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Forgotten in a crisis: Addressing dementia in humanitarian response

GLOBAL ALZHEIMER'S & DEMENTIA ACTION ALLIANCE
ALZHEIMER'S DISEASE INTERNATIONAL
ALZHEIMER'S PAKISTAN
May 2019

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Every 3 seconds someone develops dementia and it’s one of the leading causes of death worldwide. Despite being some of the most at-risk in times of natural disaster, conflict and forced migration, there is a lack of awareness that dementia is a medical condition, meaning people with dementia are being neglected when they’re most in need of support.

This report investigates ways humanitarian emergency responses can protect and support people living with dementia. It draws on the experiences of people affected by dementia, Alzheimer’s specialists in affected countries, humanitarian organisations and inter-governmental organisations including the World Health Organisation and UNHCR.

Our findings reflect a wider issue of a lack of support for older people and those with disabilities in humanitarian response. We have found that people with dementia are systemically overlooked, due to a lack of global awareness of the condition and associated stigma.

The report is a collaboration between the Global Alzheimer’s & Dementia Action Alliance, Alzheimer’s Disease International and Alzheimer’s Pakistan.

Strengthening mental health system governance in six low- and middle-income countries in Africa and South Asia: challenges, needs and potential strategies

PETERSEN, Inge
et al
February 2017

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The aim of this study was to identify key governance issues that need to be addressed to facilitate the integration of mental health services into general health care in the six participating "Emerald" countries (Ethiopia, India, Nepal, Nigeria, South Africa, and Uganda).  The study adopted a descriptive qualitative approach, using framework analysis. Purposive sampling was used to recruit a range of key informants, to ensure views were elicited on all the governance issues within the expanded framework. Key informants across the six countries included policy makers at the national level in the Department/Ministry of Health; provincial coordinators and planners in primary health care and mental health; and district-level managers of primary and mental health care services. A total of 141 key informants were interviewed across the six countries. Data were transcribed (and where necessary, translated into English) and analysed thematically using framework analysis, first at the country level, then synthesised at a cross-country level.

The economic burden of dementia in China, 1990–2030: implications for health policy

WORLD HEALTH ORGANIZATION
January 2017

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Objective To quantify and predict the economic burden of dementia in China for the periods 1990–2010 and 2020–2030, respectively, and discuss the potential implications for national public health policy. Methods Using a societal, prevalence-based, gross cost-of-illness approach and data from multiple sources, we estimated or predicted total annual economic costs of dementia in China. We included direct medical costs in outpatient and inpatient settings, direct non-medical costs – e.g. the costs of transportation – and indirect costs due to loss of productivity. We excluded comorbidity-related costs.

Findings The estimated total annual costs of dementia in China increased from 0.9 billion United States dollars (US$) in 1990 to US$47.2 billion in 2010 and were predicted to reach US$ 69.0 billion in 2020 and US$ 114.2 billion in 2030. The costs of informal care accounted for 94.4%, 92.9% and 81.3% of the total estimated costs in 1990, 2000 and 2010, respectively. In China, population ageing and the increasing prevalence of dementia were the main drivers for the increasing predicted costs of dementia between 2010 and 2020, and population ageing was the major factor contributing to the growth of dementia costs between 2020 and 2030.

Conclusion In China, demographic and epidemiological transitions have driven the growth observed in the economic costs of dementia since the 1990s. If the future costs of dementia are to be reduced, China needs a nationwide dementia action plan to develop an integrated health and social care system and to promote primary and secondary prevention.

