DISEASE CONTROL PRIORITIES IN DEVELOPING COUNTRIES

(2nd edition)

Abbreviated Table of Contents, Draft 6.4, revised 18 November 2002
edited by

Dean T. Jamison (UCLA/FIC)
David B. Evans (WHO)
George Alleyne (PAHO)
Prabhat Jha (University of Toronto)
Joel Breman (FIC)
Anthony R. Measham (World Bank, retired)
Mariam Claeson (World Bank)
Anne Mills (London School of Hygiene and Tropical Medicine)

In the late 1980s the World Bank initiated a process designed both to generate analytic background on priorities for control of specific diseases and to use this information as input for comparative cost-effectiveness estimates for interventions addressing the full range of conditions important in developing countries. The purpose of the comparative cost-effectiveness work was to provide one input into decision-making within the health sectors of highly resource-constrained low- and middle-income countries. This process resulted in the 1993 publication of Disease Control Priorities in Developing Countries** The first edition was a World Bank product edited by Dean T. Jamison, W. Henry Mosley, Anthony R. Measham and Jose Luis Bobadilla and published by Oxford University Press in 1993. It totaled 746 (+ xvii) pages in 29 chapters and 4 appendices.. A decade after publication of the first edition, the World Bank, the World Health Organization, and the Fogarty International Center of the U.S. National Institutes of Health have initiated a "Disease Control Priorities Project" that will, among other outcomes, result in a second edition of Disease Control Priorities in Developing Countries (DCP2). The Fogarty International Center is hosting the project, which is financed in part by a grant from the Bill & Melinda Gates Foundation.

DCP2 is intended both to update DCP1 and to go beyond it in a number of important ways:

(i) The coverage will be more comprehensive. While virtually all chapters of DCP1 were structured around clusters of conditions, DCP2 will, in addition, provide integrative chapters – e.g. school health systems or surgery or "Integrated Management of Childhood Illness" (IMCI) – that draw together the implementation-related responses to a number of conditions. Case studies and lessons from implementation success will be highlighted. This concern for implementation is a central additional feature of DCP2, although the volume will also deal with a broader range of conditions (but much more briefly) than did DCP1.
(ii) There will be explicit discussion of R&D priorities as well as control priorities.
(iii) Although DCP1 dealt to some extent with the instruments of policy to affect behavior (or the environment), DCP2 will attempt to do so in a more systematic way. In particular the public sector instruments for influencing behavior change that were described in DCP1 – information, education and communication; laws and regulations; taxes and subsidies; engineering design such as speed bumps; and facility location and characteristics – will be systematically assessed in each chapter.

(iv) Different instruments of policy (or control strategies more generally) place different levels of demand on a country's implementation and institutional capacity. Individual chapters will seek systematically to identify which interventions require relatively less implementation capacity and which require more.
(v) Although DCP1 briefly discussed the non-health outcomes of intervention, DCP2 will do so in a more systematic way, including consequences of intervention (and intervention finance) for reduction of financial risk at the household level. There will, in addition, in some cases be estimates of the economic benefits of intervention (CBA) as well as the more uniformly applied CEA.

(vi) An important element of DCP1 was its assumption that, to inform broad policy, it was necessary to consider major changes from the status quo, not just marginal ones. A non-marginal approach to CEA needs to be informed by burden of disease assessments in a way not required for judging the attractiveness of incremental change. This is particularly true in considering R&D priorities but often applies to control priorities as well.  DCP2 will continue very much in the spirit of DCP1 in assessing CEA of major changes, but will attempt to do so in a more standardized way.

With these objectives as background, DCP2 will be structured into four parts:

Part I will summarize results, draw out policy implications, set the historical and scientific context and overview the methods employed.

