Global Health Final Exam
What is a systems approach and why is it important? (Novartis video)
- Allows us to realize that we cannot just "dump" medications in poor-income countries -should not have to be dealing with diseases like lepresy and malaria because we know how to cure them - lacking diagnostic tools
Describe the Broad Street Pump Dilemma
- Case of Cholera (diarrhea)
What are some indicators that we are looking for in response to COVID-19?
- Loss of smell or taste - Fever over 100.4 degrees F - Chills and Fatigue - Dry Cough (no mucus) - Nausea - Difficulty breathing - spending 15 minutes or more (daily) within 6 feet of another person
What indicators was John Snow measuring?
- What pump people were using for drinking water - The number of people dying in a certain area - How far people lived from the pump
Compare the U.S. health expenditures to the rest of the world. Analyze why this is happening.
- about 2x greater than other countries that have a UHC The cost is much greater in the U.S. because we operate underneath a mixed system, instead of one universal system. - this allows for many different prices to be set from many different individuals -lots of unnecessary spending (PBMs) - we have many regulations that elevate costs (medication packaging)
Why are drug prices higher in the US?
- we personally pay for our own research and development - PBMs - we have regulations that help elevate costs (packaging)
How is Steve Davis's video directly related to governance?
-reiterates several different competing outcomes and systems: 1. Various countries engaged in the development process (vaccine nationalism) 2. Distribution factors (temperature and dosing issues) 3. Who will get the vaccine first? 4. How will multiple doses be kept tract of?
What are the 2 basic principle of UHC?
1. Access to quality care 2. Protection against financial risk
What are the pros of a UHC?
1. Everyone would have access 2. It wouldn't be linked to your job 3. It would cost much less
What are four key ways that global health initiatives are paid for?
1. Health Insurance 2. Government Expenditure 3. Donor Financing 4. Out-of-pocket expenditures
the World Bank defined a low-income country (what this book terms "impoverished") as a country with a GNI per capita of less than
$1,025
How has COVID affected global poverty?
Global extreme poverty is expected to rise for the first time in over 20 years - 8 out of the 10 "new poor" will be in middle-income countries
the percent of the total government budget (GDP or GNI) that is used for health
Government Health Expenditure
local, national, international activist groups, and local community members
civil society
The use of cash to incentivize clinic utilization as a way to offset the out-of-pocket cost of care is called a
conditional cash transfer
What does the IMHE suggest will happen as a result of COVID?
contracted health expenditure; only 1% comes from healthcare; 40 billion from outside donors
the number of public facilities that can detect and treat TB under the DOTS strategy as a percentage of the total number of public facilities
DOTS coverage rate
What are often used as a guide when implementing global health programs and analyzing impact?
Demographic Health Surveys (DHS)
Who is the second in command at the MOH?
Director General (DG)
Who are the ranking public health officials at the district level?
District Health Officers (DHOs)
Define EIS and explain what they do.
Epidemiologic Intelligence Services They serve on the front lines of public health to protect the society from the severe consequences of emerging diseases
What is the EML and who was it made by?
Essential Medicines List by the WHO - updated every 2 years; contains list of 200 essential drugs
created an incentive system for companies to develop new drugs for one of 16 neglected tropical diseases
FDA Amendments Act 2007
What is Good Manufacturing Process (GMP)? What does it entail?
FDA certifies the quality standards for factories and production processes - prequalification process
wealthy countries committed to spending 1 percent of their GNI on overseas development assistance.
G-8 Summit in Scotland
What are the 5 components of logical models?
1. Inputs: the resources used in a program 2. Processes: the activities carried out to achieve a program's objectives 3. Outputs: the immediate results achieved at the program level from the implementation of certain activities 4. Outcome: the set of short-term or immediate results achieved at the population level (objectives) 5. Impact: the long term effects or end result of the program
What are the 5 core activities of the GDD?
1. Outbreak Response 2. Surveillance 3. Pathogen Discovery 4. Training 5. Networking (Oh shoot, peter took nicotine)
What are the cons of a UHC?
1. Taxes would increase 2. Quality of care could change 3. Less choice for the individual
What percent of a government's health budget should be allotted towards drug prices?