Health financing country diagnostic: a foundation for national strategy development

MCINTYRE, Diane
KUTZIN, Joseph
2016

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Health systems’ analysis is not an exact science in the sense that it is not a case of calculating an indicator and comparing that to a target that is set in stone. Instead, the analysis rests on describing elements of the existing system and critically assessing this on the basis of a clear understanding of health financing policy, the objectives associated with UHC, and relevant comparisons with and lessons from other countries. The paper attempts to provide guidance on how this can be done by highlighting the key issues that should be considered and some of the specific questions that should be addressed. It is not intended to provide a strict chapter-bychapter outline for a system assessment, but instead to foster and guide a systematic approach to the analysis of the health financing system. The health financing country diagnostic is written for Ministries of Health, advisors and others actors responsible for developing and implementing health financing policies, and provides step-by-step guidance on how to undertake a situation analysis of a country’s health financing system. Topics considered include: key contextual factors that influence health financing policy and attainment of policy goals; overview of health expenditure patterns; review of health financing arrangements; analysis UHC goals and intermediate objectives; and overall assessment - priorities for health financing reform.

UNICEF 2016-2030 Strategy for Health “at a glance”

UNICEF
2016

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This provides an overview of UNICEF’s 2016-2030 Strategy for Health which "aims to: end preventable maternal, newborn, and child deaths; and promote the health and development of all children. With the first goal, UNICEF commits to maintaining focus on the critical unmet needs related to maternal, newborn and under-5 survival. With the second, UNICEF highlights the importance of also looking beyond survival and addressing the health and development needs of older children and adolescents. The Strategy emphasises the importance of prioritising the needs of the most deprived children and promotes multi-sectoral approaches to enhance child development and address underlying causes and determinants of poor health outcomes. It aims to shift UNICEF from vertical disease programmes to strengthening health systems and building resilience, including calling for better integration of humanitarian and development efforts by encouraging risk-informed programming in all contexts"

Public financing for health in Africa: from Abuja to the SDGs

BARROY, Helene
VAN DE MAELE, Nathalie
MUSANGO, Laurent
HSU, Justine
et al
2016

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"This report takes stock of the main public financing for health trends over the past fifteen years in the African region, and highlights opportunities for accelerated progress toward universal health coverage (UHC) based on better-informed budget planning and utilization decisions. The report presents new evidence on the critical role played by domestic public financial management systems on the level, effectiveness and quality of public spending on health in Africa. It argues that these systems should be reconsidered if countries are to move towards UHCCountry experience in reforming public finance systems to support progress towards UHC indicates that success depends on more than simply increasing the level of public budgets. Rather, it requires appropriately targeted health budget allocations, complete execution of health’s public budgets, and improved efficiency in the use of public resources for health.

The report is composed of three sections. The first section is articulated around three policy highlights: aligning budget resources and health priorities; closing the gap between health budget allocation and expenditure; and maximizing UHC performance with the money available. Section 2 is dedicated to providing detailed health financing information on countries, and includes 48 country profiles focused on key health financing trends. The last section includes information on progress towards the development of health financing strategies in the region, as well as regional and country benchmarks on key health financing indicators"

WHO/HIS/HGF/Tech.Report/16.2

Brief - Financial access to rehabilitation services

Handicap International
October 2015

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Presentations from the seminar are reported on the themes of: a diagnostic tool, universal health coverage, financial access experiences, Madagascar’s experience and advocacy. Presentations included: The economic diagnostic tool for physical and functional rehabilitation and its deployment in Burkhina Faso, Colombia and Laos;  Equity funds and cash transfers, link with UHC; Universal Health Coverage, contributory and case management schemes usable in order to finance physical and functional rehabilitation; Vietnam: Orthopaedic devices and fair cost recovery system;  Burundi: Financial access to healthcare and performance-based financing; Burkhina Faso: Equity fund for rehabilitation projects; Mali, Rwanda, Togo: Evaluation of three rehabilitation equity funds; Nepal: Cost calculation of assistive devices; Madagascar Experience (Operating and financial access of orthopaedic devices and physical rehabilitation services of Pzaga Mahajanga University Hospital,  Social Welfare Policy and Universal health coverage in Madagascar, Mutual Health Insurances)

Methods for the economic evaluation of health care programmes. 4th edition. Chapter 1 to 3)

DRUMMOND. Michael
et al
September 2015

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The analytical and policy challenges that face health systems in seeking to allocate resources efficiently and fairly are discussed. A critical appraisal framework is employed, which is useful both to researchers conducting studies and to decision-makers assessing them. Practical examples are provided throughout to aid learning and understanding. A key part of evidence-based decision making is the analysis of all the relevant evidence to make informed decisions and policy.

