世界経済・社会統計 = World development indicators

https://link.springer.com/content/pdf/10.2307%2F3343168.pdf

Development as Freedom

Sustainable Development Goals

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Editor – I am moved by Professor Allan's elegy to bygone NHS virtues of ‘calm caring and gentle pace of clinical life… and all the time in the world to deliver compassionate care' ( Clin Med October 2009 p 407). One's immediate instinct would be to say ‘Ah, but times have changed' – only

Quality of care.

OBJECTIVES Immediate ART (or early access to ART for all, EAAA) is becoming a national policy in many countries in sub-Saharan Africa. It is plausible that the switch from delayed to immediate ART could either increase or decrease patient satisfaction with treatment. A decrease in patient satisfaction would likely have detrimental consequences for long-term retention and adherence, in addition to the value lost because of the worsening patient experience itself. We conducted a pragmatic stepped-wedge cluster-randomized controlled trial (SW-cRCT) to determine the causal impact of immediate treatment for HIV on patient satisfaction. DESIGN This seven-step SW-cRCT took place in 14 public-sector health facilities in Eswatini's Hhohho region, from September 2014 to August 2017. METHODS During each step of the trial, we randomly selected days for data collection at each study facility. During these days, a random sample of HIV patients were selected for outcome assessment. In total, 2629 patients provided data on their overall patient satisfaction and satisfaction with the following four domains of the patient experience using a five-point Likert scale: wait time, consultation time, involvement in treatment decisions, and respectful treatment. Higher values on the Likert scale indicated lower patient satisfaction. We analyzed the data using a multilevel ordered logistic regression model with individuals at the first level and health facilities at the second (cluster) level. RESULTS The proportional odds ratio (OR) comparing EAAA to control was 0.91 (95% CI 0.66-1.25) for overall patient satisfaction. For the specific domains of the patient experience, the ORs describing the impact of EAAA on satisfaction were 1.04 (95% CI 0.61-1.78) for wait time, 0.90 (95% CI 0.62-1.31) for involvement in treatment decisions, 0.86 (95% CI 0.61-1.20) for consultation time, and 1.35 (95% CI 0.93-1.96) for respectful treatment. These results were robust across a wide range of sensitivity analyses. Over time - and independent of EAAA - we observed a worsening trend for both overall patient satisfaction and satisfaction in the four domains of the patient experience we measured. CONCLUSION Our findings support the policy change from delayed to immediate ART in sub-Saharan Africa. Immediate (versus delayed) ART in public-sector health facilities in Eswatini had no effect on either overall patient satisfaction or satisfaction with four specific domains of the patient experience. At the same time, we observed a strong secular trend of decreasing patient satisfaction in both the intervention and the control arm of the trial. Further implementation research should identify approaches to ensure high patient satisfaction as ART programs grow and mature.

Impact of immediate initiation of antiretroviral therapy on HIV patient satisfaction.

This study aimed to determine levels of health insurance coverage in low- and middle-income countries and how coverage varies by people's sociodemographic characteristics. We conducted a population size-weighted, one-stage individual participant data meta-analysis of health insurance coverage, using a population-based sample of 2,035,401 participants ages 15-59 from nationally representative household surveys in fifty-six countries during the period 2006-18. One in five people (20.3 percent) across the fifty-six countries in our study had health insurance. Health insurance coverage exceeded 50 percent in only seven countries and 70 percent in only three countries. Substantially more people had public health insurance than private health insurance (71.4 percent versus 28.6 percent). We found that men and older, more educated, and wealthier people were more likely to have health insurance; these sociodemographic gradients in health insurance coverage were strongest in sub-Saharan Africa and followed traditional lines of privilege. Low- and middle-income countries need to massively expand health insurance coverage if they intend to use insurance to achieve universal health coverage.

Health Insurance Coverage In Low- And Middle-Income Countries Remains Far From The Goal Of Universal Coverage.

