia E. Pace, Summer Sherburne Hawkins, and Jessica Cohen
Subjects: Male, Rural Population, Epidemiology, Colorectal cancer, media_common.quotation_subject, Colonoscopy, Medicare, 01 natural sciences, 03 medical and health sciences, 0302 clinical medicine, Rurality, Environmental health, Health insurance, Medicine, Humans, 030212 general & internal medicine, 0101 mathematics, Cost Sharing, Maine, Early Detection of Cancer, media_common, Aged, medicine.diagnostic_test, business.industry, Patient Protection and Affordable Care Act, 010102 general mathematics, Public Health, Environmental and Occupational Health, Middle Aged, Payment, medicine.disease, United States, Cost sharing, Residence, Female, Rural area, business, Colorectal Neoplasms
Abstract: Improving the prevention and early detection of colorectal cancer is a priority for reducing rural-urban disparities in colorectal cancer mortality. By eliminating out-of-pocket (OOP) costs for preventive colonoscopies, the Affordable Care Act (ACA) could have reduced rural-urban disparities in screening.We used the Maine Health Data Organization All-Payer Claims Database including all commercially-insured and Medicare beneficiaries aged 50-75 between 2009 and 2012. Rural-urban commuting areas were used to classify rural/urban residence. ICD-9 and CPT codes identified colonoscopies. We summed all OOP payments per patient-day. An interrupted time series model estimated the impact of the ACA on trends in rural-urban disparities in colonoscopy rates and OOP costs.Before the ACA, colonoscopy rates were 16% lower in rural than urban areas (5.1% vs. 6.1% of enrollees annually) and median OOP costs were nearly double ($195 vs. $98). The ACA reduced median OOP payments by $94 (p = .001) initially and $4 monthly (p = .038) in rural areas, and $63 (p .001) in urban areas. The rural-urban gap in OOP payments dropped by $4 monthly (p = .007). The ACA also reduced rural-urban disparities in colonoscopy rates (disparity decrease of 0.005 (6%) monthly, p .001). The rural-urban gap in colonoscopy rates declined 40% relative to the pre-ACA period by December 2012.The ACA was associated with significant reductions in rural-urban disparities in colonoscopies in Maine, suggesting that OOP costs are an important barrier for rural residents. Further research is needed to determine whether increased uptake, particularly in rural areas, translated into better patient outcomes for colorectal cancer.
Published: 2019

38. Estimating fiscal space for health: pitfalls and solutions - Authors' response

Author: Joseph L Dieleman, Mark Moses, and Annie Haakenstad
Subjects: Finance, Government, Financing, Government, Biomedical Research, Epidemiology, business.industry, Fiscal space, Immunology, MEDLINE, HIV Infections, Infectious Diseases, Virology, Medicine, Humans, Health Expenditures, business
Published: 2019

39. The G20 and development assistance for health: historical trends and crucial questions to inform a new era

Author: Annie Haakenstad, Rouselle F. Lavado, Jennifer Kates, Karen A. Grépin, Catherine S Chen, Thomas J. Bollyky, Jesse B. Bump, Angela E Micah, Christopher J L Murray, Sarah Alkenbrack, Junjie Wu, Trygve Ottersen, Yingxi Zhao, Joseph L Dieleman, Irene Akua Agyepong, Krycia Cowling, Anton C Harle, Golsum Tsakalos, Ajay Tandon, and Bianca S. Zlavog
Subjects: Sustainable development, Receipt, geography, Economic growth, Summit, geography.geographical_feature_category, Equity (economics), Health Policy, International Cooperation, Context (language use), General Medicine, 030204 cardiovascular system & hematology, Global Health, 03 medical and health sciences, 0302 clinical medicine, Political science, Sustainability, Global health, Healthcare Financing, Humans, 030212 general & internal medicine, Health Expenditures, Health policy, Forecasting
Abstract: One of the most important gatherings of the world's economic leaders, the G20 Summit and ministerial meetings, takes place in June, 2019. The Summit presents a valuable opportunity to reflect on the provision and receipt of development assistance for health (DAH) and the role the G20 can have in shaping the future of health financing. The participants at the G20 Summit (ie, the world's largest providers of DAH, emerging donors, and DAH recipients) and this Summit's particular focus on global health and the Sustainable Development Goals offers a unique forum to consider the changing DAH context and its pressing questions. In this Health Policy perspective, we examined trends in DAH and its evolution over time, with a particular focus on G20 countries; pointed to persistent and emerging challenges for discussion at the G20 Summit; and highlighted key questions for G20 leaders to address to put the future of DAH on course to meet the expansive Sustainable Development Goals. Key questions include how to best focus DAH for equitable health gains, how to deliver DAH to strengthen health systems, and how to support domestic resource mobilisation and transformative partnerships for sustainable impact. These issues are discussed in the context of the growing effects of climate change, demographic and epidemiological transitions, and a global political shift towards increasing prioritisation of national interests. Although not all these questions are new, novel approaches to allocating DAH that prioritise equity, efficiency, and sustainability, particularly through domestic resource use and mobilisation are needed. Wrestling with difficult questions in a changing landscape is essential to develop a DAH financing system capable of supporting and sustaining crucial global health goals.
Published: 2019

40. Malaria eradication within a generation: ambitious, achievable, and necessary

Author: Neelam Sekhri Feachem, Alex Eapen, Scott G. Filler, Margaret Lees, Kelly Harvard, Richard G A Feachem, Roly Gosling, Dean T. Jamison, Joseph L Dieleman, Jennifer Wegbreit, Xiao Ning, Richard Nchabi Kamwi, Gretchen Newby, Annie Haakenstad, Balbir Singh, Erika Larson, Hyun Ju Woo, Caroline O. Buckee, Samir Bhatt, Ingrid Chen, Neil F. Lobo, Maciej F. Boni, Kate E. Jones, Fred Binka, James Tulloch, Ben Rolfe, Bruno Moonen, Omar S. Akbari, Angela E Micah, Winnie Mpanju-Shumbusho, Corine Karema, Altaf A. Lal, Muhammad Pate, Martha L Quiñones, Michelle E. Roh, Arian Hatefi, Amelia Bertozzi-Villa, Dennis Shanks, Arjen M. Dondorp, Kenneth Staley, and Peter W. Gething
Subjects: business.industry, International Cooperation, MEDLINE, General Medicine, medicine.disease, Global Health, World Health Organization, Malaria, Environmental health, Global health, Medicine, Humans, Public Health, Disease Eradication, Malaria epidemiology, business
Published: 2019

