Search

Global population aging is the result of successes in public health, enabling longer life expectancy in many countries. The Asia Pacific region is aging more rapidly than many other parts of the world. The implications will be profound for every sector of society, requiring policy makers to reframe their thinking about the design of health and social systems to enable older populations to thrive. With increasing demand for more and different kinds of services, an imperative is shifting resources toward primary care for the prevention and comprehensive care of people with chronic conditions, and establishing linkages with community support. Major innovations are underway that accelerate progress in attaining universal health coverage for older populations. The renewed commitments under the Sustainable Development Goals to achieve universal health coverage offer a unique opportunity to invest in the foundations of the health system of the future.

The study aims to determine the type and extent of technical gaps faced by Chinese generic medicine manufacturers to achieve the standards of WHO Medicines Prequalification. The study was undertaken with four manufacturers producing anti-tuberculosis Fixed Dose Combinations (FDCs) in China from March 2010 to June 2011 and with 47 manufacturers producing anti-HIV/AIDS, anti-tuberculosis, and anti-malaria medicines in China in August 2011. The study assessed key elements required to comply with WHO Good Manufacturing Practices and completion of regulatory dossiers. For Good Manufacturing Practices, the study found technical gaps in quality management, validation and qualification, and calibration and maintenance. More technical gaps were identified in risk management and correction action and prevention action. For dossiers, the study found three technical gaps: bioequivalence testing, incomplete information from active pharmaceutical ingredients suppliers, and stability testing. The study indicates the need for technical assistance to Chinese generic medicine manufacturers, particularly for dossier preparation but also that technical gaps are attributed to differences between the standards of Chinese drug regulations and of WHO Medicines Prequalification Program.

Background The clinical specialty of obstetrics is under particular scrutiny with increasing litigation costs and unnecessary tests and procedures done in attempts to prevent litigation. We aimed to identify reports evaluating or comparing the effectiveness of medical liability reforms and quality improvement strategies in improving litigation-related outcomes in obstetrics. Methods We conducted a rapid scoping review with a 6-week timeline. MEDLINE, EMBASE, LexisNexis Academic, the Legal Scholarship Network, Justis, LegalTrac, QuickLaw, and HeinOnline were searched for publications in English from 2004 until June 2015. The selection criteria for screening were established a priori and pilot-tested. We included reports comparing or evaluating the impact of obstetrics-related medical liability reforms and quality improvement strategies on cost containment and litigation settlement across all countries. All levels of screening were done by two reviewers independently, and discrepancies were resolved by a third reviewer. In addition, two reviewers independently extracted relevant data using a pre-tested form, and discrepancies were resolved by a third reviewer. The results were summarized descriptively. Results The search resulted in 2729 citations, of which 14 reports met our eligibility criteria. Several initiatives for improving the medical malpractice litigation system were found, including no-fault approaches, patient safety policy initiatives, communication and resolution, caps on compensation and attorney fees, alternative payment system and liabilities, and limitations on litigation. Conclusions Only a few litigation policies in obstetrics were evaluated or compared. Included documents showed that initiatives to reduce medical malpractice litigation could be associated with a decrease in adverse and malpractice events. However, due to heterogeneous settings (e.g., economic structure, healthcare system) and variation in the outcomes reported, the advantages and disadvantages of initiatives may vary. Electronic supplementary material The online version of this article (10.1186/s13643-017-0569-5) contains supplementary material, which is available to authorized users.

ObjectivesThis review was commissioned by WHO, South Africa-Country office because of an exponential increase in medical litigation claims related to patient safety in obstetrical care in the country. A rapid review was conducted to examine the effectiveness of quality improvement (QI) strategies on maternal and newborn patient safety outcomes, risk of litigation and burden of associated costs.DesignA rapid review of the literature was conducted to provide decision-makers with timely evidence. Medical and legal databases (eg, MEDLINE, Embase, LexisNexis Academic, etc) and reference lists of relevant studies were searched. Two reviewers independently performed study selection, abstracted data and appraised risk of bias. Results were summarised narratively.InterventionsWe included randomised clinical trials (RCTs) of QI strategies targeting health systems (eg, team changes) and healthcare providers (eg, clinician education) to improve the safety of women and their newborns. Eligible studies were limited to trials published in English between 2004 and 2015.Primary and secondary outcome measuresRCTs reporting on patient safety outcomes (eg, stillbirths, mortality and caesarean sections), litigation claims and associated costs were included.ResultsThe search yielded 4793 citations, of which 10 RCTs met our eligibility criteria and provided information on over 500 000 participants. The results are presented by QI strategy, which varied from one study to another. Studies including provider education alone (one RCT), provider education in combination with audit and feedback (two RCTs) or clinician reminders (one RCT), as well as provider education with patient education and audit and feedback (one RCT), reported some improvements to patient safety outcomes. None of the studies reported on litigation claims or the associated costs.ConclusionsOur results suggest that provider education and other QI strategy combinations targeting healthcare providers may improve the safety of women and their newborns during childbirth.

