If a screening strategy for cervical cancer were introduced, it might provide a good opportunity to offer women other health checks, but it is unclear which interventions should be packaged together. Jane Kim and colleagues (Harvard University) have developed an analytic framework to identify an optimal package of health services to offer to women attending a clinic once for their lifetime cervical cancer screen.
Their model takes into account monetary limitations and possible shortages in trained personnel to do the health checks, and balances these constraints against the likely health benefits for the women. When they set a realistic budgetary constraint (based on the annual health budget of the poorest countries and a single health check per woman in the two decades following her reproductive years), the optimal health package included cervical cancer screening by testing for human papillomavirus (an accurate but complex test), treatment for depression, and screening or treatment for anemia. When a 50% shortage in general (for example, nurses) and specialized (for example, doctors) personnel time was also included, the health benefits of the package were maximized by using a simpler test for cervical cancer and by treating anemia but not depression; this freed up resources in some regions to screen for breast cancer or cardiovascular disease.
The results suggest that the packaging of multiple health services during a single visit has great potential to maximize health gains, provided the right interventions are chosen. The shortage of personnel, which has been ignored in previous analyses even though it is a major problem in many developing countries, affects which health conditions and specific interventions should be bundled together to provide the greatest impact on public health.
Citation: Kim JJ, Salomon JA, Weinstein MC, Goldie SJ (2006) Packaging health services when resources are limited: The example of a cervical cancer screening visit. PLoS Med 3(11): e434.
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