The global critical shortage of health workers prevents expansion of healthcare services and universal health coverage. Like most countries in sub-Saharan Africa, Kenya\'s healthcare workforce density of 13.8 health workers per 10,000 population falls below the World Health Organization (WHO) recommendation of at least 44.5 doctors, nurses, and midwives per 10,000 population. In response to the health worker shortage, the WHO recommends task sharing, a strategy that can increase access to quality health services. To improve the utilization of human and financial health resources in Kenya for HIV and other essential health services, the Kenya Ministry of Health (MOH) in collaboration with various institutions developed national task sharing policy and guidelines (TSP). To advance task sharing, this article describes the process of developing, adopting, and implementing the Kenya TSP.
The development and approval of Kenya\'s TSP occurred from February 2015 to May 2017. The U.S. Centers for Disease Control and Prevention (CDC) allocated funding to Emory University through the United States President\'s Emergency Plan for AIDS Relief (PEPFAR) Advancing Children\'s Treatment initiative. After obtaining support from leadership in Kenya\'s MOH and health professional institutions, the TSP team conducted a desk review of policies, guidelines, scopes of practice, task analyses, grey literature, and peer-reviewed research. Subsequently, a Policy Advisory Committee was established to guide the process and worked collaboratively to form technical working groups that arrived at consensus and drafted the policy. The collaborative, multidisciplinary process led to the identification of gaps in service delivery resulting from health workforce shortages. This facilitated the development of the Kenya TSP, which provides a general orientation of task sharing in Kenya. The guidelines list priority tasks for sharing by various cadres as informed by evidence, such as HIV testing and counseling tasks. The TSP documents were disseminated to all county healthcare facilities in Kenya, yet implementation was stopped by order of the judiciary in 2019 after a legal challenge from an association of medical laboratorians.
Task sharing may increase access to healthcare services in resource-limited settings. To advance task sharing, TSP and clinical practice could be harmonized, and necessary adjustments made to other policies that regulate practice (e.g., scopes of practice). Revisions to pre-service training curricula could be conducted to ensure health professionals have the requisite competencies to perform shared tasks. Monitoring and evaluation can help ensure that task sharing is implemented appropriately to ensure quality outcomes.

During periods of high community transmission of COVID-19, the public hospitals in Malaysia, an upper middle-income country, have been forced to scale down elective surgeries, prioritize cancer treatments based on treatment benefits, and postpone non-emergency imaging procedures. These inevitably led to disruptions in cancer care delivery within the public health care system. This study aims to explore the facilitators and barriers faced by healthcare providers and cancer survivors in cancer care, and to co-design a guideline to maintain the delivery of cancer care amid the disaster situations.
In-depth interviews (IDIs) will be conducted with Malaysian healthcare providers and cancer survivors and findings will be analysed thematically. The insights will be used in a subsequent phase to co-design a guideline to maintain the delivery of quality cancer care in Malaysia via a three-round modified Delphi survey with a broad range of cancer stakeholders.
Findings derived from IDIs and existing literature will be included for rating across three rounds by the expert panel. Feedback provided will be refined until consensus on the best practises for cancer care continuity during crises is achieved.
The output of the present study is not only expected to ensure the continuity of delivery of high-quality cancer care in Malaysia during the ongoing pandemic but also to be adapted during unforeseen crises in the near future.
Collaborative work between policy makers, public health physicians, members of the multidisciplinary oncology team as well as cancer survivors is vital in developing an evidenced- based contingency plan for maintaining access to cancer care.

BACKGROUND: China has achieved near-universal health coverage (UHC) for 95 percent of its population (>1.3 billion lives) as a result of healthcare reforms that began in 2009. However, one of many remaining issues in the Chinese healthcare system is the need to better optimize the allocation and use of healthcare resources in order to meet growing healthcare demands.
OBJECTIVE: The goals are to highlight the components of the China Guidelines for Pharmacoeconomic Evaluations (CGPE) 2020 Edition and discuss its future development for UHC in China.
METHODS: We review the development process of the CGPE 2020 edition, discuss the contemporary practice of the CGPE for UHC in China, describe new opportunities and challenges to the CGPE, and provide suggestions on the future development of the CGPE based on the current state of the healthcare system in China.
RESULTS: Pharmacoeconomics provides tools to evaluate the health returns and economic costs of pharmaceutical products in a scientific way for the optimal allocation of healthcare resources. Considering the great potential of pharmacoeconomics in China, demonstrated by its rapid development and recognition as a research field in the past decade, the standardization of pharmacoeconomic evaluations has become particularly important to improve the accuracy of evaluation results used for drug selection, price negotiations and adjustments.
CONCLUSIONS: Suggestions are made for the integration of CGPE into current framework of UHC in China, including standardizing the pharmacoeconomic evaluation process and updating CGPE on topics such as ethics and real-world research. The CGPE 2020 edition offers a standard to improve the quality of pharmacoeconomic evaluation research and enhance the value and efficiency of UHC in China.

