A life-course approach to hygiene: understanding burden and behavioural changes
A life-course approach to hygiene: understanding burden and behavioural changes
Hygiene refers to the practices that help to maintain health and prevent the spread of diseases. While good hygiene is primarily about behaviours, the ability to practise them well is supported by having the appropriate infrastructure in place, such as access to clean water and soap.
Poor water, sanitation and hygiene (WASH) increases death rates and ill health, creates greater demand for healthcare interventions, widens social inequalities, and has repercussions for quality of life and the wider economy.
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Value-based healthcare in Sweden: Reaching the next level
The need to get better value from healthcare investment has never been more important as ageing populations and increasing numbers of people with multiple chronic conditions force governments to make limited financial resources go further.
These pressures, along with a greater focus on patient-centred care, have raised the profile of VBHC, especially in European healthcare systems. Sweden, with its highly comprehensive and egalitarian healthcare system, has been a leader in implementing VBHC from the beginning, a fact that was underscored in a 2016 global assessment of VBHC published by The Economist Intelligence Unit.
This paper looks at the ways in which Sweden has implemented VBHC, the areas in which it has faced obstacles and the lessons that it can teach other countries and health systems looking to improve the value of their own healthcare investments.
Breast cancer patients and survivors in the Asia-Pacific workforce
With more older women also working, how will the rising trend of breast cancer survivorship manifest in workplace policies, practices and culture? What challenges do breast cancer survivors face when trying to reintegrate into the workforce, or to continue working during treatment? How can governments, companies and society at large play a constructive role?
This series of reports looks at the situation for breast cancer survivors in Australia, New Zealand and South Korea. It finds that while progress has been made, more needs to be done, particularly in South Korea, where public stigma around cancer remains high.
The Cost of Silence
Cardiovascular diseases levy a substantial financial toll on individuals, their households and the public finances. These include the costs of hospital treatment, long-term disease management and recurring incidence of heart attacks and stroke. They also include the costs of functional impairment and knock-on costs as families may lose breadwinners or have to withdraw other family members from the workforce to care for a CVD patient. Governments also lose tax revenue due to early retirement and mortality, and can be forced to reallocate public finances from other budgets to maintain an accessible healthcare system in the face of rising costs.
As such, there is a need for more awareness of the ways in which people should actively work to reduce their CVD risk. There is also a need for more primary and secondary preventative support from health agencies, policymakers and nongovernmental groups.
To inform the decisions and strategies of these stakeholders, The Economist Intelligence Unit and EIU Healthcare, its healthcare subsidiary, have conducted a study of the prevalence and costs of the top four modifiable risk factors that contribute to CVDs across the Asian markets of China, Australia, Hong Kong, Japan, Singapore, South Korea, Taiwan and Thailand.
Download the report to learn more.
The promise of equitable access to vaccines is at risk
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Value-based healthcare in Sweden: Reaching the next level
The need to get better value from healthcare investment has never been more important as ageing populations and increasing numbers of people with multiple chronic conditions force governments to make limited financial resources go further.
These pressures, along with a greater focus on patient-centred care, have raised the profile of VBHC, especially in European healthcare systems. Sweden, with its highly comprehensive and egalitarian healthcare system, has been a leader in implementing VBHC from the beginning, a fact that was underscored in a 2016 global assessment of VBHC published by The Economist Intelligence Unit.
This paper looks at the ways in which Sweden has implemented VBHC, the areas in which it has faced obstacles and the lessons that it can teach other countries and health systems looking to improve the value of their own healthcare investments.
Breast cancer patients and survivors in the Asia-Pacific workforce
With more older women also working, how will the rising trend of breast cancer survivorship manifest in workplace policies, practices and culture? What challenges do breast cancer survivors face when trying to reintegrate into the workforce, or to continue working during treatment? How can governments, companies and society at large play a constructive role?
This series of reports looks at the situation for breast cancer survivors in Australia, New Zealand and South Korea. It finds that while progress has been made, more needs to be done, particularly in South Korea, where public stigma around cancer remains high. The Cost of Silence
Cardiovascular diseases levy a substantial financial toll on individuals, their households and the public finances. These include the costs of hospital treatment, long-term disease management and recurring incidence of heart attacks and stroke. They also include the costs of functional impairment and knock-on costs as families may lose breadwinners or have to withdraw other family members from the workforce to care for a CVD patient. Governments also lose tax revenue due to early retirement and mortality, and can be forced to reallocate public finances from other budgets to maintain an accessible healthcare system in the face of rising costs.
As such, there is a need for more awareness of the ways in which people should actively work to reduce their CVD risk. There is also a need for more primary and secondary preventative support from health agencies, policymakers and nongovernmental groups.
To inform the decisions and strategies of these stakeholders, The Economist Intelligence Unit and EIU Healthcare, its healthcare subsidiary, have conducted a study of the prevalence and costs of the top four modifiable risk factors that contribute to CVDs across the Asian markets of China, Australia, Hong Kong, Japan, Singapore, South Korea, Taiwan and Thailand.
