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1. Assessing performance of the Healthcare Access and Quality Index, overall and by select age groups, for 204 countries and territories, 1990–2019: a systematic analysis from the Global Burden of Disease Study 2019

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Haakenstad, A, Yearwood, J, Fullman, N, Bintz, C, Bienhoff, K, Weaver, M, Nandakumar, V, Joffe, J, Legrand, K, Knight, M, Abbafati, C, Abbasi-Kangevari, M, Abdoli, A, Abeldano Zuniga, R, Adedeji, I, Adekanmbi, V, Adetokunboh, O, Afzal, M, Afzal, S, Agudelo-Botero, M, Ahinkorah, B, Ahmad, S, Ahmadi, A, Ahmadi, S, Ahmed, A, Ahmed Rashid, T, Aji, B, Akande-Sholabi, W, Alam, K, Al Hamad, H, Alhassan, R, Ali, L, Alipour, V, Aljunid, S, Ameyaw, E, Amin, T, Amu, H, Amugsi, D, Ancuceanu, R, Andrade, P, Anjum, A, Arabloo, J, Arab-Zozani, M, Ariffin, H, Arulappan, J, Aryan, Z, Ashraf, T, Atnafu, D, Atreya, A, Ausloos, M, Avila-Burgos, L, Ayano, G, Ayanore, M, Azari, S, Badiye, A, Baig, A, Bairwa, M, Bakkannavar, S, Baliga, S, Banik, P, Barnighausen, T, Barra, F, Barrow, A, Basu, S, Bayati, M, Belete, R, Bell, A, Bhagat, D, Bhagavathula, A, Bhardwaj, P, Bhardwaj, N, Bhaskar, S, Bhattacharyya, K, Bhutta, Z, Bibi, S, Bijani, A, Bikbov, B, Biondi, A, Bolarinwa, O, Bonny, A, Brenner, H, Buonsenso, D, Burkart, K, Busse, R, Butt, Z, Butt, N, Caetano dos Santos, F, Cahuana-Hurtado, L, Camera, L, Cardenas, R, Carneiro, V, Catala-Lopez, F, Chandan, J, Charan, J, Chavan, P, Chen, S, Choudhari, S, Chowdhury, E, Chowdhury, M, Cirillo, M, Corso, B, Dadras, O, Dahlawi, S, Dai, X, Dandona, L, Dandona, R, Dangel, W, Davila-Cervantes, C, Davletov, K, Deuba, K, Dhimal, M, Djalalinia, S, Do, H, Doshmangir, L, Duncan, B, Effiong, A, Ehsani-Chimeh, E, Elgendy, I, Elhadi, M, El Sayed, I, El Tantawi, M, Erku, D, Eskandarieh, S, Fares, J, Farzadfar, F, Ferrero, S, Ferro Desideri, L, Fischer, F, Foigt, N, Foroutan, M, Fukumoto, T, Gaal, P, Gaihre, S, Gardner, W, Garg, T, Getachew Obsa, A, Ghafourifard, M, Ghashghaee, A, Ghith, N, Gilani, S, Gill, P, Goharinezhad, S, Golechha, M, Guadamuz, J, Guo, Y, Gupta, R, Gupta, V, Hamiduzzaman, M, Hanif, A, Haro, J, Hasaballah, A, Hasan, M, Hashi, A, Hay, S, Hayat, K, Heidari, M, Heidari, G, Henry, N, Herteliu, C, Holla, R, Hossain, S, Hossain, M, Hosseinzadeh, M, Hostiuc, S, Hoveidamanesh, S, Hsieh, V, Hu, G, Huang, J, Huda, M, Ifeagwu, S, Ikuta, K, Ilesanmi, O, Irvani, S, Islam, R, Islam, S, Ismail, N, Iso, H, Isola, G, Itumalla, R, Iwagami, M, Jahani, M, Jahanmehr, N, Jain, R, Jakovljevic, M, Janodia, M, Jayapal, S, Jayaram, S, Jha, R, Jonas, J, Joo, T, Joseph, N, Jurisson, M, Kabir, A, Kalankesh, L, Kalhor, R, Kamath, A, Kamenov, K, Kandel, H, Kantar, R, Kapoor, N, Karanikolos, M, Katikireddi, S, Kavetskyy, T, Kawakami, N, Kayode, G, Keikavoosi-Arani, L, Keykhaei, M, Khader, Y, Khajuria, H, Khalilov, R, Khammarnia, M, Khan, M, Khezeli, M, Kim, M, Kim, Y, Kisa, S, Kisa, A, Klymchuk, V, Koly, K, Korzh, O, Kosen, S, Koul, P, Kuate Defo, B, Kumar, G, Kusuma, D, Kyu, H, Larsson, A, Lasrado, S, Lee, W, Lee, Y, Lee, C, Li, S, Lucchetti, G, Mahajan, P, Majeed, A, Makki, A, Malekzadeh, R, Malik, A, Malta, D, Mansournia, M, Mantovani, L, Martinez-Valle, A, Martins-Melo, F, Masoumi, S, Mathur, M, Maude, R, Maulik, P, Mckee, M, Mendoza, W, Menezes, R, Mensah, G, Meretoja, A, Meretoja, T, Mestrovic, T, Michalek, I, Mirrakhimov, E, Misganaw, A, Misra, S, Moazen, B, Mohammadi, M, Mohammed, S, Moitra, M, Mokdad, A, Molokhia, M, Monasta, L, Moni, M, Moradi, G, Moreira, R, Mosser, J, Mostafavi, E, Mouodi, S, Nagarajan, A, Nagata, C, Naghavi, M, Nangia, V, Narasimha Swamy, S, Narayana, A, Nascimento, B, Nassereldine, H, Nayak, B, Nazari, J, Negoi, I, Nepal, S, Neupane Kandel, S, Ngunjiri, J, Nguyen, H, Nguyen, C, Ningrum, D, Noubiap, J, Oancea, B, Oghenetega, O, Oh, I, Olagunju, A, Olakunde, B, Omar Bali, A, Omer, E, Onwujekwe, O, Otoiu, A, Padubidri, J, Palladino, R, Pana, A, Panda-Jonas, S, Pandi-Perumal, S, Pardhan, S, Pasupula, D, Pathak, P, Patton, G, Pawar, S, Pereira, J, Pilania, M, Piroozi, B, Podder, V, Pokhrel, K, Postma, M, Prada, S, Quazi Syed, Z, Rabiee, N, Radhakrishnan, R, Rahman, M, Rahmani, A, Ranabhat, C, Rao, C, Rao, S, Rasella, D, Rawaf, S, Rawaf, D, Rawal, L, Renzaho, A, Reshmi, B, Resnikoff, S, Rezapour, A, Riahi, S, Ripon, R, Sacco, S, Sadeghi, M, Saeed, U, Sahebkar, A, Sahiledengle, B, Sahoo, H, Sahu, M, Salama, J, Salamati, P, Samy, A, Sanabria, J, Santric-Milicevic, M, Sathian, B, Sawhney, M, Schmidt, M, Seidu, A, Sepanlou, S, Seylani, A, Shaikh, M, Sheikh, A, Shetty, A, Shigematsu, M, Shiri, R, Shivakumar, K, Shokri, A, Singh, J, Sinha, D, Skryabin, V, Skryabina, A, Sofi-Mahmudi, A, Sousa, R, Stephens, J, Sun, J, Szocska, M, Tabares-Seisdedos, R, Tadbiri, H, Tamiru, A, Thankappan, K, Topor-Madry, R, Tovani-Palone, M, Tran, M, Tran, B, Tripathi, N, Tripathy, J, Troeger, C, Uezono, D, Ullah, S, Ullah, A, Unnikrishnan, B, Vacante, M, Valadan Tahbaz, S, Valdez, P, Vasic, M, Veroux, M, Vervoort, D, Violante, F, Vladimirov, S, Vlassov, V, Vo, B, Waheed, Y, Wamai, R, Wang, Y, Ward, P, Wiangkham, T, Yadav, L, Yahyazadeh Jabbari, S, Yamagishi, K, Yaya, S, Yazdi-Feyzabadi, V, Yi, S, Yigit, V, Yonemoto, N, Younis, M, Yu, C, Yunusa, I, Zaman, S, Zastrozhin, M, Zhang, Z, Zhong, C, Zuniga, Y, Lim, S, Murray, C, Lozano, R, Haakenstad A., Yearwood J. A., Fullman N., Bintz C., Bienhoff K., Weaver M. R., Nandakumar V., Joffe J. N., LeGrand K. E., Knight M., Abbafati C., Abbasi-Kangevari M., Abdoli A., Abeldano Zuniga R. A., Adedeji I. A., Adekanmbi V., Adetokunboh O. O., Afzal M. S., Afzal S., Agudelo-Botero M., Ahinkorah B. O., Ahmad S., Ahmadi A., Ahmadi S., Ahmed A., Ahmed Rashid T., Aji B., Akande-Sholabi W., Alam K., Al Hamad H., Alhassan R. K., Ali L., Alipour V., Aljunid S. M., Ameyaw E. K., Amin T. T., Amu H., Amugsi D. A., Ancuceanu R., Andrade P. P., Anjum A., Arabloo J., Arab-Zozani M., Ariffin H., Arulappan J., Aryan Z., Ashraf T., Atnafu D. D., Atreya A., Ausloos M., Avila-Burgos L., Ayano G., Ayanore M. A., Azari S., Badiye A. D., Baig A. A., Bairwa M., Bakkannavar S. M., Baliga S., Banik P. C., Barnighausen T. W., Barra F., Barrow A., Basu S., Bayati M., Belete R., Bell A. W., Bhagat D. S., Bhagavathula A. S., Bhardwaj P., Bhardwaj N., Bhaskar S., Bhattacharyya K., Bhutta Z. A., Bibi S., Bijani A., Bikbov B., Biondi A., Bolarinwa O. A., Bonny A., Brenner H., Buonsenso D., Burkart K., Busse R., Butt Z. A., Butt N. S., Caetano dos Santos F. L., Cahuana-Hurtado L., Camera L. A., Cardenas R., Carneiro V. L. A., Catala-Lopez F., Chandan J. S., Charan J., Chavan P. P., Chen S., Choudhari S. G., Chowdhury E. K., Chowdhury M. A. K., Cirillo M., Corso B., Dadras O., Dahlawi S. M. A., Dai X., Dandona L., Dandona R., Dangel W. J., Davila-Cervantes C. A., Davletov K., Deuba K., Dhimal M., Dhimal M. L., Djalalinia S., Do H. P., Doshmangir L., Duncan B. B., Effiong A., Ehsani-Chimeh E., Elgendy I. Y., Elhadi M., El Sayed I., El Tantawi M., Erku D. A., Eskandarieh S., Fares J., Farzadfar F., Ferrero S., Ferro Desideri L., Fischer F., Foigt N. A., Foroutan M., Fukumoto T., Gaal P. A., Gaihre S., Gardner W. M., Garg T., Getachew Obsa A., Ghafourifard M., Ghashghaee A., Ghith N., Gilani S. A., Gill P. S., Goharinezhad S., Golechha M., Guadamuz J. S., Guo Y., Gupta R. D., Gupta R., Gupta V. K., Gupta V. B., Hamiduzzaman M., Hanif A., Haro J. M., Hasaballah A. I., Hasan M. M., Hasan M. T., Hashi A., Hay S. I., Hayat K., Heidari M., Heidari G., Henry N. J., Herteliu C., Holla R., Hossain S., Hossain S. J., Hossain M. B. H., Hosseinzadeh M., Hostiuc S., Hoveidamanesh S., Hsieh V. C. -R., Hu G., Huang J., Huda M. M., Ifeagwu S. C., Ikuta K. S., Ilesanmi O. S., Irvani S. S. N., Islam R. M., Islam S. M. S., Ismail N. E., Iso H., Isola G., Itumalla R., Iwagami M., Jahani M. A., Jahanmehr N., Jain R., Jakovljevic M., Janodia M. D., Jayapal S. K., Jayaram S., Jha R. P., Jonas J. B., Joo T., Joseph N., Jurisson M., Kabir A., Kalankesh L. R., Kalhor R., Kamath A. M., Kamenov K., Kandel H., Kantar R. S., Kapoor N., Karanikolos M., Katikireddi S. V., Kavetskyy T., Kawakami N., Kayode G. A., Keikavoosi-Arani L., Keykhaei M., Khader Y. S., Khajuria H., Khalilov R., Khammarnia M., Khan M. N., Khan M. A., Khan M., Khezeli M., Kim M. S., Kim Y. J., Kisa S., Kisa A., Klymchuk V., Koly K. N., Korzh O., Kosen S., Koul P. A., Kuate Defo B., Kumar G. A., Kusuma D., Kyu H. H., Larsson A. O., Lasrado S., Lee W. -C., Lee Y. H., Lee C. B., Li S., Lucchetti G., Mahajan P. B., Majeed A., Makki A., Malekzadeh R., Malik A. A., Malta D. C., Mansournia M. A., Mantovani L. G., Martinez-Valle A., Martins-Melo F. R., Masoumi S. Z., Mathur M. R., Maude R. J., Maulik P. K., McKee M., Mendoza W., Menezes R. G., Mensah G. A., Meretoja A., Meretoja T. J., Mestrovic T., Michalek I. M., Mirrakhimov E. M., Misganaw A., Misra S., Moazen B., Mohammadi M., Mohammed S., Moitra M., Mokdad A. H., Molokhia M., Monasta L., Moni M. A., Moradi G., Moreira R. S., Mosser J. F., Mostafavi E., Mouodi S., Nagarajan A. J., Nagata C., Naghavi M., Nangia V., Narasimha Swamy S., Narayana A. I., Nascimento B. R., Nassereldine H., Nayak B. P., Nazari J., Negoi I., Nepal S., Neupane Kandel S., Ngunjiri J. W., Nguyen H. L. T., Nguyen C. T., Ningrum D. N. A., Noubiap J. J., Oancea B., Oghenetega O. B., Oh I. -H., Olagunju A. T., Olakunde B. O., Omar Bali A., Omer E., Onwujekwe O. E., Otoiu A., Padubidri J. R., Palladino R., Pana A., Panda-Jonas S., Pandi-Perumal S. R., Pardhan S., Pasupula D. K., Pathak P. K., Patton G. C., Pawar S., Pereira J., Pilania M., Piroozi B., Podder V., Pokhrel K. N., Postma M. J., Prada S. I., Quazi Syed Z., Rabiee N., Radhakrishnan R. A., Rahman M. M., Rahman M., Rahman M. H. U., Rahmani A. M., Ranabhat C. L., Rao C. R., Rao S. J., Rasella D., Rawaf S., Rawaf D. L., Rawal L., Renzaho A. M. N., Reshmi B., Resnikoff S., Rezapour A., Riahi S. M., Ripon R. K., Sacco S., Sadeghi M., Saeed U., Sahebkar A., Sahiledengle B., Sahoo H., Sahu M., Salama J. S., Salamati P., Samy A. M., Sanabria J., Santric-Milicevic M. M., Sathian B., Sawhney M., Schmidt M. I., Seidu A. -A., Sepanlou S. G., Seylani A., Shaikh M. A., Sheikh A., Shetty A., Shigematsu M., Shiri R., Shivakumar K. M., Shokri A., Singh J. A., Sinha D. N., Skryabin V. Y., Skryabina A. A., Sofi-Mahmudi A., Sousa R. A. R. C., Stephens J. H., Sun J., Szocska M., Tabares-Seisdedos R., Tadbiri H., Tamiru A. T., Thankappan K. R., Topor-Madry R., Tovani-Palone M. R., Tran M. T. N., Tran B. X., Tripathi N., Tripathy J. P., Troeger C. E., Uezono D. R., Ullah S., Ullah A., Unnikrishnan B., Vacante M., Valadan Tahbaz S., Valdez P. R., Vasic M., Veroux M., Vervoort D., Violante F. S., Vladimirov S. K., Vlassov V., Vo B., Waheed Y., Wamai R. G., Wang Y. -P., Wang Y., Ward P., Wiangkham T., Yadav L., Yahyazadeh Jabbari S. H., Yamagishi K., Yaya S., Yazdi-Feyzabadi V., Yi S., Yigit