Per capita GDP has limited use as a well-being indicator because it does not capture many dimensions that imply a “good life,” such as health and equality of opportunity. However, per capita GDP has the virtues of easy interpretation and can be calculated with manageable data requirements. Against this backdrop, a need exists for a measure of well-being that preserves the advantages of per capita GDP, but also includes health and equality. We propose a new parsimonious indicator to fill this gap and calculate it for 149 countries.

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Going beyond GDP with a parsimonious indicator: Inequality-adjusted healthy lifetime income

Objective In a pandemic, government assistance is essential to support the most vulnerable households as they face health and economic challenges. However, government assistance is effective only when it reaches vulnerable households in time. In this paper, we estimated the timeliness of government assistance for the most vulnerable households (ie, the poor households) in Ethiopia during its COVID-19 response of 2020. In particular, we conducted a time-to-event analysis to compare the time to receive government assistance between poor and non-poor households in Ethiopia. Methods We used a semiparametric Cox proportional model to evaluate whether the time to first receipt of government assistance during the COVID-19 response in 2020 differed between poor and non-poor Ethiopian households. We used the Schoenfeld test to check the proportionality assumption and conducted the stratified Cox regression analysis to adjust for non-proportional variables. The data from World Bank’s High-Frequency Phone Surveys on COVID-19 and the 2019 Ethiopian Socioeconomic Survey were used for this analysis. Results We found that the poor households in rural areas were 88% (HR: 1.88; 95% CI: 1.19 to 2.98) more likely to receive government assistance than non-poor households at any point within 10 months after the start of the pandemic. However, there was no significant difference between urban poor and non-poor households’ likelihood of receiving government assistance during this timeframe. Conclusion The Ethiopian government has leveraged its existing social protection network to quickly reach poor households in rural areas during the COVID-19 response of 2020. The country will need to continue strengthening and scaling the existing social protection systems to accurately target the wider vulnerable population in urban areas.

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Coverage of social assistance in Ethiopia during the COVID-19 pandemic: a time-to-event analysis

Background: Nigeria’s neonatal mortality rate (NMR) and under-five mortality rate (U5MR) are 39 per 1,000 and 120 per 1,000 live births, respectively. On average, 0.23 million neonates and 0.7 million under-five children die every year, but some states contribute more to this burden than others. If the country is to meet its sustainable development goal (SDG) targets for NMR and U5MR, it needs to make progress at both the national and subnational levels. Methods: Using the 2016-2017 Nigeria Multiple Indicator Cluster Survey (MICS), we estimated state-level neonatal and under-five mortality rates.  Next, we estimated how long it would take for each state to reach the SDG targets for NMR and U5MR. Finally, we estimated the average number of neonatal and under-five deaths that could be averted between 2018 and 2030 in each state under different scenarios. Results: At current average annual rates of decline, Nigeria is unlikely to meet both sustainable development goals targets for NMR and U5MR. At the subnational level, some states are close to or have met both NMR and U5MR targets, while others are projected to meet the targets as late as 2088 (58 years delayed). Between 850,000 and 1.89 million neonatal deaths could be averted between 2018 and 2030, while 3.1 million to 5.96 million under-five deaths could be averted over the same period. Conclusions: Nigeria has the potential to achieve its SDG targets for NMR and U5MR, and in the process avert millions of preventable child deaths. But this will not happen under a business-as-usual approach. The NMR and U5MR trajectories achieved by high-performing states is evidence that achieving these SDG targets is possible. For the country to achieve positive results nationally, systems that encourage peer learning and transfer of technical expertise between states are needed.

How many child deaths can be averted in Nigeria? Assessing state-level prospects of achieving 2030 sustainable development goals for neonatal and under-five mortality.

Osondu Ogbuoji

Papers

Impact of immediate initiation of antiretroviral therapy on HIV patient satisfaction.

Health Insurance Coverage In Low- And Middle-Income Countries Remains Far From The Goal Of Universal Coverage.

Going beyond GDP with a parsimonious indicator: Inequality-adjusted healthy lifetime income

Coverage of social assistance in Ethiopia during the COVID-19 pandemic: a time-to-event analysis

How many child deaths can be averted in Nigeria? Assessing state-level prospects of achieving 2030 sustainable development goals for neonatal and under-five mortality.