2015 global reference list of 100 core health indicators

WORLD HEALTH ORGANIZATION (WHO)
2015

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“The Global Reference List of 100 Core Health Indicators is a standard set of 100 indicators prioritized by the global community to provide concise information on the health situation and trends, including responses at national and global levels. It contains indicators of relevance to country, regional and global reporting across the spectrum of global health priorities relating to the post-2015 health goals of the Sustainable Development Goals (SDGs). These include the Millennium Development Goals (MDGs) agenda, new and emerging priorities such as noncommunicable diseases, universal health coverage and other issues in the post-2015 development agenda.”

WHO Global disability action plan 2014-2021

WHO Disability and Rehabilitation Team
2014

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The WHO global disability action plan 2014-2021 is a significant step towards achieving health and well-being and human rights for people with disabilities. The action plan was endorsed by WHO Member States in 2014 and calls for them to remove barriers and improve access to health services and programmes; strengthen and extend rehabilitation, assistive devices and support services, and community-based rehabilitation; and enhance collection of relevant and internationally comparable data on disability, and research on disability and related services. Achieving the objectives of the action plan better enables people with disabilities to fulfil their aspirations in all aspects of life.

Universal health coverage for inclusive and sustainable development. A synthesis of 11 country case studies.

MAEDA, Akiko
ARAUJO, Edson
CASHIN, Cheryl
HARRIS, Joseph
IKEGAMI, Naoki
REICH, Michael R.
et al
2014

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Universal health coverage (UHC) for inclusive and sustainable development synthesises the experiences from 11 countries—Bangladesh, Brazil, Ethiopia, France, Ghana, Indonesia, Japan, Peru, Thailand, Turkey, and Vietnam—in implementing policies and strategies to achieve and sustain UHC. These countries represent diverse geographic and economic conditions, but all have committed to UHC as a key national aspiration and are approaching it in different ways. The UHC policies for each country are examined around three common themes: (1) the political economy and policy process for adopting, achieving, and sustaining UHC; (2) health financing policies to enhance health coverage; and (3) human resources for health policies for achieving UHC. The path to UHC is specific to each country, but countries can benefit from experiences of others and avoid potential risks

Moving towards universal health coverage: health insurance reforms in nine developing countries in Africa and Asia

Lagomarsion G.
Garabrant A.
Adyas A.
Otoo N.
Muga R.
et al
September 2012

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The implementation of national health insurance reforms designed to move towards universal health coverage by 9 low-income and lower-middle-income countries in Africa and Asia  is reported. Five countries at intermediate stages of reform (Ghana, Indonesia, the Philippines, Rwanda, and Vietnam) and four at earlier stages (India, Kenya, Mali, and Nigeria) are considered. These countries’ approaches to raising prepaid revenues, pooling risk, and purchasing services are described using the functions-of-health-systems framework. Their progress across three dimensions of coverage: who, what services, and what proportion of health costs is assessed using the coverage-box framework. Patterns in the structure of these countries’ reforms including use of tax revenues to subsidise target populations and steps towards broader risk pools are identified. Trends in progress towards universal coverage, including increasing enrolment in government health insurance and a movement towards expanded benefits packages are reported. Common, comparable indicators of progress towards universal coverage are needed.

The labour market for human resources for health in low and middle-income countries

SCHEFFLER, Richard
BRUCKNER, Tim
SPETZ, Joanne
July 2012

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This paper provides an introduction to the terms and tools of labour market analysis and connects these labour market principles to real-world case studies from LMIC. Three examples are provided of issues: workforce shortage in Thailand; unfilled posts in Kenya; and ghost workers in Rwanda. The labour market for health workers is considered and an integrated framework is provided. The technical structure and dynamics of the health worker market is discussed and applied to the first two examples. Task shifting, health worker performance and health worker productivity are also discussed.

