重新定义非传染性疾病和伤害,实现全民健康覆盖时代的公平:肯尼亚非传染性疾病和伤害减贫委员会的调查结果和建议。

Reframing Non-Communicable Diseases and Injuries for Equity in the Era of Universal Health Coverage: Findings and Recommendations from the Kenya NCDI Poverty Commission.

机构信息

Division of Non-Communicable Diseases, Ministry of Health, Nairobi, Kenya.

Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland.

出版信息

Ann Glob Health. 2021 Jan 5;87(1):3. doi: 10.5334/aogh.3085.

Abstract

BACKGROUND

Kenya has implemented a robust response to non-communicable diseases and injuries (NCDIs); however, key gaps in health services for NCDIs still exist in the attainment of Universal Health Coverage (UHC). The Kenya Non-Communicable Diseases and Injury (NCDI) Poverty Commission was established to estimate the burden of NCDIs, determine the availability and coverage of health services, prioritize an expanded set of NCDI conditions, and propose cost-effective and equity-promoting interventions to avert the health and economic consequences of NCDIs in Kenya.

METHODS

Burden of NCDIs in Kenya was determined using desk review of published literature, estimates from the Global Burden of Disease Study, and secondary analysis of local health surveillance data. Secondary analysis of nationally representative surveys was conducted to estimate current availability and coverage of services by socioeconomic status. The Commission then conducted a structured priority setting process to determine priority NCDI conditions and health sector interventions based on published evidence.

FINDINGS

There is a large and diverse burden of NCDIs in Kenya, with the majority of disability-adjusted life-years occurring before age of 40. The poorest wealth quintiles experience a substantially higher deaths rate from NCDIs, lower coverage of diagnosis and treatment for NCDIs, and lower availability of NCDI-related health services. The Commission prioritized 14 NCDIs and selected 34 accompanying interventions for recommendation to achieve UHC. These interventions were estimated to cost $11.76 USD per capita annually, which represents 15% of current total health expenditure. This investment could potentially avert 9,322 premature deaths per year by 2030.

CONCLUSIONS AND RECOMMENDATIONS

An expanded set of priority NCDI conditions and health sector interventions are required in Kenya to achieve UHC, particularly for disadvantaged socioeconomic groups. We provided recommendations for integration of services within existing health services platforms and financing mechanisms and coordination of whole-of-government approaches for the prevention and treatment of NCDIs.

摘要

背景

肯尼亚已经对非传染性疾病和伤害(NCDIs)采取了强有力的应对措施;然而,在实现全民健康覆盖(UHC)方面,NCDIs 的卫生服务仍存在一些关键差距。肯尼亚非传染性疾病和伤害(NCDI)贫困委员会的成立是为了评估 NCDIs 的负担,确定卫生服务的提供情况和覆盖范围,确定一套扩大的 NCDI 条件,并提出具有成本效益和促进公平的干预措施,以避免 NCDIs 给肯尼亚带来的健康和经济后果。

方法

肯尼亚的 NCDIs 负担是通过对已发表文献的桌面审查、全球疾病负担研究的估计以及当地卫生监测数据的二次分析来确定的。对全国代表性调查进行了二次分析,以按社会经济地位估计服务的当前可用性和覆盖范围。然后,委员会根据已发表的证据,通过结构化的优先排序程序来确定优先 NCDI 条件和卫生部门干预措施。

结果

肯尼亚的 NCDIs 负担很大且种类繁多,大部分残疾调整生命年发生在 40 岁之前。最贫穷的五个财富五分位数组的 NCDIs 死亡率要高得多,NCDIs 的诊断和治疗覆盖率较低,NCDI 相关卫生服务的可用性也较低。委员会优先考虑了 14 种 NCDIs,并选择了 34 种伴随干预措施,建议将其用于实现 UHC。据估计,这些干预措施每年每人需花费 11.76 美元,占当前总卫生支出的 15%。到 2030 年,这一投资可能会避免每年 9322 人过早死亡。

结论和建议

肯尼亚需要扩大一套优先 NCDI 条件和卫生部门干预措施,以实现 UHC,特别是为了处境不利的社会经济群体。我们为在现有卫生服务平台和融资机制中整合服务以及协调政府整体防治 NCDIs 的方法提供了建议。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f493/7792462/b33f01d15c0a/agh-87-1-3085-g1.jpg

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