Objectives: To determine if the quality of prenatal care predicts skilled institutional delivery, a primary means of reducing maternal mortality. Methods: The probability of skilled institutional delivery is predicted among 4173 rural low-income women of reproductive age in seven Mexican states, as a function of maternal retrospective reports about prenatal care services received in 1997–2003. Results: Women who received most prenatal care procedures were more likely to have a skilled institutional delivery (OR 2.29, 95% CI 1.18, 4.44). Women who received less than the 75th percentile of prenatal care procedures were not significantly different from those who received no prenatal care. Conclusions: Policies promoting increased access to prenatal services should be linked to the promotion of practice standards to impact health and behavioral outcomes.

Using published data about consumption, economic aspects, and legislation, this paper analyzes tobacco control in Indonesia, a major consumer and producer of tobacco products. Given its large population and smoking prevalence, Indonesia ranks fifth among countries with the highest tobacco consumption globally. Over 62% of Indonesian adult males smoke regularly, contributing to a growing burden of non-communicable diseases and enormous demands on the health care system. Tobacco control policies, however, have remained low on the political and public health agenda for many years. One reason was the contribution of tobacco to government revenues and employment, particularly in the industrial sector. But tobacco's importance in employment has fallen significantly since the 1970s from 38% of total manufacturing employment compared with 5.6% today. Widespread use of tobacco since the 1970s and the concomitant burden of non-communicable diseases have given rise to a more balanced view of the costs and benefits of tobacco production over the last decade. The first tobacco control regulation passed in 1999, succeeded by amendments in 2000 and 2003. Today, few restrictions exist on tobacco industry conduct, advertising, and promotion in Indonesia. We examine the relevance and prospects of advancing in Indonesia four cost-effective tobacco control strategies: price and tax measures, advertising bans, clean air legislation, and public education. We conclude with several suggestions for action for the public health community.

In recent decades, the influence of Brazil, the Russian Federation, India, China and South Africa (BRICS) within the international arena has increased enormously.1 These countries represent around 25% of the world’s gross national income, more than 40% of the world’s population and about 30% of the world’s land area.2 Although much attention has been paid to their economic performance, less widely noted is the fact that these countries are uniquely positioned to exert a decisive influence on health at the global level. Within BRICS countries, hundreds of millions of people have been lifted out of poverty. This has resulted in marked improvements in health outcomes and in substantial progress towards achieving the Millennium Development Goals.3,4 BRICS countries are also gravitating towards universal health coverage, although not at an even pace. They are leaders in the manufacture of low-cost medicines and vaccines.5 Their experiences in reducing poverty and strengthening health systems, together with their booming economies and large populations, explain why they exert such an enormous influence on health worldwide. Besides, in only a few years they have amassed a wealth of experience and knowledge from which other low- and middle-income countries can draw valuable examples. Despite their many assets, however, BRICS countries face important health problems. India has the highest number of maternal and infant deaths of any country in the world. South Africa has the greatest number of people with human immunodeficiency virus infection. Alcohol abuse is a major public health concern in the Russian Federation. In addition, BRICS countries’ strong economic growth has created a new set of problems that need to be addressed. Over the last decade, inequities in health and in the socioeconomic sphere have become accentuated in most of these countries.6 Although life expectancy has improved substantially in Brazil, China and India, BRICS countries as a whole still account for about 40% of the global burden of disease.7 They also face a “double” disease burden resulting from the coupling of infectious diseases with the emergence of new health problems triggered by environmental factors and to an increase in road traffic injuries and noncommunicable diseases. Tackling the social determinants of health continues to be a priority for BRICS countries. Globally, BRICS countries are becoming increasingly important partners in international development cooperation.8 They are helping to reshape the landscape of aid effectiveness. According to the final declaration of the Fourth High Level Forum on Aid Effectiveness, held in 2011 in Busan, the Republic of Korea, the nature, modalities and responsibilities that apply to South–South cooperation differ from those that apply to North–South cooperation.9 Although the development cooperation coming from BRICS countries has increased substantially in recent years, estimates vary because of differences in the approaches and methods used to report development cooperation for countries not represented in the Development Assistance Committee.10,11 Through “South–South” health cooperation, BRICS countries are able to reach populations beyond their own borders. These countries can engage in cooperation of this type either individually through bilateral agreements or collectively. Inter-BRICS cooperation is gaining momentum, as highlighted in the recent meeting of ministers of health held on 10–11 January 2013 in New Delhi.12 Moreover, the establishment of the BRICS development bank, agreed upon by BRICS leaders on 27 March 2013 in Durban, South Africa, will also contribute to the advancement of health in BRICS countries and beyond. The Bulletin plans to publish a theme issue on BRICS and global health to enhance people’s understanding of the dynamics of health and development in BRICS countries and of how these countries contribute to global health, both by improving health outcomes in their own territories and by engaging in mutual cooperation. This issue will cover these countries’ key health policy achievements and their most important health challenges, as well as their rising influence on international health cooperation. We welcome papers for all sections of the Bulletin and encourage authors to consider contributions on any of the following topics as they pertain to BRICS countries: universal health coverage; universal access to medicines or vaccines; emerging and existing public health challenges, notably health inequities and the double burden of disease; South–South cooperation and inter-BRICS cooperation. The deadline for submissions is October 2013. Manuscripts should be prepared in accordance with the Bulletin’s Guidelines for contributors and authors should mention this call for papers in a covering letter. All submissions will go through the Bulletin’s peer review process. Please submit to: http://submit.bwho.org.

