46 results on '"Sieleunou I"'
Search Results
2. Acné au Cameroun : qualité de vie et comorbidités psychiatriques
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Kouotou, E.A., Adegbidi, H., Bene Belembe, R., Sieleunou, I., Nansseu, J.R., Kamga, J.-P., and Ndjitoyap Ndam, E.C.
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- 2016
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3. Le financement basé sur la performance et les ruptures de stocks de médicaments essentiels au Cameroun
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Sieleunou, I., De Allegri, M., Enok Bonong, P.R., Ouédraogo, S., Ridde, Valéry, Centre population et développement (CEPED - UMR_D 196), Institut de Recherche pour le Développement (IRD)-Université de Paris (UP), Ridde, Valéry (ed.), and Mbow Sane, N. B. (préf.)
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CAMEROUN ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,[SDV.SP]Life Sciences [q-bio]/Pharmaceutical sciences ,[SHS.ECO]Humanities and Social Sciences/Economics and Finance - Abstract
En 2011, le gouvernement du Cameroun a lancé son programme de financement basé sur la performance (FBP). Notre étude a examiné les effets de l'intervention du FBP sur la disponibilité des médicaments essentiels à l'aide des données d'un essai contrôlé randomisé (ECR) réalisé avec 205 formations sanitaires de trois régions (Est, Nord-Ouest, Sud-Ouest). La disponibilité de plusieurs groupes de médicaments essentiels a été définie en évaluant les ruptures de stock au cours des 30 jours précédant la collecte des données de l'ECR. Nos estimations suggèrent que l'intervention du FBP n'a eu aucun effet sur les ruptures de stocks de médicaments pour les soins prénataux, de vaccins, de médicaments pour la prise en charge intégrée des maladies de l'enfance et de médicaments pour le travail et l'accouchement. Toutefois, l'intervention a été associée à une réduction significative de 34% des ruptures de stock de médicaments de planification familiale. Ces résultats mitigés étaient probablement la conséquence d'un échec partiel de la mise en oeuvre, allant de la perturbation et de l'interruption des services à une autonomie limitée des formations sanitaires dans la prise des décisions et à un retard considérable dans le paiement des prestations.
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- 2021
4. Implementation of blanket provider-initiated testing and counselling: Predictors of HIV seropositivity among infants, children and adolescents in Cameroon
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Yumo, H.A., primary, Nsame, D.N., additional, Kuwoh, P.B., additional, Njabon, M.B., additional, Sieleunou, I., additional, Ndenkeh, J.J.N., additional, Tene, G., additional, Memiah, P., additional, Kuaban, C., additional, and Beissner, M., additional
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- 2020
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5. An urgent need for a paradigm shift in HIV testing for older children: A sine qua non condition to achieve an AIDS-free generation
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Yumo, H.A., primary, Ndenkeh, J.J.N., additional, Sieleunou, I., additional, Nsame, D.N., additional, Kuwoh, P.B., additional, Beissner, M., additional, and Kuaban, C., additional
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- 2020
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6. How does performance-based financing affect the availability of essential medicines in Cameroon ? A qualitative study
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Sieleunou, I., Turcotte-Tremblay, A. M., De Allegri, M., Fotso, J. C. T., Yumo, H. A., Tamga, D. M., and Ridde, Valéry
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Performance-based financing ,essential medicines ,Cameroon ,essential drugs - Abstract
Performance-based financing (PBF) is being implemented across low- and middle-income countries to improve the availability and quality of health services, including medicines. Although a few studies have examined the effects of PBF on the availability of essential medicines (EMs) in low- and middle-income countries, there is limited knowledge of the mechanisms underlying these effects. Our research aimed to explore how PBF in Cameroon influenced the availability of EMs, and to understand the pathways leading to the experiential dimension related with the observed changes. The design was an exploratory qualitative study. Data were collected through in-depth interviews, using semi-structured questionnaires. Key informants were selected using purposive sampling. The respondents (n=55) included health services managers, healthcare providers, health authorities, regional drugs store managers and community members. All interviews were recorded, transcribed and analysed using qualitative data analysis software. Thematic analysis was performed. Our findings suggest that the PBF programme improved the perceived availability of EMs in three regions in Cameroon. The change in availability of EMs experienced by stakeholders resulted from several pathways, including the greater autonomy of facilities, the enforced regulation from the district medical team, the greater accountability of the pharmacy attendant and supply system liberalization. However, a sequence of challenges, including delays in PBF payments, limited autonomy, lack of leadership and contextual factors such as remoteness or difficulty in access, was perceived to hinder the capacity to yield optimal changes, resulting in heterogeneity in performance between health facilities. The participants raised concerns regarding the quality control of drugs, the inequalities between facilities and the fragmentation of the drug management system. The study highlights that some specific dimensions of PBF, such as pharmacy autonomy and the liberalization of drugs supply systems, need to be supported by equity interventions, reinforced regulation and measures to ensure the quality of drugs at all levels.
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- 2019
7. Performance-based financing in Africa : time to test measures for equity
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Ridde, Valéry, Gautier, L., Turcotte-Tremblay, A. M., Sieleunou, I., and Paul, E.
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equity ,health reforms ,Africa ,strategic purchasing ,performance-based financing ,universal health coverage - Abstract
Over the past 15 years, hundreds of millions of dollars have been invested in reforms founded on performance-based financing (PBF) in low- and middle-income countries. While evidence on its effectiveness and efficiency is still controversial, there appears to be an emerging consensus that equity has not been adequately considered. In this article, we show how PBF-type interventions in Africa have not sufficiently taken into account equity of access to care for the worst-off and their financial protection. In reviewing the history of health reforms in Africa, we show that this omission is nothing new. We suggest that strategic purchasing and PBF-type actions would benefit from being implemented in ways that promote equity and the financial protection of populations in Africa. Without such a reorientation of reforms, it will be impossible to achieve universal health coverage by 2030.
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- 2018
8. Skin Diseases Among Sub-Saharan African Prisoners: The Cameroonian Profile
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Zoung-Kanyi Bissek Ac, Kouotou Ea, Defo Defo, Sieleunou I, Atenkeng Apasew H, Nansseu Njr, and Moyou Somo R
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medicine.medical_specialty ,education.field_of_study ,Sub-Saharan Africa ,business.industry ,media_common.quotation_subject ,Population ,Prison ,Disease ,Pityriasis ,Overcrowding ,medicine.disease ,Surgery ,Skin diseases ,Family medicine ,Scabies ,medicine ,Tinea capitis ,Inmates ,business ,education ,Acne ,media_common - Abstract
Background: Overcrowding and promiscuity observed in our prisons are a spreading source of several diseases including infections transmitted by interhuman contact. It has been argued that skin diseases are the most frequent reasons for consultations in prisons. In Cameroon, no study has been done to assess the magnitude of this issue. Our study aimed at determining the profile of dermatological pathologies among Cameroonian prison inmates. Methods: This was a cross-sectional study at the Mfou Principal Prison from February to April 2014. Were included all prisoners who consulted the research team at the prison infirmary during the period of recruitment and who accepted to take part in the study. Prisoners were consulted and a structured questionnaire was used for data collection. Diagnosis was based on the anamnestic and clinical findings. Participants with uncertain diagnosis were excluded from the study. Data were entered into Microsoft excel 2010 spreadsheets and analyzed using SPSS version 17.0. Results: A total of 217 prisoners were retained for our study out of the 369 present in the prison during the study period. Among these 217 prisoners, 201 (92.6%) were males, 189 (87.1%) were Christians, 123 (56.7%) did not attend the secondary school, and 137 (63.1%) were single. Age ranged from 14 to 60 years with a mean of 32 ± 4.7 years and, age groups 21-30 and 31-40 being the most represented ones. More than half (57.1%) of our population exhibited skin diseases with scabies being present in 41% of cases. The dominating presentations of skin diseases were: scabies (71.8%), eczema (9.7%), dermatophytosis (specifically tinea corporis: 5.6%), pityriasis versicolor (4.8%), and acne (3.2%). Six point five percent of participants presented with more than one skin disease, and eczema was the most frequent disease associated with scabies in 8 cases (6.4%). Pityriasis versicolor was the most common skin disease among females (25% of women infected). Conclusion: There is a high prevalence of skin diseases among prisoners at the Mfou Principal Prison. of which scabies (71.6%), eczema (9.7%), dermatophytosis (5.6%) and pityriasis versicolor (4.8%) were the prevailing skin diseases encountered .There is thereby an urgent need to implement strong and efficient interventions in order to solve the problems of over population, poor hygiene, precarious quality of life and lack of health care in our prisons.