15-27%
issued a report6 that stated that inequality in both health risks and outcomes is a ranking human rights problem for our times.
2014 Lancet Commission on Global Governance for Health
What is the GINI coefficient for the U.S.?
41.1
What is GDP?
GDP = Gross Domestic Product; That's HOW MUCH MONEY YOUR COUNTRY MAKES IN A YEAR by producing and selling products and services.
What is the GDD and what is its purpose?
Global Disease Detection Program Purpose: to prevent emerging pathogenic outbreaks from becoming pandemics
the goal of committing at least 15 percent of government expenditure on health was created where?
Abuja Declaration
Who was the index case in the Broad Street Pump? Who were some of the exceptions to the study?
Baby Lewis Exceptions: Brewery Workers, Workhouse, and family living a mile or so away
Big Philanthropic Representative
Bill and Melinda Gates
means that donor funds are put directly into a country's health budget and under the control of the government.
Budgetary Support
help countries select indicators, align with reporting requirements, harmonize global databases, facilitate analytical capacity, and reflect evolving public health priorities. The 100 indicators are grouped into four main areas: health status, risk factors, service coverage, and health systems
Global Reference List of 100 Core Health Indicators
An ideology in which the community decides who is most at risk or in need of services
Communitarianism
What is GNI?
Comprises the total value of goods and services produced within a country (i.e. its GDP), together with it's income received from other countries (notably interest and dividends), less similar payments made to other countries.
What are conceptual frameworks?
Considers the various factors that can affect the program or intervention, clarifies the causal relationships between these factors, and identifies those that the intervention may affect. It is used for program design rather than for program M&E.
refers to a facility with personnel who are trained to perform case detection by smear microscopy, administer treatment, and keep a register of those tested and on treatment
DOTS coverage
assess the benefit of a new technology (drug, diagnostic test, or procedure) based on impact and scalability. The impact on the health budget of a country is considered after assessing the potential benefit.
Health Intervention and Technology Assessment (HITA)
What are logic models?
Help to show the logical connections between the inputs, processes, and outputs of an activity and how they link to the program's objectives (outcomes) and goals (impacts). They also clarify the linear relationships between program decisions, activities, and products.
Who did John Snow work with and what are these individuals better known as today?
Henry Whitehead ; contract tracers
What are the key shifts that leaders who govern need to make to improve their organization's performance?
In notes
What country is the most important source of generic drugs?
India
What are the functions of an M&E plan?
It shows how the results of a program relate to its goals and objectives, describes the data needed and how it will be analyzed, how the info will be used, what resources will be needed, and how the program will be accountable to stakeholders.
Identify the enablers of good governance
Leadership Skills Ethical and moral integrity Use of information, evidence, and technology Performance Measurement
a term that describes the large-scale forces that impact an economy.
Macroeconomics
What are some examples of decentralization in the U.S.?
Medicare and Medicaid at the state level
must determine a national budget for health but is often under significant neoliberal constraints.
Ministry of Finance
In most countries, who is responsible for the governance of the health sector?
Ministry of Health (MoH)
means it does not go directly into the health budget of the country but is managed separately, often by a nongovernmental organization (NGO).
Off-budget
What is one data system that has been made available for many low--income countries?
Open Medical Records Systems (OpenMRS)
a law that gives incentives to manufacturers to develop drugs for orphaned or rare diseases that affect a small portion of the population
Orphan Drug Act of 1983
One commonly used method of quality improvement
PDSA Cycle (Plan-Do-Study-Act)
This work to link the disease burden with the staff, supply, and infrastructure needed to deliver care led to the development of
Partners in Health-Universal Health Coverage (PIH-UHC) matrix.
defined 25 indicators that they call vital signs to evaluate a health system
Primary Health Care Performance Initiative (PHCPI)
What does flattening the curve mean?
Reducing the maximum number of people that need care at a certain point in time; the health care system will not exceed its capacity - slowing the rate at which the disease spreads
Describe logic models and their role in public health program planning.
Referred to as a Program Impact Pathway (PIP) or an "M&E Framework" - provide a streamlined linear interpretation of a project's planned use of resources and its desired ends
What are some ways in which the national government cares for the health of individuals in the US?
