ContextCervical cancer is a leading cause of cancer-related death among women
in developing countries. In such low-resource settings, cytology-based screening
is difficult to implement, and less complex strategies may offer additional
options.ObjectiveTo assess the cost-effectiveness of several cervical cancer screening
strategies using population-specific data.Design and SettingCost-effectiveness analysis using a mathematical model and a hypothetical
cohort of previously unscreened 30-year-old black South African women. Screening
tests included direct visual inspection (DVI) of the cervix, cytologic methods,
and testing for high-risk types of human papillomavirus (HPV) DNA. Strategies
differed by number of clinical visits, screening frequency, and response to
a positive test result. Data sources included a South African screening study,
national surveys and fee schedules, and published literature.Main Outcome MeasuresYears of life saved (YLS), lifetime costs in US dollars, and incremental
cost-effectiveness ratios (cost per YLS).ResultsWhen analyzing all strategies performed as a single lifetime screen
at age 35 years compared with no screening, HPV testing followed by treatment
of screen-positive women at a second visit, cost $39/YLS (27% cancer incidence
reduction); DVI, coupled with immediate treatment of screen-positive women
at the first visit was next most effective (26% cancer incidence reduction)
and was cost saving; cytology, followed by treatment of screen-positive women
at a second visit was least effective (19% cancer incidence reduction) at
a cost of $81/YLS. For any given screening frequency, when strategies were
compared incrementally, HPV DNA testing generally was more effective but also
more costly than DVI, and always was more effective and less costly than cytology.
When comparing all strategies simultaneously across screening frequencies,
DVI was the nondominated strategy up to a frequency of every 3 years (incremental
cost-effectiveness ratio, $460/YLS), and HPV testing every 3 years (incremental
cost-effectiveness ratio, $11 500/YLS) was the most effective strategy.ConclusionCervical cancer screening strategies that incorporate DVI or HPV DNA
testing and eliminate colposcopy may offer attractive alternatives to cytology-based
screening programs in low-resource settings.

https://jamanetwork.com/journals/jama/articlepdf/193957/JOC10234.pdf

Policy analysis of cervical cancer screening strategies in low-resource settings: clinical benefits and cost-effectiveness.

This paper describes factors affecting health worker motivation and satisfaction in the public sector in Ghana. The data are from a survey of public sector health care providers carried out in January 2002 and repeated in August 2003 using an interviewer administered structured questionnaire. It is part of a continuous quality improvement (CQI) effort in the health sector in the Greater Accra region of Ghana. Workplace obstacles identified that caused dissatisfaction and de-motivated staff in order of the most frequently mentioned were low salaries such that obtaining basic necessities of daily living becomes a problem; lack of essential equipment, tools and supplies to work with; delayed promotions; difficulties and inconveniences with transportation to work; staff shortages; housing, additional duty allowances and in-service (continuous) training. Others included children's education, vehicles to work with such as ambulances and pickups, staff transfer procedures, staff pre-service education inadequate for job requirements, and the effect of the job on family and other social factors. There were some differences in the percentages of staff selecting a given workplace obstacle between the purely rural districts, the highly urbanized Accra metropolis and the districts that were a mixture of urbanized and rural. It is unlikely that the Ghana Health Service can provide high quality of care to its end users (external customers) if workplace obstacles that de-motivate staff (internal customers) and negatively influence their performance are not properly recognized and addressed as a complex of inter-related problems producing a common result--dissatisfied poorly motivated staff and resulting poor quality services.

Health worker (internal customer) satisfaction and motivation in the public sector in Ghana.