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- 2017
9. Dépigmentation volontaire : pratiques et dermatoses associées chez les commerçantes de Yaoundé (Cameroun)
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Kouotou, E.A., Bissek, A.-C. Zoung-Kanyi, Nouind, C.C. Fouda, Defo, D., Sieleunou, I., and Ndam, E.C. Ndjitoyap
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- 2015
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10. Dermatite atopique : facteurs associés et apport des prick tests en milieu hospitalier camerounais
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Kouotou, E.A., primary, Tchanou Wamy, C., additional, Nansseu, J.R.N., additional, and Sieleunou, I., additional
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- 2017
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11. Retentissement des onychomycoses sur la qualité de vie des patients à Yaoundé, Cameroun
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Kouotou, E.-A., primary, Feungue, U. Nguena, additional, Sieleunou, I., additional, Defo, D., additional, Kopa, P. Yadieu, additional, and Somo, R. Moyou, additional
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- 2016
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12. Prevalence and drivers of human scabies in Cameroonian prisons
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Kouotou, E.A., primary, Nansseu, J.R.N., additional, Sieleunou, I., additional, Moguieu Bogne, L.-L., additional, Sangare, A., additional, Adegbidi, H., additional, Tameyi Tatsa, J., additional, and Moyou Somo, R., additional
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- 2016
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13. CO 43 : Retentissement du prurit sur la qualité de vie des patients hémodialysés chroniques
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Koutouo, E.A., primary, Tameyi Tatsa, J., additional, Kaze Folefack, F., additional, Nansseu, J.R., additional, Sieleunou, I., additional, Azingui Yumo, H., additional, Zoung-kanyi Bissek, A.-C., additional, and Nditoyap Ndam, E.C., additional
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- 2016
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14. What are the burden and spectrum of skin infections in Cameroonian prisons?
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Kouotou, E.A., primary, Nansseu, J.R.N., additional, Sieleunou, I., additional, Moguieu Bogne, L.-L., additional, Adegbidi, H., additional, Tameyi Tatsa, J., additional, Sangare, A., additional, and Moyou Somo, R., additional
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- 2016
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15. letter to the Editors - Health worker migration and universal health care in Sub-Saharan Africa
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Sieleunou, I
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Health workers, workforce, brain drain, Africa - Abstract
There is a more and more emerging consensus claiming universal access to health care in order to achieve the desired Millennium Development Goals related to health in Africa. Unfortunately, the debate of the universal coverage has focussed so far mainly on financial affordability, while it is also a human resource matter. Many countries in sub-Saharan Africa are experiencing severe shortages of skilled health care workers. There are several causes, the importance of which varies by country, but one of the most significant factors is brain drain. In those countries, scarcity of doctors increases the distance between a doctor and patients, and bridging that increased distance implies costs, both time and money. Adequate number of qualified health personnel is then vital to increase coverage and improve the quality of care. In as much as access to health services is also determined by access to qualified health workers, any reflection on the universal health coverage has to also consider the inequities in qualified health personnel distribution throughout the world.
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- 2011
16. Expérience pilote de financement bas‚ sur la performance dans le Diocèse de Batouri au Cameroun: leçons pour l'extension du modèle
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Keugoung, B., Tsafack, J. P., Fouelifack, F. Y., Sieleunou, I., Noubosse, I. A., and Boulenger, D.
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Coverage ,Performance ,Obstetrical care ,Health care financing ,Efficiency ,Health systems ,Pregnancy ,Women ,Africa, Central ,Cameroon ,Sanitation ,Resource allocation ,Evaluation ,Children ,Interventions ,Health financing ,Latrines ,Governance ,Impregnated bednets ,Child care ,Curative care ,Health interventions ,NGOs ,Utilization ,Leadership ,Birth ,Human resource management ,Prenatal care - Published
- 2011
17. Appel pour une allocation intelligente dans le financement du système de santé au Cameroun
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Sieleunou, I, primary
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- 2011
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18. Does health voucher intervention increase antenatal consultations and skilled birth attendances in Cameroon? Results from an interrupted time series analysis.
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Sieleunou I and Enok Bonong RP
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- Humans, Cameroon, Female, Pregnancy, Health Services Accessibility statistics & numerical data, Delivery, Obstetric statistics & numerical data, Midwifery statistics & numerical data, Adult, Maternal Health Services statistics & numerical data, Adolescent, Interrupted Time Series Analysis, Prenatal Care statistics & numerical data
- Abstract
Background: Limited access to health services during the antenatal period and during childbirth, due to financial barriers, is an obstacle to reducing maternal and child mortality. To improve the use of health services in the three regions of Cameroon, which have the worst reproductive, maternal, neonatal, child and adolescent health indicators, a health voucher project aiming to reduce financial barriers has been progressively implemented since 2015 in these three regions. Our research aimed to assess the impact of the voucher scheme on first antenatal consultation (ANC) and skilled birth attendance (SBA)., Methods: Routine aggregated data by month over the period January 2013 to May 2018 for each of the 33 and 37 health facilities included in the study sample were used to measure the effect of the voucher project on the first ANC and SBA, respectively. We estimated changes attributable to the intervention in terms of the levels of outcome indicators immediately after the start of the project and over time using an interrupted time series regression. A meta-analysis was used to obtain the overall estimates., Results: Overall, the voucher project contributed to an immediate and statistically significant increase, one month after the start of the project, in the monthly number of ANCs (by 26%) and the monthly number of SBAs (by 57%). Compared to the period before the start of the project, a statistically significant monthly increase was observed during the project implementation for SBAs but not for the first ANCs. The results at the level of health facilities (HFs) were mixed. Some HFs experienced an improvement, while others were faced with the status quo or a decrease., Conclusions: Unlike SBAs, the voucher project in Cameroon had mixed results in improving first ANCs. These limited effects were likely the consequence of poor design and implementation challenges., (© 2024. The Author(s).)
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- 2024
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19. Knowledge, attitude, and practices of stakeholders involved in healthcare financing programs on economic evaluations in Cameroon.
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Tchouaket E, Kruglova K, Sieleunou I, Tsafack M, Tankwa JM, Takoguen G, Argiropoulos N, Robins S, and Sia D
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There are many healthcare financing programs (HFPs) in Cameroon; however, there is a lack of information on these programs' economic effectiveness and efficiency. Involvement of local stakeholders in the economic evaluations (EEs) of HFPs is critical for ensuring contextual factors are considered prior to program implementation. We conducted a cross-sectional study to assess the need for EEs of Cameroonian HFPs. Regular staff in supervisory roles aged 18 years and above were recruited in four Cameroonian cities. Data were collected via face-to-face surveys between June 15 and August 1, 2022. Descriptive analyses summarized participants' knowledge, attitudes, and practices in relation to performing EEs of HFPs. Principal component analyses identified organizational, individual, and contextual factors that could influence participants' involvement. The total sample included 106 participants. On average, 65% of participants reported being aware of the listed HFPs; however, of these, only 28% said that they had been involved in the HFPs. Of the 106 participants, 57.5% knew about EEs; yet, almost 90% reported that the HFP in question had never been subject to an EE, and 84% had never been involved in an EE. Most participants indicated that they had intended or would like to receive EE training. Using principal component analyses, the organizational factors were classified into two components ('policy and governance' and 'planning and implementation'), the individual factors were classified into two components ('training' and 'motivation'), and the contextual factors were classified into three components ('funding,' 'political economy,' and 'public expectations'). The findings of this study highlight the need to invest in EE training to improve participation rates of Cameroonian stakeholders in the EEs of HFPs. Improved knowledge, diversified skills, and increased participation of stakeholders from all levels of the Cameroonian healthcare system are critical to the effective and efficient development, implementation, and EE of the country's HFPs., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Tchouaket et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
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- 2024
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20. Resilience of front-line facilities during COVID-19: evidence from cross-sectional rapid surveys in eight low- and middle-income countries.