41. Lenses and levels: the why, what and how of measuring health system drivers of women's, children's and adolescents' health with a governance focus

Author: Rajani Ved, Bernadette Daelmans, Kumanan Rasanathan, Shehla Zaidi, Mickey Chopra, Rajat Khosla, David Sanders, Amnesty E LeFevre, Kent Buse, Asha George, Luis Huicho, Nicki Tiffin, Helen Schneider, Annie Haakenstad, Tanya Jacobs, Mary V Kinney, and Neha S. Singh
Subjects: Holistic education, purl.org/pe-repo/ocde/ford#3.03.05 [https], Service delivery framework, business.industry, Health Policy, Corporate governance, Public Health, Environmental and Occupational Health, epistemology, Public relations, Digital health, power, Intervention (law), Action (philosophy), governance, purl.org/pe-repo/ocde/ford#3.03.02 [https], rights, Social determinants of health, Sociology, measurement, business, health systems, Analysis, Adolescent health
Abstract: Health systems are critical for health outcomes as they underpin intervention coverage and quality, promote users’ rights and intervene on the social determinants of health. Governance is essential for health system endeavours as it mobilises and coordinates a multiplicity of actors and interests to realise common goals. The inherently social, political and contextualised nature of governance, and health systems more broadly, has implications for measurement, including how the health of women, children and adolescents health is viewed and assessed, and for whom. Three common lenses, each with their own views of power dynamics in policy and programme implementation, include a service delivery lens aimed at scaling effective interventions, a societal lens oriented to empowering people with rights to effect change and a systems lens concerned with creating enabling environments for adaptive learning. We illustrate the implications of each lens for the why, what and how of measuring health system drivers across micro, meso and macro health systems levels, through three examples (digital health, maternal and perinatal death surveillance and review, and multisectoral action for adolescent health). Appreciating these underpinnings of measuring health systems and governance drivers of the health of women, children and adolescents is essential for a holistic learning and action agenda that engages a wider range of stakeholders, which includes, but also goes beyond, indicator-based measurement. Without a broadening of approaches to measurement and the types of research partnerships involved, continued investments in the health of women, children and adolescents will fall short.
Published: 2019

42. Past, present, and future of global health financing: a review of development assistance, government, out-of-pocket, and other private spending on health for 195 countries, 1995–2050

