IntroductionThe COVID-19 vaccine donation process allegedly prioritised national interests over humanitarian needs. We thus examined how donors allocated vaccines by recipient country needs versus donor national interests and how such decisions varied across donation channels (bilateral vs COVAX with country earmarking) or exposure to foreign aid norms (membership status in the Development Assistance Committee—DAC).MethodsWe used the two-part regression model to examine how the probability of becoming a recipient country and the volume of vaccines received were associated with recipient countries’ needs (disease burden and GDP per capita), donor countries’ interests (bilateral trade volume and voting distance in the United Nations General Assembly) and recipient countries’ population size. The analysis further interacted the determinants with channel and DAC status.ResultsDonors preferentially selected countries with higher disease burden, lower GDP per capita, closer trade relations, more different voting preferences, and smaller populations. Compared with bilateral arrangements, COVAX encouraged more needs-based considerations (lower GDP per capita), less interest-based calculus (more distant economic relations and voting preferences) and larger population size. Compared with the DAC counterparts, the non-DAC donors focused more on politically and economically aligned countries but also on less economically developed countries. As for the volume of vaccines donated, countries received more vaccines if they had tighter trade relations with donors, more different voting patterns than donors, and larger populations. COVAX was associated with raising the volumes of vaccines to politically distant countries, and non-DAC donors donated more to countries with stronger trade relations and political alignment.ConclusionDonors consider both recipient needs and national interests when allocating COVID-19 vaccines. COVAX and DAC partially mitigated donors’ focus on domestic interests. Future global health aid can similarly draw on multilateral and normative arrangements.
Background: Strengthening primary care is a key focus of the latest healthcare reforms in China. However, many challenges, including the workforce competence, still exist. This study aimed to evaluate the common disease management competency of rural primary care providers in Sichuan Province, western China. Methods: A cross-sectional study was conducted in 9 township health centers and 86 village clinics in 3 counties. Diarrhea and respiratory infection were selected as the evaluation cases. General partitioners were assessed through their abilities to (1) take history; (2) make diagnoses; (3) propose treatment; and (4) deal with clinical cases. Results: In total, 362 healthcare workers were surveyed, and 130 general practitioners were enrolled into our study. On average, rural primary care providers could only answer 46.4% of questions absolutely correctly, with 29.7% partly correctly and 23.8% incorrectly. Conclusion: We suggest strengthening training to improve rural primary care providers’ competencies, especially their capacities of history taking. Policy action is also needed to address regional disparities.
IntroductionCardiovascular disease (CVD) remains the leading cause of premature death globally and a major contributor to decreasing quality of life. In the present study, we investigated the contribution of social, behavioral, and physiological determinants of CVD and their different patterns among middle-aged and older adults.MethodsWe used harmonized data from 6 nationally representative individual-level longitudinal studies across 25 countries. We restricted the age to ≥50 years and defined cases as a self-reported history of CVD. The exposure variables were the demographic status (age and sex), socioeconomic position (education level, employment, and household income level), social connections (marital status and family size), behavioral factors (smoking, alcohol drinking, and frequency of moderate to vigorous physical activity), and physiological risk factors (obesity, presence of hypertension, and presence of diabetes). Mixed logistic regression models were fitted to investigate the associations, and dominance analysis was conducted to examine the relative contributions.ResultsIn total, 413,203 observations were included in the final analysis, with the CVD prevalence ranging from 10.4% in Mexico to 28.8% in the United States. Physiological risk factors were the main driver of CVD prevalence with the highest dominance proportion, which was higher in developing countries (China, 57.5%; Mexico, 72.8%) than in developed regions (United States, England, 10 European countries, and South Korea). Socioeconomic position and behavioral factors also highly contributed but were less significant in developing countries than in developed regions. The relative contribution of socioeconomic position ranged from 9.4% in Mexico to 23.4% in the United States, and that of behavioral factors ranged from 5.7% in Mexico to 26.1% in England.ConclusionThe present study demonstrated the different patterns of determinant contributions to CVD prevalence across developing and developed countries. With the challenges produced by different risk factors, the implementation of tailored prevention and control strategies will likely narrow disparities in the CVD prevalence by promoting health management and enhancing the capacity of health systems across different countries.
BACKGROUND Direct to Consumer (DTC) telemedicine platforms are digital platforms that enable patients to match with and initiate online consultations. This growing area of digital health has the potential to expand access to quality outpatient care by extending patient choice of providers and providers’ ability to interact with new patients online. OBJECTIVE This study aims to to evaluate the status of DTC telemedicine and the quality of care provided through these platforms in China, the country where DTC telemedicine has expanded most rapidly. METHODS In this cross-sectional study, we first conducted a systematic search of all DTC telemedicine platforms in China providing on-demand consultations through video or SMS/MMS and manually scraped information from each platform. We then evaluated the quality of care provided using unannounced virtual visits by standardized patients (SPs) presenting seven different disease cases. We evaluate the performance of online providers relative to national standards of care and to traditional on-site providers in rural areas. Multiple regressions were used to assess associations between quality and platform characteristics. RESULTS The systematic search identified 36 independent platforms providing synchronous or asynchronous consultations via videoconferencing or SMS/MMS text. Platforms varied widely in design, access methods, services, and pricing. The quality of care provided through online-only platforms was superior to platforms that were extensions of physical hospitals in terms of diagnosis and case management. SPs were significantly more likely to be correctly managed through videoconference compared to SMS/MMS consultations, though costs were significantly higher. Both videoconference and SMS/MMS consultations were likely to refer patients unnecessarily. Platform features and the price of consultations were significantly associated with measures of quality. CONCLUSIONS There was substantial variation in the design of DTC telemedicine platforms in China as well as the quality of care provided. Incentives inherent in the design of these platforms may influence care quality and patient costs. The expansion of DTC telemedicine may improve access to high quality care, but could increase unnecessary care and reduce equity in access without thoughtful regulation. Research is needed to inform policies governing DTC telemedicine platforms, particularly in middle-income countries such as China.
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