SummaryBackgroundA key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016.MethodsDrawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0–100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0–100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita.FindingsIn 2016, HAQ Index performance spanned from a high of 97·1 (95% UI 95·8–98·1) in Iceland, followed by 96·6 (94·9–97·9) in Norway and 96·1 (94·5–97·3) in the Netherlands, to values as low as 18·6 (13·1–24·4) in the Central African Republic, 19·0 (14·3–23·7) in Somalia, and 23·4 (20·2–26·8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China,...
SummaryBackgroundAchieving universal health coverage (UHC) requires health financing systems that provide prepaid pooled resources for key health services without placing undue financial stress on households. Understanding current and future trajectories of health financing is vital for progress towards UHC. We used historical health financing data for 188 countries from 1995 to 2015 to estimate future scenarios of health spending and pooled health spending through to 2040.MethodsWe extracted historical data on gross domestic product (GDP) and health spending for 188 countries from 1995 to 2015, and projected annual GDP, development assistance for health, and government, out-of-pocket, and prepaid private health spending from 2015 through to 2040 as a reference scenario. These estimates were generated using an ensemble of models that varied key demographic and socioeconomic determinants. We generated better and worse alternative future scenarios based on the global distribution of historic health spending growth rates. Last, we used stochastic frontier analysis to investigate the association between pooled health resources and UHC index, a measure of a country's UHC service coverage. Finally, we estimated future UHC performance and the number of people covered under the three future scenarios.FindingsIn the reference scenario, global health spending was projected to increase from US$10 trillion (95% uncertainty interval 10 trillion to 10 trillion) in 2015 to $20 trillion (18 trillion to 22 trillion) in 2040. Per capita health spending was projected to increase fastest in upper-middle-income countries, at 4·2% (3·4–5·1) per year, followed by lower-middle-income countries (4·0%, 3·6–4·5) and low-income countries (2·2%, 1·7–2·8). Despite global growth, per capita health spending was projected to range from only $40 (24–65) to $413 (263–668) in 2040 in low-income countries, and from $140 (90–200) to $1699 (711–3423) in lower-middle-income countries. Globally, the share of health spending covered by pooled resources would range widely, from 19·8% (10·3–38·6) in Nigeria to 97·9% (96·4–98·5) in Seychelles. Historical performance on the UHC index was significantly associated with pooled resources per capita. Across the alternative scenarios, we estimate UHC reaching between 5·1 billion (4·9 billion to 5·3 billion) and 5·6 billion (5·3 billion to 5·8 billion) lives in 2030.InterpretationWe chart future scenarios for health spending and its relationship with UHC. Ensuring that all countries have sustainable pooled health resources is crucial to the achievement of UHC.FundingThe Bill & Melinda Gates Foundation.
SummaryBackgroundComparable estimates of health spending are crucial for the assessment of health systems and to optimally deploy health resources. The methods used to track health spending continue to evolve, but little is known about the distribution of spending across diseases. We developed improved estimates of health spending by source, including development assistance for health, and, for the first time, estimated HIV/AIDS spending on prevention and treatment and by source of funding, for 188 countries.MethodsWe collected published data on domestic health spending, from 1995 to 2015, from a diverse set of international agencies. We tracked development assistance for health from 1990 to 2017. We also extracted 5385 datapoints about HIV/AIDS spending, between 2000 and 2015, from online databases, country reports, and proposals submitted to multilateral organisations. We used spatiotemporal Gaussian process regression to generate complete and comparable estimates for health and HIV/AIDS spending. We report most estimates in 2017 purchasing-power parity-adjusted dollars and adjust all estimates for the effect of inflation.FindingsBetween 1995 and 2015, global health spending per capita grew at an annualised rate of 3·1% (95% uncertainty interval [UI] 3·1 to 3·2), with growth being largest in upper-middle-income countries (5·4% per capita [UI 5·3–5·5]) and lower-middle-income countries (4·2% per capita [4·2–4·3]). In 2015, $9·7 trillion (9·7 trillion to 9·8 trillion) was spent on health worldwide. High-income countries spent $6·5 trillion (6·4 trillion to 6·5 trillion) or 66·3% (66·0 to 66·5) of the total in 2015, whereas low-income countries spent $70·3 billion (69·3 billion to 71·3 billion) or 0·7% (0·7 to 0·7). Between 1990 and 2017, development assistance for health increased by 394·7% ($29·9 billion), with an estimated $37·4 billion of development assistance being disbursed for health in 2017, of which $9·1 billion (24·2%) targeted HIV/AIDS. Between 2000 and 2015, $562·6 billion (531·1 billion to 621·9 billion) was spent on HIV/AIDS worldwide. Governments financed 57·6% (52·0 to 60·8) of that total. Global HIV/AIDS spending peaked at 49·7 billion (46·2–54·7) in 2013, decreasing to $48·9 billion (45·2 billion to 54·2 billion) in 2015. That year, low-income and lower-middle-income countries represented 74·6% of all HIV/AIDS disability-adjusted life-years, but just 36·6% (34·4 to 38·7) of total HIV/AIDS spending. In 2015, $9·3 billion (8·5 billion to 10·4 billion) or 19·0% (17·6 to 20·6) of HIV/AIDS financing was spent on prevention, and $27·3 billion (24·5 billion to 31·1 billion) or 55·8% (53·3 to 57·9) was dedicated to care and treatment.InterpretationFrom 1995 to 2015, total health spending increased worldwide, with the fastest per capita growth in middle-income countries. While these national disparities are relatively well known, low-income countries spent less per person on health and HIV/AIDS than did high-income and middle-income countries. Furthermore, declines in development assistance for health co...
