BASICS: Scaling Up Affordable and High-Impact Healthcare Practices
Bold Action to Stop Infections in Clinical Settings (BASICS) is centered on an important principle: low-cost interventions accompanied by minimal changes in healthcare practices will have a considerable impact on disease incidence. The cost of preventing an infection is a fraction of the cost of treating one. High infection prevalence and infection-related mortality are a sizeable economic and social burden, especially in low-income countries. BASICS will catalyze marginal resources in four demonstration countries – Bangladesh, Cambodia, Nigeria and Tanzania – to reduce that burden significantly.
The evidence from high-income countries on the economic impact of reducing healthcare-associated infections (HAIs) is compelling, and suggestive of what might be achieved in lower resource settings (though with different cost structures). One study estimated that the costs of one single severe lower respiratory infection in a U.S.-based hospital would cover the annual budget for antiseptics used for hand hygiene (Boyce, 2001). A study of a Russian neonatal ICU found that one healthcare associated bloodstream infection would cover 3,265 days of hand antiseptic use (Brown, 2003). A Swiss study found that the total cost of hand hygiene promotion was roughly one percent of the cost of nosocomial infections (Pittet et. al, 2004).
BASICS is metric driven, which allows us to capture the economic impacts in lower-resource settings. It will establish a baseline of current expenditures, track recurrent and investment costs and link those to program outcomes.
BASICS will generate substantial savings from its projected reduction of 1.4 million patient stay days. Our economic analysis will illustrate those savings and build a government and stakeholder coalition to fund BASICS in national and local budgets.
More developed healthcare systems have learned the lessons on hygiene and taken them to scale. The past several years have seen a groundswell of global attention and support towards achieving universal access to quality of healthcare (Sustainable Development Goal 3). Many of these efforts – some listed below – directly address, or align with, water, sanitation and hygiene (WASH) and infection-related challenges in healthcare:
- The World Health Organization’s (WHO) Global Action Plan on Antimicrobial Resistance (2015)
- WHO’s Guidelines on Core Components of Infection Prevention and Control Programmes (2016)
- WHO’s Supporting Countries to Achieve Health Service Resilience (2016)
- Every Woman Every Child Global Strategy to end all preventable maternal, newborn and child deaths, including stillbirths, by 2030, and improving their overall health and wellbeing
- Launch of the Quality, Equity, Dignity (QED) Network for pregnant women and newborn infants (2016)
- WHO’s Standards for improving Quality of Maternal and Newborn Care in Health (2016)
- WHO Handbook for National Quality Policy and Strategy (2018)
BASICS will develop a scaling pathway for countries with fewer resources. Global health expenditure has risen progressively since 1995 (Global Burden of Disease Health Financing Collaborator Network, 2019), providing some fiscal space to allocate government resources to BASICS once the payoffs are demonstrated. Securing government commitment will be critical in the four BASICS countries, as the public budget accounts for most health expenditure in these countries. The BASICS teams will engage with health ministries on the implications of BASICS for the composition of a country’s health expenditure.
The four BASICS demonstration countries have already shown strong political will to improve infection prevention procedures.
BASICS will deliver cumulative local impacts in each country that will deepen their commitment to the approach. Our learning model will engage government, civil society and private partners on the lessons being generated on the costs and benefits of BASICS, building a powerful local coalition for change. Once that change is delivered, the economic impacts should ultimately prove irresistible to other countries interested in infection prevention.
Ways countries have demonstrated political will on this topic
- All four of our demonstration countries have shown a commitment to improve infection prevention and broader quality of care priorities.
- All four countries signed onto the 2019 World Health Assembly Resolution to improve WASH in healthcare facilities and are engaged in post-resolution implementation activities.
- All four countries have national action plans to combat anti-microbial resistance.
- Three of the four countries (Bangladesh, Nigeria, Tanzania) signed up to be initial priority countries under the QED Network.
- In 2017, the Community Based Health Care (CBHC) under Directorate General of Health Services of the Ministry of Health and Family Welfare conducted a rapid assessment of the state of WASH in 13,000 community clinics with help from WaterAid, WHO and UNICEF.
- Formal guidelines on WASH for community clinics in 2019 with the support of WaterAid, WHO and UNICEF.
- In 2016, in response to a baseline study assessing the status of WASH led by the National Institute for Public Health, the Ministry of Health set water and sanitation targets as part of its National Health Strategic Plan 3.
- In addition, the national quality of care mechanism, which has been rolled out across all public health care facilities, has WASH targets which are tied to performance-based financing mechanisms.
- In 2019, national guidelines on WASH in health care facilities were endorsed.
- In 2018, the government created a new Infection Prevention Coordinator position within the Ministry of Health to lead the design and implementation of a national infection prevention improvement strategy.
- In 2019, the government announced a commitment to develop a national roadmap to improve WASH in healthcare facilities, implement improvements in 1,000 facilities and to integrate WASH into new health sector policies.
Boyce JM. Antiseptic technology: Access, Affordability, and Acceptance. Emerging Infectious Diseases. 2001;7:231–233.
Brown SM, et al. Use of an alcohol-based hand rub and quality improvement interventions to improve hand hygiene in a Russian neonatal intensive care unit. Infection Control and Hospital Epidemiology. 2003;24:172–179.
Pittet, D., Sax, H., Hugonnet, S., & Harbarth, S. (2004). Cost Implications of Successful Hand Hygiene Promotion. Infection Control & Hospital Epidemiology, 25(3), 264-266. doi:10.1086/502389
Global Burden of Disease Health Financing Collaborative. Past, present, and future of global health financing: a review of development assistance, government, out-of-pocket, and other private spending on health for 195 countries, 1995–2050. 2019. The Lancet.
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