Overcoming health-systems constraints to achieve the Millennium Development Goals

Travis, Phyllida; Bennett, Sara; Haines, Andy; Pang, Tikki; Bhutta, Zulfiqar A; Hyder, Adnan A.; Pielemeier, N; Mills, Anne; Evans, Timothy

doi:10.1016/s0140-6736(04)16987-0

Cited by 689 publications

(561 citation statements)

References 7 publications

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“…In estimating the incremental resource requirement of a given test, it is important to consider the resources for TB control that are constrained in a given setting. In many cases, these constrained resources will be purely financial, but in others, there may be limitations on the availability of trained staff or laboratory capacity to perform certain tests 68 . The per-test incremental outlay of the most constrained resources is therefore also likely to vary from one setting to the next.…”

Section: S65mentioning

confidence: 99%

“…Although conventional economic evaluations of interventions against diseases such as TB implicitly consider money to be the most constrained resource, other studies in low-income settings have shown that human resources, laboratory capacity, regulatory infrastructure or ability to implement new interventions may be the key limiting factors 68 . This may be especially true in the modern era of direct assistance for health -which may supply money, but not resources in the form of trained personnel 82 .…”

Section: S65mentioning

confidence: 99%

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Understanding the incremental value of novel diagnostic tests for tuberculosis

Arinaminpathy

Dowdy

2015

Nature

109

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Tuberculosis is a major source of global mortality caused by infection, partly because of a tremendous ongoing burden of undiagnosed disease. Improved diagnostic technology may play an increasingly crucial part in global efforts to end tuberculosis, but the ability of diagnostic tests to curb tuberculosis transmission is dependent on multiple factors, including the time taken by a patient to seek health care, the patient's symptoms, and the patterns of transmission before diagnosis. Novel diagnostic assays for tuberculosis have conventionally been evaluated on the basis of characteristics such as sensitivity and specificity, using assumptions that probably overestimate the impact of diagnostic tests on transmission. We argue for a shift in focus to the evaluation of such tests' incremental value, defining outcomes that reflect each test's purpose (for example, transmissions averted) and comparing systems with the test against those without, in terms of those outcomes. Incremental value can also be measured in units of outcome per incremental unit of resource (for example, money or human capacity). Using a novel, simplified model of tuberculosis transmission that addresses some of the limitations of earlier tuberculosis diagnostic models, we demonstrate that the incremental value of any novel test depends not just on its accuracy, but also on elements such as patient behaviour, tuberculosis natural history and health systems. By integrating these factors into a single unified framework, we advance an approach to the evaluation of new diagnostic tests for tuberculosis that considers the incremental value at the population level and demonstrates how additional data could inform more-effective implementation of tuberculosis diagnostic tests under various conditions

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Section: S65mentioning

confidence: 99%

Section: S65mentioning

confidence: 99%

Understanding the incremental value of novel diagnostic tests for tuberculosis

Arinaminpathy

Dowdy

2015

Nature

109

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“…The first factor is the overall strength of the health system [36,37]. While measles and tetanus-specific deaths can be prevented by relatively simple interventions, such as immunization [38,39], more comprehensive interventions are needed to prevent deaths from pneumonia and diarrhea, involving more a comprehensive approach, including behavior change, inter-sectoral collaboration, and environmental improvements [39–41], all of which require a strengthened health system [42,43]. We suppose that a substantial share of specific causes in terms of contribution might have been attributed to some vertical programs generating considerable investment in specific diseases as part of global health initiatives around 2000 [36].…”

Section: Discussionmentioning

confidence: 99%

Cause-specific child mortality performance and contributions to all-cause child mortality, and number of child lives saved during the Millennium Development Goals era: a country-level analysis

Jin

Mankadi

Rigotti

et al. 2018

Global Health Action

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Background: During the Millennium Development Goal (MDG) era, impressive reductions in the under-5 mortality rate (U5MR) have been observed, although the MDG 4 target was not met. So far, cause-specific progress in child mortality has been analyzed and discussed mainly at the global and regional levels. Objectives: We aimed to explore annual changes in cause-specific mortality at the country level, assess which causes contributed the most to child mortality reduction in 2000–2015, and estimate how many child lives were saved. Methods: We used the cause-specific child mortality estimates published by Liu and colleagues. We derived average annual changes in cause-specific child mortality rates and cause-specific contribution to overall child mortality in 2000–2015. We estimated the number of cause-specific child deaths averted during the MDG era, assuming that cause-specific child mortality remained the same as in 2000. We targeted the 75 Countdown countries where 95% of maternal and child deaths occurred during the MDG era. Results: Wide disparities existed across causes within countries, both in neonatal and post-neonatal mortality reduction, except for a few countries such as China, Rwanda, and Cambodia. In 20 of the 45 sub-Saharan African countries, malaria was the main contributor to post-neonatal mortality reduction, and pneumonia was the main contributor in only six countries. A single disease often contributed to a substantial proportion of the child mortality reduction, particularly in west and central African countries. Diarrhea-specific post-neonatal child mortality reduction accounted for 7.1 million averted child deaths (24.5%), while pneumonia accounted for another 6.7 million averted child deaths (23%). Conclusions: This study demonstrates country-specific characteristics with regards to cause-wise child mortality that could not be identified by global or regional analyses. These findings provide the global community with evidence for formulating national policies and strategies to achieve the Sustainable Development Goals in child mortality reduction.

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“…110 However, that would be unacceptable to the women's health community. On the other hand, there are a wealth of interesting, heterodox experiences and local initiatives in the developing world that have worked in providing access to maternity care for poor women, but political awareness at international level (to acknowledge failings) and State democratisation and commitment will remain pivotal to overcome the challenges.…”

Section: Here Are Two Examples Of What Has Happenedmentioning

confidence: 99%