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Peters MA, Ahmed T, Azais V, Amor Fernandez P, Baral P, Drouard S, Neill R, Bachir K, Bassounda P, Dube Q, Flora S, Montufar E, Nzelu C, Tassembedo M, Sanford Wesseh C, Alam B, Rusatira JD, Hashemi T, Karibwami AD, Moscosco V, Ogunlayi M, Ortiz de Zunigalo T, Ruel-Bergeron J, Sieleunou I, Hansen PM, and Shapira G
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- Humans, Cross-Sectional Studies, Developing Countries, Health Facilities, Ambulatory Care, COVID-19 epidemiology
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Responsive primary health-care facilities are the foundation of resilient health systems, yet little is known about facility-level processes that contribute to the continuity of essential services during a crisis. This paper describes the aspects of primary health-care facility resilience to coronavirus disease 2019 (COVID-19) in eight countries. Rapid-cycle phone surveys were conducted with health facility managers in Bangladesh, Burkina Faso, Chad, Guatemala, Guinea, Liberia, Malawi and Nigeria between August 2020 and December 2021. Responses were mapped to a validated health facility resilience framework and coded as binary variables for whether a facility demonstrated capacity in eight areas: removing barriers to accessing services, infection control, workforce, surge capacity, financing, critical infrastructure, risk communications, and medical supplies and equipment. These self-reported capacities were summarized nationally and validated with the ministries of health. The analysis of service volume data determined the outcome: maintenance of essential health services. Of primary health-care facilities, 1,453 were surveyed. Facilities maintained between 84% and 97% of the expected outpatient services, except for Bangladesh, where 69% of the expected outpatient consultations were conducted between March 2020 and December 2021. For Burkina Faso, Chad, Guatemala, Guinea and Nigeria, critical infrastructure was the largest constraint in resilience capabilities (47%, 14%, 51%, 9% and 29% of facilities demonstrated capacity, respectively). Medical supplies and equipment were the largest constraints for Liberia and Malawi (15% and 48% of facilities demonstrating capacity, respectively). In Bangladesh, the largest constraint was workforce and staffing, where 44% of facilities experienced moderate to severe challenges with human resources during the pandemic. The largest constraints in facility resilience during COVID-19 were related to health systems building blocks. These challenges likely existed before the pandemic, suggesting the need for strategic investments and reforms in core capacities of comprehensive primary health-care systems to improve resilience to future shocks., (© The Author(s) 2023. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
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- 2023
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21. Availability and use of personal protective equipment in low- and middle-income countries during the COVID-19 pandemic.
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Drouard SHP, Ahmed T, Amor Fernandez P, Baral P, Peters M, Hansen P, Hashemi T, Sieleunou I, Iyabode Ogunlayi M, Karibwami AD, Ruel Bergeron J, Montufar Velarde EE, Yansane ML, Wesseh CS, Mwansambo C, Nzelu C, Uddin H, Tassembedo M, and Shapira G
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- Humans, Developing Countries, SARS-CoV-2, Pandemics prevention & control, Personal Protective Equipment, Health Personnel, COVID-19 epidemiology, COVID-19 prevention & control
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Background: Availability and appropriate use of personal protective equipment (PPE) is of particular importance in Low and Middle-Income countries (LMICs) where disease outbreaks other than COVID-19 are frequent and health workers are scarce. This study assesses the availability of necessary PPE items during the COVID-19 pandemic at health facilities in seven LMICs., Methods: Data were collected using a rapid-cycle survey among 1554 health facilities in seven LMICs via phone-based surveys between August 2020 and December 2021. We gathered data on the availability of World Health Organization (WHO)-recommended PPE items and the use of items when examining patients suspected to be infected with COVID-19. We further investigated the implementation of service adaptation measures in a severe shortage of PPE., Results: There were major deficiencies in PPE availability at health facilities. Almost 3 out of 10 health facilities reported a stock-out of medical masks on the survey day. Forty-six percent of facilities did not have respirator masks, and 16% did not have any gloves. We show that only 43% of health facilities had sufficient PPE to comply with WHO guidelines. Even when all items were available, healthcare workers treating COVID-19 suspected patients were reported to wear all the recommended equipment in only 61% of health facilities. We did not find a statistically significant difference in implementing service adaptation measures between facilities experiencing a severe shortage or not., Conclusion: After more than a year into the COVID-19 pandemic, the overall availability of PPE remained low in our sample of low and middle-income countries. Although essential, the availability of PPE did not guarantee the proper use of the equipment. The lack of PPE availability and improper use of available PPE enable preventable COVID-19 transmission in health facilities, leading to greater morbidity and mortality and risking the continuity of service delivery by healthcare workers., Competing Interests: The authors declare no competing interest., (Copyright: © 2023 Drouard et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
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- 2023
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22. Vaccine hesitancy among healthcare workers in low- and middle-income countries during the COVID-19 pandemic: Results from facility surveys across six countries.
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Baral P, Ahmed T, Amor Fernandez P, Peters MA, Drouard SHP, Muhoza P, Mwinnyaa G, Mwansambo C, Nzelu C, Tassembedo M, Uddin MH, Wesseh CS, Yansane ML, Bergeron JR, Karibwami AD, Lopez Chicheri TIOZ, Ogunlayi MIA, Sieleunou I, Hashemi T, Hansen PM, and Shapira G
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- Humans, COVID-19 Vaccines therapeutic use, Developing Countries, Vaccination Hesitancy, Pandemics, Health Personnel, Surveys and Questionnaires, Vaccination, COVID-19 epidemiology, COVID-19 prevention & control
- Abstract
Background: Vaccine hesitancy remains a critical barrier in mitigating the effects of the ongoing COVID-19 pandemic. The willingness of health care workers (HCWs) to be vaccinated, and, in turn, recommend the COVID-19 vaccine for their patient population is an important strategy. This study aims to understand the uptake of COVID-19 vaccines and the reasoning for vaccine hesitancy among facility-based health care workers (HCWs) in LMICs., Methods: We conducted nationally representative phone-based rapid-cycle surveys across facilities in six LMICs to better understand COVID-19 vaccine hesitancy. We gathered data on vaccine uptake among facility managers, their perceptions of vaccine uptake and hesitancy among the HCWs operating in their facilities, and their perception of vaccine hesitancy among the patient population served by the facility., Results: 1,148 unique public health facilities participated in the study, with vaccines being almost universally offered to facility-based respondents across five out of six countries. Among facility respondents who have been offered the vaccine, more than 9 in 10 survey respondents had already been vaccinated at the time of data collection. Vaccine uptake among other HCWs at the facility was similarly high. Over 90% of facilities in Bangladesh, Liberia, Malawi, and Nigeria reported that all or most staff had already received the COVID-19 vaccine when the survey was conducted. Concerns about side effects predominantly drive vaccine hesitancy in both HCWs and the patient population., Conclusion: Our findings indicate that the opportunity to get vaccinated in participating public facilities is almost universal. We find vaccine hesitancy among facility-based HCWs, as reported by respondents, to be very low. This suggests that a potentially effective effort to increase vaccine uptake equitably would be to channel promotional activities through health facilities and HCWs.However, reasons for hesitancy, even if limited, are far from uniform across countries, highlighting the need for audience-specific messaging., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Baral et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
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- 2023
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23. Applying the Strategic Health Purchasing Progress Tracking Framework: Lessons from Nine African Countries.
