Human resources for health : challenges and policy issues
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Background: Acute Renal Injury(AKI) is a very common complication in critical patients (Uchino, S. et al., 2005). The most recent guidelines state that Continuous Renal Replacement Therapy(CRRT) is the gold standard treatment in patients... more
Background: Acute Renal Injury(AKI) is a very common complication in critical
patients (Uchino, S. et al., 2005). The most recent guidelines state that Continuous Renal
Replacement Therapy(CRRT) is the gold standard treatment in patients with severe AKI and
hemodynamic instability, acute brain injury or increased intracranial pressure (G. Kidney Disease:
2012). CRRT is, however, burdened by its high cost (Klarenbach, S. et al., 2009). The present study
was designed as observational and retrospective, and its objective was to calculate the costs and
evaluate the effectiveness of CRRT in relation to the mortality outcome in Intensive Care Unit(ICU)
and in the hospital 30 days after ICU discharge. Patient’s data were extracted from the “GiViTI–
Italian Group for the evaluation of interventions in Intensive Care” database. All patients treated
with CRRT in the years 2011-2014 in the Italian ICUs(189) and with a maximum SOFA score
between 8 and 12, were enrolled(2599). Based on the SOFA Score, the expected mortality rate
ranged between 22.5% and 48.5% (Vincent, J. L. et al., 1998). We considered as unit cost the
regional tariff (DRG) 3995.5 applied in the Perugia University hospital in 2015(€ 255.70). To get an
approximation of the total cost for CRRT, the DRG was multiplied by the median duration of
treatment(4 days) and the number of patients enrolled.The estimated total cost was € 2 658 257.20.
The observed mortality in the ICU was 44.4%. The mortality rate 30 days after ICU discharge
increased to 54.9% and was higher than predicted. Therefore, we suggest structuring a specific
follow-up plan for patients who underwent CRRT in ICU as they have a higher mortality risk.
patients (Uchino, S. et al., 2005). The most recent guidelines state that Continuous Renal
Replacement Therapy(CRRT) is the gold standard treatment in patients with severe AKI and
hemodynamic instability, acute brain injury or increased intracranial pressure (G. Kidney Disease:
2012). CRRT is, however, burdened by its high cost (Klarenbach, S. et al., 2009). The present study
was designed as observational and retrospective, and its objective was to calculate the costs and
evaluate the effectiveness of CRRT in relation to the mortality outcome in Intensive Care Unit(ICU)
and in the hospital 30 days after ICU discharge. Patient’s data were extracted from the “GiViTI–
Italian Group for the evaluation of interventions in Intensive Care” database. All patients treated
with CRRT in the years 2011-2014 in the Italian ICUs(189) and with a maximum SOFA score
between 8 and 12, were enrolled(2599). Based on the SOFA Score, the expected mortality rate
ranged between 22.5% and 48.5% (Vincent, J. L. et al., 1998). We considered as unit cost the
regional tariff (DRG) 3995.5 applied in the Perugia University hospital in 2015(€ 255.70). To get an
approximation of the total cost for CRRT, the DRG was multiplied by the median duration of
treatment(4 days) and the number of patients enrolled.The estimated total cost was € 2 658 257.20.
The observed mortality in the ICU was 44.4%. The mortality rate 30 days after ICU discharge
increased to 54.9% and was higher than predicted. Therefore, we suggest structuring a specific
follow-up plan for patients who underwent CRRT in ICU as they have a higher mortality risk.
This Chapter discusses contextual justifications for creating stronger Human Resource Systems in Uganda going by benchmarks from four African countries that attained middle income status in Africa (Mauritius, Seychelles, Botswana and... more
This Chapter discusses contextual justifications for creating stronger Human Resource Systems in Uganda going by benchmarks from four African countries that attained middle income status in Africa (Mauritius, Seychelles, Botswana and Ghana). These countires were not different from Uganda in its current state. However, they significantly re-evaluated their roles in delivery of public services to their citizens in the face of the growing impacts of global markets, competition, financial mobility and increasing trends towards economic liberalization totransform their economies. On account of their success stories and those of the past Ugandan polotical and Scocial Economic Systems, the Author challenges every actor to support Uganda's committment to transform its economy. This Chapter shares ideas on how Uganda's Human Resource Systems can be strengthened in the lead sectors that have been identified to drive Uganda to Middle Income Status. There lessons for the rest of Africa.
