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Objective To assess the availability of information on indicators of the World Health Organization and United Nations Children's Fund primary health-care measurement framework in Bangladesh, India, Nepal, Pakistan and Sri Lanka and to outline the opportunities for and challenges to using the framework in these countries. Methods We reviewed global and national data repositories for quantitative indicators of the framework and conducted a desk review of country documents for qualitative indicators in February-April 2023. We assessed data sources and cross-sectional survey tools to suggest possible sources of information on framework indicators that were not currently reported in the countries. We also identified specific indicators outside the framework on which information is collected in the countries and which could be used to measure primary healthcare performance. Findings Data on 54% (32/59) of the quantitative indicators were partially or completely available for the countries, ranging from 41% (24/59) in Pakistan to 64% (38/59) in Nepal. Information on 41% (66/163) of the qualitative subindicators could be acquired through desk reviews of country-specific documents. Information on input indicators was more readily available than on process and output indicators. The feasibility of acquiring information on the unreported indicators was moderate to high through adaptation of data collection instruments. Conclusion The primary health-care measurement framework provides a platform to readily assess and track the performance of primary health care. Countries should improve the completeness, quality and use of existing data for strengthening of primary health care. [phrase omitted] [phrase omitted] Objectif Etudier la disponibilite des informations concernant les indicateurs du cadre devaluation des soins de sante primaires de l'Organisation mondiale de la Sante et du Fonds des Nations Unies pour l'enfance au Bangladesh, en Inde, au Nepal, au Pakistan et au Sri Lanka, mais aussi presenter les opportunites et enjeux de l'application d'un tel cadre dans ces pays. Methodes Nous avons explore les referentiels de donnees nationaux et internationaux a la recherche d'indicateurs lies au cadre, puis nous avons effectue un examen preliminaire des documents de chaque pays pour y trouver des indicateurs qualitatifs entre fevrier et avril 2023. Nous avons evalue la provenance des donnees et les outils d'enquete transversale en vue de suggerer des sources potentielles d'informations sur certains indicateurs relatifs au cadre qui n'apparaissaient pas encore dans les pays susmentionnes. Nous avons par ailleurs identifie des indicateurs specifiques en dehors du cadre, sur lesquels les pays collectent des informations et qui pourraient servir a mesurer les performances des soins de sante primaires. Resultats Des donnees sur 54% (32/59) des indicateurs quantitatifs etaient partiellement ou entierement disponibles dans les differents pays, allant de 41% (24/59) au Pakistan a 64% (38/59) au Nepal. Des examens preliminaires de documents propres a chaque pays ont permis de recueillir des informations sur 41% (66/163) des sous-indicateurs qualitatifs. Il etait plus facile d'obtenir des precisions sur les indicateurs de moyens que sur les indicateurs de processus et de resultats. Enfin, le degre de faisabilite de l'acquisition d'informations sur les indicateurs non mentionnes etait modere a eleve, a condition d'adapter les instruments de collecte de donnees. Conclusion Le cadre d'evaluation des soins de sante primaires offre une plateforme permettant d'evaluer et de suivre aisement les performances en la matiere. Les pays devraient ameliorer l'exhaustivite, la qualite et l'utilisation des donnees existantes pour renforcer les soins de sante primaires. [phrase omitted] Objetivo Evaluar la disponibilidad de informacion sobre los indicadores del marco de medicion de la atencion primaria de salud de la Organizacion Mundial de la Salud y el Fondo de las Naciones Unidas para la Infancia en Bangladesh, India, Nepal, Pakistan y Sri Lanka, y exponer las oportunidades y los desafios que plantea la aplicacion del marco en estos paises. Metodos Se revisaron los repositorios de datos mundiales y nacionales para los indicadores cuantitativos del marco y se realizo una revision preliminar de los documentos de los paises para los indicadores cualitativos entre febrero y abril de 2023. Se evaluaron las fuentes de datos y las herramientas de encuestas transversales para sugerir posibles fuentes de informacion sobre los indicadores del marco que actualmente no se comunican en los paises. Tambien se identificaron indicadores especificos ajenos al marco sobre los que se recopila informacion en los paises y que se podrian aplicar para medir los resultados de la atencion primaria. Resultados Los datos sobre el 54% (32/59) de los indicadores cuantitativos estaban parcial o totalmente disponibles para los paises, oscilando entre el 41% (24/59) de Pakistan y el 64% (38/59) de Nepal. La informacion sobre el 41% (66/163) de los subindicadores cualitativos se pudo obtener mediante revisiones preliminares de documentos especificos de cada pais. La informacion sobre los indicadores de insumos fue mas facil de obtener que sobre los indicadores de procesos y productos. La viabilidad de adquirir informacion sobre los indicadores no declarados fue de moderada a alta mediante la adaptacion de los instrumentos de recopilacion de datos. Conclusion El marco de medicion de la atencion primaria proporciona una plataforma para evaluar y seguir facilmente el rendimiento de la atencion primaria. Los paises deben mejorar la exhaustividad, la calidad y el uso de los datos existentes para reforzar la atencion primaria., Introduction Health is central to the 2030 agenda of the United Nations (UN) sustainable development goals (SDG), and primary health care is a strategy to achieve most of the SDG [...]

