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Global Health BSc 2018/19 - CDMM1 > Global Health Actors - 1 - 5 > Flashcards

Global Health Actors - 1 - 5 Flashcards

1
Q

What is the Essential Medicines List?

A

Published by WHO - Medications considered to be most effective and safe to meet most important needs of health system.

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2
Q

How does the EML contribute to united health care?

A

Used by countries to develop their own local lists of essential medicines.

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3
Q

What two categories of medicines are included in the EML?

A

Core and complimentary

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4
Q

What do the core medicines in EML consist of?

A

Most cost-effective options for key health problems

Usable w/ little additional health resources

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5
Q

What do the complimentary medicines in EML consist of?

A

Require additional infrastructure:

  • Specially trained HCW
  • Diagnostic equipment leading to a decreased cost-benefit ratio
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6
Q

Is there another list for children?

A

Yes - Essential Medicines List for Children (EMLc) for children up to 12 y/o

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7
Q

What is the criteria for selection of essential medicines?

A

Disease burden
Sound + adequate data on efficacy, safety + comparative cost-effectiveness of available treatments
Stability in various conditions - need for special diagnostic/treatment facilities
When adequate scientific evidence not available, Expert Committee may either defer issue until more evidence becomes available or make recommendations based on expert opinion
Cost of total Tx and unit cost of medicine - patency not considered

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8
Q

Name two drugs that are in the process of applying for EML

A

Bedaquiline + Grazoprevir/elbasvir

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9
Q

What does bedaquiline treat?

A

MDR-TB as part of a combination Tx of pulmonary TB

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10
Q

Why is bedaquiline needed?

A

An estimated 9% of patients with MDR-TB had XDR-TB
In low resource settings, pts with MDR-TB are inadequately treated and often die because not enough medications are available
Second-line drugs often not available
Global stock-outs
Many MDR-TB cases go undetected and not placed on appropriate Tx, increasing risk of death +/- transmission of MDR-TB strains to others

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11
Q

What is the efficacy of bedaquiline?

A

82% in bedaquiline group and 62% in placebo

Highly likely to be cost-effective in both LICs and HICs –> faster rates of conversion so less time hospitalised

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12
Q

What are the S/E of bedaquiline?

A

QT prolongation - must take caution when co-prescribing with drugs that affect the liver

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13
Q

What is the top cause of disease burden worldwide?

A

Ischaemic Heart Disease

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14
Q

How have the top causes of disease burden changed in the last decade?

A

Shift from communicable diseases to NCDs

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15
Q

What is the largest contributor of lost DALYs?

A

Cardiovascular disease

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16
Q

Which condition receives the most international Development Assistance for Health (DAH)?

A

HIV/AIDS - 5 fold increase in DAH since 1990

Has declined though

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17
Q

Is funding relative to global burden of disease?

A

No - some conditions are top causes of GBD but relatively underfunded e.g. NCDs, maternal and reproductive health e.g. HIV/AIDS had 7.6% YLL but a 41.6% DAH whereas TB had 3.1% YLL and 3.3% DAH. GH actors decide on how diseases get funded

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18
Q

How has global health finance changed in the last decade?

A

In 90s used to be mainly bilateral GH relationship as main source of income i.e. aid given from one country to another. Now it is more a mixed landscape - more mixed pattern of funding as different actors come to play

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19
Q

Who is the largest donor of DAH globally?

A

The National Treasury of the USA

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20
Q

Who is the biggest contributor of global health financing?

A

NGOs and foundations, followed by the US. Most important funders of healthcare are national governments and their citizens

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21
Q

What are the 3 lens to view health spending through?