Author: Angela Y. Chang, Krycia Cowling, Angela E. Micah, Abigail Chapin, Catherine S. Chen, Gloria Ikilezi, Nafis Sadat, Golsum Tsakalos, Junjie Wu, Theodore Younker, Yingxi Zhao, Bianca S. Zlavog, Cristiana Abbafati, Anwar E Ahmed, Khurshid Alam, Vahid Alipour, Syed Mohamed Aljunid, Mohammed J. Almalki, Nelson Alvis-Guzman, Walid Ammar, Catalina Liliana Andrei, Mina Anjomshoa, Carl Abelardo T. Antonio, Jalal Arabloo, Olatunde Aremu, Marcel Ausloos, Leticia Avila-Burgos, Ashish Awasthi, Martin Amogre Ayanore, Samad Azari, Natasha Azzopardi-Muscat, Mojtaba Bagherzadeh, Till Winfried Bärnighausen, Bernhard T Baune, Mohsen Bayati, Yared Belete Belay, Yihalem Abebe Belay, Habte Belete, Dessalegn Ajema Berbada, Adam E. Berman, Mircea Beuran, Ali Bijani, Reinhard Busse, Lucero Cahuana-Hurtado, Luis Alberto Cámera, Ferrán Catalá-López, Bal Govind Chauhan, Maria-Magdalena Constantin, Christopher Stephen Crowe, Alexandra Cucu, Koustuv Dalal, Jan-Walter De Neve, Selina Deiparine, Feleke Mekonnen Demeke, Huyen Phuc Do, Manisha Dubey, Maha El Tantawi, Sharareh Eskandarieh, Reza Esmaeili, Mahdi Fakhar, Ali Akbar Fazaeli, Florian Fischer, Nataliya A. Foigt, Takeshi Fukumoto, Nancy Fullman, Adriana Galan, Amiran Gamkrelidze, Kebede Embaye Gezae, Alireza Ghajar, Ahmad Ghashghaee, Ketevan Goginashvili, Annie Haakenstad, Hassan Haghparast Bidgoli, Samer Hamidi, Hilda L. Harb, Edris Hasanpoor, Hamid Yimam Hassen, Simon I. Hay, Delia Hendrie, Andualem Henok, Ileana Heredia-Pi, Claudiu Herteliu, Chi Linh Hoang, Michael K. Hole, Enayatollah Homaie Rad, Naznin Hossain, Mehdi Hosseinzadeh, Sorin Hostiuc, Olayinka Stephen Ilesanmi, Seyed Sina Naghibi Irvani, Mihajlo Jakovljevic, Amir Jalali, Spencer L. James, Jost B. Jonas, Mikk Jürisson, Rajendra Kadel, Behzad Karami Matin, Amir Kasaeian, Habtamu Kebebe Kasaye, Mesfin Wudu Kassaw, Ali Kazemi Karyani, Roghayeh Khabiri, Junaid Khan, Md Nuruzzaman Khan, Young-Ho Khang, Adnan Kisa, Katarzyna Kissimova-Skarbek, Stefan Kohler, Ai Koyanagi, Kristopher J. Krohn, Ricky Leung, Lee-Ling Lim, Stefan Lorkowski, Azeem Majeed, Reza Malekzadeh, Morteza Mansourian, Lorenzo Giovanni Mantovani, Benjamin Ballard Massenburg, Martin McKee, Varshil Mehta, Atte Meretoja, Tuomo J Meretoja, Neda Milevska Kostova, Ted R Miller, Erkin M Mirrakhimov, Bahram Mohajer, Aso Mohammad Darwesh, Shafiu Mohammed, Farnam Mohebi, Ali H Mokdad, Shane Douglas Morrison, Seyyed Meysam Mousavi, Saravanan Muthupandian, Ahamarshan Jayaraman Nagarajan, Vinay Nangia, Ionut Negoi, Cuong Tat Nguyen, Huong Lan Thi Nguyen, Son Hoang Nguyen, Shirin Nosratnejad, Olanrewaju Oladimeji, Stefano Olgiati, Jacob Olusegun Olusanya, Obinna E Onwujekwe, Stanislav S Otstavnov, Adrian Pana, David M. Pereira, Bakhtiar Piroozi, Sergio I Prada, Mostafa Qorbani, Mohammad Rabiee, Navid Rabiee, Alireza Rafiei, Fakher Rahim, Vafa Rahimi-Movaghar, Usha Ram, Chhabi Lal Ranabhat, Anna Ranta, David Laith Rawaf, Salman Rawaf, Satar Rezaei, Elias Merdassa Roro, Ali Rostami, Salvatore Rubino, Mohamadreza Salahshoor, Abdallah M. Samy, Juan Sanabria, João Vasco Santos, Milena M Santric Milicevic, Bruno Piassi Sao Jose, Miloje Savic, Falk Schwendicke, Sadaf G. Sepanlou, Masood Sepehrimanesh, Aziz Sheikh, Mark G Shrime, Solomon Sisay, Shahin Soltani, Moslem Soofi, Vinay Srinivasan, Rafael Tabarés-Seisdedos, Anna Torre, Marcos Roberto Tovani-Palone, Bach Xuan Tran, Khanh Bao Tran, Eduardo A. Undurraga, Pascual R Valdez, Job F M van Boven, Veronica Vargas, Yousef Veisani, Francesco S Violante, Sergey Konstantinovitch Vladimirov, Vasily Vlassov, Sebastian Vollmer, Giang Thu Vu, Charles D A Wolfe, Naohiro Yonemoto, Mustafa Z. Younis, Mahmoud Yousefifard, Sojib Bin Zaman, Alireza Zangeneh, Elias Asfaw Zegeye, Arash Ziapour, Adrienne Chew, Christopher J L Murray, Joseph L Dieleman, Chang A.Y., Cowling K., Micah A.E., Chapin A., Chen C.S., Ikilezi G., Sadat N., Tsakalos G., Wu J., Younker T., Zhao Y., Zlavog B.S., Abbafati C., Ahmed A.E., Alam K., Alipour V., Aljunid S.M., Almalki M.J., Alvis-Guzman N., Ammar W., Andrei C.L., Anjomshoa M., Antonio C.A.T., Arabloo J., Aremu O., Ausloos M., Avila-Burgos L., Awasthi A., Ayanore M.A., Azari S., Azzopardi-Muscat N., Bagherzadeh M., Barnighausen T.W., Baune B.T., Bayati M., Belay Y.B., Belay Y.A., Belete H., Berbada D.A., Berman A.E., Beuran M., Bijani A., Busse R., Cahuana-Hurtado L., Camera L.A., Catala-Lopez F., Chauhan B.G., Constantin M.-M., Crowe C.S., Cucu A., Dalal K., De Neve J.-W., Deiparine S., Demeke F.M., Do H.P., Dubey M., El Tantawi M., Eskandarieh S., Esmaeili R., Fakhar M., Fazaeli A.A., Fischer F., Foigt N.A., Fukumoto T., Fullman N., Galan A., Gamkrelidze A., Gezae K.E., Ghajar A., Ghashghaee A., Goginashvili K., Haakenstad A., Haghparast Bidgoli H., Hamidi S., Harb H.L., Hasanpoor E., Hassen H.Y., Hay S.I., Hendrie D., Henok A., Heredia-Pi I., Herteliu C., Hoang C.L., Hole M.K., Homaie Rad E., Hossain N., Hosseinzadeh M., Hostiuc S., Ilesanmi O.S., Irvani S.S.N., Jakovljevic M., Jalali A., James S.L., Jonas J.B., Jurisson M., Kadel R., Karami Matin B., Kasaeian A., Kasaye H.K., Kassaw M.W., Kazemi Karyani A., Khabiri R., Khan J., Khan M.N., Khang Y.-H., Kisa A., Kissimova-Skarbek K., Kohler S., Koyanagi A., Krohn K.J., Leung R., Lim L.-L., Lorkowski S., Majeed A., Malekzadeh R., Mansourian M., Mantovani L.G., Massenburg B.B., McKee M., Mehta V., Meretoja A., Meretoja T.J., Milevska Kostova N., Miller T.R., Mirrakhimov E.M., Mohajer B., Mohammad Darwesh A., Mohammed S., Mohebi F., Mokdad A.H., Morrison S.D., Mousavi S.M., Muthupandian S., Nagarajan A.J., Nangia V., Negoi I., Nguyen C.T., Nguyen H.L.T., Nguyen S.H., Nosratnejad S., Oladimeji O., Olgiati S., Olusanya J.O., Onwujekwe O.E., Otstavnov S.S., Pana A., Pereira D.M., Piroozi B., Prada S.I., Qorbani M., Rabiee M., Rabiee N., Rafiei A., Rahim F., Rahimi-Movaghar V., Ram U., Ranabhat C.L., Ranta A., Rawaf D.L., Rawaf S., Rezaei S., Roro E.M., Rostami A., Rubino S., Salahshoor M., Samy A.M., Sanabria J., Santos J.V., Santric Milicevic M.M., Sao Jose B.P., Savic M., Schwendicke F., Sepanlou S.G., Sepehrimanesh M., Sheikh A., Shrime M.G., Sisay S., Soltani S., Soofi M., Srinivasan V., Tabares-Seisdedos R., Torre A., Tovani-Palone M.R., Tran B.X., Tran K.B., Undurraga E.A., Valdez P.R., van Boven J.F.M., Vargas V., Veisani Y., Violante F.S., Vladimirov S.K., Vlassov V., Vollmer S., Vu G.T., Wolfe C.D.A., Yonemoto N., Younis M.Z., Yousefifard M., Zaman S.B., Zangeneh A., Zegeye E.A., Ziapour A., Chew A., Murray C.J.L., Dieleman J.L., Global Burden Dis Hlth Financing C, Bill & Melinda Gates Foundation, Chang, A, Cowling, K, Micah, A, Chapin, A, Chen, C, Ikilezi, G, Sadat, N, Tsakalos, G, Wu, J, Younker, T, Zhao, Y, Zlavog, B, Abbafati, C, Ahmed, A, Alam, K, Alipour, V, Aljunid, S, Almalki, M, Alvis-Guzman, N, Ammar, W, Andrei, C, Anjomshoa, M, Antonio, C, Arabloo, J, Aremu, O, Ausloos, M, Avila-Burgos, L, Awasthi, A, Ayanore, M, Azari, S, Azzopardi-Muscat, N, Bagherzadeh, M, Barnighausen, T, Baune, B, Bayati, M, Belay, Y, Belete, H, Berbada, D, Berman, A, Beuran, M, Bijani, A, Busse, R, Cahuana-Hurtado, L, Camera, L, Catala-Lopez, F, Chauhan, B, Constantin, M, Crowe, C, Cucu, A, Dalal, K, De Neve, J, Deiparine, S, Demeke, F, Do, H, Dubey, M, Tantawi, M, Eskandarieh, S, Esmaeili, R, Fakhar, M, Fazaeli, A, Fischer, F, Foigt, N, Fukumoto, T, Fullman, N, Galan, A, Gamkrelidze, A, Gezae, K, Ghajar, A, Ghashghaee, A, Goginashvili, K, Haakenstad, A, Bidgoli, H, Hamidi, S, Harb, H, Hasanpoor, E, Hassen, H, Hay, S, Hendrie, D, Henok, A, Heredia-Pi, I, Herteliu, C, Hoang, C, Hole, M, Rad, E, Hossain, N, Hosseinzadeh, M, Hostiuc, S, Ilesanmi, O, Irvani, S, Jakovljevic, M, Jalali, A, James, S, Jonas, J, Jurisson, M, Kadel, R, Matin, B, Kasaeian, A, Kasaye, H, Kassaw, M, Karyani, A, Khabiri, R, Khan, J, Khan, M, Khang, Y, Kisa, A, Kissimova-Skarbek, K, Kohler, S, Koyanagi, A, Krohn, K, Leung, R, Lim, L, Lorkowski, S, Majeed, A, Malekzadeh, R, Mansourian, M, Mantovani, L, Massenburg, B, Mckee, M, Mehta, V, Meretoja, A, Meretoja, T, Kostova, N, Miller, T, Mirrakhimov, E, Mohajer, B, Darwesh, A, Mohammed, S, Mohebi, F, Mokdad, A, Morrison, S, Mousavi, S, Muthupandian, S, Nagarajan, A, Nangia, V, Negoi, I, Nguyen, C, Nguyen, H, Nguyen, S, Nosratnejad, S, Oladimeji, O, Olgiati, S, Olusanya, J, Onwujekwe, O, Otstavnov, S, Pana, A, Pereira, D, Piroozi, B, Prada, S, Qorbani, M, Rabiee, M, Rabiee, N, Rafiei, A, Rahim, F, Rahimi-Movaghar, V, Ram, U, Ranabhat, C, Ranta, A, Rawaf, D, Rawaf, S, Rezaei, S, Roro, E, Rostami, A, Rubino, S, Salahshoor, M, Samy, A, Sanabria, J, Santos, J, Milicevic, M, Jose, B, Savic, M, Schwendicke, F, Sepanlou, S, Sepehrimanesh, M, Sheikh, A, Shrime, M, Sisay, S, Soltani, S, Soofi, M, Srinivasan, V, Tabares-Seisdedos, R, Torre, A, Tovani-Palone, M, Tran, B, Tran, K, Undurraga, E, Valdez, P, Van Boven, J, Vargas, V, Veisani, Y, Violante, F, Vladimirov, S, Vlassov, V, Vollmer, S, Vu, G, Wolfe, C, Yonemoto, N, Younis, M, Yousefifard, M, Zaman, S, Zangeneh, A, Zegeye, E, Ziapour, A, Chew, A, Murray, C, and Dieleman, J
Subjects: health financing, coverage, 030204 cardiovascular system & hematology, systematic analysis, Global Health, Gross domestic product, DISEASE, burden, project, 0302 clinical medicine, Per capita, Global health, Healthcare Financing, 030212 general & internal medicine, our of pocket, 11 Medical and Health Sciences, Government spending, government, 1. No poverty, Public Health, Global Health, Social Medicine and Epidemiology, General Medicine, Public Assistance, COVERAGE, Models, Economic, 8. Economic growth, health financing, project, government, our of pocket, BURDEN, Life Sciences & Biomedicine, Human, Gross Domestic Product, Department of Error, 03 medical and health sciences, Medicine, General & Internal, General & Internal Medicine, SYSTEMATIC ANALYSIS, Revenue, Humans, medicine (all), Health policy, Finance, sex-specific mortality, Government, disease, Science & Technology, SEX-SPECIFIC MORTALITY, business.industry, Prepaid Health Plan, International health, Global Burden of Disease Health Financing Collaborator Network, Health Expenditure, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Human medicine, Health Expenditures, business, Prepaid Health Plans
Abstract: Published Erratum. Past, present, and future of global health financing: a review of development assistance, government, out-of-pocket, and other private spending on health for 195 countries, 1995-2050. Lancet. 2021 Sep 11;398(10304):956. doi: 10.1016/S0140-6736(21)01806-7. PMID: 34509230. BACKGROUND: Comprehensive and comparable estimates of health spending in each country are a key input for health policy and planning, and are necessary to support the achievement of national and international health goals. Previous studies have tracked past and projected future health spending until 2040 and shown that, with economic development, countries tend to spend more on health per capita, with a decreasing share of spending from development assistance and out-of-pocket sources. We aimed to characterise the past, present, and predicted future of global health spending, with an emphasis on equity in spending across countries. METHODS: We estimated domestic health spending for 195 countries and territories from 1995 to 2016, split into three categories-government, out-of-pocket, and prepaid private health spending-and estimated development assistance for health (DAH) from 1990 to 2018. We estimated future scenarios of health spending using an ensemble of linear mixed-effects models with time series specifications to project domestic health spending from 2017 through 2050 and DAH from 2019 through 2050. Data were extracted from a broad set of sources tracking health spending and revenue, and were standardised and converted to inflation-adjusted 2018 US dollars. Incomplete or low-quality data were modelled and uncertainty was estimated, leading to a complete data series of total, government, prepaid private, and out-of-pocket health spending, and DAH. Estimates are reported in 2018 US dollars, 2018 purchasing-power parity-adjusted dollars, and as a percentage of gross domestic product. We used demographic decomposition methods to assess a set of factors associated with changes in government health spending between 1995 and 2016 and to examine evidence to support the theory of the health financing transition. We projected two alternative future scenarios based on higher government health spending to assess the potential ability of governments to generate more resources for health. FINDINGS: Between 1995 and 2016, health spending grew at a rate of 4·00% (95% uncertainty interval 3·89-4·12) annually, although it grew slower in per capita terms (2·72% [2·61-2·84]) and increased by less than $1 per capita over this period in 22 of 195 countries. The highest annual growth rates in per capita health spending were observed in upper-middle-income countries (5·55% [5·18-5·95]), mainly due to growth in government health spending, and in lower-middle-income countries (3·71% [3·10-4·34]), mainly from DAH. Health spending globally reached $8·0 trillion (7·8-8·1) in 2016 (comprising 8·6% [8·4-8·7] of the global economy and $10·3 trillion [10·1-10·6] in purchasing-power parity-adjusted dollars), with a per capita spending of US$5252 (5184-5319) in high-income countries, $491 (461-524) in upper-middle-income countries, $81 (74-89) in lower-middle-income countries, and $40 (38-43) in low-income countries. In 2016, 0·4% (0·3-0·4) of health spending globally was in low-income countries, despite these countries comprising 10·0% of the global population. In 2018, the largest proportion of DAH targeted HIV/AIDS ($9·5 billion, 24·3% of total DAH), although spending on other infectious diseases (excluding tuberculosis and malaria) grew fastest from 2010 to 2018 (6·27% per year). The leading sources of DAH were the USA and private philanthropy (excluding corporate donations and the Bill & Melinda Gates Foundation). For the first time, we included estimates of China's contribution to DAH ($644·7 million in 2018). Globally, health spending is projected to increase to $15·0 trillion (14·0-16·0) by 2050 (reaching 9·4% [7·6-11·3] of the global economy and $21·3 trillion [19·8-23·1] in purchasing-power parity-adjusted dollars), but at a lower growth rate of 1·84% (1·68-2·02) annually, and with continuing disparities in spending between countries. In 2050, we estimate that 0·6% (0·6-0·7) of health spending will occur in currently low-income countries, despite these countries comprising an estimated 15·7% of the global population by 2050. The ratio between per capita health spending in high-income and low-income countries was 130·2 (122·9-136·9) in 2016 and is projected to remain at similar levels in 2050 (125·9 [113·7-138·1]). The decomposition analysis identified governments' increased prioritisation of the health sector and economic development as the strongest factors associated with increases in government health spending globally. Future government health spending scenarios suggest that, with greater prioritisation of the health sector and increased government spending, health spending per capita could more than double, with greater impacts in countries that currently have the lowest levels of government health spending. INTERPRETATION: Financing for global health has increased steadily over the past two decades and is projected to continue increasing in the future, although at a slower pace of growth and with persistent disparities in per-capita health spending between countries. Out-of-pocket spending is projected to remain substantial outside of high-income countries. Many low-income countries are expected to remain dependent on development assistance, although with greater government spending, larger investments in health are feasible. In the absence of sustained new investments in health, increasing efficiency in health spending is essential to meet global health targets. FUNDING: Bill & Melinda Gates Foundation. Bill & Melinda Gates Foundation Sí
Published: 2019
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43. National spending on health by source for 184 countries between 2013 and 2040

