Background Our analysis aims to model COVID-19 pandemic in India, potential impact of various measures, along with assessment of health system preparedness and cost to manage the epidemic. Methods We developed a susceptible-exposed-infectious-recovered (SEIR) mathematical model to predict the health outcomes under an unmitigated scenario which comprises of air travel restrictions alone, and the current scenario consisting of air travel restrictions along with 8-week lockdown. In addition, we also evaluate the effectiveness of 8-week lockdown along with intensified public health measures at varying level of effectiveness. We assessed the impact of these interventions on COVID-19 related health outcomes in comparison to the unmitigated scenario. Next, we ascertain the need for augmenting infrastructure and the costs of COVID-19 management in India. Findings In the event of a lockdown for 8 weeks, the peak of the epidemic shifts by 34-76 days, and the number of cases at the end of 8-week lockdown reduces by 69% to 97% with varying effectiveness of lockdown. However, the cumulative long-term cases remain the same. Intensification of public health surveillance measures with 60% effectiveness is estimated to reduce the cases at peak and cumulative number of infections by 70% and 26.6% respectively. The requirement of ICU beds and ventilators would reduce by 83% with intensified public health measures. The cost of managing COVID-19 in India is nearly 4.5% of the gross domestic product (GDP) in the absence of any intervention which increases to 6.2% with intensified public health measures for COVID-19 response. Conclusion Lockdown measures delay the onset of peak, and give much needed time to health system to prepare. Strengthening the public health system response in terms of testing, isolation treatment of cases, and contact tracing needs would lead to significant gains in terms of case load, and meeting health system needs.
Background Performance-based financing (PBF) has attracted considerable attention in recent years in low and middle-income countries. Afghanistan’s Ministry of Public Health (MoPH) implemented a PBF programme between 2010 and 2015 to strengthen the utilisation of maternal and child health services in primary health facilities. Methods We used a political economy analysis framework which aims to understand the main dynamics that influence the adoption and design of a policy and facilitates the exploration of policy processes and the roles played by key actors at various stages of implementation. Retrospective qualitative research methods were employed. The data comprised transcripts of key informant interviews and a review of PBF related documents. Results This study discovered a range of contextual factors contributing to the introduction of PBF in Afghanistan. In addition, the study identified the role, power, interest, and ideas of actors in relation to PBF and the extent to which they were involved in and affected the design, adoption, and implementation of PBF programme in the country. Besides, the study described the process of PBF programme design and how it was implemented in practice, including nonconformities to the initial design and reasons for these. Discussion Political economy factors played a critical role in the introduction, design and implementation of PBF programme in Afghanistan. This study highlighted a number of contextual factors including global and local forces supporting the introduction of PBF in Afghanistan. The process underlying the design and implementation of the PBF programme was a result of power and resource dynamics between PBF programme actors. This study makes an important contribution to the global literature through its focus on a low-income setting and a fragile and conflict-affected state where numerous forces have combined to bring a programme into existence and have influenced its implementation and outcome. Conclusion PBF programmes are inherently political as they enforce distinct arrangements for the sharing of resources and represents a risk or opportunity to actors as a result of changes to their roles and responsibilities and the modification of organisational processes. Future studies are required to focus on conducting empirical research to understand the main political economy dynamics that influence the policy cycle of such programmes. We recommend further use of political economy analysis in such studies.
The authors have withdrawn this preprint due to erroneous posting.
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