Health Equity: 05/12/10

Wednesday, May 12, 2010

[EQ] Can Foreign Policy Make a Difference to Health?

Can Foreign Policy Make a Difference to Health?

Sigrun Møgedal, Ministry of Foreign Affairs, Oslo, Norway,

Benedikte Louise Alveberg, Consultant on foreign policy and global health, Oslo, Norway
PLoS Med 7(5): e1000274. doi:10.1371/journal.pmed.1000274 - May 11, 2010

This article is part of the PLoS Medicine Global Health Diplomacy series.

Available online at: http://bit.ly/dhbGky

“……It is in the hands of member states to direct and enable WHO to undertake its normative and standard-setting functions effectively in facing the increasingly transnational nature of health threats, to be a trusted repository for knowledge and information, and to act as an effective convener of multiple players and stakeholders that can drive appropriate convergence, innovation, and effective decision making for health in a diverse landscape.

In support of effective health governance, better evidence and best practices are needed on how foreign policy can improve policy coordination at all levels and create an improved global policy environment for health. Foreign policy practitioners need to become more aware of positive and negative impact of policy options and decisions on health outcomes. This is how foreign policy can make a difference to health…..”

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[EQ] Algorithms for enhancing public health utility of national causes-of-death data

Algorithms for enhancing public health utility of national causes-of-death data

Naghavi M, Makela S, Foreman K, O'Brien J, Pourmalek F, Lozano R
Institute for Health Metrics and Evaluation, University of Washington

Population Health Metrics 2010, 8:9 (10 May 2010)

Available online PDF [44p.] at: http://www.pophealthmetrics.com/content/pdf/1478-7954-8-9.pdf

“…..Coverage and quality of cause-of-death (CoD) data varies across countries and time. Valid, reliable, and comparable assessments of trends in causes of death from even the best systems are limited by three problems:
a) changes in the International Statistical Classification of Diseases and Related Health Problems (ICD) over time;
b) the use of tabulation lists where substantial detail on causes of death is lost; and
c) many deaths assigned to causes that cannot or should not be considered underlying causes of death, often called garbage codes (GCs).

The Global Burden of Disease Study and the World Health Organization have developed various methods to enhance comparability of CoD data.

In this study, we attempt to build on these approaches to enhance the utility of national cause-of-death data for public health analysis.

Methods

Based on careful consideration of 4,434 country-years of CoD data from 145 countries from 1901 to 2008, encompassing 743 million deaths in ICD versions 1 to 10 as well as country-specific cause lists, we have developed a public health-oriented cause-of-death list. These 56 causes are organized hierarchically and encompass all deaths. Each cause has been mapped from ICD-6 to ICD-10 and, where possible, they have also been mapped to the International List of Causes of Death 1-5. We developed a typology of different classes of GCs. In each ICD revision, GCs have been identified. Target causes to which these GCs should be redistributed have been identified based on certification practice and/or pathophysiology. Proportionate redistribution, statistical models, and expert algorithms have been developed to redistribute GCs to target codes for each age sex group.

Results

The fraction of all deaths assigned to GCs varies tremendously across countries and revisions of the ICD. In general, across all country-years of data available, GCs have declined from more than 43% in ICD-7 to 24% in ICD-10. In some regions, such as Australasia, GCs in 2005 are as low as 11%, while in some developing countries, such as Thailand, they are greater than 50%. Across different age groups, the composition of GCs varies tremendously – three classes of GCs steadily increase with age, but ambiguous codes within a particular disease chapter are also common for injuries at younger ages. The impact of redistribution is to change the number of deaths assigned to particular causes for a given age-sex group. These changes alter ranks across countries for any given year by a number of different causes, change time trends, and alter the rank order of causes within a country.

Conclusions

By mapping cause-of-death CoD through different International Statistical Classification of Diseases and Related Health Problems ICD versions and redistributing garbage codes GCs, we believe the public health utility of cause-of-death CoD data can be substantially enhanced, leading to an increased demand for higher quality cause-of-death CoD data from health sector decision-makers….’





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[EQ] Improving Health Service Delivery in Developing Countries

Improving Health Service Delivery in Developing Countries

From Evidence to Action

Editors

David Peters, Sameh; El-Saharty, Banafsheh Siadat, Katja Janovsky, and Marko Vujicic
The International Bank for Reconstruction and Development / The World Bank 2009

Available online PDF [366p.] at: http://bit.ly/bQWFZq

Improving health services is a crucial part of achieving the Millennium Development Goals in low- and middle-income countries (LMICs). Despite the abundance of evidence on the efficacy of interventions that can save lives at low cost, the pathways to delivering health services effectively in LMICs are not well known. Decision makers around the world need better information about which strategies to improve health services work best, or how to make current strategies more effective.

By collecting and synthesizing what is known about implementation of health strategies, this book fills an important void in our knowledge about how to improve health services in LMICs. A major contribution of the book is to synthesize a deep and difficult literature on health services in LMICs.

The first chapters of the book are comprehensive and systematic reviews of the literature that examine important sets of strategies for improving health services through health services strengthening strategies and approaches to implementation (chapter 1); strengthening health services organizations (chapter 2); improving performance of individual health care providers (chapter 3); and empowerment of communities (chapter 4).

The book also pulls together years of international data and applies novel analytical approaches to examine how changes in the coverage of different health services affect each other on a national level (chapter 5). The analysis challenges the practice behind setting international targets for health services and offers an alternative based on each country’s experience.

This book helps us think beyond what can be learned from the simpler, reproducible, and controlled interventions that are commonly described in research but are less applicable in practice. It demonstrates how a better understanding of implementation processes—the “how to”—is a crucial complement to the evidence addressing which health intervention should be selected. By better recognizing how context matters—how enabling and inhibiting factors influence even the most standardized or well-intentioned health strategy—the book points a way for managers and decision makers to deal with the complexities they regularly face. Chapter 6 outlines a way of thinking of the institutional factors that influence the delivery of health services, which should be helpful for analysts, managers, and policy makers.

In chapter 8, the book describes how strategies were developed and implemented in the context of seven country case studies….”

Content

Overview

Health Services and the Challenge of Implementation

Common Strategies to Strengthen Health Services

Framework

How to Gain Knowledge on Strengthening Health Services

Chapter 1 Review of Strategies to Strengthen Health Services

Chapter 2 Review of Strategies to Strengthen the Performance of Health Organizations

Chapter 3 Review of Strategies to Improve Health Care Provider Performance
Chapter 4 Review of Community Empowerment Strategies for Health

Chapter 5 Analysis of Cross-country Changes in Health Services

Chapter 6 Institutional Context of Health Services
Chapter 7 Evaluation of Changes in Health Results in World Bank-assisted Health Projects

Chapter 8 Seven Country Case Studies

Chapter 9 From Evidence to Learning and Action

How to Improve Implementation

Notes

References

Glossary

Index





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