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Gatome-Munyua A, Sieleunou I, Barasa E, Ssengooba F, Issa K, Musange S, Osoro O, Makawia S, Boyi-Hounsou C, Amporfu E, and Ezenwaka U
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- Africa, Delivery of Health Care, Health Expenditures, Humans, Government Programs, Healthcare Financing
- Abstract
The Strategic Purchasing Africa Resource Center (SPARC) developed a framework for tracking strategic purchasing that uses a functional and practical approach to describe, assess, and strengthen purchasing to facilitate policy dialogue within countries. This framework was applied in nine African countries to assess their progress on strategic purchasing. This paper summarizes overarching lessons from the experiences of the nine countries. In each country, researchers populated a Microsoft Excel-based matrix using data collected through document reviews and key informant interviews conducted between September 2019 and March 2021. The matrix documented governance arrangements; core purchasing functions (benefits specification, contracting arrangements, provider payment, and performance monitoring); external factors affecting purchasing; and results attributable to the implementation of these purchasing functions. SPARC and its partners synthesized information from the country assessments to draw lessons applicable to strategic purchasing in Africa. All nine countries have fragmented health financing systems, each with distinct purchasing arrangements. Countries have made some progress in specifying a benefit package that addresses the health needs of the most vulnerable groups and entering into selective contracts with mostly private providers that specify expectations and priorities. Progress on provider payment and performance monitoring has been limited. Overall, progress on strategic purchasing has been limited in most of the countries and has not led to large-scale health system improvements because of the persistence of out-of-pocket payments as the main source of health financing and the high degree of fragmentation, which limits purchasing power to allocate resources and incentivize providers to improve productivity and quality of care.
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- 2022
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24. Why Is Strategic Purchasing Critical for Universal Health Coverage in Sub-Saharan Africa?
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Gatome-Munyua A, Sieleunou I, Sory O, and Cashin C
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- Africa South of the Sahara, Government Programs, Healthcare Financing, Humans, Financial Management, Universal Health Insurance
- Abstract
To make progress toward universal health coverage (UHC), most countries need to commit more public resources to health. However, countries can also make progress by using available resources more effectively. Health purchasing , one of the health financing functions of health systems, is the transfer of pooled funds to health providers to deliver covered services. Purchasers can be either passive or strategic in how they transfer these funds. Strategic purchasing is deliberately directing health funds to priority populations, interventions, and services, and actively creating incentives so funds are used by providers equitably and aligned with population health needs. Strategic purchasing is particularly important for countries in sub-Saharan Africa because public funding for health has often not kept pace with UHC commitments. In addition, there is wide variation in progress toward UHC targets and health outcomes on the continent that does not always correlate with per capita government health spending. This paper explores the critical role strategic purchasing can play in the movement toward UHC in sub-Saharan Africa. It explores the rationale for strategic purchasing and makes the case for a more concerted effort by governments, and the partners that support them, to focus on and invest in improving strategic purchasing as part of advancing their UHC agendas. The paper also discusses the promise of strategic purchasing and the challenges of realizing this promise in sub-Saharan Africa, and it provides options for practical steps countries can take to incrementally improve strategic purchasing functions and policies over time.
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- 2022
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25. Human immunodeficiency virus case detection and antiretroviral therapy enrollment among children below and above 18 months old: A comparative analysis from Cameroon.
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Yumo HA, Ndenkeh JN Jr, Sieleunou I, Nsame DN, Kuwoh PB, Beissner M, Loscher T, and Kuaban C
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- Adolescent, Age Factors, Cameroon epidemiology, Child, Child, Preschool, Cross-Sectional Studies, Female, HIV immunology, HIV Infections epidemiology, Humans, Infant, Male, Mass Screening methods, AIDS Serodiagnosis statistics & numerical data, Anti-HIV Agents therapeutic use, HIV Infections diagnosis, HIV Infections drug therapy, Mass Screening statistics & numerical data
- Abstract
Abstract: While pediatric human immunodeficiency virus (HIV) testing has been more focused on children below 18 months through prevention of mother to child transmission of HIV (PMTCT), the yield of this approach remains unclear comparatively to testing children above 18 months through routine provider-initiated testing and counselling (PITC). This study aimed at assessing and comparing the HIV case detection and antiretroviral therapy (ART) enrolment among children below and above 18 months of age in Cameroon. This information is required to guide the investments in HIV testing among children and adolescents.We conducted a cross-sectional study where we invited parents visiting or receiving HIV care in 3 hospitals to have their children tested for HIV. HIV testing was done using polymerase chain reaction (PCR) and antibody rapid tests for children <18 months and those ≥18 months, respectively. We compared HIV case detection and ART initiation between the 2 subgroups of children and this using Chi-square test at 5% significant level.A total of 4079 children aged 6 weeks to 15 years were included in the analysis. Compared with children <18 months, children group ≥18 months was 4-fold higher among those who enrolled in the study (80.3% vs 19.7%, P < .001); 3.5-fold higher among those who tested for HIV (77.6% vs 22.4%, P < .001); 6-fold higher among those who tested HIV+ (85.7% vs 14.3%, P = .24), and 11-fold higher among those who enrolled on ART (91.7% vs 8.3%, P = .02).Our results show that 4 out of 5 children who tested HIV+ and over 90% of ART enrolled cases were children ≥18 months. Thus, while rolling out PCR HIV testing technology for neonates and infants, committing adequate and proportionate resources in antibody rapid testing for older children is a sine quo none condition to achieve an acquired immunodeficiency syndrome (AIDS)-free generation., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)
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- 2021
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26. Strategic Health Purchasing Progress Mapping in Cameroon: A Scoping Review.
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Sieleunou I, Tamga DDM, Maabo Tankwa J, Aseh Munteh P, and Longang Tchatchouang EV
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- Cameroon, Humans, Insurance, Health, National Health Programs, Healthcare Financing, Universal Health Insurance
- Abstract
Many low- and middle-income countries are adopting far-reaching health financing policies using strategic health purchasing (SHP) approaches to address their health sector challenges. However, limited efforts have been directed toward analyzing the SHP activities nationwide. Our objective was to explore the scope and development of SHP in Cameroon. We conducted a scoping review applying the framework developed by Arksey and O'Malley and modified by Levac et al. to identify and extract data from relevant SHP studies and documents published between 2000 and 2019, which focused on Cameroon. Among the existing 30 health financing schemes, 5 present the elements of SHP: (1) national health insurance (NHI), (2) performance-based financing (PBF), (3) voucher system, (4) private health insurance, and (5) mutual health organizations. The findings suggest that the governance function of purchasing is very challenging due to the multiple purchaser markets and the resulting fragmentation of the health financing system. In addition, the misalignment of the different benefit packages across schemes leads to considerable gaps and overlaps in the population coverage. The issue of multiple highly fragmented payment systems also remains a big concern across the different schemes, with tentative harmonization observed with NHI and PBF. Achieving the full potential of SHP in Cameroon will require (1) a defragmentation of the multiple schemes, (2) an effective oversight arrangement, and (3) an alignment of provider payment method to a coherent set of incentives across the system, with the ultimate aim of promoting equity, efficiency and quality.
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- 2021
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27. Does performance-based financing curb stock-outs of essential medicines? Results from a randomised controlled trial in Cameroon.
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Sieleunou I, De Allegri M, Roland Enok Bonong P, Ouédraogo S, and Ridde V
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- Cameroon, Humans, Drugs, Essential economics, Health Care Costs statistics & numerical data, Health Services Accessibility economics, Health Services Accessibility statistics & numerical data
- Abstract
Objective: In 2011, the government of Cameroon launched its performance-based financing (PBF) scheme. Our study examined the effects of the PBF intervention on the availability of essential medicines (EM)., Methods: Randomised control trial whereby PBF and three distinct comparison groups were randomised in a total of 205 health facilities across three regions. Baseline data were collected between March and May 2012 and endline data 36 months later. We defined availability of multiple EM groups by assessing stock-outs for at least one day over the 30 days prior to the survey date and estimated changes attributable to PBF using a series of difference-in-difference regression models, adjusted for relevant facility-level covariates. Data were analysed stratified by region and area to assess effect heterogeneity., Results: Our estimates suggest that PBF intervention had no effect on the stock-outs of antenatal care drugs (P = 0.160), vaccines (P = 0.396), integrated management of childhood illness drugs (P = 0.681) and labour and delivery drugs (P = 0.589). However, the intervention was associated with a significant reduction of 34% in stock-outs of family planning medicines (P = 0.028). We observed effect heterogeneity across regions and areas, with significant decreases in stock-outs of family planning products in North-West region (P = 0.065) and in rural areas (P = 0.043)., Conclusions: The PBF intervention in Cameroon had limited effects on the reduction of EMs stock-outs. These poor results were likely the consequence of partial implementation failure, ranging from disruption and discontinuation of services to limited facility autonomy in managing decision-making and considerable delay in performance payment., (© 2020 John Wiley & Sons Ltd.)
