Bulletin of the World Health Organization最新文献

Problem: To address the long waiting times patients incur when visiting outpatient departments in India.

Approach: In 2022, the National Health Authority in India developed a paperless service, called Scan and Share, leveraging mobile technology and QR (quick-response) codes to streamline outpatient department appointments. Patients can use a mobile application (app) to scan QR codes at health facilities, generating tokens linked to registration counters. The service integrates patients' demographic data from their Ayushman Bharat Health Account with the facilities' health information systems. Collaboration with government bodies, health workers and patient advocacy groups ensured compliance with data protection regulations. For developers, the National Health Authority published detailed technical specifications outlining standards for app functionality, security and interoperability on the Ayushman Bharat Digital Mission platform.

Local setting: Launched in 2021, Ayushman Bharat Digital Mission in India aims to digitize health care, creating a shared digital infrastructure for affordable and accessible care.

Relevant changes: As at 19 October 2024, the Scan and Share service operates in 16 939 health-care facilities across 35 states and territories. The service has reduced waiting times from 1 hour to 2-5 minutes. Out of 56 801 213 tokens generated, 714 014 (1.3%) were issued in the private sector. There are currently 2074 active developers, with 1545 from the private sector.

Lessons learnt: The Scan and Share service is transforming health-care delivery by reducing outpatient department queues, waiting times and errors. High-performing states can provide valuable insights for states with low service adoption.

Smisha Agarwal talks to Gary Humphreys about the challenges faced in introducing digital tools in resource-constrained settings.

The rising incidence of noncommunicable diseases, combined with the costs of mitigating climate change, sovereign debt and regional conflicts, is undermining global health security and threatening progress towards achieving the sustainable development goals of the United Nations. The negative impact of these polycrises is disproportionately borne by low- and middle-income countries, which have the highest disease burden and lowest health-care spending. Health digitalization is emerging as a promising countermeasure, accelerated by artificial intelligence (AI) software and quantum computing hardware. We provide a multisector critical analysis of the three key enablers - governance, infrastructure and security - of the responsible AI-enabled digitalization for safe, affordable, equitable and sustainable health-care systems in low- and middle-income countries. We consider leading use cases in public-private partnerships, democratized sovereign AI and embedded human security. Our analysis proposes that these use cases demonstrate how digital AI-accelerated global health may be advanced as human-centred managed strategic competition. We conducted our analysis through an inclusive range of theoretical perspectives and practical experience spanning academia, industry and practice across the world. We provide recommendations for the responsible management of the key enablers to accelerate global health for all. We anticipate that this paper will be useful for public health decision-makers, both in low- and middle-income countries leading local health digitalization, and in high-income countries supporting this transaction through their technologies, funding and knowledge exchange.

Objective: To develop a tele-intensive care service providing peer-to-peer teleconsultation for physicians in remote and resource-constrained health-care settings for treatment of critically ill patients, and to evaluate the outcomes of the service.

Methods: The Aga Khan University started the coronavirus disease 2019 (COVID-19) tele-intensive care unit in 2020. A central command centre used two-way audiovisual technology to connect experienced intensive care specialists to clinical teams in remote hospital settings. The service, always available, used messaging applications and telephone calls. Coverage was later extended to other medical, neonatal, paediatric and surgical patients requiring critical care.

Findings: Between June 2020 and December 2023, the service provided 6014 teleconsultations to manage 1907 patients in 109 medical facilities, mostly in Pakistan and also Afghanistan, Kenya and United Republic of Tanzania. Of the 1907 patients, 652 (34.4%) had COVID-19 and 1244 (65.6%) had other illnesses. The mean duration of teleconsultations was 14.5 min. Of 581 patients for whom outcome data were available, 204 (35.1%) died. Multivariate multinomial logistic regression showed the odds of death decreased with increased number of consultations (> 3) per patient (adjusted odds ratio (aOR): 0.28; 95% confidence interval, CI: 0.16-0.48), and increased number of recommendations (≥ 5) per consultation (aOR: 3.09; 95% CI: 1.08-8.84).

