PubMed · 14616554
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David Watters. 2003. Can trainees do something completely different?. https://doi.org/10.1046/j.1445-1433.2003.02814.x
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BACKGROUND: Surgical care is essential for achieving global health equity, yet low- and middle-income countries (LMICs) face major gaps in access and planning, partly due to limited evidence on the costs and resource requirements of surgical interventions. Understanding these costs is vital for designing efficient and equitable health systems. METHODS: We conducted a systematic literature review (covering MEDLINE, EMBASE, Global Health, EconLit and grey literature) to identify studies reporting the costs of surgeries in LMICs from January 2000 to June 2023. Minor and major surgical procedures were considered, focusing on therapeutic procedures (excluding diagnostic interventions). Studies that clearly identified, quantified and costed hospital resources and services deployed in the provision of surgical care, and included at least two of the surgical production factors (ie, consumables, diagnostics, personnel, infrastructure and overhead) in the costing were included. Costs were standardised to 2023 International dollars (I$) for comparability. RESULTS: A total of 74 studies from 29 countries met the inclusion criteria, with 210 cost estimates across 65 procedure groups. Costs varied widely: from I$1.54 for a caesarean section in Tanzania to I$618 098 for paediatric cataract surgery in Zambia. Full costing studies reported higher estimates than partial costing studies. Most studies (60%) originated from upper-middle-income countries, with limited data (10%) from low-income settings. CONCLUSION: This review provides a reference list of surgical procedure costs across LMICs, highlighting considerable cost variation by procedure, specialty and country. The findings underscore the need for better-quality, standardised cost data-especially from low-income countries-to inform national surgical plans, universal health coverage benefit packages and reimbursement policies.
PURPOSE: We summarize and comment on the available literature on the effectiveness of interventions designed to change professional behaviour in order to bring evidence into practice in developing countries. DATA SOURCES: We used a strategy adapted from the Effective Practice & Organization Care (EPOC) Cochrane group. STUDY SELECTION: Forty-four studies met pre-defined selection criteria. Controlled and uncontrolled trials of interventions were included. Studies measured either professional compliance with agreed standards or patients' clinical outcomes. Data extraction. Data were extracted using a pre-defined extraction tool and studies were appraised accordingly. RESULTS OF DATA SYNTHESIS: Data were synthesized and categorized according to different types of intervention. Audit and feedback was found to be effective, at least in the short term, when combined with other approaches. Similarly, educational interventions were more effective when designed to address local educational needs and organizational barriers. We found insufficient evidence to assess the effectiveness of educational outreach, local opinion leaders, use of mass media, and reminders. Educational materials alone are unlikely to influence change. However, the majority of studies had weak designs and failed to exclude possible biases. CONCLUSION: Current evidence for the effectiveness of interventions to change health professionals' behaviour in developing countries is either scanty or flawed due to poorly designed research. Given the recent drive to improve quality of care, this should be a priority area for researchers and international agencies supporting health systems development in developing countries. This review provides an insight into some of the methodological issues that interested researchers may face.
In 1988, the World Health Assembly of the World Health Organization (WHO) resolved to eradicate poliomyelitis globally. Since then, substantial worldwide progress has been made toward that goal; the number of countries where polio is endemic declined from 125 in 1988 to six by the end of 2003. Further progress in 2004 toward interruption of transmission has continued in the three Asian countries where polio is endemic (Afghanistan, India, and Pakistan). However, in 2003, two countries in Africa experienced a resurgence of polio cases; the resurgence continued to spread in 2004 from the Nigeria-Niger endemic reservoir to involve a total of 14 countries that had not reported polio > or =1 year. Local transmission of wild poliovirus (WPV) has been reestablished in six of these 14 countries, including Sudan, where a major outbreak occurred. This report describes global efforts to eradicate polio during January 2004-March 2005 and outlines remaining challenges to interrupting transmission in countries where polio remains endemic or transmission has been reestablished.