Download the report to learn more.
The Future of Precision Medicine Oncology: Toward a New Post-Pandemic Normal
The Future of Precision Medicine Oncology: Toward a New Post-Pandemic Normal
More than a dozen roundtable participants from different sides of the healthcare landscape came together to discuss what is needed to drive precision medicine oncology progress. In doing so, they explored fundamental obstacles that lie ahead for precision medicine innovation such as expanding genomic testing access, improving clinical trials and data collection, helping patients navigate complex testing and treatment journeys, and breaking down silos among stakeholders.
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Value-based healthcare in Sweden: Reaching the next level
The need to get better value from healthcare investment has never been more important as ageing populations and increasing numbers of people with multiple chronic conditions force governments to make limited financial resources go further.
These pressures, along with a greater focus on patient-centred care, have raised the profile of VBHC, especially in European healthcare systems. Sweden, with its highly comprehensive and egalitarian healthcare system, has been a leader in implementing VBHC from the beginning, a fact that was underscored in a 2016 global assessment of VBHC published by The Economist Intelligence Unit.
This paper looks at the ways in which Sweden has implemented VBHC, the areas in which it has faced obstacles and the lessons that it can teach other countries and health systems looking to improve the value of their own healthcare investments.
Breast cancer patients and survivors in the Asia-Pacific workforce
With more older women also working, how will the rising trend of breast cancer survivorship manifest in workplace policies, practices and culture? What challenges do breast cancer survivors face when trying to reintegrate into the workforce, or to continue working during treatment? How can governments, companies and society at large play a constructive role?
This series of reports looks at the situation for breast cancer survivors in Australia, New Zealand and South Korea. It finds that while progress has been made, more needs to be done, particularly in South Korea, where public stigma around cancer remains high. The Cost of Silence
Cardiovascular diseases levy a substantial financial toll on individuals, their households and the public finances. These include the costs of hospital treatment, long-term disease management and recurring incidence of heart attacks and stroke. They also include the costs of functional impairment and knock-on costs as families may lose breadwinners or have to withdraw other family members from the workforce to care for a CVD patient. Governments also lose tax revenue due to early retirement and mortality, and can be forced to reallocate public finances from other budgets to maintain an accessible healthcare system in the face of rising costs.
As such, there is a need for more awareness of the ways in which people should actively work to reduce their CVD risk. There is also a need for more primary and secondary preventative support from health agencies, policymakers and nongovernmental groups.
To inform the decisions and strategies of these stakeholders, The Economist Intelligence Unit and EIU Healthcare, its healthcare subsidiary, have conducted a study of the prevalence and costs of the top four modifiable risk factors that contribute to CVDs across the Asian markets of China, Australia, Hong Kong, Japan, Singapore, South Korea, Taiwan and Thailand.
Download the report to learn more.
UNICEF to lead the delivery of COVID-19 vaccines to lower income countries
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Value-based healthcare in Sweden: Reaching the next level
The need to get better value from healthcare investment has never been more important as ageing populations and increasing numbers of people with multiple chronic conditions force governments to make limited financial resources go further.
These pressures, along with a greater focus on patient-centred care, have raised the profile of VBHC, especially in European healthcare systems. Sweden, with its highly comprehensive and egalitarian healthcare system, has been a leader in implementing VBHC from the beginning, a fact that was underscored in a 2016 global assessment of VBHC published by The Economist Intelligence Unit.
This paper looks at the ways in which Sweden has implemented VBHC, the areas in which it has faced obstacles and the lessons that it can teach other countries and health systems looking to improve the value of their own healthcare investments.
Breast cancer patients and survivors in the Asia-Pacific workforce
With more older women also working, how will the rising trend of breast cancer survivorship manifest in workplace policies, practices and culture? What challenges do breast cancer survivors face when trying to reintegrate into the workforce, or to continue working during treatment? How can governments, companies and society at large play a constructive role?
This series of reports looks at the situation for breast cancer survivors in Australia, New Zealand and South Korea. It finds that while progress has been made, more needs to be done, particularly in South Korea, where public stigma around cancer remains high. The Cost of Silence
Cardiovascular diseases levy a substantial financial toll on individuals, their households and the public finances. These include the costs of hospital treatment, long-term disease management and recurring incidence of heart attacks and stroke. They also include the costs of functional impairment and knock-on costs as families may lose breadwinners or have to withdraw other family members from the workforce to care for a CVD patient. Governments also lose tax revenue due to early retirement and mortality, and can be forced to reallocate public finances from other budgets to maintain an accessible healthcare system in the face of rising costs.
As such, there is a need for more awareness of the ways in which people should actively work to reduce their CVD risk. There is also a need for more primary and secondary preventative support from health agencies, policymakers and nongovernmental groups.