Conclusion: Our tele-intensive care service helped manage critically ill patients in regions where intensive care had not previously been available. While research on the clinical impact of this model is needed, decision-makers should consider its use to increase provision of critical care in remote and resource-constrained health-care settings.

Objective: To map how social, commercial, political and digital determinants of health have changed or emerged during the recent digital transformation of society and to identify priority areas for policy action.

Methods: We systematically searched MEDLINE, Embase and Web of Science on 24 September 2023, to identify eligible reviews published in 2018 and later. To ensure we included the most recent literature, we supplemented our review with non-systematic searches in PubMed® and Google Scholar, along with records identified by subject matter experts. Using thematic analysis, we clustered the extracted data into five societal domains affected by digitalization. The clustering also informed a novel framework, which the authors and contributors reviewed for comprehensiveness and accuracy. Using a two-round consensus process, we rated the identified determinants into high, moderate and low urgency for policy actions.

Findings: We identified 13 804 records, of which 204 met the inclusion criteria. A total of 127 health determinants were found to have emerged or changed during the digital transformation of society (37 digital, 33 social, 33 commercial and economic and 24 political determinants). Of these, 30 determinants (23.6%) were considered particularly urgent for policy action.

Conclusion: This review offers a comprehensive overview of health determinants across digital, social, commercial and economic, and political domains, highlighting how policy decisions, individual behaviours and broader factors influence health by digitalization. The findings deepen our understanding of how health outcomes manifest within a digital ecosystem and inform strategies for addressing the complex and evolving networks of health determinants.

When policy-makers propose health-related initiatives they need to assess the impact on health inequalities, including disparities in diet-related diseases and obesity. Health impact assessments, including health equity assessments, can provide insights into the potential health outcomes, but they are usually based on engagement with stakeholders and beneficiaries and their quality is not easy to evaluate. In this paper, we propose a policy assessment tool designed to ask a set of questions on the impact on health equity of policies and interventions that may be answerable from empirical evidence or from public health principles. The results can be graded by strength of the impact and direction of the likely effects, and can provide a summary of how a policy or initiative may increase or decrease health inequity. The questions can be used as part of the scoping review for an impact assessment. We describe the application of this approach to the evaluation of three population-based policies to assess their likely impact on obesity inequalities: (i) policies to restrict children's exposure to the promotional marketing of unhealthy foods and beverages; (ii) policies on food and beverage reformulation; and (iii) policies to improve food procurement for public institutions.

Objective: To investigate access to essential anticancer medicines for children throughout China.

Methods: We obtained cross-sectional drug use data for 2021 from 55 tertiary children's hospitals in seven geographical regions (one third of public children's hospitals in mainland China). Affordability was assessed by comparing the single-day copayment for each medicine with the same generic name and route of administration (i.e. product) or for a treatment course with daily disposable income per capita in each region. The median availability and affordability of all 33 anticancer medicines in the 2021 WHO Model list of essential medicines for children were calculated and compared by region and medicine type.

Findings: Although all medicines had been approved in China, 14 (42.4%) were available in under 50% of hospitals and six (18.2%) products had a median single-day copayment exceeding daily disposable income. Median availability was higher among the 19 medicines with approval for paediatric indications than among the 14 without (80.0% versus 48.2%, respectively; P < 0.001). Overall, 42.4% (14/33) of medicines had both good availability and affordability; the lowest proportion was in north-west China (30.3%, 10/33). A Chinese resident needed to work for 5.3 days to afford 4 weeks' induction therapy for acute lymphoblastic leukaemia, the most common childhood cancer.

Conclusion: Access to essential anticancer medicines for children remained suboptimal in China and varied across regions. Fewer than half the medicines studied had both good availability and affordability. Actions are warranted to address potential shortages and decrease the financial burden on families.