V., Yonemoto N., Younis M. Z., Yu C., Yunusa I., Zaman S. B., Zastrozhin M. S., Zhang Z. -J., Zhong C., Zuniga Y. M. H., Lim S. S., Murray C. J. L., Lozano R., Haakenstad, A, Yearwood, J, Fullman, N, Bintz, C, Bienhoff, K, Weaver, M, Nandakumar, V, Joffe, J, Legrand, K, Knight, M, Abbafati, C, Abbasi-Kangevari, M, Abdoli, A, Abeldano Zuniga, R, Adedeji, I, Adekanmbi, V, Adetokunboh, O, Afzal, M, Afzal, S, Agudelo-Botero, M, Ahinkorah, B, Ahmad, S, Ahmadi, A, Ahmadi, S, Ahmed, A, Ahmed Rashid, T, Aji, B, Akande-Sholabi, W, Alam, K, Al Hamad, H, Alhassan, R, Ali, L, Alipour, V, Aljunid, S, Ameyaw, E, Amin, T, Amu, H, Amugsi, D, Ancuceanu, R, Andrade, P, Anjum, A, Arabloo, J, Arab-Zozani, M, Ariffin, H, Arulappan, J, Aryan, Z, Ashraf, T, Atnafu, D, Atreya, A, Ausloos, M, Avila-Burgos, L, Ayano, G, Ayanore, M, Azari, S, Badiye, A, Baig, A, Bairwa, M, Bakkannavar, S, Baliga, S, Banik, P, Barnighausen, T, Barra, F, Barrow, A, Basu, S, Bayati, M, Belete, R, Bell, A, Bhagat, D, Bhagavathula, A, Bhardwaj, P, Bhardwaj, N, Bhaskar, S, Bhattacharyya, K, Bhutta, Z, Bibi, S, Bijani, A, Bikbov, B, Biondi, A, Bolarinwa, O, Bonny, A, Brenner, H, Buonsenso, D, Burkart, K, Busse, R, Butt, Z, Butt, N, Caetano dos Santos, F, Cahuana-Hurtado, L, Camera, L, Cardenas, R, Carneiro, V, Catala-Lopez, F, Chandan, J, Charan, J, Chavan, P, Chen, S, Choudhari, S, Chowdhury, E, Chowdhury, M, Cirillo, M, Corso, B, Dadras, O, Dahlawi, S, Dai, X, Dandona, L, Dandona, R, Dangel, W, Davila-Cervantes, C, Davletov, K, Deuba, K, Dhimal, M, Djalalinia, S, Do, H, Doshmangir, L, Duncan, B, Effiong, A, Ehsani-Chimeh, E, Elgendy, I, Elhadi, M, El Sayed, I, El Tantawi, M, Erku, D, Eskandarieh, S, Fares, J, Farzadfar, F, Ferrero, S, Ferro Desideri, L, Fischer, F, Foigt, N, Foroutan, M, Fukumoto, T, Gaal, P, Gaihre, S, Gardner, W, Garg, T, Getachew Obsa, A, Ghafourifard, M, Ghashghaee, A, Ghith, N, Gilani, S, Gill, P, Goharinezhad, S, Golechha, M, Guadamuz, J, Guo, Y, Gupta, R, Gupta, V, Hamiduzzaman, M, Hanif, A, Haro, J, Hasaballah, A, Hasan, M, Hashi, A, Hay, S, Hayat, K, Heidari, M, Heidari, G, Henry, N, Herteliu, C, Holla, R, Hossain, S, Hossain, M, Hosseinzadeh, M, Hostiuc, S, Hoveidamanesh, S, Hsieh, V, Hu, G, Huang, J, Huda, M, Ifeagwu, S, Ikuta, K, Ilesanmi, O, Irvani, S, Islam, R, Islam, S, Ismail, N, Iso, H, Isola, G, Itumalla, R, Iwagami, M, Jahani, M, Jahanmehr, N, Jain, R, Jakovljevic, M, Janodia, M, Jayapal, S, Jayaram, S, Jha, R, Jonas, J, Joo, T, Joseph, N, Jurisson, M, Kabir, A, Kalankesh, L, Kalhor, R, Kamath, A, Kamenov, K, Kandel, H, Kantar, R, Kapoor, N, Karanikolos, M, Katikireddi, S, Kavetskyy, T, Kawakami, N, Kayode, G, Keikavoosi-Arani, L, Keykhaei, M, Khader, Y, Khajuria, H, Khalilov, R, Khammarnia, M, Khan, M, Khezeli, M, Kim, M, Kim, Y, Kisa, S, Kisa, A, Klymchuk, V, Koly, K, Korzh, O, Kosen, S, Koul, P, Kuate Defo, B, Kumar, G, Kusuma, D, Kyu, H, Larsson, A, Lasrado, S, Lee, W, Lee, Y, Lee, C, Li, S, Lucchetti, G, Mahajan, P, Majeed, A, Makki, A, Malekzadeh, R, Malik, A, Malta, D, Mansournia, M, Mantovani, L, Martinez-Valle, A, Martins-Melo, F, Masoumi, S, Mathur, M, Maude, R, Maulik, P, Mckee, M, Mendoza, W, Menezes, R, Mensah, G, Meretoja, A, Meretoja, T, Mestrovic, T, Michalek, I, Mirrakhimov, E, Misganaw, A, Misra, S, Moazen, B, Mohammadi, M, Mohammed, S, Moitra, M, Mokdad, A, Molokhia, M, Monasta, L, Moni, M, Moradi, G, Moreira, R, Mosser, J, Mostafavi, E, Mouodi, S, Nagarajan, A, Nagata, C, Naghavi, M, Nangia, V, Narasimha Swamy, S, Narayana, A, Nascimento, B, Nassereldine, H, Nayak, B, Nazari, J, Negoi, I, Nepal, S, Neupane Kandel, S, Ngunjiri, J, Nguyen, H, Nguyen, C, Ningrum, D, Noubiap, J, Oancea, B, Oghenetega, O, Oh, I, Olagunju, A, Olakunde, B, Omar Bali, A, Omer, E, Onwujekwe, O, Otoiu, A, Padubidri, J, Palladino, R, Pana, A, Panda-Jonas, S, Pandi-Perumal, S, Pardhan, S, Pasupula, D, Pathak, P, Patton, G, Pawar, S, Pereira, J, Pilania, M, Piroozi, B, Podder, V, Pokhrel, K, Postma, M, Prada, S, Quazi Syed, Z, Rabiee, N, Radhakrishnan, R, Rahman, M, Rahmani, A, Ranabhat, C, Rao, C, Rao, S, Rasella, D, Rawaf, S, Rawaf, D, Rawal, L, Renzaho, A, Reshmi, B, Resnikoff, S, Rezapour, A, Riahi, S, Ripon, R, Sacco, S, Sadeghi, M, Saeed, U, Sahebkar, A, Sahiledengle, B, Sahoo, H, Sahu, M, Salama, J, Salamati, P, Samy, A, Sanabria, J, Santric-Milicevic, M, Sathian, B, Sawhney, M, Schmidt, M, Seidu, A, Sepanlou, S, Seylani, A, Shaikh, M, Sheikh, A, Shetty, A, Shigematsu, M, Shiri, R, Shivakumar, K, Shokri, A, Singh, J, Sinha, D, Skryabin, V, Skryabina, A, Sofi-Mahmudi, A, Sousa, R, Stephens, J, Sun, J, Szocska, M, Tabares-Seisdedos, R, Tadbiri, H, Tamiru, A, Thankappan, K, Topor-Madry, R, Tovani-Palone, M, Tran, M, Tran, B, Tripathi, N, Tripathy, J, Troeger, C, Uezono, D, Ullah, S, Ullah, A, Unnikrishnan, B, Vacante, M, Valadan Tahbaz, S, Valdez, P, Vasic, M, Veroux, M, Vervoort, D, Violante, F, Vladimirov, S, Vlassov, V, Vo, B, Waheed, Y, Wamai, R, Wang, Y, Ward, P, Wiangkham, T, Yadav, L, Yahyazadeh Jabbari, S, Yamagishi, K, Yaya, S, Yazdi-Feyzabadi, V, Yi, S, Yigit, V, Yonemoto, N, Younis, M, Yu, C, Yunusa, I, Zaman, S, Zastrozhin, M, Zhang, Z, Zhong, C, Zuniga, Y, Lim, S, Murray, C, Lozano, R, Haakenstad A., Yearwood J. A., Fullman N., Bintz C., Bienhoff K., Weaver M. R., Nandakumar V., Joffe J. N., LeGrand K. E., Knight M., Abbafati C., Abbasi-Kangevari M., Abdoli A., Abeldano Zuniga R. A., Adedeji I. A., Adekanmbi V., Adetokunboh O. O., Afzal M. S., Afzal S., Agudelo-Botero M., Ahinkorah B. O., Ahmad S., Ahmadi A., Ahmadi S., Ahmed A., Ahmed Rashid T., Aji B., Akande-Sholabi W., Alam K., Al Hamad H., Alhassan R. K., Ali L., Alipour V., Aljunid S. M., Ameyaw E. K., Amin T. T., Amu H., Amugsi D. A., Ancuceanu R., Andrade P. P., Anjum A., Arabloo J., Arab-Zozani M., Ariffin H., Arulappan J., Aryan Z., Ashraf T., Atnafu D. D., Atreya A., Ausloos M., Avila-Burgos L., Ayano G., Ayanore M. A., Azari S., Badiye A. D., Baig A. A., Bairwa M., Bakkannavar S. M., Baliga S., Banik P. C., Barnighausen T. W., Barra F., Barrow A., Basu S., Bayati M., Belete R., Bell A. W., Bhagat D. S., Bhagavathula A. S., Bhardwaj P., Bhardwaj N., Bhaskar S., Bhattacharyya K., Bhutta Z. A., Bibi S., Bijani A., Bikbov B., Biondi A., Bolarinwa O. A., Bonny A., Brenner H., Buonsenso D., Burkart K., Busse R., Butt Z. A., Butt N. S., Caetano dos Santos F. L., Cahuana-Hurtado L., Camera L. A., Cardenas R., Carneiro V. L. A., Catala-Lopez F., Chandan J. S., Charan J., Chavan P. P., Chen S., Choudhari S. G., Chowdhury E. K., Chowdhury M. A. K., Cirillo M., Corso B., Dadras O., Dahlawi S. M. A., Dai X., Dandona L., Dandona R., Dangel W. J., Davila-Cervantes C. A., Davletov K., Deuba K., Dhimal M., Dhimal M. L., Djalalinia S., Do H. P., Doshmangir L., Duncan B. B., Effiong A., Ehsani-Chimeh E., Elgendy I. Y., Elhadi M., El Sayed I., El Tantawi M., Erku D. A., Eskandarieh S., Fares J., Farzadfar F., Ferrero S., Ferro Desideri L., Fischer F., Foigt N. A., Foroutan M., Fukumoto T., Gaal P. A., Gaihre S., Gardner W. M., Garg T., Getachew Obsa A., Ghafourifard M., Ghashghaee A., Ghith N., Gilani S. A., Gill P. S., Goharinezhad S., Golechha M., Guadamuz J. S., Guo Y., Gupta R. D., Gupta R., Gupta V. K., Gupta V. B., Hamiduzzaman M., Hanif A., Haro J. M., Hasaballah A. I., Hasan M. M., Hasan M. T., Hashi A., Hay S. I., Hayat K., Heidari M., Heidari G., Henry N. J., Herteliu C., Holla R., Hossain S., Hossain S. J., Hossain M. B. H., Hosseinzadeh M., Hostiuc S., Hoveidamanesh S., Hsieh V. C. -R., Hu G., Huang J., Huda M. M., Ifeagwu S. C., Ikuta K. S., Ilesanmi O. S., Irvani S. S. N., Islam R. M., Islam S. M. S., Ismail N. E., Iso H., Isola G., Itumalla R., Iwagami M., Jahani M. A., Jahanmehr N., Jain R., Jakovljevic M., Janodia M. D., Jayapal S. K., Jayaram S., Jha R. P., Jonas J. B., Joo T., Joseph N., Jurisson M., Kabir A., Kalankesh L. R., Kalhor R., Kamath A. M., Kamenov K., Kandel H., Kantar R. S., Kapoor N., Karanikolos M., Katikireddi S. V., Kavetskyy T., Kawakami N., Kayode G. A., Keikavoosi-Arani L., Keykhaei M., Khader Y. S., Khajuria H., Khalilov R., Khammarnia M., Khan M. N., Khan M. A., Khan M., Khezeli M., Kim M. S., Kim Y. J., Kisa S., Kisa A., Klymchuk V., Koly K. N., Korzh O., Kosen S., Koul P. A., Kuate Defo B., Kumar G. A., Kusuma D., Kyu H. H., Larsson A. O., Lasrado S., Lee W. -C., Lee Y. H., Lee C. B., Li S., Lucchetti G., Mahajan P. B., Majeed A., Makki A., Malekzadeh R., Malik A. A., Malta D. C., Mansournia M. A., Mantovani L. G., Martinez-Valle A., Martins-Melo F. R., Masoumi S. Z., Mathur M. R., Maude R. J., Maulik P. K., McKee M., Mendoza W., Menezes R. G., Mensah G. A., Meretoja A., Meretoja T. J., Mestrovic T., Michalek I. M., Mirrakhimov E. M., Misganaw A., Misra S., Moazen B., Mohammadi M., Mohammed S., Moitra M., Mokdad A. H., Molokhia M., Monasta L., Moni M. A., Moradi G., Moreira R. S., Mosser J. F., Mostafavi E., Mouodi S., Nagarajan A. J., Nagata C., Naghavi M., Nangia V., Narasimha Swamy S., Narayana A. I., Nascimento B. R., Nassereldine H., Nayak B. P., Nazari J., Negoi I., Nepal S., Neupane Kandel S., Ngunjiri J. W., Nguyen H. L. T., Nguyen C. T., Ningrum D. N. A., Noubiap J. J., Oancea B., Oghenetega O. B., Oh I. -H., Olagunju A. T., Olakunde B. O., Omar Bali A., Omer E., Onwujekwe O. E., Otoiu A., Padubidri J. R., Palladino R., Pana A., Panda-Jonas S., Pandi-Perumal S. R., Pardhan S., Pasupula D. K., Pathak P. K., Patton G. C., Pawar S., Pereira J., Pilania M., Piroozi B., Podder V., Pokhrel K. N., Postma M. J., Prada S. I., Quazi Syed Z., Rabiee N., Radhakrishnan R. A., Rahman M. M., Rahman M., Rahman M. H. U., Rahmani A. M., Ranabhat C. L., Rao C. R., Rao S. J., Rasella D., Rawaf S., Rawaf D. L., Rawal L., Renzaho A. M. N., Reshmi B., Resnikoff S., Rezapour A., Riahi S. M., Ripon R. K., Sacco S., Sadeghi M., Saeed U., Sahebkar A., Sahiledengle B., Sahoo H., Sahu M., Salama J. S., Salamati P., Samy A. M., Sanabria J., Santric-Milicevic M. M., Sathian B., Sawhney M., Schmidt M. I., Seidu A. -A., Sepanlou S. G., Seylani A., Shaikh M. A., Sheikh A., Shetty A., Shigematsu M., Shiri R., Shivakumar K. M., Shokri A., Singh J. A., Sinha D. N., Skryabin V. Y., Skryabina A. A., Sofi-Mahmudi A., Sousa R. A. R. C., Stephens J. H., Sun J., Szocska M., Tabares-Seisdedos R., Tadbiri H., Tamiru A. T., Thankappan K. R., Topor-Madry R., Tovani-Palone M. R., Tran M. T. N., Tran B. X., Tripathi N., Tripathy J. P., Troeger C. E., Uezono D. R., Ullah S., Ullah A., Unnikrishnan B., Vacante M., Valadan Tahbaz S., Valdez P. R., Vasic M., Veroux M., Vervoort D., Violante F. S., Vladimirov S. K., Vlassov V., Vo B., Waheed Y., Wamai R. G., Wang Y. -P., Wang Y., Ward P., Wiangkham T., Yadav L., Yahyazadeh Jabbari S. H., Yamagishi K., Yaya S., Yazdi-Feyzabadi V., Yi S., Yigit V., Yonemoto N., Younis M. Z., Yu C., Yunusa I., Zaman S. B., Zastrozhin M. S., Zhang Z. -J., Zhong C., Zuniga Y. M. H., Lim S. S., Murray C. J. L., and Lozano R.