BackgroundIncorporation of information technology advancements in healthcare has gained wide acceptance in the last two decades. Developed countries have successfully incorporated information technology advancements in their healthcare system thus, improving healthcare. However, only a limited application of information technology advancements is seen in developing countries in their healthcare system. Hence, this study was aimed at assessing knowledge and utilization of computer among health workers in Addis Ababa hospitals.MethodsA quantitative cross-sectional study was conducted among 304 health workers who were selected using stratified sampling technique from all governmental hospitals in Addis Ababa. Data was collected from April 15 to April 30, 2010 using a structured, self-administered, and pre-tested questionnaire from five government hospitals in Addis Ababa. The data was entered into Epi Info version 3.5.1 and exported to SPSS version 16. Analysis was done using multinomial logistic regression technique.ResultsA total of 270 participants, age ranging from 21 to 60 years responded to the survey (88.8% response rate). A total of 91 (33.7%) respondents had an adequate knowledge of computers while 108 (40.0%) had fair knowledge and 71(26.3%) of the respondents showed inadequate knowledge. A total of 38(14.1%) were adequately utilizing computers, 14(5.2%) demonstrated average or fair utilization and majority of the respondents 218(80.7%) inadequately utilized computers. Significant predictor variables were average monthly income, job satisfaction index and own computer possession.ConclusionsComputer knowledge and utilization habit of health workers were found to be very low. Increasing accessibility to computers and delivering training on the use of computers for workers will increases the knowledge and utilization of computers. This will facilitate the rate of diffusion of the technology to the health sector. Hence, programs targeted at enhancing knowledge and skill of computer use and increasing access to computer should be designed. The association between computer knowledge/skill and health care delivery competence should be studied.
Abstract:The global population is expected to reach between 7.5 and 10.5 billion by the year 2050. Ethiopia is the second most populous country in Sub-Saharan Africa next to Nigeria. Total Fertility Rate of Ethiopia is 4.1 children per women; contraceptive prevalence rate is 29% for all child bearing age women. The prevalence of long acting reversible contraceptive methods (LARCs) in Ethiopia was very low (4.2%). The cause for low prevalence of LARCs is not known. Thisstudy assessed the acceptance and factors associated with acceptance of long acting reversible contraceptive methods (LARCs) among reproductive age women in Adama Town, Oromia regional state, Ethiopia, 2016. Institution-based cross-sectional study was employed. A total of 644 women attending family planning clinics in health facilities in Adamatownin March 2016 were randomly selected. Structured, pretested and interviewer administered questionnaire was used to collect data. Univariateand Multivariable logistic regression analysis was employed to identify factors associated with acceptance of LARCs methods. Adjusted Odds ratios (AOR) with 95% confidence interval (CI) were used to assess the association among study variables. The acceptance of LARCs methods was found 27.9% Respondents` age (25-34 years) (AOR, 0.19; 95% CI: 0.07, 0.54) were negatively associated, occupation (govern employed) (AOR, 8.80; 95% CI: 1.38, 56.13), Supportive partners attitude (AOR, 30.26; 95% CI: 10.52, 87.03), time taken to arrive the health facility (AOR, 5.68; 95% CI: 2.11, 15.27), partners discussion (AOR, 23.23; 95% CI: 8.55, 63.08) and ever using LARCs before (AOR, 5.50; 95% CI: 2.11, 14.31) were found to have significant and positive association with acceptance of LARCs. CurrentLARCs acceptance is low (27.9%). Regional Health Bureau, Adama Town Health Office and other stakeholders should continue promotion of LARCs. Health professionals should teach both the clients and their partners about the benefits and disadvantage of LARCs. Partners should discus on benefits of using LARCs.
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