Two decades of primary health care expansion in Latin America: evaluation and forecasting study for health-related SDGs
拉丁美洲初级卫生保健扩张二十年:健康相关可持续发展目标的评估和预测研究
基本信息
- 批准号:MC_PC_MR/T023678/1
- 负责人:
- 金额:$ 56.06万
- 依托单位:
- 依托单位国家:英国
- 项目类别:Research Grant
- 财政年份:2020
- 资助国家:英国
- 起止时间:2020 至 无数据
- 项目状态:已结题
- 来源:
- 关键词:
项目摘要
The recent Astana Declaration emphasizes the importance of health systems based on a strong Primary Health Care (PHC), which should be part and coordinate multisectoral actions addressing economic and social determinants of health. PHC should be one of the main hubs of the network of interventions composing the welfare state, synergistically connecting the healthcare system with social and poverty-relief interventions. Several Latin American countries (LAC) have implemented and expanded over the last two decades PHC, healthcare system components, and social assistance interventions with different degrees of intensity and connection. However, recent economic crisis and austerity measures are threatening the consolidation of public healthcare systems and of the welfare state in the majority of LAC. Some evaluations of PHC in a limited number of countries have found positive effects on specific health outcomes, but no study has performed multi-country comparisons or adopted a comprehensive approach for the estimation of the effects -including long-term effects- of PHC programs on a broad range of health outcomes (notifiable diseases, hospitalizations and mortality - overall and for specific causes and age-groups), measuring its synergistic impact with the other healthcare system components and with social assistance, in particular conditional (CCT) and social pensions (SP). Similarly, no research has measured the influence of PHC coverage duration and of contextual factors such as local governance indexes or human development index. While the synergistic impact of PHC with CCT is expected because the health conditionalities should be attended in the PHC units, the interaction effects of SP with PHC are plausible because of the physiological effects of the relief from poverty, in particular in the pathways of prevention and cure. The aim of this project is to systematically address all these issues for a comprehensive evaluation of the effectiveness of PHC on the broadest possible range of morbidity and mortality outcomes in Brazil, Colombia, Ecuador and Mexico (BCEM). The comparative evaluation will be possible because BCEM have undertaken different PHC, healthcare and social assistance implementations during the last two decades. Aggregate and individual-level, longitudinal and cross-sectional, socioeconomic and health data from a wide range of sources in each BCEM will be merged and the most robust quasi-experimental designs will be used to evaluate these comprehensive PHC impacts on such a wide number of outcomes. With the large amount of data and parameters from all the retrospective impact evaluations, and using a microsimulation modelling approach -arguably one of the most accurate forecasting techniques up-to-date - we will forecast the effects of different PHC coverage reductions - due to budget constraints or austerity measures - in conjunction with the above mentioned welfare state components, versus scenarios of coverage stabilization or coverage expansion, evaluating differences in a broad range of health outcomes in BCEM up to 2030. Using all the granularity of data and effect estimates, we will evaluate the most effective PHC, CCT and SP expansion coverage dynamics -on specific subpopulations- in the next years. We will also calibrate and select the best policy scenarios for the reduction of health inequalities and the achievement of each health-related SDG in each BCME. This project will also consolidate a network of researchers in LAC and will develop algorithms and methods to integrate ex-post and ex-ante impact evaluations of public policies using ecologic and individual-level data. All the datasets created in the study will be made available in an open dynamic platform of comprehensive LAC data from healthcare systems, social interventions and health outcome, and the research network will use the platform and the developed algorithms to stimulate continuous cycles of monitoring, evaluation and forecasting.