Background: Supervised toothbrushing (STB) significantly reduces the incidence and progression of dental caries. School years present a favorable age for introducing such healthy habits for a lifetime. Aim: To estimate the cost‐effectiveness of implementing a STB program in India in preventing dental caries incidence. Design: An operational framework of a national STB program was devised. A mathematical model was then developed to evaluate this program's clinical effectiveness and economic impact in the Indian scenario. This study considered a hypothetical cohort of the Indian population aged from 6 to 75 years. Two groups were compared: no intervention and STB in government schools. The health outcomes assessed were a number of tooth caries incidences averted and quality‐adjusted life years gained. Results: The STB program in the government schools of India would prevent at least one tooth from developing caries in an individual's lifetime. Considering the current treatment‐seeking behavior, the STB program saves INR 153 (US$ 1.95) per carious tooth incidence averted and INR 22 202 (US$ 283) per QALY gained. Conclusion: In India, the school‐based STB program is expected to be a cost‐effective strategy for reducing the dental caries burden and its associated treatment costs. [ABSTRACT FROM AUTHOR]

Setting reimbursement rates in national insurance schemes requires robust cost data. Collecting provider-generated cost accounting information is a potential mechanism for improving the cost evidence. To inform strategies for obtaining cost data to set reimbursement rates, this analysis aims to describe the role of cost accounting in public and private health sectors in India and describe the importance, perceived barriers and facilitators to improving cost accounting systems. In-depth interviews were conducted with 11 key informants. The interview tool guide was informed by a review of published and grey literature and government websites. The interviews were recorded as both audio and video and transcribed. A thematic coding framework was developed for the analysis. Multiple discussions were held to add, delete, classify or merge the themes. The themes identified were as follows: the status of cost accounting in the Indian hospital sector, legal and regulatory requirements for cost reporting, challenges to implementing cost accounting and recommendations for improving cost reporting by health care providers. The findings indicate that the sector lacks maturity in cost accounting due to a lack of understanding of its benefits, limited capacity and weak enforcement of cost reporting regulations. Providers recognize the value of cost analysis for investment decisions but have mixed opinions on the willingness to gather and report cost information, citing resource constraints and a lack of trust in payers. Additionally, heterogeneity among providers will require tailored approaches in developing cost accounting reporting frameworks and regulations. Health care cost accounting systems in India are rudimentary with a few exceptions, raising questions about how to source these data sustainably. Strengthening cost accounting systems in India will require standardized data formats, integrated into existing data management systems, that both meet the needs of policy makers and are acceptable to hospital providers. [ABSTRACT FROM AUTHOR]

Background: Ventilator‑associated pneumonia (VAP) is the commonest healthcare‑associated infection (HAI) in intensive care units (ICU), especially in trauma patients. VAP imposes a significant cost burden on the healthcare ecosystem. However, there are few data from the developing world. Methodology: We conducted this study in the trauma ICU (TICU) of PGIMER, Chandigarh, from October 2021 to December 2022. The incidence, incidence density, and average length of stay (ALOS) of both VAP and non‑VAP patients were established. The health system cost was assessed using a mixed (top‑down and bottom‑up) micro‑costing approach. We collected data for all the resources (direct and indirect costs) utilized during service delivery and estimated the health system cost per bed per day. Results: In this study, 494 patients were admitted to TICU, of which 484 received Mechanical Ventilation (MV) and 47 developed VAP. We included 41 and 44 patients with and without VAP. The VAP incidence rate was 9.7% and the VAP incidence density was 10.79/1000 MV days. The ALOS for VAP patients was 21 days, and for non‑ VAP patients was 8.2 days. Our study estimated a total health system cost of INR 25,927 per bed per day. The health system cost of treating a VAP patient was INR 544,467 compared to INR 207,416 for a non‑VAP patient. Conclusion: Treatment of VAP poses substantial costs for the health system and patients. There is a need to focus on preventing VAP, which would eventually reduce the length of stay and the resultant financial impact on the health system and the patient. [ABSTRACT FROM AUTHOR]