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- 2020
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28. Parental and child-level predictors of HIV testing uptake, seropositivity and treatment initiation among children and adolescents in Cameroon.
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Yumo HA, Ajeh RA, Sieleunou I, Ndenkeh JN Jr, Jordan MR, Sam-Agudu NA, Kuaban C, and Loescher T
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- AIDS Serodiagnosis statistics & numerical data, Adolescent, Adult, Anti-HIV Agents therapeutic use, Cameroon epidemiology, Child, Child, Preschool, Counseling, Female, HIV Infections drug therapy, HIV Infections epidemiology, HIV Seropositivity epidemiology, Humans, Infant, Infant, Newborn, Male, Mass Screening statistics & numerical data, Middle Aged, Parent-Child Relations, Parents, Patient Acceptance of Health Care statistics & numerical data, Young Adult, HIV Infections diagnosis
- Abstract
Background: There is a growing body of evidence positioning targeted provider-initiated testing and counselling (tPITC, also known as index case testing) as a promising HIV case-finding and linkage strategy among children and adolescents. However, the effectiveness and efficiency of this strategy is limited by low HIV testing uptake and case detection rates. Despite this fact, there is very little literature on factors associated with HIV testing uptake, HIV seropositivity and ART-enrolment in tPITC implementation among African children. This study aims to bridge this information gap and contribute in improving the effectiveness and efficiency of tPITC among children and adolescents in Cameroon and beyond., Methods: In three ART clinics where tPITC was previously inexistent, we introduced the routine implementation of this strategy by inviting parents living with HIV/AIDS in care to have their biological children (6 weeks-19 years) HIV-tested. Children of consenting parents were HIV-tested; those testing positive were enrolled on ART. Parental and child-level characteristics associated with HIV testing uptake, seropositivity and ART-enrollment were assessed using bivariate and multivariate regression analysis at 5% significance level., Results: We enrolled 1,236 parents, through whom 1,990 children/adolescents were recruited for HIV testing. Among enrolled parents, 46.2% (571/1,236) had at least one child tested, and 6.8% (39/571) of these parents had at least one HIV-positive child. Among enrolled children/adolescents, 56.7% (1,129/1,990) tested for HIV and 3.5% (40/1129) tested HIV-positive. Parental predictors of HIV testing uptake among children/adolescents were sex, occupation and duration on ART: female [aOR = 1.6 (1.1-2.5)], office workers/students [aOR = 2.0 (1.2-3.3)], and parents with ART duration > 5 years [aOR = 2.0 (1.3-2.9)] had significantly higher odds to test a child than male, farmers/traders, and parents with ART duration < 5 years respectively. The only child-level predictor of testing uptake was age: children < 18 months [aOR = 5(2-10)] had significantly higher odds to test for HIV than adolescents > 15 years. Parents of children identified as HIV-positive were more likely to be female, aged 40-60 years, farmers/traders, widows/divorcees and not on ART. Children found HIV-positive and who were ART-enrolled were more likely to be female and aged 5-9 years. However, none of the above-mentioned associations was statistically significant., Conclusions: Parents who were male, farmers/traders, and on ART for ≤ 5 years were less likely to test their children for HIV. Also, adolescents 10-19 years old were less likely to be tested. Therefore, these groups should be targeted with intensive counseling and follow-up to facilitate optimal testing uptake. No association was found between parental or child-level characteristics and HIV seropositivity among tested children. This finding prompts for further research to investigate approaches to better identify and target HIV testing to children/adolescents with the highest likelihood of HIV seropositivity., Clinical Trial Registration: Reg: CinicalTrials.gov # NCT03024762., Competing Interests: The authors have declared that no competing interests exist.
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- 2020
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29. Learning for Universal Health Coverage.
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Meessen B, Akhnif EH, Kiendrébéogo JA, Belghiti Alaoui A, Bello K, Bhattacharyya S, Faich Dini HS, Dkhimi F, Dossou JP, Gamble Kelley A, Keugoung B, Millimouno TM, Pfaffmann Zambruni J, Rouve M, Sieleunou I, and van Heteren G
- Abstract
The journey to universal health coverage (UHC) is full of challenges, which to a great extent are specific to each country. 'Learning for UHC' is a central component of countries' health system strengthening agendas. Our group has been engaged for a decade in facilitating collective learning for UHC through a range of modalities at global, regional and national levels. We present some of our experience and draw lessons for countries and international actors interested in strengthening national systemic learning capacities for UHC. The main lesson is that with appropriate collective intelligence processes, digital tools and facilitation capacities, countries and international agencies can mobilise the many actors with knowledge relevant to the design, implementation and evaluation of UHC policies. However, really building learning health systems will take more time and commitment. Each country will have to invest substantively in developing its specific learning systemic capacities, with an active programme of work addressing supportive leadership, organisational culture and knowledge management processes., Competing Interests: Competing interests: BM holds minority shares in Blue Square, a firm developing software solutions for health systems, including for PBF programmes. Other authors have no conflict of interest., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2019
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30. How does performance-based financing affect the availability of essential medicines in Cameroon? A qualitative study.
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Sieleunou I, Turcotte-Tremblay AM, De Allegri M, Taptué Fotso JC, Azinyui Yumo H, Magne Tamga D, and Ridde V
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- Cameroon, Drug Industry, Health Personnel, Humans, Pharmacies economics, Qualitative Research, Drugs, Essential economics, Drugs, Essential supply & distribution, Healthcare Financing, Reimbursement, Incentive
- Abstract
Performance-based financing (PBF) is being implemented across low- and middle-income countries to improve the availability and quality of health services, including medicines. Although a few studies have examined the effects of PBF on the availability of essential medicines (EMs) in low- and middle-income countries, there is limited knowledge of the mechanisms underlying these effects. Our research aimed to explore how PBF in Cameroon influenced the availability of EMs, and to understand the pathways leading to the experiential dimension related with the observed changes. The design was an exploratory qualitative study. Data were collected through in-depth interviews, using semi-structured questionnaires. Key informants were selected using purposive sampling. The respondents (n = 55) included health services managers, healthcare providers, health authorities, regional drugs store managers and community members. All interviews were recorded, transcribed and analysed using qualitative data analysis software. Thematic analysis was performed. Our findings suggest that the PBF programme improved the perceived availability of EMs in three regions in Cameroon. The change in availability of EMs experienced by stakeholders resulted from several pathways, including the greater autonomy of facilities, the enforced regulation from the district medical team, the greater accountability of the pharmacy attendant and supply system liberalization. However, a sequence of challenges, including delays in PBF payments, limited autonomy, lack of leadership and contextual factors such as remoteness or difficulty in access, was perceived to hinder the capacity to yield optimal changes, resulting in heterogeneity in performance between health facilities. The participants raised concerns regarding the quality control of drugs, the inequalities between facilities and the fragmentation of the drug management system. The study highlights that some specific dimensions of PBF, such as pharmacy autonomy and the liberalization of drugs supply systems, need to be supported by equity interventions, reinforced regulation and measures to ensure the quality of drugs at all levels., (© The Author(s) 2019. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.)
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- 2019
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31. Effectiveness of symptom-based diagnostic HIV testing versus targeted and blanket provider-initiated testing and counseling among children and adolescents in Cameroon.
