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91. Ebola, Liberia, and the “Cult of Bankable Projects”

Author:
Shefa Siegel
Publication Date:
04-2015
Content Type:
Journal Article
Institution:
Carnegie Council
Abstract:
Fragile states are unable to cope with additional shocks like Ebola; without passable roads, electricity, and social solidarity there is no viable way to administer basic medical care or prevent minerals from illegally crossing porous borders, much less suddenly contain a runaway virus. Yet instead of addressing core issues of state failure, development aid continues pushing narrowly focused agendas that have little meaning in places where institutions and infrastructure are broken. Why, in response to the disastrous events we saw unfolding in Liberia, were we not calling for public and private investment in the region to be shifted from one bureaucratic budget line to another?
Topic:
Development, Humanitarian Aid, Infectious Diseases, Health Care Policy, and Ebola

92. Equatorial Guinea Plays a Leading Role in Combating Malaria

Author:
Mark L. Asquino
Publication Date:
09-2015
Content Type:
Journal Article
Journal:
The Ambassador's Review
Abstract:
In August 2014, I attended a ceremony at the Willard Hotel in Washington, DC that celebrated the tenth anniversary of the Bioko Island Malaria Control Project. Those speaking at the event included senior executives from Marathon Oil Corporation, Noble Energy Inc., and Atlantic Methanol Production Company, which are all US petroleum companies that operate in Equatorial Guinea. Teodoro Obiang Nguema Mbasogo, President of Equatorial Guinea, also delivered remarks. All of the speakers were enthusiastic about a dynamic project that has had a trans­formative effect on the health of generations of Equatoguineans by reducing the morbidity and mortality of malaria infection. What follows is an overview of the project’s history as well as the commitment to US innovation and a shared audacity to tackle one of human­kind’s most endemic and fatal diseases.
Topic:
Development, Health, Human Welfare, Infectious Diseases, and Health Care Policy
Political Geography:
United States and Equatorial Guinea

93. Quality and Accountability in Healthcare Delivery: Audit Evidence from Primary Care Providers in India

Author:
Jishnu Das, Alaka Holla, Aakash Mohpal, and Karthik Muralidharan
Publication Date:
02-2015
Content Type:
Working Paper
Institution:
Centre for Policy Research, India
Abstract:
We present among the first direct evidence on the quality of healthcare in low-income settings using a unique and original set of audit studies, where standardized patients were presented to a nearly-representative sample of rural public and private primary care providers in the Indian state of Madhya Pradesh. We report three main findings. First, private providers are mostly unqualified but spent more time with patients, and completed more items on a checklist of essential history and examination items than public providers, while being no different in their diagnostic and treatment accuracy. Second, we identify the private practices of qualified public sector doctors, and show that the same doctors exert higher effort and are more likely to provide correct treatment in their private practices. Third, we find a strong positive correlation between provider effort and prices charged in the private sector, whereas we find no correlation between effort and wages in the public sector. Our results suggest that market-based accountability in the unregulated private sector may be providing better incentives for provider effort than administrative accountability in the public sector in this setting. While the overall quality of care is low in both the public and private sectors, these differences in provider effort may partly explain the dominant market share of fee-charging private providers even in the presence of a system of free public healthcare.
Topic:
Government, Health, Privatization, Health Care Policy, Social Policy, and Rural
Political Geography:
South Asia, India, and Asia

94. Physician Shortages in the Indian Public Sector

Author:
Anjali Chikersal
Publication Date:
06-2015
Content Type:
Special Report
Institution:
Centre for Policy Research, India
Abstract:
India is one of the few countries that has been estimated to have a “critical” shortage of health workers and therefore unlikely to be able to provide essential health interventions to its people (WHO 2006). The dire impacts of these shortages are evident from the fact that it has fallen short of meeting its MDG goals on several fronts. As the current discourse on Universal Health Care debates the means of expanding coverage to all citizens, the one aspect universally agreed upon is the persistent challenge that a shortage of health workforce in the public sector poses, and the pressing need to address this gap. This policy brief outlines the core issues at the root of the problem and examines the reasons for the severe shortages in the key element of this workforce, the physicians, in the Indian public sector. It then provides an overview of WHO’s Global Policy Recommendations to address this challenge and looks at the strategies that various Indian states have so far adopted. Finally, it offers a set of practical and goal oriented recommendations aimed at directly and urgently addressing the challenge in the Indian context.
Topic:
Health, Governance, Health Care Policy, Public Policy, and Public Sector
Political Geography:
South Asia and India