To inform the decisions and strategies of these stakeholders, The Economist Intelligence Unit and EIU Healthcare, its healthcare subsidiary, have conducted a study of the prevalence and costs of the top four modifiable risk factors that contribute to CVDs across the Asian markets of China, Australia, Hong Kong, Japan, Singapore, South Korea, Taiwan and Thailand.
Download the report to learn more.
Gavi raises US$ 2 billion, but needs US$ 5 billion more in 2021 for vaccine procurement in lower income countries
Gavi raises US$ 2 billion, but needs US$ 5 billion more in 2021 for vaccine procurement in lower income countries
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Value-based healthcare in Sweden: Reaching the next level
The need to get better value from healthcare investment has never been more important as ageing populations and increasing numbers of people with multiple chronic conditions force governments to make limited financial resources go further.
These pressures, along with a greater focus on patient-centred care, have raised the profile of VBHC, especially in European healthcare systems. Sweden, with its highly comprehensive and egalitarian healthcare system, has been a leader in implementing VBHC from the beginning, a fact that was underscored in a 2016 global assessment of VBHC published by The Economist Intelligence Unit.
This paper looks at the ways in which Sweden has implemented VBHC, the areas in which it has faced obstacles and the lessons that it can teach other countries and health systems looking to improve the value of their own healthcare investments.
Breast cancer patients and survivors in the Asia-Pacific workforce
With more older women also working, how will the rising trend of breast cancer survivorship manifest in workplace policies, practices and culture? What challenges do breast cancer survivors face when trying to reintegrate into the workforce, or to continue working during treatment? How can governments, companies and society at large play a constructive role?
This series of reports looks at the situation for breast cancer survivors in Australia, New Zealand and South Korea. It finds that while progress has been made, more needs to be done, particularly in South Korea, where public stigma around cancer remains high. The Cost of Silence
Cardiovascular diseases levy a substantial financial toll on individuals, their households and the public finances. These include the costs of hospital treatment, long-term disease management and recurring incidence of heart attacks and stroke. They also include the costs of functional impairment and knock-on costs as families may lose breadwinners or have to withdraw other family members from the workforce to care for a CVD patient. Governments also lose tax revenue due to early retirement and mortality, and can be forced to reallocate public finances from other budgets to maintain an accessible healthcare system in the face of rising costs.
As such, there is a need for more awareness of the ways in which people should actively work to reduce their CVD risk. There is also a need for more primary and secondary preventative support from health agencies, policymakers and nongovernmental groups.
To inform the decisions and strategies of these stakeholders, The Economist Intelligence Unit and EIU Healthcare, its healthcare subsidiary, have conducted a study of the prevalence and costs of the top four modifiable risk factors that contribute to CVDs across the Asian markets of China, Australia, Hong Kong, Japan, Singapore, South Korea, Taiwan and Thailand.
Download the report to learn more.
Virtual hospital ward rounds involve wider number of clinical experts and families
Virtual hospital ward rounds have been a feature of some medical specialities for around two decades. But as the novel coronavirus spread rapidly in early 2020, the importance of restricting the exposure of the health workforce to infectious patients pushed the needle for this form of telemedicine.
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Value-based healthcare in Sweden: Reaching the next level
The need to get better value from healthcare investment has never been more important as ageing populations and increasing numbers of people with multiple chronic conditions force governments to make limited financial resources go further.
These pressures, along with a greater focus on patient-centred care, have raised the profile of VBHC, especially in European healthcare systems. Sweden, with its highly comprehensive and egalitarian healthcare system, has been a leader in implementing VBHC from the beginning, a fact that was underscored in a 2016 global assessment of VBHC published by The Economist Intelligence Unit.
This paper looks at the ways in which Sweden has implemented VBHC, the areas in which it has faced obstacles and the lessons that it can teach other countries and health systems looking to improve the value of their own healthcare investments.
Breast cancer patients and survivors in the Asia-Pacific workforce
With more older women also working, how will the rising trend of breast cancer survivorship manifest in workplace policies, practices and culture? What challenges do breast cancer survivors face when trying to reintegrate into the workforce, or to continue working during treatment? How can governments, companies and society at large play a constructive role?
This series of reports looks at the situation for breast cancer survivors in Australia, New Zealand and South Korea. It finds that while progress has been made, more needs to be done, particularly in South Korea, where public stigma around cancer remains high. The Cost of Silence
Cardiovascular diseases levy a substantial financial toll on individuals, their households and the public finances. These include the costs of hospital treatment, long-term disease management and recurring incidence of heart attacks and stroke. They also include the costs of functional impairment and knock-on costs as families may lose breadwinners or have to withdraw other family members from the workforce to care for a CVD patient. Governments also lose tax revenue due to early retirement and mortality, and can be forced to reallocate public finances from other budgets to maintain an accessible healthcare system in the face of rising costs.
As such, there is a need for more awareness of the ways in which people should actively work to reduce their CVD risk. There is also a need for more primary and secondary preventative support from health agencies, policymakers and nongovernmental groups.