Abstract

Background: Health-care needs change throughout the life course. It is thus crucial to assess whether health systems provide access to quality health care for all ages. Drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019), we measured the Healthcare Access and Quality (HAQ) Index overall and for select age groups in 204 locations from 1990 to 2019. Methods: We distinguished the overall HAQ Index (ages 0–74 years) from scores for select age groups: the young (ages 0–14 years), working (ages 15–64 years), and post-working (ages 65–74 years) groups. For GBD 2019, HAQ Index construction methods were updated to use the arithmetic mean of scaled mortality-to-incidence ratios (MIRs) and risk-standardised death rates (RSDRs) for 32 causes of death that should not occur in the presence of timely, quality health care. Across locations and years, MIRs and RSDRs were scaled from 0 (worst) to 100 (best) separately, putting the HAQ Index on a different relative scale for each age group. We estimated absolute convergence for each group on the basis of whether the HAQ Index grew faster in absolute terms between 1990 and 2019 in countries with lower 1990 HAQ Index scores than countries with higher 1990 HAQ Index scores and by Socio-demographic Index (SDI) quintile. SDI is a summary metric of overall development. Findings: Between 1990 and 2019, the HAQ Index increased overall (by 19·6 points, 95% uncertainty interval 17·9–21·3), as well as among the young (22·5, 19·9–24·7), working (17·2, 15·2–19·1), and post-working (15·1, 13·2–17·0) age groups. Large differences in HAQ Index scores were present across SDI levels in 2019, with the overall index ranging from 30·7 (28·6–33·0) on average in low-SDI countries to 83·4 (82·4–84·3) on average in high-SDI countries. Similarly large ranges between low-SDI and high-SDI countries, respectively, were estimated in the HAQ Index for the young (40·4–89·0), working (33·8–82·8), and post-working (30·4–79·1) g

Published
2022

2. Assessing performance of the Healthcare Access and Quality Index, overall and by select age groups, for 204 countries and territories, 1990-2019: a systematic analysis from the Global Burden of Disease Study 2019