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Yumo HA, Ajeh RA, Beissner M, Ndenkeh JN Jr, Sieleunou I, Jordan MR, Sam-Agudu NA, and Kuaban C
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- Adolescent, Age Factors, Antiretroviral Therapy, Highly Active, Cameroon epidemiology, Child, Counseling, Diagnostic Tests, Routine, Female, HIV Infections drug therapy, HIV Infections virology, Humans, Male, Mass Screening, Outcome Assessment, Health Care, Symptom Assessment, HIV Infections diagnosis, HIV Infections epidemiology
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Objectives: The concurrent implementation of targeted (tPITC) and blanket provider-initiated testing and counselling (bPITC) is recommended by the World Health Organization (WHO) for HIV case-finding in generalized HIV epidemics. This study assessed the effectiveness of this intervention compared to symptom-based diagnostic HIV testing (DHT) in terms of HIV testing uptake, case detection and antiretroviral therapy (ART) enrollment among children and adolescents in Cameroon, where estimated HIV prevalence is relatively low at 3.7%., Methods: In three hospitals where DHT was the standard practice before, tPITC and bPITC were implemented by inviting HIV-positive parents in care at the ART clinics to have their biological children (6 weeks-19 years) tested for HIV (tPITC). Concurrently, at the outpatient departments, similarly-age children/adolescents were systematically offered HIV testing via accompanying parents/guardians. The mean monthly number of children tested for HIV, identified HIV-positive and ART-enrolled were used to compare the outcomes of different HIV testing strategies before and after the intervention., Results: In comparing DHT to bPITC, there was a significant increase in the mean monthly number of children/adolescents tested for HIV (223.0 vs 348.3, p = 0.0073), but with no significant increase in the mean monthly number of children/adolescents: testing HIV-positive (10.5 vs 9.7, p = 0.7574) and ART- enrolled (7.3 vs 6.3, p = 0.5819). In comparing DHT to tPITC, there was no significant difference in the mean monthly number of children/adolescents: tested for HIV (223 vs 193.8, p = 0.4648); tested HIV-positive (10.5 vs 10.6, p = 0.9544), and ART-enrolled (7.3 vs 5.8, p = 0.4672). When comparing DHT versus bPITC+tPITC, there was a significant increase in the mean monthly number of children/adolescents: tested for HIV (223.0 to 542.2, p<0.0001), testing HIV-positive (10.5 vs 20.3, p = 0.0256), and ART-enrolled (7.3 vs 12.2, p = 0.0388)., Conclusions: These findings suggest that concurrent implementation of bPITC+tPITC was more effective compared to DHT in terms of HIV testing uptake, case detection and ART enrolment. However, considering that DHT and bPITC had comparable outcomes with regards to case detection and ART enrolment, bPITC+tPITC may not be efficient. Thus, this finding does not support concurrent bPITC+tPITC implementation as recommended by WHO. Rather, continued DHT+tPITC could effectively and efficiently accelerate HIV case detection and ART coverage among children and adolescents in Cameroon and similar low-prevalence context., Competing Interests: The authors have declared that no competing interests exist.
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- 2019
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32. Performance-based Financing in Africa: Time to Test Measures for Equity.
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Ridde V, Gautier L, Turcotte-Tremblay AM, Sieleunou I, and Paul E
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- Africa, Health Care Reform economics, Health Care Reform organization & administration, Healthcare Disparities economics, Healthcare Disparities organization & administration, Healthcare Disparities statistics & numerical data, Healthcare Financing, Humans, Reimbursement, Incentive statistics & numerical data, Universal Health Insurance economics, Universal Health Insurance organization & administration, Universal Health Insurance statistics & numerical data, Reimbursement, Incentive organization & administration
- Abstract
Over the past 15 years, hundreds of millions of dollars have been invested in reforms founded on performance-based financing (PBF) in low- and middle-income countries. While evidence on its effectiveness and efficiency is still controversial, there appears to be an emerging consensus that equity has not been adequately considered. In this article, we show how PBF-type interventions in Africa have not sufficiently taken into account equity of access to care for the worst-off and their financial protection. In reviewing the history of health reforms in Africa, we show that this omission is nothing new. We suggest that strategic purchasing and PBF-type actions would benefit from being implemented in ways that promote equity and the financial protection of populations in Africa. Without such a reorientation of reforms, it will be impossible to achieve universal health coverage by 2030.
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- 2018
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33. Deconstructing the notion of "global health research partnerships" across Northern and African contexts.
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Gautier L, Sieleunou I, and Kalolo A
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- Africa South of the Sahara, Humans, Capacity Building, Cooperative Behavior, Ethics, Research, Global Health
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Background: Global health conceives the notion of partnership between North and South as central to the foundations of this academic field. Indeed, global health aspires to an equal positioning of Northern and Southern actors. While the notion of partnership may be used to position the field of global health morally, this politicization may mask persisting inequalities in global health. In this paper, we reflect on global health partnerships by revisiting the origins of global health and deconstructing the notion of partnership. We also review promising initiatives that may help to rebalance the relationship., Results and Discussion: Historical accounts are helpful in unpacking the genesis of collaborative research between Northerners and Southerners - particularly those coming from the African continent. In the 1980s, the creation of a scientific hub of working relationships based on material differences created a context that was bound to create tensions between the alleged "partners". Today, partnerships provide assistance to underfunded African research institutions, but this assistance is often tied with hypotheses about program priorities that Northern funders require from their Southern collaborators. African researchers are often unable to lead or contribute substantially to publications for lack of scientific writing skills, for instance. Conversely, academics from African countries report frustrations at not being consulted when the main conceptual issues of a research project are discussed. However, in the name of political correctness, these frustrations are not spoken aloud. Fortunately, initiatives that shift paternalistic programs to formally incorporate a mutually beneficial design at their inception with equal input from all stakeholders are becoming increasingly prominent, especially initiatives involving young researchers., Conclusion: Several concrete steps can be undertaken to rethink partnerships. This goes hand in hand with reconceptualizing global health as an academic discipline, mainly through being explicit about past and present inequalities between Northern and Southern universities that this discipline has thus far eluded. Authentic and transformative partnerships are vital to overcome the one-sided nature of many partnerships that can provide a breeding-ground for inequality.
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- 2018
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34. Burden of human scabies in sub-Saharan African prisons: Evidence from the west region of Cameroon.
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Kouotou EA, Nansseu JRN, Sangare A, Moguieu Bogne LL, Sieleunou I, Adegbidi H, Tameyi Tatsa J, and Moyou Somo R
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- Adolescent, Adult, Aged, Aged, 80 and over, Bedding and Linens, Cameroon epidemiology, Clothing, Cross-Sectional Studies, Crowding, Educational Status, Female, Humans, Male, Middle Aged, Prevalence, Risk Factors, Scabies diagnosis, Sex Factors, Young Adult, Prisons statistics & numerical data, Scabies epidemiology
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Background/objectives: There is little data on the profile and magnitude of scabies in sub-Saharan African prisons. The present study aimed to assess the prevalence and determinants of scabies in prisons of the west region of Cameroon., Methods: We conducted a cross-sectional study from March to August 2014, and consecutively recruited volunteer detainees of three randomly selected prisons in the West Region of Cameroon. The diagnosis was based on clinical findings after assessment by two experienced and well-trained dermatologists., Results: We enrolled 755 prisoners, 17 (2%) of whom were women. Their mean age was 32 ± 12 years. There were 242 cases (32%) of scabies, with significantly more cases in the most crowded prison (P < 0.0001). Men were significantly more affected than women (P = 0.004) and the prevalence of scabies significantly decreased when the level of education increased (P < 0.0001). In addition to a low level of education (adjusted odds ratio (aOR) 1.90; P < 0.0001), sharing clothes/bedding (aOR 2.72; P < 0.0001) and the number of detainees per cell > 10 (aOR 1.89; P = 0.002), but not age, duration of incarceration, number of baths/week and washing/week, were independent drivers of scabies occurrence., Conclusion: Almost one-third of prisoners suffered from scabies in our prisons. A low educational level, the sharing of clothes/bedding and number of detainees/cell > 10 were independent determinants of the disease. Urgent measures must be undertaken to reduce the burden of scabies in our prisons., (© 2017 The Australasian College of Dermatologists.)