To inform the decisions and strategies of these stakeholders, The Economist Intelligence Unit and EIU Healthcare, its healthcare subsidiary, have conducted a study of the prevalence and costs of the top four modifiable risk factors that contribute to CVDs across the Asian markets of China, Australia, Hong Kong, Japan, Singapore, South Korea, Taiwan and Thailand.
Download the report to learn more.
Using imaging and AI to help diagnose and manage covid-19 patients
Faced with rapidly escalating case numbers soon after covid-19 emerged in the city of Wuhan at the end of 2019, China quickly sought ways to support the rapid diagnosis and evaluation of patients.
Computed tomography (CT) features were included in covid-19 diagnostic criteria and the country began using artificial intelligence (AI), to analyse CT images.
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Value-based healthcare in Sweden: Reaching the next level
The need to get better value from healthcare investment has never been more important as ageing populations and increasing numbers of people with multiple chronic conditions force governments to make limited financial resources go further.
These pressures, along with a greater focus on patient-centred care, have raised the profile of VBHC, especially in European healthcare systems. Sweden, with its highly comprehensive and egalitarian healthcare system, has been a leader in implementing VBHC from the beginning, a fact that was underscored in a 2016 global assessment of VBHC published by The Economist Intelligence Unit.
This paper looks at the ways in which Sweden has implemented VBHC, the areas in which it has faced obstacles and the lessons that it can teach other countries and health systems looking to improve the value of their own healthcare investments.
Breast cancer patients and survivors in the Asia-Pacific workforce
With more older women also working, how will the rising trend of breast cancer survivorship manifest in workplace policies, practices and culture? What challenges do breast cancer survivors face when trying to reintegrate into the workforce, or to continue working during treatment? How can governments, companies and society at large play a constructive role?
This series of reports looks at the situation for breast cancer survivors in Australia, New Zealand and South Korea. It finds that while progress has been made, more needs to be done, particularly in South Korea, where public stigma around cancer remains high. The Cost of Silence
Cardiovascular diseases levy a substantial financial toll on individuals, their households and the public finances. These include the costs of hospital treatment, long-term disease management and recurring incidence of heart attacks and stroke. They also include the costs of functional impairment and knock-on costs as families may lose breadwinners or have to withdraw other family members from the workforce to care for a CVD patient. Governments also lose tax revenue due to early retirement and mortality, and can be forced to reallocate public finances from other budgets to maintain an accessible healthcare system in the face of rising costs.
As such, there is a need for more awareness of the ways in which people should actively work to reduce their CVD risk. There is also a need for more primary and secondary preventative support from health agencies, policymakers and nongovernmental groups.
To inform the decisions and strategies of these stakeholders, The Economist Intelligence Unit and EIU Healthcare, its healthcare subsidiary, have conducted a study of the prevalence and costs of the top four modifiable risk factors that contribute to CVDs across the Asian markets of China, Australia, Hong Kong, Japan, Singapore, South Korea, Taiwan and Thailand.
Download the report to learn more.
Outside the hospital: cancer monitoring with apps
Patient monitoring apps allow patients with chronic diseases to report on their condition from outside of the hospital – where they spend most of their time – putting the patient, rather than the hospital, at the centre of the care pathway.
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Value-based healthcare in Sweden: Reaching the next level
The need to get better value from healthcare investment has never been more important as ageing populations and increasing numbers of people with multiple chronic conditions force governments to make limited financial resources go further.
These pressures, along with a greater focus on patient-centred care, have raised the profile of VBHC, especially in European healthcare systems. Sweden, with its highly comprehensive and egalitarian healthcare system, has been a leader in implementing VBHC from the beginning, a fact that was underscored in a 2016 global assessment of VBHC published by The Economist Intelligence Unit.
This paper looks at the ways in which Sweden has implemented VBHC, the areas in which it has faced obstacles and the lessons that it can teach other countries and health systems looking to improve the value of their own healthcare investments.
Breast cancer patients and survivors in the Asia-Pacific workforce
With more older women also working, how will the rising trend of breast cancer survivorship manifest in workplace policies, practices and culture? What challenges do breast cancer survivors face when trying to reintegrate into the workforce, or to continue working during treatment? How can governments, companies and society at large play a constructive role?
This series of reports looks at the situation for breast cancer survivors in Australia, New Zealand and South Korea. It finds that while progress has been made, more needs to be done, particularly in South Korea, where public stigma around cancer remains high. The Cost of Silence
Cardiovascular diseases levy a substantial financial toll on individuals, their households and the public finances. These include the costs of hospital treatment, long-term disease management and recurring incidence of heart attacks and stroke. They also include the costs of functional impairment and knock-on costs as families may lose breadwinners or have to withdraw other family members from the workforce to care for a CVD patient. Governments also lose tax revenue due to early retirement and mortality, and can be forced to reallocate public finances from other budgets to maintain an accessible healthcare system in the face of rising costs.
As such, there is a need for more awareness of the ways in which people should actively work to reduce their CVD risk. There is also a need for more primary and secondary preventative support from health agencies, policymakers and nongovernmental groups.
