Eastern Mediterranean Provincial Office, World Wellbeing Association Dr. Hossein Salehi May 20-24, 2007 Alexandria, Egyp.


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Limit Improvement WORKSHOP ON Wellbeing Framework Advancement FOR Territorial Nation OFFICE STAFF Instruments for Strategy Examination: Cost Adequacy Investigation Eastern Mediterranean Provincial Office, World Wellbeing Association Dr. Hossein Salehi May 20-24, 2007 Alexandria, Egypt
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Limit DEVELOPMENT WORKSHOP ON HEALTH SYSTEM DEVELOPMENT FOR REGIONAL COUNTRY OFFICE STAFF Tools for Policy Analysis: Cost Effectiveness Analysis Eastern Mediterranean Regional Office, World Health Organization Dr. Hossein Salehi May 20-24, 2007 Alexandria, Egypt

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Introduction; Concept of expense Cost: Accounting expense Economic expense (estimation of inevitable assets)

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Project A; MRI Annual expense $1,000,000 Annual Benefit 1,000 DALY turned away Project B; Immunization for HB Annual expense $1,000.000 Annual Benefit 1,600 DALY deflected Project C; (best option) Annual expense $1,000,000 Annual Benefit 1,800 DALY turned away

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Introduction; Concept of expense; cont Opportunity cost “opportunity expense is the best\'s estimation done without alternative”

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Introduction; Concept of expense, cont Who bear (s) the expense? Singular (private) expense Implementing office cost (open expense) Society ( Social Cost ) versus Private expense

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Why costing? Planning Provider installment Fee-for-Services Capitation Efficiency Providers Interventions

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Intervention cost Intervention expense Cost-Benefit Analysis (CBA) Cost-Effectiveness Analysis (CEA) Generalized Cost-Effectiveness Analysis (GCEA)

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WHO-GCEA Attention to ebb and flow inefficiencies in the designation of assets Context-particular CEA is excessively requesting for most nations There are no universal rule for CEA

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CEA; Cost-Benefit proportion Cost a1 c h O Health advantages (DALYs deflected)

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Cost a1 C1 a2 C2 h O Health advantages (DALYs turned away) `

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a4 c4 a3 b3 a2 a1 c3 b2 b1 c2 c1

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a4 c4 a3 b3 a2 a1 c3 b2 b1 c2 c1

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League Table League Table

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League Table

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League Table

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WHO CHOICE Project Prepared for 14 sub-districts: WHO political groupings and mortality strata All outcomes on www.who.int/decision Country contextualization instrument as of now being settled after tests in Thailand, Estonia, Sri Lanka (emotional wellness), Ghana, Mexico

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Maternal and neonatal Referral consideration level Treatment of extreme pre-eclampsia/eclampsia* Antibiotics for pre-term prelabour crack of layers (pPROM)* Antenatal steroids for pre-term births* Management of impeded work, breech & fetal misery (OL)* Management of serious baby blues discharge (PPH)* Management of maternal sepsis* Emergency neonatal consideration (ENC) blend of 15-18 Management of low conception weight babies (vLBW)* Management of serious neonatal infections* Management of extreme neonatal asphyxia* Management of neonatal jaundice* Primary-level consideration including outreach Selected antenatal consideration mediations (ANC) mix of 1-4 Tetanus toxoid (TT) Screening for pre-eclampsia Screening & treatment of asymptomatic bacteruria Screening & treatment of syphilis Skilled maternal and prompt infant consideration (SMNC) mix of 5 - 8 Normal conveyance by gifted chaperon Active administration of the third phase of work Initial administration of baby blues drain (PPH) Neonatal revival Community-based intercessions Community infant consideration bundle mix of 19-20 Support for breastfeeding moms Support for low conception weight babies Community-based case administration for neonatal pneumonia

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Mgmt of Post partum discharge and stun 95% Antibiotics for pPROM 95% Mgmt of maternal sepsis 95% Antenatal steroids Mgmt of deterred work 95% Emergency infant consideration 95% Pre-eclampsia/eclampsia 95% SMNC 95% Other ANC 95% Tetanus 95% Breastfeeding and nurture LBW 95% Results for Afr-E locale Community-based Mgmt of pneumonia (95%) Community mgmt of pneumonia 95%

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Antenatal steroids95% Antibiotics for pPROM 95% Mgmt of discouraged work 95% Screening for syphilis 95% ENC 95% Maternal sepsis 95% Resuscitation and referral tend to eclampsia 95% Mgmt of PPH 95% Community mgmt of pneumonia 95% Eclampsia and screening for bacteruria 95% Normal conveyance by talented orderly 95% LBW95% Breastfeeding 95% Tetanus 95% Tetanus 80% Breastfeeding 80% Breastfeeding half Results for Sear-D area Results for Sear-D district

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Issues in GCEA Estimating expense Estimating medical advantages Discounting Uncertainty Ethical issues Equity

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Ethical Issues in CEA How ought to conditions of wellbeing and handicap be assessed? Whose valuation? Is estimation of a year of life relies on upon one’s age? financial status,…? Should medical advantages be marked down? How dispersion of advantages be considered? What need ought to be given to most ailing or most exceedingly bad off? Vast advantages to a couple versus little advantages to a substantial gathering. Which one? (Guideline of salvage) Fair risk or best result?

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Which ?

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CAPACITY DEVELOPMENT WORKSHOP ON HEALTH SYSTEM DEVELOPMENT FOR REGIONAL COUNTRY OFFICE STAFF Tools for Policy Analysis: Cost Effectiveness Analysis Eastern Mediterranean Regional Office, World Health Organization Dr. Hossein Salehi May 20-24, 2007 Alexandria, Egypt

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Cost-Effectiveness The case: You have $10,000,000. What project(s) will you choose for execution. If it\'s not too much trouble consider expense adequacy, wellbeing conditions, moral issue, equity,… .:tslidesep.

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