Parts II will be organized by major clusters of conditions and risk factors – structured closely along the lines of the World Bank/WHO burden of disease assessment. Chapters in this part will discuss the nature, consequences and experience with control measures and report CEA for interventions that are specific to the condition or risk factor in the chapter. It will place these CEAs in the context of CEAs that address not only the condition discussed in the chapter but, also, other conditions. (For example the circulatory system disease chapter in Part II would assess CEA of condition-specific interventions – like aspirin and beta-blockers for secondary prevention – but would only summarize results from the assessment of control of smoking, which would be discussed in a later chapter because smoking control is also relevant for several cancers and COPD.)

Parts III and IV will deal with implementation of priorities. Part III will do so through inclusion of chapters on strengthening national health systems – public health, clinical services and overall strengthening of management and capacity. Part IV will deal with the role for international collective action – for international public goods like R&D, for country-specific development assistance and for dealing with populations (like refugees) that no national government adequately represents.

The following pages convey, first, the Abbreviated Table of Contents in brief and then the chapter-by-chapter version.

DCP2 – Abbreviated Table of Contents (in Brief)
Chapter Count = 74

PART ONE: DISEASE CONTROL PRIORITIES IN DEVELOPING COUNTRIES [9 chapters]

A. Findings and Recommendations [4 chapters]

B. Background and Methods [5 chapters]


PART TWO: CONDITIONS, RISK FACTORS, AND CONSEQUENCES [33 chapters]

A. Infectious Disease, Reproductive Health, and Undernutrition [12 chapters]

B. Noncommunicable Disease and Injury  [11 chapters]

C. Risk Factors [6 chapters]

D. Consequences [4 chapters]


PART THREE: IMPLEMENTING PRIORITIES -- STRENGTHENING NATIONAL HEALTH SYSTEMS [24 chapters]

A. Strengthening Public Health Services [9 chapters]

B. Strengthening Personal Health Services [9 chapters]

C. Capacity Strengthening and Management Reform [6 chapters]
PART FOUR: IMPLEMENTING PRIORITIES -- INTERNATIONAL COLLECTIVE ACTION FOR HEALTH [8 chapters]

A. International Assistance in the Provision of Services [3 chapters]
B. Research, Development, and International Public Goods [5 chapters]


STATISTICAL ANNEX
DCP2 – Abbreviated Table of Contents
Editors' Preface
0. Forward

PART ONE: DISEASE CONTROL PRIORITIES IN DEVELOPING COUNTRIES [Introductory pages to overview the purpose and content of Part One.]

A. Findings and Recommendations

1. Disease Control Priorities in Developing Countries: An Overview
2. Implementing Priorities: Mother and Child Health
3. Implementing Priorities: Chronic Diseases
4. Implementing Priorities: Reaching the Poor

B. Background and Methods
5. The Economic Benefits of Disease Control
6. Science and Technology for Disease Control: Past, Present, and Future

7. The Burden of Disease and Mortality by Condition and by Risk Factor: WHO Estimates for the Year 2000
(In addition to summarizing the WHO results this chapter will highlight methods and assumptions and point to directions for research to improve disease and risk factor burden assessment.)

8. Assessing Disease Burden Reduction from Successful Interventions
(This chapter will pay particular attention to issues of co-morbidity and of conditions as risk factors for other conditions. This will facilitate quantifying the total consequences of successful intervention against a specific condition or risk factor.)

9. Methods of Economic Analysis
(Cost-effectiveness in producing health; cost-benefit analysis; and cost-effectiveness analysis of reducing financial risk and preventing poverty)

PART TWO: CONDITIONS, RISK FACTORS AND INTERVENTIONS

A. Infectious Disease, Reproductive Health, and Undernutrition
10. Tuberculosis
11. Sexually Transmitted Infections
12. AIDS
    •     burden and health consequences (e.g. for other infections, for psychiatric conditions)
    •     determinants and prevention
    •     treatment of opportunistic infections
    •     antiretroviral therapy
13. Diarrheal Diseases
(also to include hepatitis A and discussion of rotavirus vaccine development)

14. Vaccine-Preventable Disease
(pertussis, poliomyelitis, diphtheria, measles, tetanus, Japanese B encephalitis, yellow fever, hepatitis B, haemophilus influenzae B)

