Background: In developing countries, most people with mental, neurological and substance-abuse (MNS) disorders do not receive adequate care mainly because of a lack of mental health professionals. Non-specialist health workers, but also other professionals with health roles, such as teachers, may therefore have an important role to play in delivering MNS health care. Researchers in The Cochrane Collaboration carried out a review of the effects of using non-specialist health workers or other professionals with health roles to help people with MNS disorders in developing countries. After searching for all relevant studies in scientific databases, they found 38 studies published before October 2012. Their findings are summarised below. What is a non-specialist health worker? Any type of health worker (like a doctor, nurse or lay health worker) who is not a specialist in mental health or neurology but who may have had some training in these fields. We also looked at teachers, as they can be particularly important in the care of children and youths. What the research says: The studies in this review were from 22 developing countries. In most studies, lay health workers delivered the mental health care, and addressed depression or anxiety (or both), or post-traumatic stress disorder. The review shows that the use of non-specialist health workers, compared with usual healthcare services: Â· may increase the number of adults who recover from depression or anxiety (or both) two to six months after treatment; Â· may slightly reduce symptoms formothers with depression; Â· may slightly reduce the symptoms of adults with post-traumatic stress disorder (non-specialists and teachers were used in one study); Â· probably slightly improves the symptoms of people with dementia; Â· probably improves/slightly improves the mental well-being, burden and distress of carers of people with dementia; Â· may decrease the quantity of alcohol consumed by problem drinkers. It is uncertain whether lay health workers or teachers reducepost-traumatic stress disorder symptoms among children. There were too few studies to draw any conclusions about the cost-effectiveness of using non-specialist health workers or teachers, or about their impact on people with other MNS conditions such as epilepsy, schizophrenia, and alcohol and drug abuse problems. In addition, very few studies measured unintended consequences of non-specialist health worker-led care - such effects could impact on the appropriateness and quality of care. Quality of the evidence: Overall, non-specialist health workers and teachers have some promising benefits in improving people's outcomes for general and perinatal depression, post-traumatic stress disorder and alcohol-use disorders, and patient and carer outcomes for dementia. However, this evidence is of low or very low quality in some areas, and for some issues no evidence is available. Therefore, we cannot make conclusions about which specific interventions using non-specialist health workers to help people with MNS disorders are more effective.

/pdf/non-specialist-health-worker-interventions-for-the-care-of-4p2djvvv9r.pdf

Non-specialist health worker interventions for the care of mental, neurological and substance-abuse disorders in low- and middle-income countries.

/pdf/economic-analysis-of-malaria-control-in-sub-saharan-africa-5479xp8ike.pdf

Economic Analysis of Malaria Control in Sub-Saharan Africa

Literature on community-based rehabilitation (CBR) published between 1978 and 2002 is reviewed to assess the evidence base for CBR. There were 128 articles found that met the criteria set by the authors. The articles have been classified according to the methodology used and the key aspects studied. The review showed an ever-increasing number of publications on CBR. Theory papers and descriptive studies are the most common types of papers in CBR literature. Intervention studies and case reports are relatively rare. No systematic review has yet been carried out although reviews on specific aspects of CBR have become available. The key aspects of 'implementation' and 'stakeholders' are relatively well presented but the numbers of articles on 'participation' and 'use of local resources' are noticeably low. This study reveals that there is no real focus of research in CBR and therefore the evidence base for CBR is fragmented and incoherent on almost all aspects of CBR. It is recommended that comprehensive review studies should be carried out on key aspects of CBR projects. This should be supported by systematic research in CBR projects in order to establish evidence-based practices.

The evidence base for community-based rehabilitation: a literature review

https://www.who.int/apoc/publications/amazigo_2007.pdf

Performance of predictors: evaluating sustainability in community-directed treatment projects of the African programme for onchocerciasis control.

1. Introduction 1.1 Context 1.2 DCPP standardized unit costs 1.3 Current approaches to estimating unit costs 2. Methods 2.1 Frames of reference 2.2 Selection of health care inputs 2.3 Sources of data 2.4 Unit of account 2.5 Dealing with traded and non traded goods 2.6 Standardizing costs across regions 2.7 Approaches and assumptions behind pricing of each health care input 3. Results 4. Discussion 4.1 Critical consideration of methods 4.2 Conclusions Annexes References List of Tables and Boxes Tables Table 1 Types of costs and sources Table 2 Relative hospital cost indices for World Bank regions Table 3 Cost per inpatient hospital bed day Table 4 Cost per outpatient hospital visit Table 5 Cost per health center visit Table 6 Annual salaries Table 7 Daily salary rates Table 8 Costs of selected laboratory tests and hospital procedures Table 9 Selected equipment costs Table 10 Fuel, cost per litre Table 11 Building cost per square metre Boxes Box 1 Factors that could account for differences in cost-effectiveness ratios for the same intervention Box 2 Hospital level definitions adopted by WHO-CHOICE Box 3 WHO-CHOICE definitions of staff levels Box 4 Standardizing costs across regions Box 5 How might the data be used? Abstract The Disease Control Priorities Project (DCPP) is a three-year effort to help inform disease control priorities in developing countries at a regional level using economic evaluation of specified interventions, an assessment of the size of the disease burden and consideration of how best to scale up interventions within a health system context. As part of the project a set of standardized regional unit costs have been estimated for a range of health care resource inputs. This Working Paper presents these data on the unit costs of health care inputs for the six low and middle-income World Bank regions. The aim is to provide DCPP chapter authors with a set of unit costs and ratios of relative costs for different regions in order that the same estimates and ratios are used in the analysis of a 'DCPP base case'. The objectives of this Working Paper are to: introduce and justify the approach taken to unit pricing for regions; provide preliminary results; illustrate how such information might be used; and discuss the pros and cons of the approach we have taken. In addition the paper explores some of the methodological issues around estimating costs and highlights where further research is required.