Author

Lozano, R., Haakenstad, A., Yearwood, J. A., Fullman, N., Bintz, C., Bienhoff, K., Weaver, M. R., Nandakumar, V., Joffe, J. N., LeGrand, K. E., Knight, M., Abbafati, C., Abbasi-Kangevari, M., Abdoli, A., Zuniga, R. A. A., Adedeji, I. A., Adekanmbi, V., Adetokunboh, O. O., Afzal, M. S., Afzal, S., Agudelo-Botero, M., Ahinkorah, B. O., Ahmad, S., Ahmadi, A., Ahmadi, S., Ahmed, A., Rashid, T. A., Aji, B., Akande-Sholabi, W., Alam, K., Al Hamad, H., Alhassan, R. K., Ali, L., Alipour, V., Aljunid, S. M., Ameyaw, E. K., Amin, T. T., Amu, H., Amugsi, D. A., Ancuceanu, R., Andrade, P. P., Anjum, A., Arabloo, J., Arab-Zozani, M., Ariffin, H., Arulappan, J., Aryan, Z., Ashraf, T., Atnafu, D. D., Atreya, A., Ausloos, M., Avila-Burgos, L., Ayano, G., Ayanore, M. A., Azari, S., Badiye, A. D., Baig, A. A., Bairwa, M., Bakkannavar, S. M., Baliga, S., Banik, P. C., Barnighausen, T. W., Barra, F., Barrow, A., Basu, S., Bayati, M., Belete, R., Bell, A. W., Bhagat, D. S., Bhagavathula, A. S., Bhardwaj, P., Bhardwaj, N., Bhaskar, S., Bhattacharyya, K., Bhutta, Z. A., Bibi, S., Bijani, A., Bikbov, B., Biondi, A., Bolarinwa, O. A., Bonny, A., Brenner, H., Buonsenso, D., Burkart, K., Busse, R., Butt, Z. A., Butt, N. S., dos Santos, F. L. C., Cahuana Hurtado, Lucero, Camera, Luis Alberto, Cardenas, R., Carneiro, V. L. A., Catala-Lopez, F., Chandan, J. S., Charan, J., Chavan, P. P., Chen, S. M., Chen, S., Choudhari, S. G., Chowdhury, E. K., Chowdhury, M. A. K., Cirillo, M., Corso, B., Dadras, O., Dahlawi, S. M. A., Dai, X. C., Dandona, L., Dandona, R., Dangel, W. J., Davila-Cervantes, C. A., Davletov, K., Deuba, K., Dhimal, M., Dhimal, M. L., Djalalinia, S., Do, H. P., Doshmangir, L., Duncan, B. B., Effiong, A., Ehsani-Chimeh, E., Elgendy, I. Y., Elhadi, M., El Sayed, I., El Tantawi, M., Erku, D. A., Eskandarieh, S., Fares, J., Farzadfar, F., Ferrero, S., Desideri, L. F., Fischer, F., Foigt, N. A., Foroutan, M., Fukumoto, T., Gaal, P. A., Gaihre, S., Gardner, W. M., Garg, T., Obsa, A. G., Ghafourifard, M., Ghashghaee, A., Ghith, N., Gilani, S. A., Gill, P. S., Goharinezhad, S., Golechha, M., Guadamuz, J. S., Guo, Y. M., Das Gupta, R., Gupta, R., Gupta, V. K., Gupta, V. B., Hamiduzzaman, M., Hanif, A., Haro, J. M., Hasaballah, A. I., Hasan, M. M., Hasan, M. T., Hashi, A., Hay, S. I., Hayat, K., Heidari, M., Heidari, G., Henry, N. J., Herteliu, C., Holla, R., Hossain, S., Hossain, S. J., Hossain, M. B. H., Hosseinzadeh, M., Hostiuc, S., Hoveidamanesh, S., Hsieh, V. C. R., Hu, G. Q., Huang, J. J., Huda, M. M., Ifeagwu, S. C., Ikuta, K. S., Ilesanmi, O. S., Irvani, S. S. N., Islam, R. M., Islam, S. M. S., Ismail, N. E., Iso, H., Isola, G., Itumalla, R., Iwagami, M., Jahani, M. A., Jahanmehr, N., Jain, R., Jakovljevic, M., Janodia, M. D., Jayapal, S. K., Jayaram, S., Jha, R. P., Jonas, J. B., Joo, T., Joseph, N., Jurisson, M., Kabir, A., Kalankesh, L. R., Kalhor, R., Kamath, A. M., Kamenov, K., Kandel, H., Kantar, R. S., Kapoor, N., Karanikolos, M., Katikireddi, S. V., Kavetskyy, T., Kawakami, N., Kayode, G. A., Keikavoosi-Arani, L., Keykhaei, M., Khader, Y. S., Khajuria, H., Khalilov, R., Khammarnia, M., Khan, M. N., Khan, M. A. B., Khan, M., Khezeli, M., Kim, M. S., Kim, Y. J., Kisa, S., Kisa, A., Klymchuk, V., Koly, K. N., Korzh, O., Kosen, S., Koul, P. A., Defo, B. K., Kumar, G. A., Kusuma, D., Kyu, H. H., Larsson, A. O., Lasrado, S., Lee, W. C., Lee, Y. H., Lee, C. B., Li, S. S., Lucchetti, G., Mahajan, P. B., Majeed, A., Makki, A., Malekzadeh, R., Malik, A. A., Malta, D. C., Mansournia, M. A., Mantovani, L. G., Martinez-Valle, A., Martins-Melo, F. R., Masoumi, S. Z., Mathur, M. R., Maude, R. J., Maulik, P. K., McKee, M., Mendoza, W., Menezes, R. G., Mensah, G. A., Meretoja, A., Meretoja, T. J., Mestrovic, T., Michalek, I. M., Mirrakhimov, E. M., Misganaw, A., Misra, S., Moazen, B., Mohammadi, M., Mohammed, S., Moitra, M., Mokdad, A. H., Molokhia, M., Monasta, L., Moni, M. A., Moradi, G., Moreira, R. S., Mosser, J. F., Mostafavi, E., Mouodi, S., Nagarajan, A. J., Nagata, C., Naghavi, M., Nangia, V., Swamy, S. N., Narayana, A. I., Nascimento, B. R., Nassereldine, H., Nayak, B. P., Nazari, J., Negoi, I., Nepal, S., Kandel, S. N., Ngunjiri, J. W., Nguyen, H. L. T, Nguyen, C. T., Ningrum, D. N. A., Noubiap, J. J., Oancea, B., Oghenetega, O. B., Oh, I. H., Olagunju, A. T., Olakunde, B. O., Bali, A. O., Omer, E., Onwujekwe, O. E., Otoiu, A., Padubidri, J. R., Palladino, R., Pana, A., Panda-Jonas, S., Pandi-Perumal, S. R., Pardhan, S., Pasupula, D. K., Pathak, P. K., Patton, G. C., Pawar, S., Pereira, J., Pilania, M., Piroozi, B., Podder, V., Pokhrel, K. N., Postma, M. J., Prada, S. I., Syed, Z. Q., Rabiee, N., Radhakrishnan, R. A., Rahman, M. M., Rahman, M., Rahman, M. H. U., Rahmani, A. M., Ranabhat, C. L., Rao, C. R., Rao, S. J., Rasella, D., Rawaf, S., Rawaf, D. L., Rawal, L., Renzaho, A. M. N., Reshmi, B., Resnikoff, S., Rezapour, A., Riahi, S. M., Ripon, R. K., Sacco, S., Sadeghi, M., Saeed, U., Sahebkar, A., Sahiledengle, B., Sahoo, H., Sahu, M., Salama, J. S., Salamati, P., Samy, A. M., Sanabria, J., Santric-Milicevic, M. M., Sathian, B., Sawhney, M., Schmidt, M. I., Seidu, A. A., Sepanlou, S. G., Seylani, A., Shaikh, M. A., Sheikh, A., Shetty, A., Shigematsu, M., Shiri, R., Shivakumar, K. M., Shokri, A., Singh, J. A., Sinha, D. N., Skryabin, V. Y., Skryabina, A. A., Sofi-Mahmudi, A., Sousa, R. A. R. C., Stephens, J. H., Sun, J., Szocska, M., Tabares-Seisdedos, R., Tadbiri, H., Tamiru, A. T., Thankappan, K. R., Topor-Madry, R., Tovani-Palone, M. R., Tran, M. T. N., Tran, B. X., Tripathi, N., Tripathy, J. P., Troeger, C. E., Uezono, D. R., Ullah, S., Ullah, A., Unnikrishnan, B., Vacante, M., Tahbaz, S. V., Valdez, P. R., Vasic, M., Veroux, M., Vervoort, D., Violante, F. S., Vladimirov, S. K., Vlassov, V., Vo, B., Waheed, Y., Wamai, R. G., Wang, Y. P., Wang, Y. Z., Ward, P., Wiangkham, T., Yadav, L., Jabbari, S. H. Y., Yamagishi, K., Yaya, S., Yazdi-Feyzabadi, V., Yi, S. Y., Yigit, V., Yonemoto, N., Younis, M. Z., Yu, C. H., Yunusa, I., Bin Zaman, S., Zastrozhin, M. S., Zhang, Z. J., Zhong, C. W., Zuniga, Y. M. H., Lim, S. S., Murray, C. J. L., GBD 2019 Healthcare Access Quality, Clinicum, Department of Neurosciences, HUS Comprehensive Cancer Center, Haakenstad, Annie, Yearwood, Jamal Akeem, Fullman, Nancy, Bintz, Corinne, Bienhoff, Kelly, Weaver, Marcia R, Nandakumar, Vishnu, Joffe, Jonah N, Legrand, Kate E, Knight, Megan, Abbafati, Cristiana, Abbasi-Kangevari, Mohsen, Abdoli, Amir, Abeldaño Zuñiga, Roberto Ariel, Adedeji, Isaac Akinkunmi, Adekanmbi, Victor, Adetokunboh, Olatunji O, Afzal, Muhammad Sohail, Afzal, Saira, Agudelo-Botero, Marcela, Ahinkorah, Bright Opoku, Ahmad, Sajjad, Ahmadi, Ali, Ahmadi, Sepideh, Ahmed, Ali, Ahmed Rashid, Tarik, Aji, Budi, Akande-Sholabi, Wuraola, Alam, Khurshid, Al Hamad, Hanadi, Alhassan, Robert Kaba, Ali, Liaqat, Alipour, Vahid, Aljunid, Syed Mohamed, Ameyaw, Edward Kwabena, Amin, Tarek Tawfik, Amu, Hubert, Amugsi, Dickson A, Ancuceanu, Robert, Andrade, Pedro Prata, Anjum, Afifa, Arabloo, Jalal, Arab-Zozani, Morteza, Ariffin, Hany, Arulappan, Judie, Aryan, Zahra, Ashraf, Tahira, Atnafu, Desta Debalkie, Atreya, Alok, Ausloos, Marcel, Avila-Burgos, Leticia, Ayano, Getinet, Ayanore, Martin Amogre, Azari, Samad, Badiye, Ashish D, Baig, Atif Amin, Bairwa, Mohan, Bakkannavar, Shankar M, Baliga, Shrikala, Banik, Palash Chandra, Bärnighausen, Till Winfried, Barra, Fabio, Barrow, Amadou, Basu, Sanjay, Bayati, Mohsen, Belete, Rebuma, Bell, Arielle Wilder, Bhagat, Devidas S, Bhagavathula, Akshaya Srikanth, Bhardwaj, Pankaj, Bhardwaj, Nikha, Bhaskar, Sonu, Bhattacharyya, Krittika, Bhutta, Zulfiqar A, Bibi, Sadia, Bijani, Ali, Bikbov, Bori, Biondi, Antonio, Bolarinwa, Obasanjo Afolabi, Bonny, Aime, Brenner, Hermann, Buonsenso, Danilo, Burkart, Katrin, Busse, Reinhard, Butt, Zahid A, Butt, Nadeem Shafique, Caetano dos Santos, Florentino Luciano, Cahuana-Hurtado, Lucero, Cámera, Luis Alberto, Cárdenas, Rosario, Carneiro, Vera L A, Catalá-López, Ferrán, Chandan, Joht Singh, Charan, Jaykaran, Chavan, Prachi P, Chen, Simiao, Chen, Shu, Choudhari, Sonali Gajanan, Chowdhury, Enayet Karim, Chowdhury, Mohiuddin Ahsanul Kabir, Cirillo, Massimo, Corso, Barbara, Dadras, Omid, Dahlawi, Saad M A, Dai, Xiaochen, Dandona, Lalit, Dandona, Rakhi, Dangel, William Jame, Dávila-Cervantes, Claudio Alberto, Davletov, Kairat, Deuba, Keshab, Dhimal, Meghnath, Dhimal, Mandira Lamichhane, Djalalinia, Shirin, Do, Huyen Phuc, Doshmangir, Leila, Duncan, Bruce B, Effiong, Andem, Ehsani-Chimeh, Elham, Elgendy, Islam Y, Elhadi, Muhammed, El Sayed, Iman, El Tantawi, Maha, Erku, Daniel Asfaw, Eskandarieh, Sharareh, Fares, Jawad, Farzadfar, Farshad, Ferrero, Simone, Ferro Desideri, Lorenzo, Fischer, Florian, Foigt, Nataliya A, Foroutan, Masoud, Fukumoto, Takeshi, Gaal, Peter Andra, Gaihre, Santosh, Gardner, William M, Garg, Tushar, Getachew Obsa, Abera, Ghafourifard, Mansour, Ghashghaee, Ahmad, Ghith, Nermin, Gilani, Syed Amir, Gill, Paramjit Singh, Goharinezhad, Salime, Golechha, Mahaveer, Guadamuz, Jenny S, Guo, Yuming, Gupta, Rajat Da, Gupta, Rajeev, Gupta, Vivek Kumar, Gupta, Veer Bala, Hamiduzzaman, Mohammad, Hanif, Asif, Haro, Josep Maria, Hasaballah, Ahmed I, Hasan, Md Mehedi, Hasan, M Tasdik, Hashi, Abdiwahab, Hay, Simon I, Hayat, Khezar, Heidari, Mohammad, Heidari, Golnaz, Henry, Nathaniel J, Herteliu, Claudiu, Holla, Ramesh, Hossain, Sahadat, Hossain, Sheikh Jamal, Hossain, Mohammad Bellal Hossain, Hosseinzadeh, Mehdi, Hostiuc, Sorin, Hoveidamanesh, Soodabeh, Hsieh, Vivian Chia-rong, Hu, Guoqing, Huang, Junjie, Huda, M Mamun, Ifeagwu, Susan C, Ikuta, Kevin S, Ilesanmi, Olayinka Stephen, Irvani, Seyed Sina Naghibi, Islam, Rakibul M, Islam, Sheikh Mohammed Shariful, Ismail, Nahlah Elkudssiah, Iso, Hiroyasu, Isola, Gaetano, Itumalla, Ramaiah, Iwagami, Masao, Jahani, Mohammad Ali, Jahanmehr, Nader, Jain, Rajesh, Jakovljevic, Mihajlo, Janodia, Manthan Dilipkumar, Jayapal, Sathish Kumar, Jayaram, Shubha, Jha, Ravi Prakash, Jonas, Jost B, Joo, Tama, Joseph, Nitin, Jürisson, Mikk, Kabir, Ali, Kalankesh, Leila R, Kalhor, Rohollah, Kamath, Aruna