To inform the decisions and strategies of these stakeholders, The Economist Intelligence Unit and EIU Healthcare, its healthcare subsidiary, have conducted a study of the prevalence and costs of the top four modifiable risk factors that contribute to CVDs across the Asian markets of China, Australia, Hong Kong, Japan, Singapore, South Korea, Taiwan and Thailand.
Download the report to learn more.
Scaling up and sustaining the digital transformation of US hospitals brought about by covid-19
As the covid-19 pandemic spread across the US, one of the world’s worst-affected countries, hospitals faced an unprecedented dual challenge: coping with the surge in patients with a novel disease while continuing to care for the many non-covid patients whose needs could not be ignored.
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Value-based healthcare in Sweden: Reaching the next level
The need to get better value from healthcare investment has never been more important as ageing populations and increasing numbers of people with multiple chronic conditions force governments to make limited financial resources go further.
These pressures, along with a greater focus on patient-centred care, have raised the profile of VBHC, especially in European healthcare systems. Sweden, with its highly comprehensive and egalitarian healthcare system, has been a leader in implementing VBHC from the beginning, a fact that was underscored in a 2016 global assessment of VBHC published by The Economist Intelligence Unit.
This paper looks at the ways in which Sweden has implemented VBHC, the areas in which it has faced obstacles and the lessons that it can teach other countries and health systems looking to improve the value of their own healthcare investments.
Breast cancer patients and survivors in the Asia-Pacific workforce
With more older women also working, how will the rising trend of breast cancer survivorship manifest in workplace policies, practices and culture? What challenges do breast cancer survivors face when trying to reintegrate into the workforce, or to continue working during treatment? How can governments, companies and society at large play a constructive role?
This series of reports looks at the situation for breast cancer survivors in Australia, New Zealand and South Korea. It finds that while progress has been made, more needs to be done, particularly in South Korea, where public stigma around cancer remains high. The Cost of Silence
Cardiovascular diseases levy a substantial financial toll on individuals, their households and the public finances. These include the costs of hospital treatment, long-term disease management and recurring incidence of heart attacks and stroke. They also include the costs of functional impairment and knock-on costs as families may lose breadwinners or have to withdraw other family members from the workforce to care for a CVD patient. Governments also lose tax revenue due to early retirement and mortality, and can be forced to reallocate public finances from other budgets to maintain an accessible healthcare system in the face of rising costs.
As such, there is a need for more awareness of the ways in which people should actively work to reduce their CVD risk. There is also a need for more primary and secondary preventative support from health agencies, policymakers and nongovernmental groups.
To inform the decisions and strategies of these stakeholders, The Economist Intelligence Unit and EIU Healthcare, its healthcare subsidiary, have conducted a study of the prevalence and costs of the top four modifiable risk factors that contribute to CVDs across the Asian markets of China, Australia, Hong Kong, Japan, Singapore, South Korea, Taiwan and Thailand.
Download the report to learn more.
Putting money on the table: Nigeria’s policy response to hepatitis B and C
Putting money on the table: Nigeria’s policy response to hepatitis B and C
Nigeria has seen a steady increase in the prevalence of viral hepatitis over the past few decades. The introduction of a routine immunisation programme in 2004 for hepatitis B contributed to a drop in the overall rate of hepatitis infection in children; the number of cases in adults continues to rise.1
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Sustaining the push to elimination and beyond: Rwanda’s policy response to...
For decades, Rwanda has battled significant levels of hepatitis B (HBV) and C (HCV) infections. Sidonie Uwimpuhwe, Rwanda’s Country Director at the Clinton Health Access Initiative (CHAI) reports that an estimated 4% of the population were with living with HCV, whilst HBV prevalence was around 2% when the programme started. The burden is more pronounced in those over the age of 55, where HCV prevalence rises to 16%.1 The scale of infection is also slightly higher in vulnerable populations, such as those living with other conditions like HIV. Since HIV, HBV and HCV share transmission routes, prevalence of coinfections with HIV continues to be an issue. In 2017, a study found that the prevalence of HBV and HCV antibodies in people living with HIV were 4.3% and 4.6% respectively. Although antibody testing cannot confirm a chronic HBV or HCV infection, the study highlighted that these figures acted as a good proxy for chronicity.2
The 1994 genocide, saw health facilities and workforce severely impacted.3 The genocide claimed over a million lives and is thought to have led to widespread hepatitis transmission due to mass casualties.2 Thousands were also raped and exposed to HIV or HCV.4 Alongside exposure to contaminated blood during this period, unsafe needle use, dental care and past traditional practices led to higher transmission rates within the population. This contributes to today’s high caseload of hepatitis, especially in older people.