Unit costs of health care inputs in low and middle income regions. Working Paper No. 9, Disease Control Priorities Project

Alexandra a township in South Africa with 200000 inhabitants is 15 kilometers from Johannesburg. The Alexandra Health Center and University Clinic is the major provider of comprehensive health care in a way that empowers the community; it is a model of health care for similar communities in the Third World. The aims of outreach are to increase accessibility to health care improve compliance with treatment for chronic diseases and ensure the working of preventive and promotive care programs. As the services have improved attendance from neighboring areas has increased. The outreach system ensures that the focus remains on the residents of Alexandra and the townships disadvantaged people such as squatters the elderly and the disabled. The services consist of: promotion of community participation support of community organizations outreach services community education and research on outreach and community services and information gathering for the establishment of a health information system. The outreach services cover maternal and neonatal health child health workers health geriatric and chronic care and community-based rehabilitation and education. To meet these requirements a community-based network of health extension workers could be developed who are selected employed and trained by the Alexandra Health Center. Training would cover primary health care community resources communication and education techniques and community-based information systems. The workers would be based in health units each covering some 2000 families from which many outreach services could be provided. Their tasks would be home visiting environmental supervision and community organization and education. The Alexandra Health Center also provides assistance with financial management and offers the services of a doctor and physiotherapists for the Nokuthula Center for Mentally Handicapped Children.

Primary health care in support of community development.

This study provides a detailed analysis of costs and expenditure patterns at a primary health care centre serving an impoverished community of about 200,000 people. Data were collected on costs and utilisation of services at the Alexandra Health Centre and University Clinic (AHC) for the financial year ending March 1990. Capital and running costs were kept separate. The sources of data collection were statistics routinely collected in the different sections of the clinic, the accounting records, staff duty rosters and a prospective study done to collect information to apportion drug costs and to calculate the cost of a prescription. The audited operating expenditure at AHC for the 1990 financial year was R3.9 million, or R4,45 million with donations (mainly drugs and staff). Sixty-three per cent of total costs went on staff, 16% on drugs and supplies, 9% on buildings, furniture and transport, 3% on laboratory services, 2% on security and 8% on other items. The outpatients department accounted for 57% of expenditure, the 24-hour unit 37% and the outreach section 6%. Looked at another way, 66% went on curative services, 32% on preventive and promotive (including 13% on maternity costs) services, and 2% on rehabilitation services. The average cost per visit to each of 14 services is presented. The cost of a visit to casualty is R38.85, to the antenatal clinic R18.65 and to the child health outreach programme for immunisation R6.67. The component costs of each visit are analysed. The major cost component of a consultation is usually clinical staff, and detailed staff allocations for each section are given.(ABSTRACT TRUNCATED AT 250 WORDS)

Costs of primary health care at the Alexandra Health Centre.

Community development and primary health care.

Democracy in health services management.

In this article publications on the demography and environmental and health status of Alexandra Township are reviewed and a demographic survey carried out in 1990 is reported. The demographic data presented in the article describe the age, sex and ethnic profile of the population. It also describes the health and disease status, provides some vital statistics, describes the health services and discusses the implications for the development of appropriate health care strategies. Approximately 19% of the population live in informal dwellings or shelters, 14% in the newly upgraded areas and 67% in old Alexandra. Mean household occupancy was 4.04 with a male/female (m/f) ratio of 0.86. It was 3.08 in informal dwellings (m/f = 1.11), 4.30 in the newly upgraded areas (m/f = 0.74) and 4.28 for Old Alex (m/f = 0.82). Old Alex had the highest proportion of inhabitants aged over 60 years. On average females have been resident in Alexandra for 16.8 years and males for 14.9 years.

Robb D

Papers

Primary health care in support of community development.

Costs of primary health care at the Alexandra Health Centre.

Community development and primary health care.

Democracy in health services management.

A profile of Alexandra.