BACKGROUND: We compared the prevalence, awareness, treatment, and control of hypertension in Iran based on two hypertension guidelines; the 2017 ACC/AHA -with an aggressive blood pressure target of 130/80 mmHg- and the commonly used JNC8 guideline cut-off of 140/90 mmHg. We shed light on the implications of the 2017 ACC/AHA for population subgroups and high-risk individuals who were eligible for non-pharmacologic and pharmacologic therapies.
METHODS: Data was obtained from the Iran national STEPS 2016 study. Participants included 27,738 adults aged ≥25 years as a representative sample of Iranians. Regression models of survey design were used to examine the determinants of prevalence, awareness, treatment, and control of hypertension.
RESULTS: The prevalence of hypertension based on JNC8 was 29.9% (95% CI: 29.2-30.6), which soared to 53.7% (52.9-54.4) based on the 2017 ACC/AHA. The percentage of awareness, treatment, and control were 59.2% (58.0-60.3), 80.2% (78.9-81.4), and 39.1% (37.4-40.7) based on JNC8, which dropped to 37.1% (36.2-38.0), 71.3% (69.9-72.7), and 19.6% (18.3-21.0), respectively, by applying the 2017 ACC/AHA. Based on the new guideline, adults aged 25-34 years had the largest increase in prevalence (from 7.3 to 30.7%). They also had the lowest awareness and treatment rate, contrary to the highest control rate (36.5%) between age groups. Compared with JNC8, based on the 2017 ACC/AHA, 24, 15, 17, and 11% more individuals with dyslipidaemia, high triglycerides, diabetes, and cardiovascular disease events, respectively, fell into the hypertensive category. Yet, based on the 2017 ACC/AHA, 68.2% of individuals falling into the hypertensive category were eligible for receiving pharmacologic therapy (versus 95.7% in JNC8). LDL cholesterol< 130 mg/dL, sufficient physical activity (Metabolic Equivalents≥600/week), and Body Mass Index were found to change blood pressure by - 3.56(- 4.38, - 2.74), - 2.04(- 2.58, - 1.50), and 0.48(0.42, 0.53) mmHg, respectively.
CONCLUSIONS: Switching from JNC8 to 2017 ACC/AHA sharply increased the prevalence and drastically decreased the awareness, treatment, and control in Iran. Based on the 2017 ACC/AHA, more young adults and those with chronic comorbidities fell into the hypertensive category; these individuals might benefit from earlier interventions such as lifestyle modifications. The low control rate among individuals receiving treatment warrants a critical review of hypertension services.

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The challenge of Universal Health Coverage (UHC) led countries to make greater efforts to increase the proportion of population protected, to define and expand their benefit plans, and to provide financial resources to support payment for the benefits provided. The implementation of the health insurance policy in our country has allowed reaching important milestones, evidencing, however, an insufficient effect on timely access and on meeting the health needs of a large portion of the population. In this article we begin by highlighting the main advances and limitations in the process towards a UHC, guding the development of the pending agenda, based on the proposals issued by international organizations aimed at improving health systems globally. The pending challenges include efforts to involve and articulate the various actors in the task at hand of redesigning healthcare processes, strengthening the ethical dimension of their practice, as well as promoting citizen participation in the generation of a high-quality health system that would facilitate effective and timely access to health services. This requires the adoption of measures that extend to the entire health system, based on a shared vision and led by those responsible for its execution and governance.
El desafío de la Cobertura Universal en Salud (CUS) orientó a los países a desplegar sus mayores esfuerzos en la ampliación de la proporción de población protegida, la delimitación y ampliación de sus planes de beneficios, así como en la provisión de recursos financieros que permitan respaldar el pago de las prestaciones brindadas. En nuestro país, a través de la implementación de la política de aseguramiento en salud, ha sido posible arribar a importantes logros, evidenciando, sin embargo, un insuficiente efecto en el acceso oportuno y en la satisfacción de las necesidades de salud de gran parte de la población. En el presente artículo partimos por destacar los principales avances y limitaciones en el proceso hacia una CUS, orientando el desarrollo de la agenda pendiente, sobre la base de los planteamientos emitidos por Organizaciones Internacionales que apuntan hacia una mejora de los sistemas de salud a nivel global. Los desafíos pendientes incluyen esfuerzos de involucramiento y articulación de los diversos actores, en la tarea de rediseñar los procesos de atención, fortalecer la dimensión ética de su ejercicio, así como promover la participación ciudadana en la generación de un sistema de salud de alta calidad, que permita un acceso efectivo y oportuno a servicios de salud; ello obliga a adoptar medidas que alcancen a todo el sistema de salud, orientadas en una visión compartida y liderada por los responsables de su conducción y gobierno.