There is little difference in rates of HCV infection between urban and rural areas. Rates of HBV, however, are higher in the rural communities, with transmission from motherto-child, between household members and families being the main drivers.4 Prior to the introduction of direct-acting antivirals (DAAs) in 2014, people with HCV were treated with a series of interferon injections, which were expensive, ineffective (only about 40% of patients responded) and had major side effects.5
Building back the health system
The country was forced to build back its health system after its civil war and created ambitious plans to restore health services. Vision 2020 is a government development framework launched in 2000, with the objectives of reducing poverty, health problems and uniting the nation.6 Leadership at national and local levels was maintained during partnerships with non-governmental organisations to ensure that foreign aid was used in line with national strategies.7, 8
Facing a workforce crisis, emphasis was placed on increasing the numbers of health professionals by training physicians and nurses.9 A performance-based financing system was launched in 2005 to reward community health centres and district hospitals for better patient follow-up and primary care indicators, thus improving existing services.9
Ensuring that the population could access healthcare was recognised as a key mechanism to reduce poverty. A national mutual health insurance scheme, mutuelles de santé, was piloted in 1999.9 The most vulnerable citizens were enrolled into national social protection programmes and fully subsidised communitybased health insurance schemes (CBHI). In 2012, over 90% of the population was covered by insurance, that figure is now at 95%, and costs zero to a few dollars per year for individuals.10, 11
Keeping up the momentum: hepatitis prevention, testing and treatment
Using the momentum from the post-genocide health system rebuilding, Rwanda increased its activities towards tackling its hepatitis epidemic. In 1999, Rwanda introduced screening for HCV in recognition of its largely asymptomatic nature.12 The hepatitis B vaccine was introduced into the country’s expanded programme of immunisation (EPI) in 2000 in recognition of growing prevalence.13 Dr Sabin Nsanzimana, Director General of the Rwanda Biomedical Centre, adds that a birth-dose HBV immunisation programme is due to be introduced in 2021.
As part of prevention efforts, the Ministry of Health has introduced annual mass-media campaigns to raise awareness of hepatitis and mass screening in the general population and
“Rwanda’s viral hepatitis interventions are not part of a standalone programme. Everything is being built on top of existing infrastructure within the health system.”
Dr Sabin Nsanzimana
reduce stigma. The campaigns are delivered through community health workers, media outlets such as radio and television, and churches.14 The Ministry of Health also ensures that health practitioners are provided with training and education about risk reduction for exposure to hepatitis, infection control measures and implementation of the national clinical guidelines.15
To quantify the burden of hepatitis, robust screening and testing programmes are required. In 2013 Rwanda scaled up capacity for HCV testing by using existing HIV programmes, testing platforms and laboratory systems. All hospitals were provided with WHO-prequalified rapid diagnostic tests for HCV-antibody detection.16 National guidelines recommend that all adults are tested at least once, with annual testing for anyone with potential exposure to HCV infection. High risk groups are also recommended to undergo annual testing and pregnant women are advised to receive systematic testing. Screening and testing for HCV is currently available in multiple settings within hospitals, including antenatal care appointments, outpatient departments and blood transfusion centres.17
The reduction of financial and geographical barriers promotes access to health services and contributes to the success of any plan or programme. The Rwandan government has consistently negotiated price reductions for rapid diagnostic tests and treatments; it has also prioritised the inclusion of HCV screening, diagnosis and treatment under both public and private health insurance schemes.18 Dr Emmanuel Musabeyezu, a key player in the establishment of the hepatitis programme in Rwanda and a specialist in hepatitis management, highlighted the importance of coverage of hepatitis care under the public system, with people more likely to use the services and get tested if they do not have to pay.
In the past, people living with HCV in Rwanda were only treated by a small number of specialists. However, Rwanda has adopted a public health approach and decentralised health services away from specialists to general practitioners at the district level as part of scaling-up services.19, 20 Dr Musabeyezu explained that enables screening, viral load testing and treatment in a location convenient to individuals. This move has improved accessibility for patients and extended services to geographically hard-to-reach populations that would otherwise go untreated.
Rwanda’s aggressive approach to combating viral hepatitis is paying off. By the end of 2018, approximately 700,000 people were screened for HCV and 10,000 were cured with treatment.
“When you feel you are achieving something, it makes you work harder.”
Dr Emmanuel Musabeyezu
A bold and holistic elimination plan
Rwanda is one of the few countries in subSaharan Africa that has managed to achieve most of the health-related Millennium Development Goals, including noteworthy accomplishments in maternal and child health, control of HIV, tuberculosis and malaria.22
In 2018 Rwanda set its sights on a new challenge, committing to eliminating hepatitis C by 2024. It was the first country in subSaharan Africa to propose a five-year HCV elimination plan that included initiatives such as raising community awareness, ensuring affordability of screening and treatment, and solidarity with international partners.23 If Rwanda achieves its goal, it will have done so six years ahead of the 2030 global target for elimination set by the World Health Organization.2
Spurred on by the elimination plan and building on the significant progress already made towards the goal, Rwanda started work on refining and scaling up its existing hepatitis services. Due to the substantial improvement in the affordability of screening tests, demand for screening has increased rapidly. The Rwandan Ministry of Health harnessed this opportunity to use the HCV screening programme to also screen people for HBV.24 This has been facilitated by the introduction of a new rapid diagnostic test that can be offered at the point of care, produces results in twenty minutes and costs just US$1, reduced from US$30.