Research FDA (regulations) CDC Public Education Planned Parenthood Senior Living Facilities Public Transportation Emergency Medical Services (EMTs)
What are results frameworks?
Show the causal relationships between the various intermediate results that are critical to achieving the strategic objective. The effectiveness of these activities can be measured at each step along the way.
sets rigorous principles for aid coordination and supports long-term systems development to maximize the support for health in a given country
The Framework Convention on Global Health
What is GAVI?
The Global Alliance for Vaccines and Immunizations (NGO)
called for results and mutual accountability in aid
The Paris Declaration on Aid Effectiveness
What does decentralization mean?
The release of authority for execution from senior to subordinate levels. - Budgets for health care are separate from the federal budget - Very true in the U.S.
Define Universal Health Coverage
The state in which all people can use the promotive, preventative, curative, rehabilitative, and palliative health services they need, that are of sufficient quality and ensuring that the use of these services does not expose the user to financial hardship
What is macroeconomics?
The study of the economy as a whole; looking at how markets respond to supply and demand
The benchmarks for full coverage of an intervention are called the
UHC Target
What are two organizations involved in global governance?
WHO and UNICEF
Who is the major source of external financing in most countries?
World Bank
What is a co-pay?
a fixed payment collected at the time of visit; a flat fee one must pay at the point of service
What are bilateral organizations?
a government agency or nonprofit organization that receives funding from its home country's government to then be used toward a developing country.
What is co-insurance?
a type of insurance in which the insured pays a share of the payment made against a claim. - PERCENTAGAE of the cost one must pay after meeting their deductible
What are the 5 elements of a good governing body?
a. Maintain strategic direction of policy development and implementation b. Detect and correct any undesirable trends and distortions c. Articulating the case for health and national government d. Regulating the behavior of a wide range of actors from health care financiers to health care providers e. Establishing transparent and effective accountability systems
What are deductibles?
amounts that must be paid by the patient for medical services before the policy begins to pay
What is a premium?
an amount to be paid for an insurance policy. - a monthly fee one must pay for the privilege of having insurance
The focus on systems rather than individuals helps to create what improvement specialists call a
blame-free environment
a multipartner group that includes the Ministry of Health, civil society groups, NGOs, and the private sector. Their purpose is to assure that those most affected by AIDS are decisionmakers in creating national plans.
country coordinating mechanism
What does DOTS stand for?
directly observed therapy short course
Who was John Snow?
father of epidemiology
the impact that a disease or intervention has on the population
health outcome
What are the main components of an M&E plan?
i. The introduction ii. The program description and framework iii. A detailed description of the plan indicators iv. The data collection plan v. A plan for monitoring vi. A plan for evaluation vii. A plan for the utilization of the information gained viii. A mechanism for updating the plan
specific, observable, and measurable factor that can be used to track the progress of patients, health systems, and populations
indicator
gauges the strength of case finding in a country
indicator case detection rate
What is the GINI coefficient?
measure of inequality in which 0 corresponds to perfect equality, and 1 is a society in which a single individual owns all wealth
What are the reason for most personal bankruptcies in the U.S.?
medical bills
Define leadership
mobilizing others to envision and realize a better future.
Define management
planning and using resources efficiently to produce intended results.
consists of two or more bodies, at least one of which is private (such as a corporation or NGO) and one public (the government).
public-private partnerships (PPPs)
What is a multilateral organization?
receives funding from many different countries
What is the morbidity method?
relies on anticipated disease burden to forecast drug needs
the use of commercial marketing concepts and tools in programs designed to influence individuals' behavior to improve their well-being and that of society
social marketing
Define governance
steering an organization in a shared strategic direction that involves the negotiation of competing influences and demands
Define Public Health Surveillance
the continuous, systematic collection, analysis and interpretation of health-related data needed for the planning, implementation, and evaluation of public health practice
What remains as the major barrier to access of certain drugs?
the cost
Consumers in developed countries pay higher prices and those in less developing countries pay lower, subsidized prices.
tiered pricing
Number of patients who achieved treatment success as a percentage of all patients who were diagnosed with TB and started on treatment
treatment success rate
What is the consumption method?
using utilization of services or products to predict future needed quantities -demand signal