最近的《阿斯塔纳宣言》强调了建立在强有力的初级保健基础上的卫生系统的重要性,这一系统应成为解决健康问题的经济和社会决定因素的多部门行动的一部分,并协调这些行动。初级保健应该是构成福利国家的干预网络的主要枢纽之一,协同地将保健系统与社会和扶贫干预联系起来。过去二十年来,一些拉丁美洲国家实施并扩大了初级保健、保健系统组成部分和社会援助干预措施,其力度和联系程度各不相同。然而,最近的经济危机和紧缩措施正威胁着大多数拉丁美洲和加勒比地区公共医疗保健系统和福利国家的巩固。在少数国家对初级保健进行的一些评估发现,初级保健对具体的健康结果产生了积极影响,但没有任何研究进行多国比较,或采用综合方法来估计初级保健方案对广泛的健康结果的影响,包括长期影响(应报告的疾病、住院和死亡率-总体和具体原因及年龄组),衡量其与卫生保健系统其他组成部分和社会援助的协同作用,特别是有条件的(CCT)和社会养老金(SP)。同样,也没有任何研究衡量初级保健覆盖范围的持续时间以及地方治理指数或人类发展指数等背景因素的影响。虽然初级保健与有条件现金援助的协同作用是可以预期的,因为初级保健单位应注意健康条件,但由于脱贫的生理效应,特别是在预防和治疗的途径中,SP与初级保健的相互作用是合理的。该项目的目的是系统地解决所有这些问题,以便全面评价初级保健对巴西、哥伦比亚、厄瓜多尔和墨西哥尽可能广泛的发病率和死亡率结果的有效性。比较评估将是可能的,因为BCEM在过去二十年中开展了不同的初级保健、保健和社会援助实施工作。每个BCEM中来自广泛来源的汇总和个人层面、纵向和横截面、社会经济和健康数据将被合并,最稳健的准实验设计将用于评估这些综合PHC对如此广泛的结果的影响。根据所有回顾性影响评估的大量数据和参数,并使用微观模拟建模方法-可以说是迄今为止最准确的预测技术之一-我们将结合上述福利国家组成部分,预测由于预算限制或紧缩措施而导致的不同初级保健覆盖面减少的影响,以及覆盖面稳定或覆盖面扩大的情况,评估BCEM到2030年的广泛健康结果的差异。使用所有粒度的数据和效果估计,我们将评估最有效的PHC,CCT和SP扩展覆盖动态-在特定的亚群-在未来几年。我们还将校准和选择最佳政策情景,以减少健康不平等和实现每个BCME中与健康相关的可持续发展目标。该项目还将巩固拉丁美洲和加勒比地区的研究人员网络,并将开发算法和方法,利用生态和个人层面的数据,整合公共政策的事后和事前影响评估。研究中创建的所有数据集将在一个开放的动态平台上提供,该平台包含来自医疗保健系统、社会干预和健康结果的综合LAC数据,研究网络将使用该平台和开发的算法来刺激连续的监测、评估和预测周期。
项目成果
期刊论文数量(10)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
Understanding the social determinants of child mortality in three latin american countries: an approach with machine learning
了解三个拉丁美洲国家儿童死亡率的社会决定因素:机器学习方法
- DOI:10.18332/popmed/164445
- 发表时间:2023
- 期刊:
- 影响因子:0
- 作者:Chivardi C
- 通讯作者:Chivardi C
The Comprehensive Health Impact of Cash Transfers, Social Pensions and Primary Care in Brazil: An Integrated Evaluation and Forecasting Analysis to Mitigate the Effects of the COVID19-Related Economic Crisis
巴西现金转移、社会养老金和初级保健对健康的综合影响:综合评估和预测分析,以减轻与新冠病毒相关的经济危机的影响
- DOI:10.2139/ssrn.4133606
- 发表时间:2022
- 期刊:
- 影响因子:0
- 作者:Aransiola T
- 通讯作者:Aransiola T
Understanding the social determinants of child mortality in Latin America over the last two decades: a machine learning approach.