The Rwandan government recognised that access to treatment plays a major role in the uptake of screening. It negotiated further reductions in treatment costs from US$80,000 to US$60. The reductions in medications costs were also a result of the fall in prices of generic medicines. The total estimated cost for the five-year plan was US$113m, but these dramatic savings mean the program cost is now predicted to be US$43m.25
In addition to the geographical expansion of screening and testing sites to remote areas of the country, Rwanda is working towards training more physicians and nurses to be able to prescribe and monitor DAA treatment. Basing this initiative on a previous strategy for HIV control, the diagnosis and treatment of simple cases of HCV will be shifted from specialists to primary care doctors and nurses. Individuals with complications will still be referred to specialists.4
Final push to elimination: ensuring sustainability
Dr Musabeyezu highlights that Rwanda now faces the challenge of ensuring that the increasing number of people attending screening are linked to appropriate and high-quality care. At a system level, there is a need to ensure good supply management for medications to prevent or mitigate shortages. Programme monitoring and evaluation enables programmes to improve over time. To support this process, Ms Uwimpuhwe says CHAI is working with the Rwandan government to strengthen existing infrastructure, increase the skills of health workers through strong training and mentorship programs, as well as supportive e-learning tools and strong digital solutions to improve patient management and support.
Looking forward, Rwanda needs to continue working on improving accessibility to services in remote areas. Engaging with religious leaders, local government and the private sector will play a critical part in its success. Dr Nsanzimana adds that the government is exploring including hepatitis services in Rwanda’s CBHI.
Rwanda continues to pave the way towards viral hepatitis elimination and the learnings from its journey—characterised by sustained political commitment and investment, with innovative integration of services—will provide valuable insights for other countries in the region.
While every effort has been taken to verify the accuracy of this information, The Economist Intelligence Unit Ltd. cannot accept any responsibility or liability for reliance by any person on this report or any of the information, opinions or conclusions set out in this report. The findings and views expressed in the report do not necessarily reflect the views of the sponsor.
[1] Clinton Health Access Initiative. 2020. Partnerships Will Help Rwanda Eliminate Hepatitis C In Five Years - Clinton Health Access Initiative. [online] Available at: https://www.clintonhealthaccess.org/partnerships-will-help-rwanda-eliminate-hepatitis-c-in-five-years/
[2] Umutesi, J., Simmons, B., Makuza, J., Dushimiyimana, D., Mbituyumuremyi, A., Uwimana, J., Ford, N., Mills, E. and Nsanzimana, S., 2017. Prevalence of hepatitis B and C infection in persons living with HIV enrolled in care in Rwanda. BMC Infectious Diseases, [online] 17(1). Available at: https:// bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-017-2422-9.
[3] Mbituyumuremyi, A., Van Nuil, J., Umuhire, J., Mugabo, J., Mwumvaneza, M., Makuza, J., Umutesi, J., Nsanzimana, S. and Gupta, N., 2017. Controlling hepatitis C in Rwanda: a framework for a national response. Bulletin of the World Health Organization, 96(1), pp.51-58.
[4] Donovan, P., 2002. Rape and HIV/AIDS in Rwanda. The Lancet, 360, pp.s17-s18.
[5] Ourworldunited.shorthandstories.com. 2020. Eliminating Hepatitis C In Rwanda. Available at: https://ourworldunited.shorthandstories.com/Eliminate_HepatitisC_Rwanda/index.html
[6] The Republic of Rwanda, 2012. Rwanda Vision 2020. [online] Kigali: The Republic of Rwanda. Available at: http://www.minecofin.gov.rw/fileadmin/templates/documents/NDPR/Vision_2020_.pdf
[7] Emery, N., 2013. Rwanda’s Historic Health Recovery: What The U.S. Might Learn. [online] The Atlantic. Available at: https://www.theatlantic.com/ health/archive/2013/02/rwandas-historic-health-recovery-what-the-us-might-learn/273226/
[8] Farmer, P., Nutt, C., Wagner, C., Sekabaraga, C., Nuthulaganti, T., Weigel, J., Farmer, D., Habinshuti, A., Mugeni, S., Karasi, J. and Drobac, P., 2013. Reduced premature mortality in Rwanda: lessons from success. BMJ, 346(jan18 1), pp.f65-f65.
[9] Mbituyumuremyi, A., Van Nuil, J., Umuhire, J., Mugabo, J., Mwumvaneza, M., Makuza, J., Umutesi, J., Nsanzimana, S. and Gupta, N., 2017. Controlling hepatitis C in Rwanda: a framework for a national response. Bulletin of the World Health Organization, 96(1), pp.51-58.