A

Health lens
Development lens
Ministry of Defence lens

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22
Q

Describe the health spending source in LICs

A

Rely on DAH and out-of-pocket financing - this can deter access to healthcare (if > 40% of income = catastrophic)

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23
Q

Describe the health spending source in MICs

A

Domestic spending but when governments lack the capacity to increase health spending, much is left to be financed out of pocket

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24
Q

Describe the health spending source in HICs

A

Mainly government spending and prepaid private insurance schemes with some out of pocket

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25
What is the global governance for health? (GGH)
Collection of rules, norms, institutions and processes that shape the health of the world's populations. Governance strategies aim to organise stakeholders + manage social, economic and political affairs to improve global health and narrow health inequalities - The Lance - University of Oslo commission
26
What is the global health system?
A constellation of actors whose primary purpose is to promote, restore or maintain health. Sets of rules that prescribe behavioural roles, constrain activity and shape expectations. Such actors may operate at the community, national or global levels and may include governmental, intergovernmental, private-for-profit +/- not-for profit entities (Slezak et al, 2010)
27
What diagram illustrates the global health system?
Frenk diagram, 2013
28
How many sectors does the Global Health system have?
3: State, Market + Civil society
29
What is the state sector in the GH system?
Legislature Executive Judiciary Role of government - usually most powerful policy actor in a country
30
What is the market sector in the GH system?
Represents important political power: huge resources + major contributors of national economies Private finance, provision, partnerships and joint ventures Trade associations, think tanks and professional associations
31
What is the civil society sector in the GH system?
Voluntary, free association situated between market and state sector "A buffer zone strong enough to keep both state and market in check, thereby preventing each from becoming too powerful and dominating" (Giddens, 2001)
32
What is the definition of global health?
Collaborative trans-national research and action for promoting health for all (Beaglehole et al.) Advocates the importance of health + burden of disease on the progress + future stability of each country and the world as a transnational body through action fuelled by evidence-based MDT
33
What institutions does the global system used to deal with challenges to health that require cross-border collective action to address effectively?
Formal and informal
34
Give examples of formal institutions in the global system
WHO | Governments
35
Give examples of informal institutions in the global system
BMGF MSF Hold themselves in account + quality of care they are providing
36
Is there an independent regulatory body to critique financially independent organisations about their standards?
No! How do we ensure that they align their agenda to countries?
37
What is the global system being more and more influenced by?
Politics as formed by member states | Health is being seen as a commodity by countries
38
What are the trends and challenges in global health?
``` Vaccine-preventable diseases Infectious diseases Anti-microbial resistance Behaviour of people Climate change NCDs Population growth LICs to MICs - epidemiological transition Political environment is changing - BRIC (Brazil, Russia, India, China) ```
39
What are the 4 essential functions of the global health system?
Production global public goods i.e. R&D, standards and guidelines, comparative evidence and analyses Management of externalities across countries e.g. surveillance and info sharing Mobilisation of global solidarity - development financing, technical cooperation Stewardship = convening for negotiation + cross-sector health advocacy
40
What category does MSF fall into?
All 3 - very little institutional funding; recruit local staff to do work
41
Who are the top 3 key global health actors?
WHO BMFG Gavi
42
What are the criticisms of the WHO?
Large institution but slow to act e.g. Ebola outbreak Political institution and disconnect - people who run offices are political + a lot of autonomy that regional offices have so how much authority does the central Geneva office have? Undermined by other economic giants e.g. BMGF + World Bank Emergency medicine increasing capacity - pushes WHO beyond their status Many policies don't consider affordability - disconnect between policies and what happens on the ground Unstable financial situation - mandatory contributions are much smaller than voluntary contributions - countries can decide what money is spent on
43
Why is the global health environment crucial for humanitarian settings?
Mapping of relevant institutions Power dynamics Shift from worldwide nation-based health policy making structures towards more diversity that puts emphasis on private sector actors
44
What are the global health priorities?