M, Kamenov, Kaloyan, Kandel, Himal, Kantar, Rami S, Kapoor, Neeti, Karanikolos, Marina, Katikireddi, Srinivasa Vittal, Kavetskyy, Tara, Kawakami, Norito, Kayode, Gbenga A, Keikavoosi-Arani, Leila, Keykhaei, Mohammad, Khader, Yousef Saleh, Khajuria, Himanshu, Khalilov, Rovshan, Khammarnia, Mohammad, Khan, Md Nuruzzaman, Khan, Moien AB, Khan, Maseer, Khezeli, Mehdi, Kim, Min Seo, Kim, Yun Jin, Kisa, Sezer, Kisa, Adnan, Klymchuk, Vitalii, Koly, Kamrun Nahar, Korzh, Oleksii, Kosen, Soewarta, Koul, Parvaiz A, Kuate Defo, Barthelemy, Kumar, G Anil, Kusuma, Dian, Kyu, Hmwe Hmwe, Larsson, Anders O, Lasrado, Savita, Lee, Wei-Chen, Lee, Yo Han, Lee, Chiachi Bonnie, Li, Shanshan, Lucchetti, Giancarlo, Mahajan, Preetam Bhalchandra, Majeed, Azeem, Makki, Alaa, Malekzadeh, Reza, Malik, Ahmad Azam, Malta, Deborah Carvalho, Mansournia, Mohammad Ali, Mantovani, Lorenzo Giovanni, Martinez-Valle, Adolfo, Martins-Melo, Francisco Rogerlândio, Masoumi, Seyedeh Zahra, Mathur, Manu Raj, Maude, Richard Jame, Maulik, Pallab K, Mckee, Martin, Mendoza, Walter, Menezes, Ritesh G, Mensah, George A, Meretoja, Atte, Meretoja, Tuomo J, Mestrovic, Tomislav, Michalek, Irmina Maria, Mirrakhimov, Erkin M, Misganaw, Awoke, Misra, Sanjeev, Moazen, Babak, Mohammadi, Mokhtar, Mohammed, Shafiu, Moitra, Modhurima, Mokdad, Ali H, Molokhia, Mariam, Monasta, Lorenzo, Moni, Mohammad Ali, Moradi, Ghobad, Moreira, Rafael Silveira, Mosser, Jonathan F, Mostafavi, Ebrahim, Mouodi, Simin, Nagarajan, Ahamarshan Jayaraman, Nagata, Chie, Naghavi, Mohsen, Nangia, Vinay, Narasimha Swamy, Sreeniva, Narayana, Aparna Ichalangod, Nascimento, Bruno Ramo, Nassereldine, Hasan, Nayak, Biswa Prakash, Nazari, Javad, Negoi, Ionut, Nepal, Samata, Neupane Kandel, Sandhya, Ngunjiri, Josephine W, Nguyen, Huong Lan Thi, Nguyen, Cuong Tat, Ningrum, Dina Nur Anggraini, Noubiap, Jean Jacque, Oancea, Bogdan, Oghenetega, Onome Bright, Oh, In-Hwan, Olagunju, Andrew T, Olakunde, Babayemi Oluwaseun, Omar Bali, Ahmed, Omer, Emad, Onwujekwe, Obinna E, Otoiu, Adrian, Padubidri, Jagadish Rao, Palladino, Raffaele, Pana, Adrian, Panda-Jonas, Songhomitra, Pandi-Perumal, Seithikurippu R, Pardhan, Shahina, Pasupula, Deepak Kumar, Pathak, Praveen Kumar, Patton, George C, Pawar, Shrikant, Pereira, Jeevan, Pilania, Manju, Piroozi, Bakhtiar, Podder, Vivek, Pokhrel, Khem Narayan, Postma, Maarten J, Prada, Sergio I, Quazi Syed, Zahiruddin, Rabiee, Navid, Radhakrishnan, Raghu Anekal, Rahman, Md Mosfequr, Rahman, Mosiur, Rahman, Mahfuzar, Rahman, Mohammad Hifz Ur, Rahmani, Amir Masoud, Ranabhat, Chhabi Lal, Rao, Chythra R, Rao, Sowmya J, Rasella, Davide, Rawaf, Salman, Rawaf, David Laith, Rawal, Lal, Renzaho, Andre M N, Reshmi, Bhageerathy, Resnikoff, Serge, Rezapour, Aziz, Riahi, Seyed Mohammad, Ripon, Rezaul Karim, Sacco, Simona, Sadeghi, Masoumeh, Saeed, Umar, Sahebkar, Amirhossein, Sahiledengle, Biniyam, Sahoo, Harihar, Sahu, Maitreyi, Salama, Joseph S, Salamati, Payman, Samy, Abdallah M, Sanabria, Juan, Santric-Milicevic, Milena M, Sathian, Brijesh, Sawhney, Monika, Schmidt, Maria Inê, Seidu, Abdul-Aziz, Sepanlou, Sadaf G, Seylani, Allen, Shaikh, Masood Ali, Sheikh, Aziz, Shetty, Adithi, Shigematsu, Mika, Shiri, Rahman, Shivakumar, K M, Shokri, Azad, Singh, Jasvinder A, Sinha, Dhirendra Narain, Skryabin, Valentin Yurievich, Skryabina, Anna Aleksandrovna, Sofi-Mahmudi, Ahmad, Sousa, Raúl A R C, Stephens, Jacqueline H, Sun, Jing, Szócska, Mikló, Tabarés-Seisdedos, Rafael, Tadbiri, Hooman, Tamiru, Animut Tagele, Thankappan, Kavumpurathu Raman, Topor-Madry, Roman, Tovani-Palone, Marcos Roberto, Tran, Mai Thi Ngoc, Tran, Bach Xuan, Tripathi, Niharika, Tripathy, Jaya Prasad, Troeger, Christopher E, Uezono, Deinzel Roble, Ullah, Saif, Ullah, Anayat, Unnikrishnan, Bhaskaran, Vacante, Marco, Valadan Tahbaz, Sahel, Valdez, Pascual R, Vasic, Milena, Veroux, Massimiliano, Vervoort, Dominique, Violante, Francesco S, Vladimirov, Sergey Konstantinovitch, Vlassov, Vasily, Vo, Bay, Waheed, Yasir, Wamai, Richard G, Wang, Yuan-Pang, Wang, Yanzhong, Ward, Paul, Wiangkham, Taweewat, Yadav, Lalit, Yahyazadeh Jabbari, Seyed Hossein, Yamagishi, Kazumasa, Yaya, Sanni, Yazdi-Feyzabadi, Vahid, Yi, Siyan, Yiğit, Vahit, Yonemoto, Naohiro, Younis, Mustafa Z, Yu, Chuanhua, Yunusa, Ismaeel, Zaman, Sojib Bin, Zastrozhin, Mikhail Sergeevich, Zhang, Zhi-Jiang, Zhong, Chenwen, Zuniga, Yves Miel H, Lim, Stephen S, Murray, Christopher J L, Lozano, Rafael, Haakenstad, A, Yearwood, J, Fullman, N, Bintz, C, Bienhoff, K, Weaver, M, Nandakumar, V, Joffe, J, Legrand, K, Knight, M, Abbafati, C, Abbasi-Kangevari, M, Abdoli, A, Abeldano Zuniga, R, Adedeji, I, Adekanmbi, V, Adetokunboh, O, Afzal, M, Afzal, S, Agudelo-Botero, M, Ahinkorah, B, Ahmad, S, Ahmadi, A, Ahmadi, S, Ahmed, A, Ahmed Rashid, T, Aji, B, Akande-Sholabi, W, Alam, K, Al Hamad, H, Alhassan, R, Ali, L, Alipour, V, Aljunid, S, Ameyaw, E, Amin, T, Amu, H, Amugsi, D, Ancuceanu, R, Andrade, P, Anjum, A, Arabloo, J, Arab-Zozani, M, Ariffin, H, Arulappan, J, Aryan, Z, Ashraf, T, Atnafu, D, Atreya, A, Ausloos, M, Avila-Burgos, L, Ayano, G, Ayanore, M, Azari, S, Badiye, A, Baig, A, Bairwa, M, Bakkannavar, S, Baliga, S, Banik, P, Barnighausen, T, Barra, F, Barrow, A, Basu, S, Bayati, M, Belete, R, Bell, A, Bhagat, D, Bhagavathula, A, Bhardwaj, P, Bhardwaj, N, Bhaskar, S, Bhattacharyya, K, Bhutta, Z, Bibi, S, Bijani, A, Bikbov, B, Biondi, A, Bolarinwa, O, Bonny, A, Brenner, H, Buonsenso, D, Burkart, K, Busse, R, Butt, Z, Butt, N, Caetano dos Santos, F, Cahuana-Hurtado, L, Camera, L, Cardenas, R, Carneiro, V, Catala-Lopez, F, Chandan, J, Charan, J, Chavan, P, Chen, S, Choudhari, S, Chowdhury, E, Chowdhury, M, Cirillo, M, Corso, B, Dadras, O, Dahlawi, S, Dai, X, Dandona, L, Dandona, R, Dangel, W, Davila-Cervantes, C, Davletov, K, Deuba, K, Dhimal, M, Djalalinia, S, Do, H, Doshmangir, L, Duncan, B, Effiong, A, Ehsani-Chimeh, E, Elgendy, I, Elhadi, M, El Sayed, I, El Tantawi, M, Erku, D, Eskandarieh, S, Fares, J, Farzadfar, F, Ferrero, S, Ferro Desideri, L, Fischer, F, Foigt, N, Foroutan, M, Fukumoto, T, Gaal, P, Gaihre, S, Gardner, W, Garg, T, Getachew Obsa, A, Ghafourifard, M, Ghashghaee, A, Ghith, N, Gilani, S, Gill, P, Goharinezhad, S, Golechha, M, Guadamuz, J, Guo, Y, Gupta, R, Gupta, V, Hamiduzzaman, M, Hanif, A, Haro, J, Hasaballah, A, Hasan, M, Hashi, A, Hay, S, Hayat, K, Heidari, M, Heidari, G, Henry, N, Herteliu, C, Holla, R, Hossain, S, Hossain, M, Hosseinzadeh, M, Hostiuc, S, Hoveidamanesh, S, Hsieh, V, Hu, G, Huang, J, Huda, M, Ifeagwu, S, Ikuta, K, Ilesanmi, O, Irvani, S, Islam, R, Islam, S, Ismail, N, Iso, H, Isola, G, Itumalla, R, Iwagami, M, Jahani, M, Jahanmehr, N, Jain, R, Jakovljevic, M, Janodia, M, Jayapal, S, Jayaram, S, Jha, R, Jonas, J, Joo, T, Joseph, N, Jurisson, M, Kabir, A, Kalankesh, L, Kalhor, R, Kamath, A, Kamenov, K, Kandel, H, Kantar, R, Kapoor, N, Karanikolos, M, Katikireddi, S, Kavetskyy, T, Kawakami, N, Kayode, G, Keikavoosi-Arani, L, Keykhaei, M, Khader, Y, Khajuria, H, Khalilov, R, Khammarnia, M, Khan, M, Khezeli, M, Kim, 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Padubidri, J, Palladino, R, Pana, A, Panda-Jonas, S, Pandi-Perumal, S, Pardhan, S, Pasupula, D, Pathak, P, Patton, G, Pawar, S, Pereira, J, Pilania, M, Piroozi, B, Podder, V, Pokhrel, K, Postma, M, Prada, S, Quazi Syed, Z, Rabiee, N, Radhakrishnan, R, Rahman, M, Rahmani, A, Ranabhat, C, Rao, C, Rao, S, Rasella, D, Rawaf, S, Rawaf, D, Rawal, L, Renzaho, A, Reshmi, B, Resnikoff, S, Rezapour, A, Riahi, S, Ripon, R, Sacco, S, Sadeghi, M, Saeed, U, Sahebkar, A, Sahiledengle, B, Sahoo, H, Sahu, M, Salama, J, Salamati, P, Samy, A, Sanabria, J, Santric-Milicevic, M, Sathian, B, Sawhney, M, Schmidt, M, Seidu, A, Sepanlou, S, Seylani, A, Shaikh, M, Sheikh, A, Shetty, A, Shigematsu, M, Shiri, R, Shivakumar, K, Shokri, A, Singh, J, Sinha, D, Skryabin, V, Skryabina, A, Sofi-Mahmudi, A, Sousa, R, Stephens, J, Sun, J, Szocska, M, Tabares-Seisdedos, R, Tadbiri, H, Tamiru, A, Thankappan, K, Topor-Madry, R, Tovani-Palone, M, Tran, M, Tran, B, Tripathi, N, Tripathy, J, Troeger, C, Uezono, D, Ullah, S, Ullah, A, Unnikrishnan, B, Vacante, M, Valadan Tahbaz, S, Valdez, P, Vasic, M, Veroux, M, Vervoort, D, Violante, F, Vladimirov, S, Vlassov, V, Vo, B, Waheed, Y, Wamai, R, Wang, Y, Ward, P, Wiangkham, T, Yadav, L, Yahyazadeh Jabbari, S, Yamagishi, K, Yaya, S, Yazdi-Feyzabadi, V, Yi, S, Yigit, V, Yonemoto, N, Younis, M, Yu, C, Yunusa, I, Zaman, S, Zastrozhin, M, Zhang, Z, Zhong, C, Zuniga, Y, Lim, S, Murray, C, Lozano, R, Bill & Melinda Gates Foundation, King Edward Medical University (Pakistán), Kuwait University (Kuwait), Romanian National Authority for Scientific Research and Innovation, Romanian Ministry of Research Innovation and Digitalization, Alexander von Humboldt Foundation, Federal Ministry of Education & Research (Alemania), Unión Europea. Comisión Europea. H2020, University of Aberdeen (Reino Unido), Novo Nordisk Foundation, National Health and Medical Research Council (Australia), National Research, Development and Innovation Office (Hungria), National Records of Scotland (Reino Unido), Medical Research Council (Reino Unido), Scottish Government (Reino Unido), Jatiya Kabi Kazi Nazrul Islam University (Bangladesh), Xiamen University Malaysia (Malasia), National Council for Scientific and Technological Development (Brasil), Ministero della Salute (Italia), Fondazione IRCCS. Istituto Nazionale dei Tumori, King College London, IRCCS Materno Infantile Burlo Garofolo (Italia), Edwards Lifesciences Foundation, Fundação de Amparo à Pesquisa do Estado de Minas Gerais (Brasil), Manipal Academy of Higher Education (India), Ministerio de Ciencia e Innovación. Centro de Excelencia Severo Ochoa (España), Government of Catalonia (España), International Center of Medical Sciences Research (Pakistán), Ain Shams University (Egipto), Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red - CIBERSAM (Salud Mental), INCLIVA Health Research Institute (España), Canadian Institutes of Health Research, Australian Government, and Ministry of Education, Science and Technological Development (Serbia)