In OECD countries, medicines spending accounts for approximately 17% of total health spending or 1.5% of gross domestic product (GDP) [1]. New technologies and pharmaceuticals have been important contributors to rising health care costs. At the same time, patients may not have access to cost–effective medicines because of lack of health insurance coverage, limited insurance benefits, high medicines prices, physician prescribing choices, or differences between available essential medicines and consumer demand [2]. With the exception of a few countries [3], however, the approach to reform tends to be piecemeal rather than comprehensive. With the goal of universal health care coverage by 2020, the Government of China has implemented comprehensive health care reforms nationwide [4]. Between 2009 and 2011, the reforms focused on increasing access to essential medicines as well as expanding health insurance, strengthening the primary care system, financing public health, and reforming public hospitals [5]. By 2011, government investments in health reform reached Yuan 1.13 trillion (US$ 174 billion, at Yuan 6.5 per US$) [6]. Total health expenditures increased from 3.5% to 5.0% of GDP between 1995 and 2010 – amounting to an increase from US$ 21 to US$ 220 per capita [7]. The reform of the essential medicines system is a major focus of the national reform agenda. Spending on medicines accounted for 41.9% of total health expenditures in 2010, or 2.1% of GDP (Figure 1) [7]. In this paper, we review existing literature, published government documents about the essential medicines reform in China, and international literature on essential medicines and health care reform internationally. The paper first presents economic and demographic trends to explain rapid increases in medicines consumption across China. The 2009 health care reform is discussed, in terms of each component’s linkage with medicines reforms. We discuss in detail the reform of the essential medicines system, including the Essential Medicines List (EML), procurement, pricing, financing, and quality. We conclude that China’s comprehensive approach in reforming its essential medicines system could be a model for other countries that strive to ensure access to medicines while also controlling costs. Figure 1 Private and general government health expenditures, and percent of total health spending devoted to pharmaceuticals, 1995–2010. Source: ref. [7].

The quality of reporting practice guidelines is often poor, and there is no widely accepted guidance or standards for such reporting in health care. The international RIGHT (Reporting Items for practice Guidelines in HealThcare) Working Group was established to address this gap. The group followed an existing framework for developing guidelines for health research reporting and the EQUATOR (Enhancing the QUAlity and Transparency Of health Research) Network approach. It developed a checklist and an explanation and elaboration statement. The RIGHT checklist includes 22 items that are considered essential for good reporting of practice guidelines: basic information (items 1 to 4), background (items 5 to 9), evidence (items 10 to 12), recommendations (items 13 to 15), review and quality assurance (items 16 and 17), funding and declaration and management of interests (items 18 and 19), and other information (items 20 to 22). The RIGHT checklist can assist developers in reporting guidelines, support journal editors and peer reviewers when considering guideline reports, and help health care practitioners understand and implement a guideline.