Human Resources for Health Observer, No. 11

Tools and methods for evaluating the efficiency of development interventions

PALENBERG, Markus A
April 2011

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"This report investigates tools and methods for assessing aid efficiency. It explains concepts of efficiency and efficiency analysis and presents a catalogue of 15 methods that can be used to assess the efficiency of aid interventions. Each method is described and characterised. Several general observations and recommendations conclude the report"
BMZ Evaluation Working Papers

Good practice in the development of management information systems for social protection

CHIRCHIR, Richard
KIDD, Stephen
2011

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This paper "aims to fill a gap in the literature by examining good practice in the design of MISs for social protection. Section 2 will describe MISs, pointing out that they are more than systems of computer hardware and application software. Section 3 will discuss the type of information required by social protection MISs, and the challenges in capturing, transferring and processing this information. Section 4 will assess the potential for introducing new technologies into social protection MISs in developing countries. Section 5 will conclude by examining issues around the integration of MISs in countries with multiple social protection schemes, and the extent to which a national Single Registry is an appropriate model"
Pension watch : briefings on social protection in older age, Briefing no 5

Bridging the gaps between research, policy and practice in low- and middle-income countries : a survey of health care providers

GUINDON, G Emmanuel
et al
May 2010

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This article discusses the results of a survey to examine the gaps that continue to exist between research based evidence and clinical practice. Health care providers in 10 low- and middle-income countries were surveyed about their use of research-based evidence and examined factors that may facilitate or impede such use. The conclusion is that locally conducted or published research plays an important role in changing the professional practice of health care providers surveyed in low- and middle-income countries and increased investments in local research, or at least in locally adapted publications of research-based evidence from other settings, are therefore needed. Although access to the Internet was viewed as a significant factor in whether research-based evidence led to concrete changes in practice, few respondents reported having easy access to the Internet. Therefore, efforts to improve Internet access in clinical settings need to be accelerate

Bridging the gaps between research, policy and practice in low- and middle-income countries a survey of researchers

LAVIS, John N
et al
May 2010

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This article describes the findings from a study which examined efforts to bridge the gaps between research, policy and practice in 10 low- and middle-income countries in which researchers conducting research in one of four clinical areas relevant to the Millennium Development Goals: prevention of malaria (Ghana, Laos, Senegal and Tanzania), care of women seeking contraception (China, Kazakhstan, Laos and Mexico), care of children with diarrhoea (Ghana, India, Pakistan and Senegal) and care of patients with tuberculosis (China, India, Iran and Mexico) were surveyed

Don’t just do it, do it right : evidence for better health in low and middle income countries

THARYAN, Prathap
March 2010

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This article puts forward the argument that evidence for better health outcomes involves a two-step process: getting the right sort of evidence - evidence that is convincing and is for low- and middle-income countries - and getting this evidence used - through access to reliable evidence (such as the Cochrane Library) to getting evidence into policy and practice

The IMF, the global crisis and human resources for health : still constraining policy space

LEFRANÇOIS, Fabien
February 2010

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This report "...examines evidence from nine IMF country programmes, chosen based on their HIV prevalence rates, and finds that although the IMF has changed its tune and is talking about greater flexibility, these changes are not enough and are only temporary. "In 2006, the World Health Organisation (WHO) estimated that 57 countries were facing a severe health workforce crisis.... Addressing this shortage, and action alongside it to strengthen health systems around the world, requires substantial, concerted effort from both aid donors and recipient governments. The current global downturn threatens to undermine steps taken in this direction so far and jeopardise progress towards the health-related Millennium Development Goals. "...the IMF has adapted its rhetoric so that it now claims its programmes are more flexible on fiscal and monetary policies, which determine to what extent governments can maintain or increase spending - including of foreign aid - and stimulate economic activity"

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