Subjects
Adult, Adolescent, Population, Global Health, Health Services Accessibility, Global Burden of Disease, Health system quality, Young Adult, Nations, Health systems, health care access, Risk Factors, Quality-Adjusted Life Year, Humans, Child, Global Burden of Disease Study 2019, Health-care access, Aged, Quality of Health Care, quality, performance, The Healthcare Access and Quality Index, Risk Factor, Infant, Newborn, Infant, eu-repo/semantics/review [info], Public Health, Global Health, Social Medicine and Epidemiology, General Medicine, Health-care quality, Middle Aged, 3141 Health care science, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Indicator, Medical-care, Child, Preschool, Deaths, Amenable mortality, Quality-Adjusted Life Years, Age groups, Trends, Human
Abstract

Background: Health-care needs change throughout the life course. It is thus crucial to assess whether health systems provide access to quality health care for all ages. Drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019), we measured the Healthcare Access and Quality (HAQ) Index overall and for select age groups in 204 locations from 1990 to 2019. Methods: We distinguished the overall HAQ Index (ages 0-74 years) from scores for select age groups: the young (ages 0-14 years), working (ages 15-64 years), and post-working (ages 65-74 years) groups. For GBD 2019, HAQ Index construction methods were updated to use the arithmetic mean of scaled mortality-to-incidence ratios (MIRs) and risk-standardised death rates (RSDRs) for 32 causes of death that should not occur in the presence of timely, quality health care. Across locations and years, MIRs and RSDRs were scaled from 0 (worst) to 100 (best) separately, putting the HAQ Index on a different relative scale for each age group. We estimated absolute convergence for each group on the basis of whether the HAQ Index grew faster in absolute terms between 1990 and 2019 in countries with lower 1990 HAQ Index scores than countries with higher 1990 HAQ Index scores and by Socio-demographic Index (SDI) quintile. SDI is a summary metric of overall development. Findings: Between 1990 and 2019, the HAQ Index increased overall (by 19·6 points, 95% uncertainty interval 17·9-21·3), as well as among the young (22·5, 19·9-24·7), working (17·2, 15·2-19·1), and post-working (15·1, 13·2-17·0) age groups. Large differences in HAQ Index scores were present across SDI levels in 2019, with the overall index ranging from 30·7 (28·6-33·0) on average in low-SDI countries to 83·4 (82·4-84·3) on average in high-SDI countries. Similarly large ranges between low-SDI and high-SDI countries, respectively, were estimated in the HAQ Index for the young (40·4-89·0), working (33·8-82·8), and post-working (30·4-79·1) groups. Absolute convergence in HAQ Index was estimated in the young group only. In contrast, divergence was estimated among the working and post-working groups, driven by slow progress in low-SDI countries. Interpretation: Although major gaps remain across levels of social and economic development, convergence in the young group is an encouraging sign of reduced disparities in health-care access and quality. However, divergence in the working and post-working groups indicates that health-care access and quality is lagging at lower levels of social and economic development. To meet the needs of ageing populations, health systems need to improve health-care access and quality for working-age adults and older populations while continuing to realise gains among the young. O Adetokunboh acknowledges support from Department of Science and Innovation and National Research Foundation. S Afzal acknowledges the institutional support of King Edward Medical University. S Aljunid acknowledges Department of Health Policy and Management, College of Public Health, Health Science Centre, Kuwait University for the approval and support to participate in this research project. M Ausloos, C Herteliu, and A Pana acknowledge partial support by a grant of the Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084. C Herteliu also acknowledges partial support by a grant of the Romanian Ministry of Research Innovation and Digitalization, MCID, project number ID-585-CTR-42-PFE-2021. T Bärnighausen was supported by the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award, funded by the Federal Ministry of Education and Research. B Bikbov acknowledges funding from the European Union’s Horizon 2020 research and innovation programme under Marie Sklodowska-Curie grant agreement No. 703226. Institute of Applied Health Sciences; School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Scotland. The salary for N Ghith is covered by a grant from Novo Nordisk Foundation (NNF16OC0021856). V B Gupta acknowledges funding support from National Health and Medical Research Council (NHMRC) Australia. V K Gupta acknowledges funding support from National Health and Medical Research Council (NHMRC) Australia. T Joo acknowledges support from the National Research, Development and Innovation Office of Hungary under grant RRF-2.3.1-21-2022-00006 (Data-driven Health Division of Health Security National Laboratory). S Vittal Katikireddi acknowledges funding from a NRS Senior Clinical Fellowship (SCAF/15/02), the Medical Research Council (MC_UU_00022/2), and the Scottish Government Chief Scientist Office (SPHSU17). M N Khan acknowledges the support of Jatiya Kabi Kazi Nazrul Islam University, Mymensingh, Bangladesh. Y J Kim acknowledges support from the Research Management Centre Xiamen University Malaysia [XMUMRF/2020-C6/ITCM/0004]. G Lucchetti is a grantee of the Brazilian National Council for Scientific and Technological Development Research Productivity - Level 1D. L Mantovani acknowledges support by Italian Ministry of Health Ricerca Corrente - IRCCS Multimedica. M Molokhia acknowledges support by the National Institute for Health Research Biomedical Research Center at Guy’s and St Thomas’ National Health Service Foundation Trust and King’s College London. L Monasta reports support for the present manuscript from the Italian Ministry of Health on project Ricerca Corrente 34/2017 and payments made to the Institute for Maternal and Child Health IRCCS Burlo Garofolo. R Moreira acknowledges the CNPQ productivity grant (316607/2021-5). B R Nascimento is partially supported by CNPq (Research Productivity Grant, 312382/2019-7), the Edwards Lifesciences Foundation (Improving the prevention and detection of Heart Valve disease across the Lifespan, 2021), and FAPEMIG (grant APQ-000627-20). J R Padubidri acknowledges Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India for their constant support in conducting research. D Rasella reports financial support from the Spanish Ministry of Science and Innovation and State Research Agency through the Centro de Excelencia Severo Ochoa 2019-2023 programme (CEX2018-000806-S), and financial support from the Generalitat de Catalunya through the Centres de Recerca de Catalunya programme. U Saeed would like to acknowledge the International Center of Medical Sciences Research (ICMSR), Islamabad (44000), Pakistan. A M Samy acknowledges the support from Ain Shams University and the Egyptian Fulbright Mission Program. U Saeed would like to acknowledge Kasturba Medical College, Mangalore. Manipal Academy of Higher Education, Manipal for supporting research activities. R T-S is supported by the Spanish Ministry of Science and Innovation, Institute of Health Carlos III, CIBERSAM, INCLIVA (PID2021-129099OB-I00). D Vervoort is supported by the Canadian Institutes of Health Research (CIHR) Vanier Canada Graduate Scholarship. S B Zaman acknowledges receiving a scholarship from the Australian Government Research Training Program (RTP) in support of his academic career. Serbian part of this GBD contribution was co-financed through Grant OI 175 014 of the Ministry of Education Science and Technological Development of The Republic of Serbia. This work was supported, in whole or in part, by the Bill & Melinda Gates Foundation OPP1152504. Under the grant conditions of the Foundation, a Creative Commons Attribution 4.0 Generic License has already been assigned to the Author Accepted Manuscript version that might arise from this submission. Sí

Published
2022

3. Measuring the availability of human resources for health and its relationship to universal health coverage for 204 countries and territories from 1990 to 2019: A systematic analysis for the Global Burden of Disease Study 2019