15. Malaria

16. Tropical Diseases, Part One: Conditions with Ongoing Control Measures
(Chagas disease, leprosy, filariasis, onchocerciasis)
17. Tropical Diseases, Part Two: Conditions Lacking Effective Means of Control
(African trypanosomiais, dengue, and the leishmaniases)

18. Helminthic Infections
(the geohelminthic infections and schistosomiasis)

19. Respiratory Diseases of Children
(also to include meningitis; discussion of pneumoccal and influenza vaccines here)

20. Maternal Conditions, Perinatal Conditions, and Reproductive Health
[This chapter would discuss:
    1     the magnitude of remaining burden (very briefly) from the following—maternal malnutrition, hypertensive disorders of pregnancy, abortion, intrauterine growth retardation (IUGR), pre-term delivery, stillbirth, neonatal mortality, conditions arising in the perinatal period, maternal hemorrhage and sepsis, obstructed labor and other maternal conditions.
    2     the main risk factors for these conditions and the cost-effectiveness of interventions to address them.
    3     the cost-effectiveness of surgical or other approaches to repair of maternal injury incurred during pregnancy and childbirth.
 Issues related to family planning would be discussed in Chapter 44.]
21. Stunting, Wasting, and Micronutrient Deficiency Disorders
 [This chapter would:
    1     review the determinants of SWMDDs including IUGR, preterm delivery, discontinuation of breastfeeding, inadequate dietary energy, inadequate dietary quality, and infections of different types. Approximate estimates of the attributable fraction of malnutrition due to each determinant will be calculated for several paradigmatic environments.
    2     discuss the consequences of stunting, wasting, and micronutrient deficiency disorders (SWMDDs) for child mortality, for subsequent child growth and development (including cognitive), and for adult health.
    3     provide estimates of the cost-effectiveness of important interventions to address the different dimensions of malnutrition: e.g. food and micronutrient supplements, food fortification, and treatment of severe malnutrition. Infection control to reduce malnutrition would be discussed in the appropriate disease-related chapters; school feeding programs would be discussed in the chapter on school health (chapter 47); and famine would be discussed in the chapter on displaced populations (chapter 69).
    4     Broad community-based programs designed to affect health or nutrition-related behavior (including food aid and food-for-work) would be discussed in the chapter on that topic (chapter 43).
 Food subsidy policies would be discussed in chapter 50. Results from all these other chapters would be briefly pulled together in chapter 21.]

B. Noncommunicable Disease and Injury
[The word "noncommunicable" is used here because it is in widespread use. The introductory discussion will highlight the infectious origins of, or risk factors for, many of the "NCDs".]

22. Malignant Neoplasms

23. Diabetes

24. Major Psychiatric Disorders
(unipolar major depression, manic-depressive illness, schizophrenia and suicide)
25. Neurological Disorders
 (epilepsy, stroke, Parkinson's, Alzheimer's and other dementias)

26. Cardiovascular Disease
 (ischaemic and hypertensive heart disease, congestive heart failure; rheumatic heart disease and cardiomyopathies, and peripheral vascular disease; stroke will be dealt with in the chapter on neurological disorders)

27. Respiratory Diseases of Adults
(chronic obstructive pulmonary disease, asthma, pneumonia, influenza, other)

28. Diseases of the Genitourinary System
(including sexual dysfunction; kidney dialysis)

29. Skin Diseases
30. Oral, Dental, and Craniofacial Diseases and Disorders
31. Unintentional Injury
(includes hip fractures in elderly)

32. Intentional Injury
(Note: suicide is dealt with in the chapter on major psychiatric disorders; PTSS will be dealt with in this chapter.)