95. Antimicrobial Resistance as an Emerging Threat to National Security

Author:
Maxine Builder
Publication Date:
01-2015
Content Type:
Working Paper
Institution:
Atlantic Council
Abstract:
Growing rates of antimicrobial resistance (AMR) pose a threat to public health that could undo many of the medical advances made over the last seventy years, eroding the global medical safety net and posing a significant threat to national security. Diseases once eliminated by a single course of antibiotics show drug resistance, often to several different classes of drugs. Some of the implications of increasing rates of AMR are intuitive, such as longer duration of illness, extended hospital stays, and higher rates of mortality. But other effects of a postantibiotics world are less obvious, such as the inability to perform life-saving operations or the ability for a simple scratch on the arm to kill. Humanity could soon find itself living in a reality in which communicable diseases such as tuberculosis, cholera, pneumonia, and other common infections cannot be controlled. This potentially catastrophic problem still can be abated, and the global health community, including the World Health Organization (WHO), has highlighted AMR as a priority in global health. But all sectors of the international community, not simply those in public health, need to take immediate steps to reverse the current trends and eliminate the systematic misuse of antimicrobial drugs, especially in livestock, and restore the pipeline of new antimicrobial drugs. The significant health and economic costs of AMR are difficult to quantify due to incomplete data that often underreports the extent of the problem, since there are no standard metrics or consensus on methodology to measure rates of AMR. But even the piecemeal statistics that exist paint a bleak picture. In a 2013 report, the US Centers for Disease Control and Prevention (CDC) reports at least two million Americans acquire serious infections to one or more strains of AMR bacteria annually, and at least 23,000 people die of these infections.1 A 2008 study estimated the excess direct costs to the US medical system attributable to AMR infections at $20 billion, with additional estimated productivity losses to be as high as $35 billion.2 With the increase in resistant infections and continuing rise in medical costs, the cost to the American medical system no doubt also has increased. This trend is not a uniquely American problem; it is truly global in scope. The European Union (EU) reports about 25,000 deaths annually due to drug-resistant bacteria, at an overall, combined cost of $2 billion in healthcare costs and productivity losses.3 There were over 14.7 million incidents of moderate-to-severe adverse reactions to antibiotics each year between 2001 and 2005 in China. Of these, 150,000 patients died annually.4 The most recent available data on China estimates that treatment of AMR infections during that same time period cost at least $477 million, with productivity losses of more than $55 million each year.5 A 2005 study of the United Kingdom (UK) found that the real annual gross domestic losses due to AMR were between 0.4 and 1.6 percent.6 Although slightly outdated, this estimate may be a useful guide in assessing the global impact of AMR, and given the trend of increasing resistance, it is likely that the impact will also increase accordingly. That said, it is prudent to repeat that the disparities in the quality of data reporting standards across China, the United States, the United Kingdom, and the European Union make it difficult to directly compare the severity of the impacts AMR has on each entity. The primary cause of AMR globally is antibiotic overuse and misuse, be it from doctors inappropriately prescribing antibiotics to treat viral infections or individuals seeking over-the-counter antibiotics for self-treatment. But another driver, less obvious than overuse in humans, is the use of antimicrobials in livestock, and the ratio of use in animals as compared to humans is astounding. In the United States, about 80 percent of all antibiotics are consumed in either agriculture or aquaculture. Generally, these drugs are administered to livestock as growth promoters and are medically unnecessary. Resistance in livestock quickly spreads to humans, and many community-acquired infections are the result of a contaminated food supply. Although most infections are acquired in the community, most deaths attributed to resistant infections occur in healthcare settings, and healthcare-acquired (or nosocomial) infections are another driver of AMR. At this point, AMR does not pose an immediate and direct threat to national security. Rather, this is a creeping global security crisis. If current trends continue, these drugs upon which the world relies will lose effectiveness. The gains made in fighting infectious diseases will be reversed, and a wide range of routine surgeries and easily treatable infections will become much more dangerous and deadly. This will cause the health of the world's working population to deteriorate, and the economic productivity and social cohesion of the globe to decline. At any time, a “black swan” event—triggered by an outbreak of drug-resistant tuberculosis, cholera, or pneumonia, for example—could prove catastrophic, endangering the fabric of societies and our globalized economy, forcing a stop to international trade and travel to prevent further spread. The issue of AMR is a tragedy of the commons in which individual incentives lead to the overuse and eventual destruction of a shared resource. International cooperation is required to walk back from this ledge and avoid a postantibiotics world, even though it is impossible to completely reverse the damage already done.
Topic:
Health, National Security, Infectious Diseases, and Health Care Policy
Political Geography:
United States, China, United Kingdom, America, and Europe

96. Better Hospitals, Better Health Systems, Better Health – A Proposal for a Global Hospital Collaborative for Emerging Economies

Author:
Center for Global Development
Publication Date:
11-2015
Content Type:
Special Report
Institution:
Center for Global Development
Abstract:
Hospitals are central to building and maintaining healthy populations around the world. They serve as the first point of care for many, offer access to specialized care, act as loci for medical education and research, and influence standards for national health systems at large. Yet despite their centrality within health systems, hospitals have been sidelined to the periphery of the global health agenda as scarce financial resources, technical expertise, and political will instead focus on the expansion of accessible primary care. As a result, many hospitals in low- and middle-income countries have failed to evolve and modernize, both in operations and infrastructure, while the knowledge base on hospital effectiveness and efficiency remains small and inadequate. In turn, the standard of care and efficiency achieved by these hospitals has stagnated. The gap in treatment capacity and quality between wealthier and poorer countries—and between hospitals serving wealthier and poorer populations—is widening, just as emerging economies are poised to expand the range and depth of healthcare through universal health coverage.
Topic:
World Health Organization and Health Care Policy
Political Geography:
Global Focus

97. Healthcare-Seeking Practices of African and Rural-to-Urban Migrants in Guangzhou

Author:
Tabea Bork-Huffer
Publication Date:
12-2015
Content Type:
Journal Article
Institution:
German Institute of Global and Area Studies
Abstract:
Taking the examples of Chinese rural-to-urban migrant and African migrant businesspeople in Guangzhou, this article inquires into the commonalities and differences in the health status and health- care-seeking practices of both groups. While both populations of migrants are diverse and heterogeneous, there are many commonali- ties with regard to the challenges they face compared to the Chinese local population. Mixed-methods research frameworks and qualitative and quantitative methods were applied. While existing publications emphasise lacking financial access to healthcare, further individual and social factors account for migrants’ healthcare choices. Their access to healthcare can be improved only by introducing insurance schemes with portable benefits, providing localised and culturally adequate health services adapted to migrants’ specific needs and health risks, and enhancing patient orientation and responsiveness by health professionals.
Topic:
Migration, Health Care Policy, Urban, and Rural
Political Geography:
Africa, China, and Asia