Assessing the use of an essential health package in a sector wide approach in Malawi.
Assessing the use of an essential health package in a sector wide approach in Malawi.
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DOI：
10.1186/1478-4505-9-4
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发表时间：
2011-01-17
影响因子：
4
通讯作者：
Mwase T
中科院分区：
文献类型：
--
作者：
Bowie C;Mwase T
许多发展中国家采用的全部门办法难以评估。一种方法是考虑基本保健一揽子计划，这通常是全部门办法政策和计划的载体。在马拉维这样的国家，不可能通过衡量卫生成果来衡量全民健康计划的影响。但是，可以从覆盖面的角度评估干预措施的选择及其实施情况。本文介绍了一种尝试，以评估马拉维的全部门性做法，通过其EHP使用这些现有的技术效率的措施。采用疾病负担模型确定优先疾病及其估计发病率。卫生管理信息系统（HMIS）的数据被用来衡量这些干预措施的覆盖面。对选定的和潜在的干预措施的成本效益进行了审查，以评估EHP中使用的每种干预措施的适当性。支出数据用于评估EHP的供资水平。在55项EHP干预措施中，有33项被认为具有潜在的成本效益（<150美元/DALY），12项成本效益不高（> 150美元/DALY），10项没有成本效益估计数。确定了15种潜在的干预措施，这些措施具有成本效益，可应对排名前20位的疾病之一。在SWAp期间，几乎所有EHP服务的供应都有所增加。每千人的门诊人次及住院日数均由2002/03年度的929人次增至2007/08年度的1 135人次，而住院日数则由2002/03年度的124日增至2007/08年度的179日。然而，到2007/08年度，所需资源与所提供资源之间的平均差距为估计需求的0.68%。有两项涉及疟疾治疗的服务提供过多，但大多数服务提供不足，有些服务，如产妇护理，提供的服务还不到所需的一半。在整个期间，全民健康计划的资金不足，平均占必要费用的57%。到2007/2008年，包括马拉维政府在内的全部门办法伙伴为资助全民健康计划支付的资金为每年人均13.5美元，几乎是经修订的全民健康计划每年人均所需支出估计数的一半。全部门办法对一些成本效益很高的保健干预措施进行了投资。就接受治疗的病人人数而言，紧急卫生方案提供了所需服务的三分之二。这是在紧急卫生方案资金严重不足、人口增加和工作人员短缺的情况下实现的。通过全部门办法进程确定行之有效、物有所值的干预措施和指定用途的资金，能够以极低的成本在提供保健服务方面产生可衡量的改进。
The sector wide approach (SWAp) used in many developing countries is difficult to assess. One way is to consider the essential health package (EHP) which is commonly the vehicle for a SWAp's policies and plans. It is not possible to measure the impact of an EHP by measuring health outcomes in countries such as Malawi. But it is possible to assess the choice of interventions and their delivery in terms of coverage. This paper describes an attempt to assess the Malawi SWAp through its EHP using these available measures of technical efficiency. A burden of disease model was used to identify the priority diseases and their estimated incidence. Data from the health management information system (HMIS) were used to measure the coverage of these interventions. A review of the cost-effectiveness of the chosen and potential interventions was undertaken to assess the appropriateness of each intervention used in the EHP. Expenditure data were used to assess the level of funding of the EHP. 33 of the 55 EHP interventions were found to be potentially cost-effective (<$150/DALY), 12 were not so cost-effective (>$150/DALY) and cost-effective estimates were not available for ten. 15 potential interventions, which were cost-effective and tackling one of the top 20 ranked diseases, were identified. Provision had increased in nearly all EHP services over the period of the SWAp. The rates of out patient attendances and inpatient days per 1000 population had both increased from 929 attendances in 2002/3 to 1135 in 2007/08 and from 124 inpatient days in 2002/03 to 179 in 2007/08. However, by 2007/08 the mean gap between what was required and what was provided was 0.68 of the estimated need. Two services involving the treatment of malaria were overprovided, but the majority were underprovided, with some such as maternity care providing less than half of what was required. The EHP was under-funded throughout the period covering on average 57% of necessary costs. By 2007/08 the funding paid by SWAp partners including the government of Malawi to fund the EHP was at US$13.5 per capita per annum, which was almost half of the revised EHP estimated required expenditure per capita per annum. The SWAp had invested in some very cost-effective health interventions. In terms of numbers of patients treated, the EHP had delivered two thirds of the services required. This was despite serious under-funding of the EHP, an increase in the population and shortage of staff. The identification of interventions of proven effectiveness and good value for money and earmarked funding through a SWAp process can produce measurable improvement in health service delivery at extremely low cost.
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DOI：
10.2471/blt.07.042259
发表时间：
2008-02-01
期刊：
Bulletin of the World Health Organization: International Journal of Public Health
影响因子：
--
作者：
Shillcutt, Samuel;Morel, Chantal;Mills, A
通讯作者：
Mills, A
影响因子：
3.3
作者：
Sundewall, J;Sahlin-Andersson, K
通讯作者：
Sahlin-Andersson, K
影响因子：
168.9
作者：
Cecchini, Michele;Sassi, Franco;Chisholm, Daniel
通讯作者：
Chisholm, Daniel
影响因子：
4
作者：
Sundewall, Jesper;Forsberg, Birger Carl;Tomson, Goran
通讯作者：
Tomson, Goran
影响因子：
4.5
作者：
Chilopora, Garvey;Pereira, Caetano;Bergstrom, Staffan
通讯作者：
Bergstrom, Staffan