C. Risk Factors

33. Poor Water Supplies and Sanitation
(and related hygienic practices)

34. Indoor Air Pollution

35. Ambient Air and Water Pollution: Burden and Strategies for Control

36. The Growing Burden of Risk from Obesity, Hypertension, and Blood Lipid Levels
37. Tobacco Use: Burden and Strategies for Control

38. Abuse of Alcohol and Other Drugs

D. Consequences of Disease and Injury
39. Learning and Developmental Disorders
40. Loss of Vision and Other Sensory Capacity
41. Pain and its Management
(this chapter would cut across levels)

42. Musculoskeletal Disability and Rehabilitation
(this chapter would cut across levels and would deal with physical rehabilitation and prostheses; also, osteoarthritis)


PART THREE: IMPLEMENTING PRIORITIES -- STRENGTHENING NATIONAL HEALTH SYSTEMS

A.  Strengthening Public Health Services

43. Disease and Risk Factor Surveillance
(This chapter will include discussion of risk factors for NCDs.)
44. Resistance to Antimicrobials
45. Community Health and Nutrition Programs
[This chapter would discuss food transfer programs (including food-for work) and community-based approaches to health promotion, with particular emphasis on safe water use and hand washing, breastfeeding, growth monitoring and related intervention and other services that could be provided by community-level workers.]
46. Family Planning Programs
47. Disease Elimination and Eradication Programs
48. Meeting Needs of School-Aged Children and Adolescents
49. Occupational Health

50. Improving Lifestyles: Dietary and Behavioral Interventions for Control of Noncommunicable Disease

51. Using Taxes and Subsidies to Achieve Health and Fiscal Objectives

B. Strengthening Personal Health Services

52. Managing the Sick Child
[This chapter would discuss management at peripheral facilities and at home, and related community action. In essence, the chapter would deal with the evolving concept of "integrated management of childhood illness".]
53. General Primary Care
(Note: Some 'primary care' will, in practice, take place at district hospitals. This is not necessarily inefficient (although it may be). And, obviously, what in one environment can be done in a sophisticated primary care setting will in other environments only be feasible in a more advanced facility.

54. The District Hospital
(medical and diagnostic services, including inpatient psychiatric services and discussion of nosocomial infection and iatrogenic problems)

55. The Referral Hospital
56. Long-Term Care
(This would include long-term care both within and outside of specialized long-term care facilities. It would emphasize the needs of the elderly, but not exclusively so.)

57. Surgery
 (this chapter would cut across all levels)
58. Diagnostic Services
(this chapter would cut across all levels)

59. Emergency Care
(this chapter would cut across levels)

60. Complementary and Integrative Medicine

C. Capacity Strengthening and Management Reform

61. Health Care Providers: The Role of Compensation and Incentives

62. Ensuring Supplies of Appropriate Drugs and Vaccines

63. Ensuring Quality of Care
64. Strengthening Management of Public Health Functions
65. Strengthening Management of Clinical Services
(including discussion of purchaser/provider splits and hospital autonomy)

66.  Strengthening Institutional and Governance Capacity

PART FOUR: IMPLEMENTING PRIORITIES -- INTERNATIONAL COLLECTIVE ACTION FOR HEALTH

A. International Assistance in the Provision of Services

67. Responses to Natural and Man-Made Disasters
(This would include discussion both of natural disasters, such as hurricanes, earthquakes, and floods, as well as man-made accidental disasters, such as Bhopal or Chernobyl. A question would be whether to cover deliberate disasters outside of war like the World Trade Center.)

68. Health Needs of Refugees and Displaced Populations
 (to include discussion of famine- and conflict-affected populations)

69. Development Assistance Priorities

B. Research, Development, and International Public Goods
70. Information to Improve Decision-Making for Health
71. Strategic and Applied Research
    •     Biological Research (including genomics and molecular medicine)
    •     Protocol Development and Evaluation
    •     Demographic and Epidemiological Research (including genetic epidemiology)
    •      Health Services and Finance Research
    •     Ethics of R&D
72. New Product Development and Testing
 (drugs, vaccines, diagnostic devices; to include a discussion of where regulatory policy is a significant barrier to action)
73. Research Capacity Strengthening
74. International Norms, Standards, Agreements, and Regulations

Statistical Annex