Author: Patrick Reidy, Christopher J L Murray, Joseph L Dieleman, Christoph Kurowski, Kyle J Foreman, Tara Templin, Nafis Sadat, Timothy G Evans, Annie Haakenstad, and Abigail Chapin
Subjects: Medicine(all), Financing, Government, Government, Gross Domestic Product, 030503 health policy & services, Purchasing power, General Medicine, Global Health, Gross domestic product, Purchasing, 03 medical and health sciences, 0302 clinical medicine, Currency, Development economics, Income, Liberian dollar, Global health, Per capita, Humans, 030212 general & internal medicine, Business, Health Expenditures, 0305 other medical science, Forecasting
Abstract: Summary Background A general consensus exists that as a country develops economically, health spending per capita rises and the share of that spending that is prepaid through government or private mechanisms also rises. However, the speed and magnitude of these changes vary substantially across countries, even at similar levels of development. In this study, we use past trends and relationships to estimate future health spending, disaggregated by the source of those funds, to identify the financing trajectories that are likely to occur if current policies and trajectories evolve as expected. Methods We extracted data from WHO's Health Spending Observatory and the Institute for Health Metrics and Evaluation's Financing Global Health 2015 report. We converted these data to a common purchasing power-adjusted and inflation-adjusted currency. We used a series of ensemble models and observed empirical norms to estimate future government out-of-pocket private prepaid health spending and development assistance for health. We aggregated each country's estimates to generate total health spending from 2013 to 2040 for 184 countries. We compared these estimates with each other and internationally recognised benchmarks. Findings Global spending on health is expected to increase from US$7·83 trillion in 2013 to $18·28 (uncertainty interval 14·42–22·24) trillion in 2040 (in 2010 purchasing power parity-adjusted dollars). We expect per-capita health spending to increase annually by 2·7% (1·9–3·4) in high-income countries, 3·4% (2·4–4·2) in upper-middle-income countries, 3·0% (2·3–3·6) in lower-middle-income countries, and 2·4% (1·6–3·1) in low-income countries. Given the gaps in current health spending, these rates provide no evidence of increasing parity in health spending. In 1995 and 2015, low-income countries spent $0·03 for every dollar spent in high-income countries, even after adjusting for purchasing power, and the same is projected for 2040. Most importantly, health spending in many low-income countries is expected to remain low. Estimates suggest that, by 2040, only one (3%) of 34 low-income countries and 36 (37%) of 98 middle-income countries will reach the Chatham House goal of 5% of gross domestic product consisting of government health spending. Interpretation Despite remarkable health gains, past health financing trends and relationships suggest that many low-income and lower-middle-income countries will not meet internationally set health spending targets and that spending gaps between low-income and high-income countries are unlikely to narrow unless substantive policy interventions occur. Although gains in health system efficiency can be used to make progress, current trends suggest that meaningful increases in health system resources will require concerted action. Funding Bill & Melinda Gates Foundation.
Published: 2016
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44. Tracking development assistance for HIV/AIDS