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- 2018
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35. Erratum to: 'Setting performance-based financing in the health sector agenda: a case study in Cameroon'.
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Sieleunou I, Turcotte-Tremblay AM, Fotso JT, Tamga DM, Yumo HA, Kouokam E, and Ridde V
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- 2017
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36. Setting performance-based financing in the health sector agenda: a case study in Cameroon.
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Sieleunou I, Turcotte-Tremblay AM, Fotso JT, Tamga DM, Yumo HA, Kouokam E, and Ridde V
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- Africa South of the Sahara, Cameroon, Decision Making, Humans, Policy Making, Health Policy, Healthcare Financing
- Abstract
Background: More than 30 countries in sub-Saharan Africa have introduced performance-based financing (PBF) in their healthcare systems. Yet, there has been little research on the process by which PBF was put on the national policy agenda in Africa. This study examines the policy process behind the introduction of PBF program in Cameroon., Methods: The research is an explanatory case study using the Kingdon multiple streams framework. We conducted a document review and 25 interviews with various types of actors involved in the policy process. We conducted thematic analysis using a hybrid deductive-inductive approach for data analysis., Results: By 2004, several reports and events had provided evidence on the state of the poor health outcomes and health financing in the country, thereby raising awareness of the situation. As a result, decision-makers identified the lack of a suitable health financing policy as an important issue that needed to be addressed. The change in the political discourse toward more accountability made room to test new mechanisms. A group of policy entrepreneurs from the World Bank, through numerous forms of influence (financial, ideational, network and knowledge-based) and building on several ongoing reforms, collaborated with senior government officials to place the PBF program on the agenda. The policy changes occurred as the result of two open policy windows (i.e. national and international), and in both instances, policy entrepreneurs were able to couple the policy streams to effect change., Conclusion: The policy agenda of PBF in Cameroon underlined the importance of a perceived crisis in the policy reform process and the advantage of building a team to carry forward the policy process. It also highlighted the role of other sources of information alongside scientific evidence (eg.: workshop and study tour), as well as the role of previous policies and experiences, in shaping or influencing respectively the way issues are framed and reformers' actions and choices.
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- 2017
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37. Transferring the Purchasing Role from International to National Organizations During the Scale-Up Phase of Performance-Based Financing in Cameroon.
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Sieleunou I, Turcotte-Tremblay AM, Yumo HA, Kouokam E, Fotso JT, Tamga DM, and Ridde V
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Abstract -The World Bank and the government of Cameroon launched a performance-based financing (PBF) program in Cameroon in 2011. To ensure its rapid implementation, the performance purchasing role was sub-contracted to a consultancy firm and a nongovernmental organization, both international. However, since the early stage, it was agreed upon that this role would later be transferred to a national entity. This explanatory case study aims at analyzing the process of this transfer using Dolowitz and Marsh's framework. We performed a document review and interviews with various stakeholders ( n = 33) and then conducted thematic analysis of interview recordings. Sustainability, ownership, and integration of the PBF intervention into the health system emerged as the main reasons for the transfer. The different aspects of transfer from international entities to a national body consisted of (1) the decision-making power, (2) the "soft" elements (e.g., ideas, expertise), and (3) the "hard" elements (e.g., computers, vehicles). Factors facilitating the transfer included the fact that it was planned from the start and the modification of the legal status of the national organization that became responsible for strategic purchasing. Other factors hindered the transfer, such as the lack of a legal act clarifying the conditions of the transfer and the lack of posttransition support agreements. The Cameroonian experience suggests that key components of a successful transfer of PBF functions from international to national organizations may include clear guidelines, co-ownership and planning of the transition by all parties, and posttransition support to new actors.
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- 2017
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38. [Epidemiological and clinical profile of skin damages in black African patients on chronic hemodialysis].
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Kouotou EA, Folefack FK, Tatsa JT, Sieleunou I, Njingang JR, Ashuntantang G, and Bissek AZ
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- Adult, Age Factors, Aged, Cameroon, Cross-Sectional Studies, Female, Humans, Kidney Failure, Chronic epidemiology, Male, Middle Aged, Sex Factors, Skin Diseases diagnosis, Skin Diseases epidemiology, Black People, Kidney Failure, Chronic ethnology, Kidney Failure, Chronic therapy, Renal Dialysis adverse effects, Skin Diseases ethnology, Skin Diseases etiology
- Abstract
Introduction: Dermatologic manifestations are common among patients on chronic hemodialysis and may represent systemic involvement. Our study aims to determine the epidemiological and clinical profile of skin damages in black patients living in Yaounde, Cameroon., Methods: We conducted a cross sectional study including all patients receiving chronic haemodialysis treatment for at least 3 months in two hemodialysis centers in Yaounde from February to May 2014. Patients underwent an interview and a dermatological examination. Chi-squared tests and Student's t-test (or equivalents) were used for statistical analysis, with significance level at p <0.05., Results: A total of 112 patients (78 (69.9%) men) with an average age of 48.6 ± 13 years and a mean duration of dialysis of 46,3 ± 37 months were included in the study. Skin lesions were present in 94 (83.9%) patients. Xerosis (63.3%), pruritus (37.5%), melanoderma (34.8%), acne (12.5%) and half and half nails (10.7%) were the most common dermatologic manifestations. Xerosis was associated with anuria (p = 0.0001) and advanced age (p = 0.032); melanoderma was associated with anuria (p = 0.042) and time spent on dialysis (p = 0.027) while half and half nails were associated with young age (p = 0.018) and biweekly dialysis (p = 0.01 )., Conclusion: Skin damages are frequent and dominated by xerosis, pruritus and melanoderma in patients on chronic hemodialysis living in Yaounde. Biweekly dialysis, advanced age, anuria and time spent on dialysis were associated factors., Competing Interests: Les auteurs ne déclarent aucun conflit d'intérêts.
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- 2016
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39. An appeal for large scale production of antiretroviral drugs in Africa.
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Martial NP and Sieleunou I
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- Acquired Immunodeficiency Syndrome epidemiology, Africa epidemiology, Anti-HIV Agents economics, Budgets, Financing, Organized, Global Health, HIV Infections epidemiology, Humans, Pandemics, Acquired Immunodeficiency Syndrome drug therapy, Anti-HIV Agents supply & distribution, HIV Infections drug therapy
- Abstract
The Acquired Immuno Deficiency Syndrome (AIDS) remains a major global public health challenge especially in Africa. The deadline set for the Millennium Development Goals (MDGs) has elapsed, meanwhile most low and middle income countries did not reach the targets. With regards to the fight against HIV / AIDS, many African countries show slow progress in implementing efficient and effective strategies to counter this pandemic. The fact that most HIV/AIDS programs in Sub-Saharan African countries are still very dependent on external funding to carry out their activities, including the supply of Antiretroviral Treatment (ART), highlights the concern of sustainability. So far, solutions that have been proposed are mainly symptomatic, claiming more budget commitment from government. Without rejecting this view, we call for the implementation of sustainable solutions to deal with the long term ART challenges. A way forward is to promote the establishment of an effective machinery for the manufacturing and large scale distribution of ART. In addition to the health gains, we argue that such an initiative would have a three-dimensional impact: (i) political, (ii) economic and (iii) social., Competing Interests: The authors declare no competing interest.
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- 2016
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40. Features of human scabies in resource-limited settings: the Cameroon case.
