RH - week 5

Question 1

capacity

Answer 1

country-less assessment for prioritization on immunization

Question 2

CAPACITI decision- support tool

Answer 2

• for prioritisation

Question 2

CAPACITI decision- support tool

Answer 2

• for prioritization among multiple immunization products, services or strategies
• incorporates input from multiple stakeholders, evidence across disciplines, operational and socio-ethical aspects, and data uncertainty

Question 3

steps in the tool

Answer 3

1. decision question
2. criteria for decision- making
3. evidence assessment
4. appraisal
5. recommendation

Question 4

evidence assessment

Answer 4

• evidence collection
• evidence statements
• performance matrix

Question 5

appraisal

Answer 5

• comparison by criterion
• comparison across criteria

Question 6

UHC benefit package of Pakistan: principles and approach
Guiding Principles of Benefit Package Design
UHC Benefit Package design should be:

Answer 6

• Impartial, democratic, inclusive and based on national values and clearly defined criteria
• Open and transparent in all steps of the process and decisions
• Trade-offs should be clearly data driven and evidence-based
• Progressing from data to dialogue to decision
• Linked to robust financing mechanisms and effective service delivery mechanisms 9

Question 7

steps for the development of UHC (universal health coverage) benefit package

Answer 7

A: installing an advisory committee
B: defining decision criteria
C: selecting services
D1: assessment
D2: Appraisal
E: communication and appeal
F: monitoring and evaluation

Question 8

stages for the development of UHC benefit package (D1)

Answer 8

• Selection & description of interventions at all five platforms through a consultative process completed – 193 interventions
• Describe all activities and inputs – workforce, equipment, medicines, diagnostics etc.
• Unit costs estimated – bottom-up normative costing
• Extensive review of ICERs for interventions – based on global, regional, local best evidence
• Optimization of interventions based on – cost-effectiveness, DALYs averted, targeted population, budgetary impact – ‘Hiptool’

Question 9

feasibility

Answer 9

financial risk protection

Question 10

equity

Answer 10

social and economic impact

Question 11

Health losses per specialty reflect:

Answer 11

• Regular number of surgeries
• Number of elective (>1 month possible delay) surgeries
• Number of delayed surgeries
• QALY gains of the surgeries

Question 12

Conclusion: delay of elective procedures not without consequences

Answer 12

• Urgency classification was meant to be a temporary tool. Not expected to be applied for 2 years or even longer.
• Delays of elective surgeries also have negative health consequences: 320 thousand QALYs have not been delivered.
• This stresses the importance of continuing to deliver regular care as much as possible, even in times of scarcity.

Question 13

Health losses can be constrained in future pandemics by:

Answer 13

• aiming for high volumes: search for ways to continue as many surgeries as possible
  o dination in/between regions, with independent treatment centers (ZBCs), and with foreign hospitals
• aiming for health effects:
  o Prioritize surgeries with the highest QALY gains
  o Reassess possible prioritizations of elective surgeries

Question 14

Expert opinion
Disadvantages:

Answer 14

• Level of agreement on prioritization between experts is low (MacCormick AD, Parry BR. Med Decis Making 2006)
• Prioritization across disciplines is complicated by the high degree of specialization in modern medicine.
• Most importantly, this approach does not systematically optimize population health
• Not clear which values are considered à not transparent

Question 15

Ethical perspective
Four criteria to allocate scarce resources:

Answer 15

1) Maximize the benefits produced by scare resources
2) Treat people equally
3) Promote and reward instrumental values
4) Give priority to the worst-off (the sickest).