Background The economic burden of uncorrected refractive error (URE) is thought to be high in Mozambique, largely as a consequence of the lack of resources and systems to tackle this largely avoidable problem. The Mozambique Eyecare... more
Background
The economic burden of uncorrected refractive error (URE) is thought to be high in Mozambique, largely as a consequence of the lack of resources and systems to tackle this largely avoidable problem. The Mozambique Eyecare Project (MEP) has established the first optometry training and human resource deployment initiative to address the burden of URE in Lusophone Africa. The nature of the MEP programme provides the opportunity to determine, using Cost Benefit Analysis (CBA), whether investing in the establishment and delivery of a comprehensive system for optometry human resource development and public sector deployment is economically justifiable for Lusophone Africa.
Methods
A CBA methodology was applied across the period 2009–2049. Costs associated with establishing and operating a school of optometry, and a programme to address uncorrected refractive error, were included. Benefits were calculated using a human capital approach to valuing sight. Disability weightings from the Global Burden of Disease study were applied. Costs were subtracted from benefits to provide the net societal benefit, which was discounted to provide the net present value using a 3% discount rate.
Results
Using the most recently published disability weightings, the potential exists, through the correction of URE in 24.3 million potentially economically productive persons, to achieve a net present value societal benefit of up to $1.1 billion by 2049, at a Benefit-Cost ratio of 14:1. When CBA assumptions are varied as part of the sensitivity analysis, the results suggest the societal benefit could lie in the range of $649 million to $9.6 billion by 2049.
Conclusion
This study demonstrates that a programme designed to address the burden of refractive error in Mozambique is economically justifiable in terms of the increased productivity that would result due to its implementation.
The economic burden of uncorrected refractive error (URE) is thought to be high in Mozambique, largely as a consequence of the lack of resources and systems to tackle this largely avoidable problem. The Mozambique Eyecare Project (MEP) has established the first optometry training and human resource deployment initiative to address the burden of URE in Lusophone Africa. The nature of the MEP programme provides the opportunity to determine, using Cost Benefit Analysis (CBA), whether investing in the establishment and delivery of a comprehensive system for optometry human resource development and public sector deployment is economically justifiable for Lusophone Africa.
Methods
A CBA methodology was applied across the period 2009–2049. Costs associated with establishing and operating a school of optometry, and a programme to address uncorrected refractive error, were included. Benefits were calculated using a human capital approach to valuing sight. Disability weightings from the Global Burden of Disease study were applied. Costs were subtracted from benefits to provide the net societal benefit, which was discounted to provide the net present value using a 3% discount rate.
Results
Using the most recently published disability weightings, the potential exists, through the correction of URE in 24.3 million potentially economically productive persons, to achieve a net present value societal benefit of up to $1.1 billion by 2049, at a Benefit-Cost ratio of 14:1. When CBA assumptions are varied as part of the sensitivity analysis, the results suggest the societal benefit could lie in the range of $649 million to $9.6 billion by 2049.
Conclusion
This study demonstrates that a programme designed to address the burden of refractive error in Mozambique is economically justifiable in terms of the increased productivity that would result due to its implementation.
With the increasing global health workers shortage, developing countries like Uganda are embracing task shifting as a form of availing health care amidst the growing population and increasing disease burden. This study examined the... more
With the increasing global health workers shortage, developing countries like Uganda are embracing task shifting as a form of availing health care amidst the growing population and increasing disease burden. This study examined the quality of healthcare delivered under task shifting in low and high task shifting environments from patients' perspective in Kalangala and Bukomansimbi Districts respectively. An exploratory design was employed with both qualitative and quantitative approaches guided by Banduras theories of social learning and social cognitive. Bivariate analysis was carried out through cross-tabulations on associations between task shifting and quality of healthcare indicators to generate chi-square and p-values. Quality of care was assessed as generally good but much better in high task shifting environments because of the availability of simulations, supervision and mentorship programs which facilitate the health workers to learn even when they possess lower qualifications. The study asserts that good quality healthcare can be provided by virtually any person who is conditioned through training, supervision and mentoring. This has a huge implication for Human Resource for Health (HRH) planning, forecasting and development in the epoch of healthy worker shortage. The study designed and recommended a task shifting model that would facilitate the development of policy framework for task shifting implementation.
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