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Kouotou EA, Nansseu JR, Sieleunou I, Defo D, Bissek AC, and Ndam EC
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- Adolescent, Adult, Aged, Aged, 80 and over, Cameroon epidemiology, Child, Child, Preschool, Cross-Sectional Studies, Female, Humans, Infant, Infant, Newborn, Male, Middle Aged, Physical Examination, Prevalence, Scabies diagnosis, Socioeconomic Factors, Young Adult, Developing Countries, Scabies epidemiology, Scabies transmission
- Abstract
Background: The persistent high prevalence of human scabies, especially in low- and middle-income countries prompted us to research the sociodemographic profile of patients suffering from it, and its spreading factors in Cameroon, a resource-poor setting., Methods: We conducted a cross-sectional survey from October 2011 to September 2012 in three hospitals located in Yaoundé, Cameroon, and enrolled patients diagnosed with human scabies during dermatologists' consultations who volunteered to take part in the study., Results: We included 255 patients of whom 158 (62 %) were male. Age ranged from 0 to 80 years old with a median of 18 (Inter quartile range: 3-29) years. One to eight persons of our patients' entourage exhibited pruritus (mean = 2.1 ± 1.8). The number of persons per bed/room varied from 1 to 5 (mean = 2.1 ± 0.8). The first dermatologist's consultation occurred 4 to 720 days after the onset of symptoms (mean = 77.1 ± 63.7). The post-scabies pruritus (10.2 % of cases) was unrelated to the complications observed before correct treatment (all p values > 0.05), mainly impetiginization (7.1 %) and eczematization (5.9 %)., Conclusion: Human scabies remains preponderant in our milieu. Populations should be educated on preventive measures in order to avoid this disease, and clinicians' knowledges must be strengthened for its proper diagnosis and management.
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- 2015
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41. [The practice of skin bleaching and associated skin diseases among female traders in Yaoundé, Cameroon (sub-Saharan African)].
- Author
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Kouotou EA, Bissek AC, Nouind CC, Defo D, Sieleunou I, and Ndam EC
- Subjects
- Adult, Cameroon, Comorbidity, Cross-Sectional Studies, Drug Eruptions epidemiology, Esthetics, Female, Hand Dermatoses chemically induced, Hand Dermatoses epidemiology, Humans, Middle Aged, Occupations, Ochronosis chemically induced, Ochronosis epidemiology, Pigmentation Disorders epidemiology, Self Report, Skin Diseases epidemiology, Surveys and Questionnaires, Young Adult, Commerce, Drug Eruptions etiology, Pigmentation Disorders chemically induced, Skin Lightening Preparations adverse effects
- Published
- 2015
- Full Text
- View/download PDF
42. What does UHC mean?
- Author
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Bermejo RA, Xu J, Henao DE, Ho BL, and Sieleunou I
- Subjects
- Humans, Terminology as Topic, Universal Health Insurance trends
- Published
- 2014
- Full Text
- View/download PDF
43. Assessing communities of practice in health policy: a conceptual framework as a first step towards empirical research.
- Author
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Bertone MP, Meessen B, Clarysse G, Hercot D, Kelley A, Kafando Y, Lange I, Pfaffmann J, Ridde V, Sieleunou I, and Witter S
- Subjects
- Clinical Competence, Concept Formation, Cooperative Behavior, Health Personnel, Health Services Needs and Demand, Humans, Internationality, Knowledge, Delivery of Health Care, Empirical Research, Health Policy, Health Services Research, Information Dissemination, Program Evaluation, Translational Research, Biomedical
- Abstract
Communities of Practice (CoPs) are groups of people that interact regularly to deepen their knowledge on a specific topic. Thanks to information and communication technologies, CoPs can involve experts distributed across countries and adopt a 'transnational' membership. This has allowed the strategy to be applied to domains of knowledge such as health policy with a global perspective. CoPs represent a potentially valuable tool for producing and sharing explicit knowledge, as well as tacit knowledge and implementation practices. They may also be effective in creating links among the different 'knowledge holders' contributing to health policy (e.g., researchers, policymakers, technical assistants, practitioners, etc.). CoPs in global health are growing in number and activities. As a result, there is an increasing need to document their progress and evaluate their effectiveness. This paper represents a first step towards such empirical research as it aims to provide a conceptual framework for the analysis and assessment of transnational CoPs in health policy.The framework is developed based on the findings of a literature review as well as on our experience, and reflects the specific features and challenges of transnational CoPs in health policy. It organizes the key elements of CoPs into a logical flow that links available resources and the capacity to mobilize them, with knowledge management activities and the expansion of knowledge, with changes in policy and practice and, ultimately, with an improvement in health outcomes. Additionally, the paper addresses the challenges in the operationalization and empirical application of the framework.
- Published
- 2013
- Full Text
- View/download PDF
44. Health worker migration and universal health care in Sub-Saharan Africa.
- Author
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Sieleunou I
- Subjects
- Africa South of the Sahara, Global Health, Health Services Accessibility economics, Humans, Quality of Health Care, Universal Health Insurance, Emigration and Immigration statistics & numerical data, Health Personnel statistics & numerical data, Health Services Accessibility statistics & numerical data, Health Workforce statistics & numerical data
- Abstract
There is a more and more emerging consensus claiming universal access to health care in order to achieve the desired Millennium Development Goals related to health in Africa. Unfortunately, the debate of the universal coverage has focussed so far mainly on financial affordability, while it is also a human resource matter. Many countries in sub-Saharan Africa are experiencing severe shortages of skilled health care workers. There are several causes, the importance of which varies by country, but one of the most significant factors is brain drain. In those countries, scarcity of doctors increases the distance between a doctor and patients, and bridging that increased distance implies costs, both time and money. Adequate number of qualified health personnel is then vital to increase coverage and improve the quality of care. In as much as access to health services is also determined by access to qualified health workers, any reflection on the universal health coverage has to also consider the inequities in qualified health personnel distribution throughout the world.
- Published
- 2011
45. [Call for an intelligent allocation in financing the health system in Cameroon].
- Author
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Sieleunou I
- Subjects
- Budgets methods, Cameroon, Catchment Area, Health economics, Catchment Area, Health legislation & jurisprudence, Developing Countries economics, Health Planning, Health Policy, Health Services Needs and Demand, Resource Allocation methods, Financing, Government methods, Financing, Government organization & administration, Health Care Rationing, Health Services economics, National Health Programs economics
- Published
- 2011
- Full Text
- View/download PDF
46. Determinants of survival in AIDS patients on antiretroviral therapy in a rural centre in the Far-North Province, Cameroon.
- Author
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Sieleunou I, Souleymanou M, Schönenberger AM, Menten J, and Boelaert M
- Subjects
- Acquired Immunodeficiency Syndrome immunology, Adolescent, Adult, Antiretroviral Therapy, Highly Active, Body Mass Index, CD4 Lymphocyte Count, Cameroon epidemiology, Drug Evaluation, Epidemiologic Methods, Female, Hospitals, Rural, Humans, Male, Medically Underserved Area, Middle Aged, Treatment Outcome, Young Adult, Acquired Immunodeficiency Syndrome drug therapy, Acquired Immunodeficiency Syndrome mortality, Anti-HIV Agents therapeutic use, Developing Countries
- Abstract
Objective: To analyse the outcomes of antiretroviral therapy (ART) in routine conditions in a rural hospital in the Far-North province of Cameroon., Method: Retrospective cohort study of 1187 patients >15 years who started ART between July 2001 and December 2006. The survival time was estimated by Kaplan-Meier analysis and Cox proportional hazard models were fitted to explain survival., Results: Upon enrollment, 90.4% patients were in WHO stage III or IV and 56.1% had a BMI <18.5. Median CD4 count was 105 cells/mm(3) (IQR 40-173). At the end of the study period, 338/1187 had died and 59/1187 were lost to follow-up. The survival probability was 77% at 1 year [95% CI: 75-80] and 47% at 5 years [95% CI: 40-55]. The median survival time was 58 months. CD4 count, haemoglobin, BMI, sex and clinical stage at enrollment were independent predictors of mortality., Conclusion: This study confirms the clinical benefit of ART programs in a remote and resource-constrained setting operating in routine conditions. The challenge ahead is to secure earlier access to ART and to maintain its longer-term benefit.
- Published
- 2009
- Full Text
- View/download PDF
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