Author: Lavanya Singh, Christopher J L Murray, Matthew T. Schneider, Hannah Hamavid, Abigail Chapin, Maxwell Birger, Joseph L Dieleman, and Annie Haakenstad
Subjects: Economic growth, health financing, Tuberculosis, International Cooperation, Concise Communications, Immunology, millennium development goals, 030204 cardiovascular system & hematology, Global Health, Capital Financing, 03 medical and health sciences, 0302 clinical medicine, Acquired immunodeficiency syndrome (AIDS), Global health, Humans, Immunology and Allergy, Medicine, 030212 general & internal medicine, Epidemics, Health Services Administration, health care economics and organizations, Acquired Immunodeficiency Syndrome, geography, Summit, geography.geographical_feature_category, human immunodeficiency virus, business.industry, International community, Millennium Development Goals, medicine.disease, Infectious Diseases, ComputingMethodologies_DOCUMENTANDTEXTPROCESSING, HIV/AIDS, business, International development, development assistance for health, Malaria
Abstract: Supplemental Digital Content is available in the text, Objective: To better understand the global response to HIV/AIDS, this study tracked development assistance for HIV/AIDS at a granular, program level. Methods: We extracted data from the Institute for Health Metrics and Evaluation's Financing Global Health 2015 report that captured development assistance for HIV/AIDS from 1990 to 2015 for all major bilateral and multilateral aid agencies. To build on these data, we extracted additional budget data, and disaggregated development assistance for HIV/AIDS into nine program areas, including prevention, treatment, and health system support. Results: Since 2000, $109.8 billion of development assistance has been provided for HIV/AIDS. Between 2000 and 2010, development assistance for HIV/AIDS increased at an annualized rate of 22.8%. Since 2010, the annualized rate of growth has dropped to 1.3%. Had development assistance for HIV/AIDS continued to climb after 2010 as it had in the previous decade, $44.8 billion more in development assistance would have been available for HIV/AIDS. Since 1990, treatment and prevention were the most funded HIV/AIDS program areas receiving $24.6 billion and $22.7 billion, respectively. Since 2010, these two program areas and HIV/AIDS health system strengthening have continued to grow, marginally, with majority support from the US government and the Global Fund. An average of $252.9 of HIV/AIDS development assistance per HIV/AIDS prevalent case was disbursed between 2011 and 2013. Conclusion: The scale-up of development assistance for HIV/AIDS from 2000 to 2010 was unprecedented. During this period, international donors prioritized HIV/AIDS treatment, prevention, and health system support. Since 2010, funding for HIV/AIDS has plateaued.
Published: 2016
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45. Evaluating facility-based antiretroviral therapy programme effectiveness: a pilot study comparing viral load suppression and retention rates