BACKGROUND: There is widespread and growing interest in designing and implementing social health insurance schemes (SHIS) across many low- and middle-income countries as a means to improve financial protection and achieve universal health coverage. SHIS recently gained traction in Nigeria, but evidence regarding optimal design features of SHIS is sparse and there is lack of a simple and standardised checklist that scheme designers, implementers and researchers could use to assess, guide and inform the design of SHIS. This paper seeks to develop a checklist based on concepts as well as theoretical and empirical evidence that can inform and guide scheme designers and implementers on design options to maximise the effectiveness of the scheme.
METHODS: We conducted a review of literature exploring the relevant concepts for the development of a framework and checklist to identify the key factors or variables required to inform the design of SHIS. The checklist details critical considerations/questions to address and options for design. The developed checklist was then used to examine conditions for readiness and appropriateness of SHIS design in two states in Nigeria (Kaduna and Niger).
RESULTS: This paper describes the development of a SHIS checklist. The findings also demonstrate that the newly developed checklist, consisting of six design domains, can be used by scheme designers and policy-makers as a simple and effective tool to assess and inform SHIS design features across Nigeria to maximise the chances of the effectiveness of the schemes.
CONCLUSIONS: In conclusion, given that the development of SHIS in the Nigerian states is still in its early stages, applying the SHIS design checklist can serve as a first step to ensuring a feasible and sustainable insurance scheme. The introduction of SHIS, if properly designed and implemented, can be a significant first step towards improving the accessibility, equity and efficiency of healthcare in Nigeria.

International guidelines recommend countries to expand antiretroviral therapy (ART) to all HIV-infected individuals and establish local-level priorities in relation to other treatment, prevention and mitigation interventions through fair processes. However, no practical guidance is provided for such priority-setting processes. Evidence-informed deliberative processes (EDPs) fill this gap and combine stakeholder deliberation to incorporate relevant social values with rational decision-making informed by evidence on these values. This study reports on the first-time implementation and evaluation of an EDP in HIV control, organised to support the AIDS Commission in West Java province, Indonesia, in the development of its strategic plan for 2014-2018.
Under the responsibility of the provincial AIDS Commission, an EDP was implemented to select priority interventions using six steps: (i) situational analysis; (ii) formation of a multistakeholder Consultation Panel; (iii) selection of criteria; (iv) identification and assessment of interventions\' performance; (v) deliberation; and (vi) selection of funding and implementing institutions. An independent researcher conducted in-depth interviews (n = 21) with panel members to evaluate the process.
The Consultation Panel included 23 stakeholders. They identified 50 interventions and these were evaluated against four criteria: impact on the epidemic, stigma reduction, cost-effectiveness and universal coverage. After a deliberative discussion, the Consultation Panel prioritised a combination of several treatment, prevention and mitigation interventions.
The EDP improved both stakeholder involvement and the evidence base for the strategic planning process. EDPs fill an important gap which international guidelines and current tools for strategic planning in HIV control leave unaddressed.

OBJECTIVE: Rural-urban differences in health remain a concern worldwide. Few studies have investigated the dynamic changes in health between rural and urban areas. This study aims to examine whether the rural-urban gap in patients\' receipt of guideline-recommended care and avoidable hospitalizations has decreased in 10 years under a universal coverage health system.
METHODS: A retrospective cohort study design.
METHODS: This study utilized nationwide health insurance claims data of 3 representative cohorts of patients with newly diagnosed type 2 diabetes in 2000, 2005, and 2010 in Taiwan. The two outcome variables were receipt of guideline-recommended care and avoidable hospitalizations for diabetes. Generalized estimating equations models were used to estimate the rural-urban differences while controlling for physician-clustering effects.
RESULTS: Rural diabetic patients were less likely to receive guideline-recommended examinations/tests in 2000 (eβ = 0.97; 95% confidence interval [CI]: 0.96-0.99); however, the average number of examinations/tests increased and the rural-urban difference had diminished in 2010. The likelihood of avoidable hospitalizations for diabetes among rural diabetic patients was higher than that for their urban counterparts in 2000 (odds ratio [OR]: 1.13; 95% CI: 1.01-1.25). Although the likelihood of avoidable hospitalizations for diabetes decreased from 2000 to 2010, the rural-urban gap remained during this period.
CONCLUSIONS: The rural-urban disparity in receiving recommended diabetes care diminished over the past decade. However, significant gaps between rural and urban areas in avoidable hospitalizations for diabetes persisted despite the universal health system.

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