Health security + humanitarian biomedicine Communicable diseases Health system strengthening - to govern health in the new global context + strengthen local response - shift from health system strengthening to political and economic systems
45
How does humanitarian action play a part in global health setting?
Prominent part of the political and moral landscape - ideology of profession + a movement Humanitarianism operates under the notion that there is agreement over the existence of a common core of universal humanitarian values
46
What is the policy triangle made up of?
``` Content Context Process Actors There is a central issue of power ```
47
What are the contextual factors?
``` Economic - different between countries Social/cultural - dominant national ideologies influence what is possible e.g. difficulties of reforming health system post conflict Ideological Political system Conflict Globalisation ```
48
What are the 3 groups of global actors?
Individuals Groups Organisations Some sectors of the population may be more powerful than others e.g. young v old, rich v poor, hereditary powers, political affiliations
49
What is the policy process usually like?
A clear, rational and linear process for generation of policy is often not the case in practice + policies can enter at different stages of the process POWER plays a massive part of the process
50
What is agenda setting like?
Inherently unstable - some issues are permanent, transient or cyclical Interplay of actors/interests, ideas, institutions Mediation is crucial - aims of a policy and practice of policies often don't align
51
What is policy maintenance like?
Takes up a lot of time for policy makers - rarely policy leaps Involves a diverse group of interests - formal and informal Level of influence depends on how well connected they are + how successful they are at getting issues onto the policy agenda
52
What are the 10 steps of outbreaks?
``` Establish the presence of outbreak Diagnose Develop case definition Describe the epidemiology: time, place, person Active case finding, contact tracing Develop + test hypothesis about its cause.... re-evaluate Respond Repost (evaluate) ```
53
When did the ebola outbreak in West Africa occur?
Started in Guinea in December 2013 and then spread to Sierra Leone and Liberia
54
What are the 6 system building blocks?
``` Service delivery Health workforce Information Medical products, vaccines + technologies Financing Leadership/governance ```
55
What are the overall goals/outcomes of health systems?
Improved health (level and equity) Responsiveness Social and financial risk protection Improved efficiency
56
What were the reasons for the Ebola outbreak spreading initially?
Lack of healthcare workforce - one doctor for 70 000 people Mobile population when Ebola was unknown Lack of surveillance and alerting system Lack of cooperation across borders (started where 3 countries shared borders with each other) Unwillingness to declare - financial implications Lack of international response - travel restrictions Complex coordination of response
57
How did the Ebola outbreak affect healthcare workers?
Up to 16% of cases were in HCW initially - had an effect afterwards as number of HCW decreased dramatically as number of cases increased > 500 HCW died
58
What were the wider impacts of the effect on HCW during the Ebola outbreak?
Health facilities understaffed/closed 25% drop in malaria treatment Expanded Programme on Immunization (EPI) activities stopped Maternal deaths rose by about 30%
59
How did the MSF respond to the Ebola outbreak?
Patient management in Emergency Medical Clinics - maternal care for infected women, survivors' clinics, anti-malarial distribution Disinfection - homes, bodies; cremation Training and support to others (Sierra Leone) Training staff in Amsterdam, Brussels + Geneva Vaccine research
60
What happened in Freetown, the capital of Sierra Leone during the Ebola outbreak 2013?
Prevalence rates would not go down in the densely populated city so divided city into administrative regions to different organisations e.g. MSF, Oxfam etc Community education + mobilisation - targeted gangs Support alert system (phone lines) Set up community surveillance system - daily reporting Improve contact tracing quality Chart chains of transmission - find gaps Dignified quarantine response Pilot system Successful and rolled out to other areas - hampered by multiple ministries + local communities
61
What are the 6 pillars of response?
``` Case management + isolation Case finding Contact tracing Safe + dignified burial Social mobilisation/community engagement Supporting and existing health structures ```
62
What are the negative lessons learnt from the Ebola outbreak?
Failure to invest in PH preventative systems - Delay in WHO declaring a Public Health Emergency of International Concern Failure to focus on people - before and during International response slow + poorly coordinated - self interest led to lack of commitment Migration, movement + outbreaks Public health response was insufficient Impact of misinformation + media storm on public perception - affects political will
63
What are the positive lessons learnt from the Ebola outbreak?
Rapid implementation of research | Compassionate controls

Global Health BSc 2018/19 - CDMM1 (12 decks)

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