Author: Nancy Fullman, Gloria Ikilezi, Anne Gasasira, Jane Achan, Aubrey J. Levine, Emmanuela Gakidou, D. Allen Roberts, Herbert C. Duber, and Annie Haakenstad
Subjects: Adult, Male, 0301 basic medicine, Pediatrics, medicine.medical_specialty, Patient Dropouts, Anti-HIV Agents, Human immunodeficiency virus (HIV), HIV Infections, Pilot Projects, medicine.disease_cause, 03 medical and health sciences, 0302 clinical medicine, Acquired immunodeficiency syndrome (AIDS), Chart review, medicine, Humans, Uganda, 030212 general & internal medicine, Retrospective Studies, Adult patients, business.industry, Public Health, Environmental and Occupational Health, Retrospective cohort study, Health Services, Middle Aged, Viral Load, Patient mix, medicine.disease, 030112 virology, Antiretroviral therapy, Logistic Models, Infectious Diseases, Emergency medicine, Female, Parasitology, Health Facilities, business, Delivery of Health Care, Viral load, Program Evaluation
Abstract: Objectives Increased demand for antiretroviral therapy (ART) services combined with plateaued levels of development assistance for HIV/AIDS requires that national ART programmes monitor programme effectiveness. In this pilot study, we compared commonly utilised performance metrics of 12- and 24-month retention with rates of viral load (VL) suppression at 15 health facilities in Uganda. Methods Retrospective chart review from which 12- and 24-month retention rates were estimated, and parallel HIV RNA VL testing on consecutive adult patients who presented to clinics and had been on ART for a minimum of six months. Rates of VL suppression were then calculated at each facility and compared to retention rates to assess the correlation between performance metrics. Multilevel logistic regression models predicting VL suppression and 12- and 24-month retention were constructed to estimate facility effects. Results We collected VL samples from 2961 patients and found that 88% had a VL ≤1000 copies/ml. Facility rates of VL suppression varied between 77% and 96%. When controlling for patient mix, a significant variation in facility performance persisted. Retention rates at 12 and 24 months were 91% and 79%, respectively, with a comparable facility-level variation. However, neither 12-month (ρ = 0.16) nor 24-month (ρ = -0.19) retention rates were correlated with facility rates of VL suppression. Conclusions Retaining patients in care and suppressing VL are both critical outcomes. Given the lack of correlation noted in this study, the utilisation of VL monitoring may be necessary to truly assess the effectiveness of health facilities delivering ART services.
Published: 2016
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46. Non-technical health care quality and health system responsiveness in middle-income countries: a cross-sectional study in China, Ghana, India, Mexico, Russia, and South Africa