This chapter focuses on the collection and management of public health information, in contrast to clinical information, which concerns individual patient care encounters Even when aggregated, clinical data are necessary, but not sufficient, to inform efforts to improve the health of populations While substantial attention has been focused on these facility-based clinical consultations and the health management information system (HMIS) used to track the relevant data, we focus here on the broader health information system (HIS) needed to inform decisions at individual, facility, district, and national levels Considered here are the routine data collection systems upon which program management, planning, monitoring, and evaluation depend Information needs for specific tasks, such as for research or for program evaluation, are discussed in the chapters on research (chapters 4 and 7) Other chapters in this volume refer to information needs to enable disease control or to evaluate programs and improve the delivery of interventions Those interested in these issues should also pay special attention to chapter 53 and chapters 70–73 This chapter bridges the global and the local issues; it makes the case for strengthening the evidence base for action through comprehensive health information systems that include census, vital events, monitoring, public health surveillance, resource tracking, facility-based service statistics, and household surveys

Information to Improve Decision Making for Health

Purpose – This paper seeks to explore the factors affecting provision of service quality in the public health sector in Kenya, focusing on employee capability, technology, communication and financial resources. The paper reviews existing literature and experiences on public health service provision and quality management. Design/methodology/approach – The paper reports on empirical evidence drawn from a case study of Kenyatta National Hospital – the largest referral hospital in Eastern & Central Africa. A total of one hundred and three respondents, comprising; sixteen doctors, thirty two nurses, twenty nine clinical officers, fourteen laboratory technologists and twelve pharmacists. Data was collected using closed and open ended questionnaires. Findings: Low employee’s capacity led to a decrease in provision of service quality public health sector by factor of 0.981 with while Inadequate Technology adoption in provision of health service led to a decrease in provision of service quality by a factor of 0.917. The Ineffective communication channels affected delivery service quality in public health sector by a factor of 0.768 while insufficient financial resources resulted to decrease in provision of health service quality by factor of 0.671. This implied that low employees capacity, low technology adoption, ineffective communication channels and insufficient fund affect delivery of service quality to patients in public health sector affecting health service quality perceptions, patient satisfaction and loyalty. Practical Implications – In the paper the implications for policy include: comprehensive healthcare policy, addressing the plight of the worker, the working environment, the resources to enable the healthcare personnel perform effectively, and emotional intelligence management of the workforce. Originality/value- The paper shows that the respondents in this study were various professionals in the healthcare provision, covering the comprehensive process of healthcare provision from diagnosis to treatment. The approach to study the largest referral hospital in Eastern and Central Africa region and data collected is indicative of special case of Kenyatta National hospital and may be entirely different from other public health institutions within the Eastern and Central Africa region.

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Factors Affecting Provision of Service Quality in the Public Health Sector: A Case of Kenyatta National Hospital

Nations face numerous challenges in providing high-quality end-of-life care for their citizens, and an aging population that has a prolonged trajectory of decline and substantial needs for care magnifies these challenges. As nations begin to address these challenges, it will be essential to determine whether their responses are effective, but current national data collection efforts are sporadic, and data are often collected only for patients who receive care through certain funding programs or provider organizations or in selected sites of care. Therefore, governments do not know whether their citizens are receiving adequate care, whether current programs are improving care, or how their outcomes compare with those of other countries. This article describes the importance of developing national minimum data sets that can be used to assess the quality of end-of-life care that older adults receive and recommends key variables that these data sets should include.

How Should Nations Measure the Quality of End‐of‐Life Care for Older Adults? Recommendations for an International Minimum Data Set

There is limited information on national health expenditures, services, and outcomes in African countries during the 1990s. We intend to make statistical information available for national level comparisons. National level data were collected from numerous international databases, and supplemented by national household surveys and World Bank expenditure reviews. The results were tabulated and analysed in an exploratory fashion to provide benchmarks for groupings of African countries and individual country comparison. There is wide variation in scale and outcome of health care spending between African countries, with poorer countries tending to do worse than wealthier ones. From 1990-96, the median annual per capita government expenditure on health was nearly US$ 6, but averaged US$ 3 in the lowest-income countries, compared to US$ 72 in middle-income countries. Similar trends were found for health services and outcomes. Results from individual countries (particularly Ethiopia, Ghana, Cote d'Ivoire and Gabon) are used to indicate how the data can be used to identify areas of improvement in health system performance. Serious gaps in data, particularly concerning private sector delivery and financing, health service utilization, equity and efficiency measures, hinder more effective health management. Nonetheless, the data are useful for providing benchmarks for performance and for crudely identifying problem areas in health systems for individual countries.

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A.E. Elmendorf

Papers

Benchmarks for health expenditures, services and outcomes in Africa during the 1990s