Author

Haakenstad, A., Irvine, C.M.S., Knight, M., Bintz, C., Aravkin, A.Y., Zheng, P., Gupta, V., Abrigo, M.R.M., Abushouk, A.I., Adebayo, O.M., Agarwal, G., Alahdab, F., Al-Aly, Z., Alam, K., Alanzi, T.M., Alcalde-Rabanal, J.E., Alipour, V., Alvis-Guzman, N., Amit, A.M.L., Andrei, C.L., Andrei, T., Antonio, C.A.T., Arabloo, J., Aremu, O., Ayanore, M.A., Banach, M., Bärnighausen, T.W., Barthelemy, C.M., Bayati, M., Benzian, H., Berman, A.E., Bienhoff, K., Bijani, A., Bikbov, B., Biondi, A., Boloor, A., Busse, R., Butt, Z.A., Cámera, L.A., Campos-Nonato, I.R., Cárdenas, R., Carvalho, F., Chansa, C., Chattu, S.K., Chattu, V.K., Chu, D-T, Dai, X., Dandona, L., Dandona, R., Dangel, W.J., Daryani, A., De Neve, J-W, Dhimal, M., Dipeolu, I.O., Djalalinia, S., Do, H.T., Doshi, C.P., Doshmangir, L., Ehsani-Chimeh, E., El Tantawi, M., Fernandes, E., Fischer, F., Foigt, N.A., Fomenkov, A.A., Foroutan, M., Fukumoto, T., Fullman, N., Gad, M.M., Ghadiri, K., Ghafourifard, M., Ghashghaee, A., Glucksman, T., Goudarzi, H., Gupta, R.D., Hamadeh, R.R., Hamidi, S., Haro, J.M., Hasanpoor, E., Hay, S.I., Hegazy, M.I., Heibati, B., Henry, N.J., Hole, M.K., Hossain, N., Househ, M., Ilesanmi, O.S., Imani-Nasab, M-H, Irvani, S.S.N., Islam, S.M.S., Jahani, M.A., Joshi, A., Kalhor, R., Kayode, G.A., Khalid, N., Khatab, K., Kisa, A., Kochhar, S., Krishan, K., Kuate Defo, B., Lal, D.K., Lami, F.H., Larsson, A.O., Leasher, J.L., LeGrand, K.E., Lim, L-L, Mahotra, N.B., Majeed, A., Maleki, A., Manjunatha, N., Massenburg, B.B., Mestrovic, T., Mini, G.K., Mirica, A., Mirrakhimov, E.M., Mohammad, Y., Mohammed, S., Mokdad, A.H., Morrison, S.D., Naghavi, M., Ndwandwe, D.E., Negoi, I., Negoi, R.I., Ngunjiri, J.W., Nguyen, C.T., Nigatu, Y.T., Onwujekwe, O.E., Ortega-Altamirano, D.V., Otstavnov, N., Otstavnov, S.S., Owolabi, M.O., Pakhare, A.P., Pepito, V.C.F., Perico, N., Pham, H.Q., Pigott, D.M., Pokhrel, K.N., Rabiee, M., Rabiee, N., Rahimi-Movaghar, V., Rawaf, D.L., Rawaf, S., Rawal, L., Remuzzi, G., Renzaho, A.M.N., Resnikoff, S., Rezaei, N., Rezapour, A., Rickard, J., Roever, L., Sahu, M., Samy, A.M., Sanabria, J., Santric-Milicevic, M.M., Saraswathy, S.Y.I., Seedat, S., Senthilkumaran, S., Serván-Mori, E., Shaikh, M.A., Sheikh, A., Silva, D.A.S., Stein, C., Stein, D.J., Titova, M.V., Topp, S.M., Tovani-Palone, M.R., Ullah, S., Unnikrishnan, B., Vacante, M., Valdez, P.R., Vasankari, T.J., Venketasubramanian, N., Vlassov, V., Vos, T., Yearwood, J.A., Yonemoto, N., Younis, M.Z., Yu, C., Zadey, S., Zaman, S.B., Zerfu, T.A., Zhang, Z-J, Ziapour, A., Zodpey, S., Lim, S.S., Murray, C.J.L., Lozano, R., Haakenstad, A., Irvine, C.M.S., Knight, M., Bintz, C., Aravkin, A.Y., Zheng, P., Gupta, V., Abrigo, M.R.M., Abushouk, A.I., Adebayo, O.M., Agarwal, G., Alahdab, F., Al-Aly, Z., Alam, K., Alanzi, T.M., Alcalde-Rabanal, J.E., Alipour, V., Alvis-Guzman, N., Amit, A.M.L., Andrei, C.L., Andrei, T., Antonio, C.A.T., Arabloo, J., Aremu, O., Ayanore, M.A., Banach, M., Bärnighausen, T.W., Barthelemy, C.M., Bayati, M., Benzian, H., Berman, A.E., Bienhoff, K., Bijani, A., Bikbov, B., Biondi, A., Boloor, A., Busse, R., Butt, Z.A., Cámera, L.A., Campos-Nonato, I.R., Cárdenas, R., Carvalho, F., Chansa, C., Chattu, S.K., Chattu, V.K., Chu, D-T, Dai, X., Dandona, L., Dandona, R., Dangel, W.J., Daryani, A., De Neve, J-W, Dhimal, M., Dipeolu, I.O., Djalalinia, S., Do, H.T., Doshi, C.P., Doshmangir, L., Ehsani-Chimeh, E., El Tantawi, M., Fernandes, E., Fischer, F., Foigt, N.A., Fomenkov, A.A., Foroutan, M., Fukumoto, T., Fullman, N., Gad, M.M., Ghadiri, K., Ghafourifard, M., Ghashghaee, A., Glucksman, T., Goudarzi, H., Gupta, R.D., Hamadeh, R.R., Hamidi, S., Haro, J.M., Hasanpoor, E., Hay, S.I., Hegazy, M.I., Heibati, B., Henry, N.J., Hole, M.K., Hossain, N., Househ, M., Ilesanmi, O.S., Imani-Nasab, M-H, Irvani, S.S.N., Islam, S.M.S., Jahani, M.A., Joshi, A., Kalhor, R., Kayode, G.A., Khalid, N., Khatab, K., Kisa, A., Kochhar, S., Krishan, K., Kuate Defo, B., Lal, D.K., Lami, F.H., Larsson, A.O., Leasher, J.L., LeGrand, K.E., Lim, L-L, Mahotra, N.B., Majeed, A., Maleki, A., Manjunatha, N., Massenburg, B.B., Mestrovic, T., Mini, G.K., Mirica, A., Mirrakhimov, E.M., Mohammad, Y., Mohammed, S., Mokdad, A.H., Morrison, S.D., Naghavi, M., Ndwandwe, D.E., Negoi, I., Negoi, R.I., Ngunjiri, J.W., Nguyen, C.T., Nigatu, Y.T., Onwujekwe, O.E., Ortega-Altamirano, D.V., Otstavnov, N., Otstavnov, S.S., Owolabi, M.O., Pakhare, A.P., Pepito, V.C.F., Perico, N., Pham, H.Q., Pigott, D.M., Pokhrel, K.N., Rabiee, M., Rabiee, N., Rahimi-Movaghar, V., Rawaf, D.L., Rawaf, S., Rawal, L., Remuzzi, G., Renzaho, A.M.N., Resnikoff, S., Rezaei, N., Rezapour, A., Rickard, J., Roever, L., Sahu, M., Samy, A.M., Sanabria, J., Santric-Milicevic, M.M., Saraswathy, S.Y.I., Seedat, S., Senthilkumaran, S., Serván-Mori, E., Shaikh, M.A., Sheikh, A., Silva, D.A.S., Stein, C., Stein, D.J., Titova, M.V., Topp, S.M., Tovani-Palone, M.R., Ullah, S., Unnikrishnan, B., Vacante, M., Valdez, P.R., Vasankari, T.J., Venketasubramanian, N., Vlassov, V., Vos, T., Yearwood, J.A., Yonemoto, N., Younis, M.Z., Yu, C., Zadey, S., Zaman, S.B., Zerfu, T.A., Zhang, Z-J, Ziapour, A., Zodpey, S., Lim, S.S., Murray, C.J.L., and Lozano, R.

Abstract

Background Human resources for health (HRH) include a range of occupations that aim to promote or improve human health. The UN Sustainable Development Goals (SDGs) and the WHO Health Workforce 2030 strategy have drawn attention to the importance of HRH for achieving policy priorities such as universal health coverage (UHC). Although previous research has found substantial global disparities in HRH, the absence of comparable cross-national estimates of existing workforces has hindered efforts to quantify workforce requirements to meet health system goals. We aimed to use comparable and standardised data sources to estimate HRH densities globally, and to examine the relationship between a subset of HRH cadres and UHC effective coverage performance. Methods Through the International Labour Organization and Global Health Data Exchange databases, we identified 1404 country-years of data from labour force surveys and 69 country-years of census data, with detailed microdata on health-related employment. From the WHO National Health Workforce Accounts, we identified 2950 country-years of data. We mapped data from all occupational coding systems to the International Standard Classification of Occupations 1988 (ISCO-88), allowing for standardised estimation of densities for 16 categories of health workers across the full time series. Using data from 1990 to 2019 for 196 of 204 countries and territories, covering seven Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) super-regions and 21 regions, we applied spatiotemporal Gaussian process regression (ST-GPR) to model HRH densities from 1990 to 2019 for all countries and territories. We used stochastic frontier meta-regression to model the relationship between the UHC effective coverage index and densities for the four categories of health workers enumerated in SDG indicator 3.c.1 pertaining to HRH: physicians, nurses and midwives, dentistry personnel, and pharmaceutical personnel. We identified minimum workfor

Published
2022

4. Measuring the availability of human resources for health and its relationship to universal health coverage for 204 countries and territories from 1990 to 2019: a systematic analysis for the Global Burden of Disease Study 2019

Author

Haakenstad, A, Irvine, CMS, Knight, M, Bintz, C, Aravkin, AY, Zheng, P, Gupta, V, Abrigo, MRM, Abushouk, A, Adebayo, OM, Agarwal, G, Alahdab, F, Al-Aly, Z, Alam, K, Alanzi, TM, Alcalde-Rabanal, JE, Alipour, V, Alvis-Guzman, N, Amit, AML, Liliana Andrei, C, Andrei, T, Antonio, CAT, Arabloo, J, Aremu, O, Ayanore, MA, Banach, M, Barnighausen, TW, Barthelemy, CM, Bayati, M, Benzian, H, Berman, AE, Bienhoff, K, Bijani, A, Bikbov, B, Biondi, A, Boloor, A, Busse, R, Butt, ZA, Camera, LA, Campos-Nonato, IR, Cardenas, R, Carvalho, F, Chansa, C, Chattu, SK, Chattu, VK, Chu, D-T, Dai, X, Dandona, L, Dandona, R, Dangel, WJ, Daryani, A, De Neve, J-W, Dhimal, M, Dipeolu, IO, Djalalinia, S, Hoa, TD, Doshi, CP, Doshmangir, L, Ehsani-Chimeh, E, El Tantawi, M, Fernandes, E, Fischer, F, Foigt, NA, Fomenkov, AA, Foroutan, M, Fukumoto, T, Fullman, N, Gad, MM, Ghadiri, K, Ghafourifard, M, Ghashghaee, A, Glucksman, T, Goudarzi, H, Das Gupta, R, Hamadeh, RR, Hamidi, S, Haro, JM, Hasanpoor, E, Hay, S, Hegazy, M, Heibati, B, Henry, NJ, Hole, MK, Hossain, N, Househ, M, Ilesanmi, OS, Imani-Nasab, M-H, Irvani, SSN, Islam, SMS, Jahani, MA, Joshi, A, Kalhor, R, Kayode, GA, Khalid, N, Khatab, K, Kisa, A, Kochhar, S, Krishan, K, Defo, BK, Lal, DK, Lami, FH, Larsson, AO, Leasher, JL, LeGrand, KE, Lim, L-L, Mahotra, NB, Majeed, A, Maleki, A, Manjunatha, N, Massenburg, BB, Mestrovic, T, Mini, GK, Mirica, A, Mirrakhimov, EM, Mohammad, Y, Mohammed, S, Mokdad, AH, Morrison, SD, Naghavi, M, Ndwandwe, DE, Negoi, I, Negoi, RI, Ngunjiri, JW, Cuong, TN, Nigatu, YT, Onwujekwe, OE, Ortega-Altamirano, D, Otstavnov, N, Otstavnov, SS, Owolabi, MO, Pakhare, AP, Filipino Pepito, VC, Perico, N, Pham, HQ, Pigott, DM, Pokhrel, KN, Rabiee, M, Rabiee, N, Rahimi-Movaghar, V, Rawaf, DL, Rawaf, S, Rawal, L, Remuzzi, G, Renzaho, AMN, Resnikoff, S, Rezaei, N, Rezapour, A, Rickard, J, Roever, L, Sahu, M, Samy, AM, Sanabria, J, Santric-Milicevic, MM, Saraswathy, SYI, Seedat, S, Senthilkumaran, S, Servan-Mori, E, Shaikh, MA, Sheikh, A, Silva, DAS, Stein, C, Stein, DJ, Titova, MV, Topp, SM, Tovani-Palone, MR, Ullah, S, Unnikrishnan, B, Vacante, M, Valdez, PR, Vasankari, TJ, Venketasubramanian, N, Vlassov, V, Vos, T, Yearwood, JA, Yonemoto, N, Younis, MZ, Yu, C, Zadey, S, Bin Zaman, S, Zerfu, TA, Zhang, Z-J, Ziapour, A, Zodpey, S, Lim, SS, Murray, CJL, Lozano, R, Haakenstad, A, Irvine, CMS, Knight, M, Bintz, C, Aravkin, AY, Zheng, P, Gupta, V, Abrigo, MRM, Abushouk, A, Adebayo, OM, Agarwal, G, Alahdab, F, Al-Aly, Z, Alam, K, Alanzi, TM, Alcalde-Rabanal, JE, Alipour, V, Alvis-Guzman, N, Amit, AML, Liliana Andrei, C, Andrei, T, Antonio, CAT, Arabloo, J, Aremu, O, Ayanore, MA, Banach, M, Barnighausen, TW, Barthelemy, CM, Bayati, M, Benzian, H, Berman, AE, Bienhoff, K, Bijani, A, Bikbov, B, Biondi, A, Boloor, A, Busse, R, Butt, ZA, Camera, LA, Campos-Nonato, IR, Cardenas, R, Carvalho, F, Chansa, C, Chattu, SK, Chattu, VK, Chu, D-T, Dai, X, Dandona, L, Dandona, R, Dangel, WJ, Daryani, A, De Neve, J-W, Dhimal, M, Dipeolu, IO, Djalalinia, S, Hoa, TD, Doshi, CP, Doshmangir, L, Ehsani-Chimeh, E, El Tantawi, M, Fernandes, E, Fischer, F, Foigt, NA, Fomenkov, AA, Foroutan, M, Fukumoto, T, Fullman, N, Gad, MM, Ghadiri, K, Ghafourifard, M, Ghashghaee, A, Glucksman, T, Goudarzi, H, Das Gupta, R, Hamadeh, RR, Hamidi, S, Haro, JM, Hasanpoor, E, Hay, S, Hegazy, M, Heibati, B, Henry, NJ, Hole, MK, Hossain, N, Househ, M, Ilesanmi, OS, Imani-Nasab, M-H, Irvani, SSN, Islam, SMS, Jahani, MA, Joshi, A, Kalhor, R, Kayode, GA, Khalid, N, Khatab, K, Kisa, A, Kochhar, S, Krishan, K, Defo, BK, Lal, DK, Lami, FH, Larsson, AO, Leasher, JL, LeGrand, KE, Lim, L-L, Mahotra, NB, Majeed, A, Maleki, A, Manjunatha, N, Massenburg, BB, Mestrovic, T, Mini, GK, Mirica, A, Mirrakhimov, EM, Mohammad, Y, Mohammed, S, Mokdad, AH, Morrison, SD, Naghavi, M, Ndwandwe, DE, Negoi, I, Negoi, RI, Ngunjiri, JW, Cuong, TN, Nigatu, YT, Onwujekwe, OE, Ortega-Altamirano, D, Otstavnov, N, Otstavnov, SS, Owolabi, MO, Pakhare, AP, Filipino Pepito, VC, Perico, N, Pham, HQ, Pigott, DM, Pokhrel, KN, Rabiee, M, Rabiee, N, Rahimi-Movaghar, V, Rawaf, DL, Rawaf, S, Rawal, L, Remuzzi, G, Renzaho, AMN, Resnikoff, S, Rezaei, N, Rezapour, A, Rickard, J, Roever, L, Sahu, M, Samy, AM, Sanabria, J, Santric-Milicevic, MM, Saraswathy, SYI, Seedat, S, Senthilkumaran, S, Servan-Mori, E, Shaikh, MA, Sheikh, A, Silva, DAS, Stein, C, Stein, DJ, Titova, MV, Topp, SM, Tovani-Palone, MR, Ullah, S, Unnikrishnan, B, Vacante, M, Valdez, PR, Vasankari, TJ, Venketasubramanian, N, Vlassov, V, Vos, T, Yearwood, JA, Yonemoto, N, Younis, MZ, Yu, C, Zadey, S, Bin Zaman, S, Zerfu, TA, Zhang, Z-J, Ziapour, A, Zodpey, S, Lim, SS, Murray, CJL, and Lozano, R