Author: Rifat Atun, Pascal Geldsetzer, Erin James, and Annie Haakenstad
Subjects: Male, China, Cross-sectional study, Population, MEDLINE, India, Ghana, Likert scale, Russia, 03 medical and health sciences, South Africa, 0302 clinical medicine, Environmental health, Humans, 030212 general & internal medicine, education, Mexico, Aged, Quality of Health Care, education.field_of_study, 030503 health policy & services, Health Policy, Public Health, Environmental and Occupational Health, Articles, Middle Aged, Confidence interval, Geography, Cross-Sectional Studies, Vignette, Health Care Surveys, Female, 0305 other medical science, Delivery of Health Care, Health care quality
Abstract: Background While there is increasing recognition that the non-technical aspects of health care quality - particularly the inter-personal dimensions of care - are important components of health system performance, evidence from population-based studies on these outcomes in low- and middle-income countries is sparse. This study assesses these non-technical aspects of care using two measures: health system responsiveness (HSR), which quantifies the degree to which the health system meets the expectations of the population, and non-technical health care quality (QoC), for which we 'filtered out' these expectations. Pooling data from six large middle-income countries, this study therefore aimed to determine how HSR and QoC vary between countries and by individuals' sociodemographic characteristics within countries. Methods We pooled individual-level data, collected between 2007 and 2010, from nationally representative household surveys of (primarily) adults aged 50 years and older in China, Ghana, India, Mexico, Russia, and South Africa. The outcome measure was a binary indicator for a 'bad' rating (HSR: "very bad" or "bad" on a five-point Likert scale; QoC: a worse rating of one's own visit than that of the character in an anchoring vignette) on at least one of seven dimensions for the most recent primary care visit. Results 23 749 adults who reported to have sought primary care during the preceding 12 months were includedin the analysis. The proportion of participants who gave a bad rating for their last primary care visit on at least one of seven dimensions varied from 4.3% (95% confidence interval (CI) = 2.8-6.7) in China to 33.1% (95% CI = 23.6-44.2) in South Africa for HSR, and from 17.0% (95% CI = 11.4-24.5) in Russia to 50.8% (95% CI = 46.0-55.6) in Ghana for QoC. There was a strong negative association between increasing household wealth and both bad HSR and QoC in India and South Africa. Conclusions Achieving universal health coverage (UHC) with good-quality health services ("effective UHC") will require efforts to improve HSR and QoC across the population in Ghana and South Africa. Additionally, a particular focus on raising HSR and QoC for the poorest population groups is needed in India and South Africa.
Published: 2018

47. Understanding the roles of faith-based health-care providers in Africa: review of the evidence with a focus on magnitude, reach, cost, and satisfaction

Author: Harrison Hines, Edward J Mills, Jill Olivier, Harold Coulombe, Annie Haakenstad, Frank Dimmock, Joseph L Dieleman, Mari Shojo, Clarence Tsimpo, Regina Gemignani, Quentin Wodon, and Minh Cong Nguyen
Subjects: Sustainable development, medicine.medical_specialty, business.industry, media_common.quotation_subject, Public health, Religion and Medicine, Health Care Costs, General Medicine, Public relations, Millennium Development Goals, humanities, Faith, Patient satisfaction, Patient Satisfaction, General partnership, Health care, Humans, Medicine, Cooperative Behavior, business, Empirical evidence, Delivery of Health Care, Africa South of the Sahara, health care economics and organizations, media_common
Abstract: Summary At a time when many countries might not achieve the health targets of the Millennium Development Goals and the post-2015 agenda for sustainable development is being negotiated, the contribution of faith-based health-care providers is potentially crucial. For better partnership to be achieved and for health systems to be strengthened by the alignment of faith-based health-providers with national systems and priorities, improved information is needed at all levels. Comparisons of basic factors (such as magnitude, reach to poor people, cost to patients, modes of financing, and satisfaction of patients with the services received) within faith-based health-providers and national systems show some differences. As the first report in the Series on faith-based health care, we review a broad body of published work and introduce some empirical evidence on the role of faith-based health-care providers, with a focus on Christian faith-based health providers in sub-Saharan Africa (on which the most detailed documentation has been gathered). The restricted and diverse evidence reported supports the idea that faith-based health providers continue to play a part in health provision, especially in fragile health systems, and the subsequent reports in this Series review controversies in faith-based health care and recommendations for how public and faith sectors might collaborate more effectively.
Published: 2015
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48. Countdown to 2030: tracking progress towards universal coverage for reproductive, maternal, newborn, and child health

Author: Purnima Menon, Mariam Claeson, Hannah H. Leslie, Kent Buse, Margaret E Kruk, Troy Jacobs, Blerta Maliqi, Inácio Crochemore Mohnsam da Silva, Neha S. Singh, Anita Raj, Catherine Kyobutungi, Agbessi Amouzou, Aluísio J D Barros, Peter Waiswa, Allisyn C. Moran, Alexander Manu, Theresa Diaz, Susan M Sawyer, Lara M. E. Vaz, Ana Langer, Hannah Tappis, Fernando C. Wehrmeister, William Weiss, Jocelyn DeJong, Kate Somers, Honorati Masanja, Asha George, Danzhen You, Doris Chou, Stuart Gillespie, Youssouf Keita, Paul Spiegel, Taona Kuo, Ellen Piwoz, Shehla Zaidi, Ahmad Reza Hosseinpoor, Austen Davis, Safia S Jiwani, Carmen Barroso, Mengjia Liang, Stefan Peterson, Mickey Chopra, Zulfiqar A Bhutta, Kelechi Ohiri, Oscar J. Mujica, Ties Boerma, George C Patton, Rajat Khosla, Irene Akua Agyepong, Liliana Carvajal Aguirre, John Grove, Joy E Lawn, Shams El Arifeen, Kumanan Rasanathan, Fernanda Ewerling, Jennifer Harris Requejo, Robert E. Black, Tanya Marchant, Luis Huicho, Cesar G. Victora, Carine Ronsmans, Rajani Ved, Josephine Borghi, Sennen Hounton, Tanya Guenther, David S Sanders, Mariam L Sabin, Bernadette Daelmans, Ghada Saad-Haddad, Lois Park, Yue Chu, Annie Haakenstad, Luis Paulo Vidaletti, Monica Fox, Devaki Nambiar, and Marleen Temmerman
Subjects: Conservation of Natural Resources, Maternal Health, 030231 tropical medicine, Population, Psychological intervention, Nutritional Status, Global Health, 03 medical and health sciences, 0302 clinical medicine, Universal Health Insurance, Environmental health, Political science, Global health, Countdown, Humans, Infant Health, 030212 general & internal medicine, Mortality, education, Reproductive health, education.field_of_study, Health Equity, business.industry, Child Health, General Medicine, Health equity, Child mortality, Reproductive Health, business, Adolescent health
Abstract: Summary Building upon the successes of Countdown to 2015, Countdown to 2030 aims to support the monitoring and measurement of women's, children's, and adolescents' health in the 81 countries that account for 95% of maternal and 90% of all child deaths worldwide. To achieve the Sustainable Development Goals by 2030, the rate of decline in prevalence of maternal and child mortality, stillbirths, and stunting among children younger than 5 years of age needs to accelerate considerably compared with progress since 2000. Such accelerations are only possible with a rapid scale-up of effective interventions to all population groups within countries (particularly in countries with the highest mortality and in those affected by conflict), supported by improvements in underlying socioeconomic conditions, including women's empowerment. Three main conclusions emerge from our analysis of intervention coverage, equity, and drivers of reproductive, maternal, newborn, and child health (RMNCH) in the 81 Countdown countries. First, even though strong progress was made in the coverage of many essential RMNCH interventions during the past decade, many countries are still a long way from universal coverage for most essential interventions. Furthermore, a growing body of evidence suggests that available services in many countries are of poor quality, limiting the potential effect on RMNCH outcomes. Second, within-country inequalities in intervention coverage are reducing in most countries (and are now almost non-existent in a few countries), but the pace is too slow. Third, health-sector (eg, weak country health systems) and non-health-sector drivers (eg, conflict settings) are major impediments to delivering high-quality services to all populations. Although more data for RMNCH interventions are available now, major data gaps still preclude the use of evidence to drive decision making and accountability. Countdown to 2030 is investing in improvements in measurement in several areas, such as quality of care and effective coverage, nutrition programmes, adolescent health, early childhood development, and evidence for conflict settings, and is prioritising its regional networks to enhance local analytic capacity and evidence for RMNCH.
Published: 2017

