RESUMEN

BACKGROUND: The Federal Ministry of National Health Services, Regulations and Coordination (MNHSR&C) in Pakistan has committed to progress towards universal health coverage (UHC) by 2030 by providing an Essential Package of Health Services (EPHS). Starting in 2019, the Disease Control Priorities 3rd edition (DCP3) evidence framework was used to guide the development of Pakistan's EPHS. In this paper, we describe the methods and results of a rapid costing approach used to inform the EPHS design process. METHODS: A total of 167 unit costs were calculated through a context-specific, normative, ingredients-based, and bottom-up economic costing approach. Costs were constructed by determining resource use from descriptions provided by MNHSR&C and validated by technical experts. Price data from publicly available sources were used. Deterministic univariate sensitivity analyses were carried out. RESULTS: Unit costs ranged from 2019 US$ 0.27 to 2019 US$ 1478. Interventions in the cancer package of services had the highest average cost (2019 US$ 837) while interventions in the environmental package of services had the lowest (2019 US$ 0.68). Cost drivers varied by platform; the two largest drivers were drug regimens and surgery-related costs. Sensitivity analyses suggest our results are not sensitive to changes in staff salary but are sensitive to changes in medicine pricing. CONCLUSION: We estimated a large number of context-specific unit costs, over a six-month period, demonstrating a rapid costing method suitable for EPHS design.

Asunto(s)

RESUMEN

BACKGROUND: Countries designing a health benefit package (HBP) to support progress towards universal health coverage (UHC) require robust cost-effectiveness evidence. This paper reports on Pakistan's approach to assessing the applicability of global cost-effectiveness evidence to country context as part of a HBP design process. METHODS: A seven-step process was developed and implemented with Disease Control Priority 3 (DCP3) project partners to assess the applicability of global incremental cost-effectiveness ratios (ICERs) to Pakistan. First, the scope of the interventions to be assessed was defined and an independent, interdisciplinary team was formed. Second, the team familiarized itself with intervention descriptions. Third, the team identified studies from the Tufts Medical School Global Health Cost-Effectiveness Analysis (GH-CEA) registry. Fourth, the team applied specific knock-out criteria to match identified studies to local intervention descriptions. Matches were then cross-checked across reviewers and further selection was made where there were multiple ICER matches. Sixth, a quality scoring system was applied to ICER values. Finally, a database was created containing all the ICER results with a justification for each decision, which was made available to decision-makers during HBP deliberation. RESULTS: We found that less than 50% of the interventions in DCP3 could be supported with evidence of cost-effectiveness applicable to the country context. Out of 78 ICERs identified as applicable to Pakistan from the Tufts GH-CEA registry, only 20 ICERs were exact matches of the DCP3 Pakistan intervention descriptions and 58 were partial matches. CONCLUSION: This paper presents the first attempt globally to use the main public GH-CEA database to estimate cost-effectiveness in the context of HBPs at a country level. This approach is a useful learning for all countries trying to develop essential packages informed by the global database on ICERs, and it will support the design of future evidence and further development of methods.

Asunto(s)

RESUMEN

Hybrid renewable energy sources are sustainable and eco-friendly and challenge the alternative sources of conventional energy production facilities. Pakistan's present energy dilemma is a serious impediment to its economic progress. This paper proposes a techno-economic analysis of commercial-scale photovoltaic (PV) systems for commercial agricultural farms in Punjab, Pakistan. A survey was conducted to gather the load data of the farms from major cities of north, center, and south Punjab. For the PV system design, the K-means approach was used to cluster data from 93 farmers into nine clusters with similar electrical consumption. A complete technical, economic, and environmental study is undertaken of the PV systems deployed in five selected cities. The most practical locations are Attock and Multan, which have the lowest Levelized Cost of Energy at 5.52 and 5.37 cents/kWh, respectively. PV installations are nevertheless technically, economically, and environmentally feasible for all cities. Throughout its lifespan, the planned PV system has the potential for Faisalabad and Chiniot to minimize 154 metric tons of emissions, resulting in a greener environment.

RESUMEN

BACKGROUND: Obesity is constantly increasing among adolescents since the last few decades becoming an alarming situation worldwide. The objective of this study was to know the determinants of eating habits and physical activities among school-going female adolescents of public sectors schools of Rawalpindi Pakistan. METHODS: A cross sectional study with mixed method with both quantitative and qualitative approach was conducted on three public sector schools of Rawalpindi Pakistan. Sample size of 384 female students of grade 5-10 were interviewed on reliable and validated tool after taking their consent and ethically approval. Moreover, four focus group discussion (FGD) with 30-45 minutes spent on each were conducted by inviting 6-8 participants in each group. Qualitative findings were triangulated with quantitative results. Study was ethically approved from the institutional review board of Health Services Academy Islamabad Pakistan. RESULTS: Females schools' students were included in this study were 384 with mean (SD) age 11.9±1 year. Majority (38%) were of class 7th and their mothers (42%) were educated. Mostly (42%) students were obese (53%) eat the vegetables rarely in their diet. Above half (59%) were those students who eat deep fried potato chips daily. There was a significance difference were seen among normal and obese female students regarding the dietary habits in different class of enrolment (<0.001), mother's education (0.04), intake of sweat confectionary (0.01), intake of meat (0.00), junk food (0.00), use of energy drink (0.03), use of milk (0.02), physical activity (0.00) and play games (0.00). However, intake of vegetables (0.23) and mother's education (0.081) were found insignificant in this study. Majority (88.5%) of students were also playing games in their daily activity. Below half (44%) respondents used to involve in physical activity. Qualitative findings triangulate with quantitative findings and themes were generated like; awareness on healthy diet, eating junk food, dislikes vegetables in diet and physical activity. CONCLUSIONS: Study concluded the factors including student's age, mother's education, intake of junk food, physical activity and play games are associated with obesity among the female students of government school in urban area of the country.

Asunto(s)

RESUMEN

The objective of this study was to explore women's preferences and factors influencing the obstetric services in a rural setting of Sindh Province. This cross sectional study was conducted on 100 women who were interviewed by using a validated questionnaire. The women who had given birth during the year preceding the study were eligible for inclusion in the study. The mean age of the participants was 27.5±2.0 and majority 86 (86%) of them were housewives. About 87 (87%) participants had an opinion that their obstetrical health decisions were always taken by their household members and families. 65 (65.7%) women reported that they consulted public hospitals for their antenatal care visits and 69 (69.6%) women preferred private health facilities for antenatal visits. More than half (62.2%) of the participants had delivered their last child in a public health facility, however, 39 (39.2%) women still preferred to deliver at home. Factors such as availability and affordability for health services were significant among pregnant women, those with income more than twenty thousand rupees per month, those with formal education as they were getting better obstetric care compared to those who had less income (<0.05) and those with no formal education. Study concluded that affordability and availability of services around pregnancy and birth were major factors responsible for preference for maternal care and could be linked with poor obstetrical care among rural women of Sindh. However, it is imperative to provide the obstetric care which is accessible without inconvenience.

Asunto(s)