To evaluate the impact of Mexico's conditional cash transfer programme on the quality of health care received by poor women. Quality is measured by maternal reports of prenatal care procedures received that correspond with clinical guidelines.The data describe retrospective reports of care received from 892 women in poor rural communities in seven Mexican states. The women were participating in an effectiveness study and randomly assigned to incorporation into the programme in 1998 or 1999. Eligible women accepted cash transfers conditional on obtaining health care and nutritional supplements, and participated in health education sessions.Oportunidades beneficiaries received 12.2% more prenatal procedures compared with non-beneficiaries (adjusted mean 78.9, 95% Confidence Interval (CI): 77.5-80.3; P0.001).The Oportunidades conditional cash transfer programme is associated with better quality of prenatal care for low-income, rural women in Mexico. This result is probably a manifestation of the programme's empowerment goal, by encouraging beneficiaries to be informed and active health consumers.

One in three children globally is stunted in growth. Many of the conditions that promote child stunting are amenable to quality care provided by skilled health workers.The study uses household and facility data from the Indonesian Family Life Surveys in 1993 and 1997. The first set of multivariate regression models evaluate whether the number of medical doctors (MDs), nurses, and midwives predict quality of care as measured by adherence to clinical guidelines. The second set explains the relationships between quality and length among children less than 36 months. Using the information generated from these two sets of regressions, we simulate the effect of increasing the number of MDs, nurses, and midwives on child length and stunting.Increases in the number of MDs and nurses predict increases in the quality of care. Higher quality care is associated with child length in centimeters and stunting. Simulations suggest that large health gains among children under 24 months of age result by placing MDs where none are available.Improvements in child health could be made by increasing the number of qualified health staff. The returns to investing in improvements in human resources for health are high.

In Mexico, family planning advice has been incorporated into the clinical guidelines for prenatal care. However, the relationship between women's receipt of family planning advice during prenatal care and subsequent contraceptive use has not been evaluated.Data were collected in 2003 and 2004 in 17 Mexican states from 2,238 urban low-income women postpartum. Participating women reported on prenatal services received and contraceptive use. Logistic and multinomial logistic regression models evaluated whether receiving family planning advice during prenatal care predicted current contraceptive use, after quality of care in the community, service utilization, delivery characteristics, household socioeconomic characteristics, and maternal and infant characteristics were controlled for.Overall, 47% of women used a modern contraceptive method. Women who received family planning advice during prenatal care were more likely to use a contraceptive than were those who did not receive such advice (odds ratio, 2.2). Women who received family planning advice had a higher probability of using condoms (relative risk ratio, 2.3) and IUDs (5.2), and of undergoing sterilization (1.4), than of using no method.Integrating family planning advice into prenatal care may be an important strategy for reaching women when their demand for contraception is high.

Objective. To evaluate variations in prenatal care quality by public and private clinical settings and by household wealth. Design. The study uses 2003 data detailing retrospective reports of 12 prenatal care procedures received that correspond to clinical guidelines. The 12 procedures are summed up, and prenatal care quality is described as the average procedures received by clinical setting, provider qualifications, and household wealth. Setting. Low-income communities in 17 states in urban Mexico. Participants. A total of 1253 women of reproductive age who received prenatal care within 1 year of the survey. Main outcome measure. The mean of the 12 prenatal care procedures received, reported as unadjusted and adjusted for individual, household, and community characteristics. Results. Women received significantly more procedures in public clinical settings [80.7, 95% confidence interval (CI) = 79.3–82.1; P ≤ 0.05] compared with private (60.2, 95% CI = 57.8–62.7; P ≤ 0.05). Within private clinical settings, an increase in household wealth is associated with an increase in procedures received. Care from medical doctors is associated with significantly more procedures (78.8, 95% CI = 77.5–80.1; P ≤ 0.05) compared with non-medical doctors (50.3, 95% CI = 46.7–53.9; P ≤ 0.05). These differences are independent of individual, household, and community characteristics that affect health-seeking behavior. Conclusions. Significant differences in prenatal care quality exist across clinical settings, provider qualifications, and household wealth in urban Mexico. Strategies to improve quality include quality reporting, training, accreditation, regulation, and franchising.