49. Cobertura y oportunidad de la atención prenatal en mujeres pobres de 6 países de Mesoamérica

Author: Emily Dansereau, Alexandra Schaefer, Marielle C. Gagnier, Ali H. Mokdad, Claire R. McNellan, Paola Zúñiga Brenes, Bernardo Hernández Prado, Sima S. Desai, Casey K. Johanns, Erin B. Palmisano, Annie Haakenstad, Emma Iriarte, and Diego Ríos-Zertuche
Abstract: El presente estudio hace una revision de los factores asociados a la cantidad y oportunidad de las consultas de atencion prenatal (AP) para mujeres pobres de Guatemala, Honduras, Mexico, Nicaragua, Panama y El Salvador. Entrevistamos a 8,366 mujeres respecto a la AP que recibieron considerando su parto mas reciente en los ultimos dos anos. Llevamos a cabo regresiones logisticas para a analizar caracteristicas demograficas, de hogares y de salud asociadas a la asistencia a por lo menos una consulta de AP por personal calificado, cuatro consultas con personal calificado y una consulta con personal calificado durante el primer trimestre del embarazo. Encontramos que, en los paises del estudio, un 78% de las mujeres asistio a por lo menos una consulta de AP por personal calificado, mientras que un 62% concurrio por lo menos a cuatro consultas por personal calificado y un 56% asistio a una consulta con profesionales de salud durante el primer trimestre del embarazo. El pais que registro la mayor proporcion de mujeres que asistieron a consultas de AP por personal calificado fue Nicaragua (81%), mientras que Guatemala y Panama tuvieron la proporcion mas baja (18% y 38% respectivamente). En multiples paises, las mujeres solteras, con menor nivel educativo, adolescentes, indigenas, que no deseaban concebir y carecian de exposicion a los medios masivos de comunicacion presentaron menos probabilidades de cumplir con las directrices internacionales sobre AP. A pesar de las vastas reformas a las politicas y de numerosas iniciativas orientadas a los pobres, muchas mujeres de las areas mas pobres de Mesoamerica siguen sin recibir la atencion prenatal adecuada.
Published: 2017
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50. The effect of facility-based antiretroviral therapy programs on outpatient services in Kenya and Uganda

Author: Nancy Fullman, D. Allen Roberts, Emily Dansereau, Kelsey Bannon, Herbert C. Duber, Emelda A. Okiro, Thomas A. Odeny, Emmanuela Gakidou, Alexandra Wollum, Ruben Conner, Gloria Ikilezi, Pamela Njuguna, Caroline Kisia, Brendan DeCenso, Michael Hanlon, Aubrey J. Levine, Jane Achan, Anne Gasasira, Samuel H. Masters, Annie Haakenstad, and Roy Burstein
Subjects: medicine.medical_specialty, Pediatrics, HIV Infections, Health informatics, Health administration, 03 medical and health sciences, 0302 clinical medicine, Health systems, Ambulatory care, Acquired immunodeficiency syndrome (AIDS), Environmental health, parasitic diseases, Ambulatory Care, Humans, Outpatient clinic, Medicine, Uganda, 030212 general & internal medicine, Service (business), business.industry, 030503 health policy & services, Health Policy, Nursing research, Public health, lcsh:Public aspects of medicine, lcsh:RA1-1270, medicine.disease, Kenya, Antiretroviral therapy, Anti-Retroviral Agents, Regression Analysis, HIV/AIDS, 0305 other medical science, business, Research Article
Abstract: Background Considerable debate exists concerning the effects of antiretroviral therapy (ART) service scale-up on non-HIV services and overall health system performance in sub-Saharan Africa. In this study, we examined whether ART services affected trends in non-ART outpatient department (OPD) visits in Kenya and Uganda. Methods Using a nationally representative sample of health facilities in Kenya and Uganda, we estimated the effect of ART programs on OPD visits from 2007 to 2012. We modeled the annual percent change in non-ART OPD visits using hierarchical mixed-effects linear regressions, controlling for a range of facility characteristics. We used four different constructs of ART services to capture the different ways in which the presence, growth, overall, and relative size of ART programs may affect non-ART OPD services. Results Our final sample included 321 health facilities (140 in Kenya and 181 in Uganda). On average, OPD and ART visits increased steadily in Kenya and Uganda between 2007 and 2012. For facilities where ART services were not offered, the average annual increase in OPD visits was 4·2% in Kenya and 13·5% in Uganda. Among facilities that provided ART services, we found average annual OPD volume increases of 7·2% in Kenya and 5·6% in Uganda, with simultaneous annual increases of 13·7% and 12·5% in ART volumes. We did not find a statistically significant relationship between annual changes in OPD services and the presence, growth, overall, or relative size of ART services. However, in a subgroup analysis, we found that Ugandan hospitals that offered ART services had statistically significantly less growth in OPD visits than Ugandan hospitals that did not provide ART services. Conclusions Our findings suggest that ART services in Kenya and Uganda did not have a statistically significant deleterious effects on OPD services between 2007 and 2012, although subgroup analyses indicate variation by facility type. Our findings are encouraging, particularly given recent recommendations for universal access to ART, demonstrating that expanding ART services is not inherently linked to declines in other health services in sub-Saharan Africa.
Published: 2017

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