- DOI:10.1038/s41598-023-47994-w
- 发表时间:2023-11-27
- 期刊:
- 影响因子:4.6
- 作者:
- 通讯作者:
The Impact of Two Decades of Conditional Cash Transfers on Child Health in Latin America: A Multicounty Evaluation and Forecasting Analysis to Mitigate the Effects of the Global Economic Crisis
两年有条件现金转移对拉丁美洲儿童健康的影响:减轻全球经济危机影响的多县评估和预测分析
- DOI:10.2139/ssrn.4325232
- 发表时间:2023
- 期刊:
- 影响因子:0
- 作者:Cavalcanti D
- 通讯作者:Cavalcanti D
Working Paper: Understanding the social determinants of child mortality in Latin America over the last two decades: a machine learning approach
工作论文:了解过去二十年拉丁美洲儿童死亡率的社会决定因素:机器学习方法
- DOI:
- 发表时间:2022
- 期刊:
- 影响因子:0
- 作者:Carlos Chivardia
- 通讯作者:Carlos Chivardia
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Davide Rasella其他文献
Política econômica e saúde pública: equilíbrio fiscal e bem-estar da população
经济政治和公共事务:财政均衡和民众幸福
- DOI:
- 发表时间:
2018 - 期刊:
- 影响因子:0
- 作者:
Rômulo Paes;Davide Rasella;Júlio Carepa - 通讯作者:
Júlio Carepa
The effects of cash transfer programmes on HIV/AIDS prevention and care outcomes: a systematic review and meta-analysis of intervention studies
现金转移计划对艾滋病毒/艾滋病预防和护理结果的影响:干预研究的系统综述和荟萃分析
- DOI:
10.1016/s2352-3018(22)00290-9 - 发表时间:
2023-06-01 - 期刊:
- 影响因子:13.000
- 作者:
Nathalia Sernizon Guimarães;Laio Magno;Adelzon Assis de Paula;Miriam Silliman;Rodrigo Volmir Rezende Anderle;Davide Rasella;James Macinko;Luís Eugênio de Souza;Inês Dourado - 通讯作者:
Inês Dourado
Impacto do Programa Água para Todos (PAT) sobre a morbi-mortalidade por diarreia em crianças do Estado da Bahia, Brasil
Impacto do Programa Água para Todos (PAT) sobre a morbi-mortalidade por diarreia em crianças do Estado da Bahia, 巴西
- DOI:
- 发表时间:
2013 - 期刊:
- 影响因子:0
- 作者:
Davide Rasella - 通讯作者:
Davide Rasella
Effects of conditional cash transfers on tuberculosis incidence and mortality according to race, ethnicity and socioeconomic factors in the 100 Million Brazilian Cohort
在“1 亿巴西队列研究”中,根据种族、民族和社会经济因素,有条件现金转移对结核病发病率和死亡率的影响
- DOI:
10.1038/s41591-024-03381-0 - 发表时间:
2025-01-03 - 期刊:
- 影响因子:50.000
- 作者:
Gabriela S. Jesus;Priscila F.P.S. Gestal;Andrea F. Silva;Daniella M. Cavalcanti;Iracema Lua;Maria Yury Ichihara;Mauricio L. Barreto;Delia Boccia;Mauro N. Sanchez;Davide Rasella - 通讯作者:
Davide Rasella
Health effects of the Brazilian Conditional Cash Transfer programme over 20 years and projections to 2030: a retrospective analysis and modelling study
巴西有条件现金转移计划 20 多年的健康影响及对 2030 年的预测:一项回顾性分析和建模研究
- DOI:
10.1016/s2468-2667(25)00091-x - 发表时间:
2025-07-01 - 期刊:
- 影响因子:25.200
- 作者:
Daniella Medeiros Cavalcanti;José Alejandro Ordoñez;Andrea Ferreira da Silva;Elisa Landin Basterra;Ana L Moncayo;Carlos Chivardi;Philipp Hessel;Alberto Pietro Sironi;Rômulo Paes de Sousa;Tereza Campello;Luis Eugênio Souza;Davide Rasella - 通讯作者:
Davide Rasella
Davide Rasella的其他文献
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