Abstract

BACKGROUND: Human resources for health (HRH) include a range of occupations that aim to promote or improve human health. The UN Sustainable Development Goals (SDGs) and the WHO Health Workforce 2030 strategy have drawn attention to the importance of HRH for achieving policy priorities such as universal health coverage (UHC). Although previous research has found substantial global disparities in HRH, the absence of comparable cross-national estimates of existing workforces has hindered efforts to quantify workforce requirements to meet health system goals. We aimed to use comparable and standardised data sources to estimate HRH densities globally, and to examine the relationship between a subset of HRH cadres and UHC effective coverage performance. METHODS: Through the International Labour Organization and Global Health Data Exchange databases, we identified 1404 country-years of data from labour force surveys and 69 country-years of census data, with detailed microdata on health-related employment. From the WHO National Health Workforce Accounts, we identified 2950 country-years of data. We mapped data from all occupational coding systems to the International Standard Classification of Occupations 1988 (ISCO-88), allowing for standardised estimation of densities for 16 categories of health workers across the full time series. Using data from 1990 to 2019 for 196 of 204 countries and territories, covering seven Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) super-regions and 21 regions, we applied spatiotemporal Gaussian process regression (ST-GPR) to model HRH densities from 1990 to 2019 for all countries and territories. We used stochastic frontier meta-regression to model the relationship between the UHC effective coverage index and densities for the four categories of health workers enumerated in SDG indicator 3.c.1 pertaining to HRH: physicians, nurses and midwives, dentistry personnel, and pharmaceutical personnel. We identified minimum workf

Published
2022

5. Catastrophic health expenditure during the COVID-19 pandemic in five countries: a time-series analysis.

Author

Haakenstad A, Bintz C, Knight M, Bienhoff K, Chacon-Torrico H, Curioso WH, Dieleman JL, Gage A, Gakidou E, Hay SI, Henry NJ, Hernández-Vásquez A, Méndez Méndez JS, Villarreal HJ, and Lozano R

Subjects
Humans, Pandemics, Research Design, Databases, Factual, Health Expenditures, COVID-19 epidemiology
Abstract

Background: The COVID-19 pandemic disrupted health systems in 2020, but it is unclear how financial hardship due to out-of-pocket (OOP) health-care costs was affected. We analysed catastrophic health expenditure (CHE) in 2020 in five countries with available household expenditure data: Belarus, Mexico, Peru, Russia, and Viet Nam. In Mexico and Peru, we also conducted an analysis of drivers of change in CHE in 2020 using publicly available data., Methods: In this time-series analysis, we defined CHE as when OOP health-care spending exceeds 10% of consumption expenditure. Data for 2004-20 were obtained from individual and household level survey microdata (available for Mexico and Peru only), and tabulated data from the National Statistical Committee of Belarus and the World Bank Health Equity and Financial Protection Indicator database (for Viet Nam and Russia). We compared 2020 CHE with the CHE predicted from historical trends using an ensemble model. This method was also used to assess drivers of CHE: insurance coverage, OOP expenditure, and consumption expenditure. Interrupted time-series analysis was used to investigate the role of stay-at-home orders in March, 2020 in changes in health-care use and sector (ie, private vs public)., Findings: In Mexico, CHE increased to 5·6% (95% uncertainty interval [UI] 5·1-6·2) in 2020, higher than predicted (3·2%, 2·5-4·0). In Belarus, CHE was 13·5% (11·8-15·2) in 2020, also higher than predicted (9·7%, 7·7-11·3). CHE was not different than predicted by past trends in Russia, Peru, and Viet Nam. Between March and April, 2020, health-care visits dropped by 4·6 (2·6-6·5) percentage points in Mexico and by 48·3 (40·6-56·0) percentage points in Peru, and the private share of health-care visits increased by 7·3 (4·3-10·3) percentage points in Mexico and by 20·7 (17·3-24·0) percentage points in Peru., Interpretation: In three of the five countries studied, health systems either did not protect people from the financial risks of health care or did not maintain health-care access in 2020, an indication of health systems failing to maintain basic functions. If the 2020 response to the COVID-19 pandemic accelerated shifts to private health-care use, policies to cover costs in that sector or motivate patients to return to the public sector are needed to maintain financial risk protection., Funding: The Bill & Melinda Gates Foundation., Competing Interests: Declaration of interests JLD reports support for the present manuscript from the Bill & Melinda Gates Foundation. JLD reports grants or contracts from the Bill & Melinda Gates Foundation, Gates Ventures, and Peterson Center on Healthcare, all outside the submitted work. HJV reports a grant from his university from the Mexican Association of Pharmaceutical Research Industries and direct payment from Roche for attending two meetings of the Roche Mexico Academic Advisory Board regarding long running trends in the Mexican health system; all outside the submitted work. All other authors declare no competing interests., (Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Published
2023
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6. Medically assisted reproduction for people living with HIV in Europe: A cross-country exploratory policy comparison.

Author

Andersen MH, Alexander MT, Bintz C, Ford C, Mitchem M, Pham A, Silverman L, and Irwin R

Subjects
Europe, Female, Humans, Policy, Reproduction, HIV Infections drug therapy, Reproductive Techniques, Assisted
Abstract

Objective: To explore the availability and accessibility of medically assisted reproduction (MAR) for people living with HIV in Europe, including the feasibility of cross-border care., Methods: We used a polymorphous engagement approach, primarily based on digital and email-based interviews with representatives of national HIV organizations, clinical researchers (infectious disease and/or infertility specialists), European and national professional societies (fertility and/or infectious disease), national regulatory authorities and individual clinics in 14 countries in the WHO European region. The research design and results were also informed by two surveys and a review of the secondary literature, news articles and clinic websites., Results: Although MAR is possible for people living with HIV in 12 out of the 14 countries mapped, accessing services can be challenging for logistical or financial reasons. People living with HIV also face barriers to MAR independent of their HIV status, such as limitations on single women and same-sex couples accessing services. Cross-border care is available for most patients who are self-financing but is limited for publicly funded patients., Conclusions: Even when MAR is available to and accessible for people living with HIV, there may still be barriers to treatment. Further research on patient experiences is needed to understand these discrepancies between availability and accessibility on paper and in practice., (© 2022 The Authors. HIV Medicine published by John Wiley & Sons Ltd on behalf of British HIV Association.)

Published
2022
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7. Measuring contraceptive method mix, prevalence, and demand satisfied by age and marital status in 204 countries and territories, 1970-2019: a systematic analysis for the Global Burden of Disease Study 2019.

Author

Haakenstad A, Angelino O, Irvine CMS, Bhutta ZA, Bienhoff K, Bintz C, Causey K, Dirac MA, Fullman N, Gakidou E, Glucksman T, Hay SI, Henry NJ, Martopullo I, Mokdad AH, Mumford JE, Lim SS, Murray CJL, and Lozano R

Subjects
Bayes Theorem, Child, Contraceptive Agents, Family Planning Services, Female, Humans, Marital Status, Pregnancy, Prevalence, Contraception, Global Burden of Disease
Abstract

Background: Meeting the contraceptive needs of women of reproductive age is beneficial for the health of women and children, and the economic and social empowerment of women. Higher rates of contraceptive coverage have been linked to the availability of a more diverse range of contraceptive methods. We present estimates of the contraceptive prevalence rate (CPR), modern contraceptive prevalence rate (mCPR), demand satisfied, and the method of contraception used for both partnered and unpartnered women for 5-year age groups in 204 countries and territories between 1970 and 2019., Methods: We used 1162 population-based surveys capturing contraceptive use among women between 1970 and 2019, in which women of reproductive age (15-49 years) self-reported their, or their partner's, current use of contraception for family planning purposes. Spatiotemporal Gaussian process regression was used to generate estimates of the CPR, mCPR, demand satisfied, and method mix by age and marital status. We assessed how age-specific mCPR and demand satisfied changed with the Socio-demographic Index (SDI), a measure of social and economic development, using the meta-regression Bayesian, regularised, trimmed method from the Global Burden of Diseases, Injuries, and Risk Factors Study., Findings: In 2019, 162·9 million (95% uncertainty interval [UI] 155·6-170·2) women had unmet need for contraception, of whom 29·3% (27·9-30·6) resided in sub-Saharan Africa and 27·2% (24·4-30·3) resided in south Asia. Women aged 15-19 years (64·8% [62·9-66·7]) and 20-24 years (71·9% [68·9-74·2]) had the lowest rates of demand satisfied, with 43·2 million (95% UI 39·3-48·0) women aged 15-24 years with unmet need in 2019. The mCPR and demand satisfied among women aged 15-19 years were substantially lower than among women aged 20-49 years at SDI values below 60 (on a 0-100 scale), but began to equalise as SDI increased above 60. Between 1970 and 2019, the global mCPR increased by 20·1 percentage points (95% UI 18·7-21·6). During this time, traditional methods declined as a proportion of all contraceptive methods, whereas the use of implants, injections, female sterilisation, and condoms increased. Method mix differs substantially depending on age and geography, with the share of female sterilisation increasing with age and comprising more than 50% of methods in use in south Asia. In 28 countries, one method was used by more than 50% of users in 2019., Interpretation: The dominance of one contraceptive method in some locations raises the question of whether family planning policies should aim to expand method mix or invest in making existing methods more accessible. Lower rates of demand satisfied among women aged 15-24 years are also concerning because unintended pregnancies before age 25 years can forestall or eliminate education and employment opportunities that lead to social and economic empowerment. Policy makers should strive to tailor family planning programmes to the preferences of the groups with the most need, while maintaining the programmes used by existing users., Funding: Bill & Melinda Gates Foundation., Competing Interests: Declaration of interests NF reports other funding support from WHO as a consultant from June to September 2019 and Gates Ventures since 2020, all outside the submitted work. NJH reports grants or contracts from the Bill & Melinda Gates Foundation, outside the submitted work. All other authors declare no competing interests., (Copyright © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Published
2022
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8. [Mother and Child Protection in Val-de-Marne].

Author

Iraola É and Bintz C

Subjects
Child, Female, Humans, Mothers
Abstract

In the department of Val-de-Marne, the Mother and Child Protection is characterised by a global approach to health, special accessibility of its services, multi-disciplinarity and the expertise of its teams. It is based on the concept of proportionate universalism and devotes a special place to partnership arrangements. Its working dynamics are based on the methodology of the project system: it is a question of co-construction, activating transversality while advocating participatory democracy. The working dynamics are, therefore, diversified., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Published
2021
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