[10] Clinton Health Access Initiative. 2020. Partnerships Will Help Rwanda Eliminate Hepatitis C In Five Years - Clinton Health Access Initiative. [online] Available at: https://www.clintonhealthaccess.org/partnerships-will-help-rwanda-eliminate-hepatitis-c-in-five-years/
[11] Makaka, A., Breen, S. and Binagwaho, A., 2012. Universal health coverage in Rwanda: a report of innovations to increase enrolment in communitybased health insurance. The Lancet, 380, p.S7.
[12] Umutesi, G., Shumbusho, F., Kateera, F., Serumondo, J., Kabahizi, J., Musabeyezu, E., Ngwije, A., Gupta, N. and Nsanzimana, S., 2019. Rwanda launches a 5-year national hepatitis C elimination plan: A landmark in sub-Saharan Africa. Journal of Hepatology, 70(6), pp.1043-1045.
[13] Muvunyi, C., Harelimana, J., Sebatunzi, O., Atmaprakash, A., Seruyange, E., Masaisa, F., Manzi, O., Nyundo, M. and Hategekimana, T., 2018. Hepatitis B vaccination coverage among healthcare workers at a tertiary hospital in Rwanda. BMC Research Notes, 11(1).
[14] Mbituyumuremyi, A., Van Nuil, J., Umuhire, J., Mugabo, J., Mwumvaneza, M., Makuza, J., Umutesi, J., Nsanzimana, S. and Gupta, N., 2017. Controlling hepatitis C in Rwanda: a framework for a national response. Bulletin of the World Health Organization, 96(1), pp.51-58.
[15] Ibid
[16] Umutesi, G., Shumbusho, F., Kateera, F., Serumondo, J., Kabahizi, J., Musabeyezu, E., Ngwije, A., Gupta, N. and Nsanzimana, S., 2019. Rwanda launches a 5-year national hepatitis C elimination plan: A landmark in sub-Saharan Africa. Journal of Hepatology, 70(6), pp.1043-1045.
[17] Mbituyumuremyi, A., Van Nuil, J., Umuhire, J., Mugabo, J., Mwumvaneza, M., Makuza, J., Umutesi, J., Nsanzimana, S. and Gupta, N., 2017. Controlling hepatitis C in Rwanda: a framework for a national response. Bulletin of the World Health Organization, 96(1), pp.51-58.
[18] Ibid
[19] Ibid
[20] Clinton Health Access Initiative. 2020. Partnerships Will Help Rwanda Eliminate Hepatitis C In Five Years - Clinton Health Access Initiative. [online] Available at: https://www.clintonhealthaccess.org/partnerships-will-help-rwanda-eliminate-hepatitis-c-in-five-years/
[21] Ibid
[22] Mbituyumuremyi, A., Van Nuil, J., Umuhire, J., Mugabo, J., Mwumvaneza, M., Makuza, J., Umutesi, J., Nsanzimana, S. and Gupta, N., 2017. Controlling hepatitis C in Rwanda: a framework for a national response. Bulletin of the World Health Organization, 96(1), pp.51-58.
[23] Rwanda’s fight in the elimination of Hepatitis C Virus. Kigali: Ministry of Health; 2019. Available from: http://moh.gov.rw/index.php?id=19&tx_news_ pi1[news]=76&tx_news_pi1[day]=1&tx_news_pi1[month]=8&tx_news_pi1[year]=2019&cHash=5bd9a53465e639666f11d1b7aa0ea60a
[24] Clinton Health Access Initiative. 2020. Partnerships Will Help Rwanda Eliminate Hepatitis C In Five Years - Clinton Health Access Initiative. [online] Available at: https://www.clintonhealthaccess.org/partnerships-will-help-rwanda-eliminate-hepatitis-c-in-five-years/
[25] Ourworldunited.shorthandstories.com. 2020. Eliminating Hepatitis C In Rwanda. Available at: https://ourworldunited.shorthandstories.com/ Eliminate_HepatitisC_Rwanda/index.html
Value-based healthcare in Sweden: Reaching the next level
The need to get better value from healthcare investment has never been more important as ageing populations and increasing numbers of people with multiple chronic conditions force governments to make limited financial resources go further.
These pressures, along with a greater focus on patient-centred care, have raised the profile of VBHC, especially in European healthcare systems. Sweden, with its highly comprehensive and egalitarian healthcare system, has been a leader in implementing VBHC from the beginning, a fact that was underscored in a 2016 global assessment of VBHC published by The Economist Intelligence Unit.
This paper looks at the ways in which Sweden has implemented VBHC, the areas in which it has faced obstacles and the lessons that it can teach other countries and health systems looking to improve the value of their own healthcare investments.
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With more older women also working, how will the rising trend of breast cancer survivorship manifest in workplace policies, practices and culture? What challenges do breast cancer survivors face when trying to reintegrate into the workforce, or to continue working during treatment? How can governments, companies and society at large play a constructive role?
This series of reports looks at the situation for breast cancer survivors in Australia, New Zealand and South Korea. It finds that while progress has been made, more needs to be done, particularly in South Korea, where public stigma around cancer remains high.