Browsing by Person "Sempé, Lucas"

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Addressing pressures on health services in Belo Horizonte, Brazil through community-based care for poor older people: a qualitative study
(Elsevier, 2023-10-28) Lloyd-Sherlock, Peter; Fialho de Carvalho, Poliana; Giacomin, Karla; Sempé, Lucas
Background In low and middle-income countries, there is growing interest in managing pressures on health services through community interventions for older people. Evidence on the effects of such interventions is scarce. We draw on qualitative data to examine these effects for a specific scheme, Programa Maior Cuidado (PMC) in the Brazilian city of Belo Horizonte. Methods Building on quantitative findings reported elsewhere, we use qualitative data to develop and test theories of change. These include data from 50 meetings with policymakers, managers and staff in 30 health centres and social assistance posts. Data collection was embedded in key informant interaction and knowledge coproduction. Data include participant and non-participant observation, focus groups and semi-structured interviews with key informants, as well as older people and carers from seven families. Findings The data reveal three theories of change. Theory 1 is PMC maintains older people’s health which reduces their need for inpatient or outpatient care. We find strong evidence to support this, through effects on use of medication, chronic disease management and risk prevention. Theory 2 is PMC promotes timely intervention by anticipating health problems, thus reducing demand for emergency and acute care. We find some evidence for this, but it was limited by limited availability of timely treatment or referral beyond PMC. Theory 3 is PMC facilitates hospital discharge. We find limited evidence for this, reflecting a lack of formal liaison between PMC and hospitals. Interpretation Schemes like PMC have potential to reduce pressures on health service utilisation by older people, if they are well articulated with wider health services.
Age discrimination, the right to life, and COVID-19 vaccination in countries with limited resources
(Wiley, 2022-09-30) Lloyd-Sherlock, Peter; Guntupalli, Aravinda; Sempé, Lucas
This paper seeks to develop and apply a simple yardstick based on remaining life expectancy to assess whether specific health policies unfairly discriminate against people on the basis of their age. This reveals that the COVID-19 vaccine prioritization policies of several countries have discriminated against older people. Conversely, the exclusion of older people from COVID-19 vaccine testing is shown to be non-discriminatory, as is some degree of age prioritization for limited acute COVID-19 care. Age discrimination in vaccine prioritization is shown to be embedded in wider ageist attitudes in health policy, which give the lives of older people a lower social value than the lives of people at younger ages.
Appraisal of a Learning Coaching Strategy in Rural Areas of Peru in a Results-based Budgeting Rationality
(Sistema de Información Científica Redalyc, 2015) Sempé, Lucas
This research analyzes a learning coaching strategy called Acompañamiento Pedagógico promoted by the ministry of Education of Peru since 2008 focusing in rural multi-grade (Spanish and bilingual) schools aiming to improve learning outcomes. It focuses on the learning achievements of its students and also seeks providing advice for improving functioning of the current strategy. The first goal was to determine if there is a significant difference in learning achievements in Spanish reading and comprehension and mathematics between coached and noncoached schools and were performed mixed-designed ANOVAs tests. The finding of statistically significant interactions between receiving coaching for 3-years disclosures an effective strategy in order to increase the goal of any educational system, the learning of students. The second goal of the research was analyzing if the present learning coaching strategy meets the standards set by the national results-based budgeting approach. For that purpose, a documentary review of policy design, focalization and expenditure were performed, finding a design inconsistency, some coverage problems and absence of clear standards and organization parameters.
Balance de la Estrategia de Acompañamiento Pedagógico en Áreas Rurales de Perú en la Lógica del Presupuesto de Resultados
(2015-12-17) Sempé, Lucas
La presente investigación analiza la estrategia nacional llamada “Acompañamiento pedagógico” promovida por el Ministerio de Educación del Perú desde el año 2008, centrada en escuelas multi-grado rurales con lengua castellana y bilingues. La investigación se centra en los logros de aprendizaje de sus estudiantes así como evaluar y recomendar mejoras en su implementación. El primer objetivo fue determiner si existe diferencia significativa entre escuelas que han recibido acompañamiento pedagógico y aquellas que no han recibido en las pruebas nacionales tomadas a alumnus de segundo grado de primaria en comprensión lectora y matemáticas. Para ello se realizaron diversos tests de análisis de varianzas mixtas. Los hallazgos demuestran que han habido interacciones estadísticamente significativas entre recibir acompañamiento pedagógico por 3 años, lo cual indica que la estrategia es efectiva a fin de mejorar los aprendizajes de los estudiantes. La segunda meta de la investigación fue analizar la estrategia de acuerdo a la lógica subyacente en la política nacional de presupuesto por resultados en la que se enmarca la estrategia. Se realizó una revision y análisis documental, centrándose en el diseño lógico, focalización, organización y gasto público. Se encontraron inconsistencias en el diseño, problema de cobertura y la ausencia de estándares claros de organización.
Balance de la implementación del mecanismo de financiamiento por desempeño: compromisos de desempeño como impulsora de la mejora en la modernización de la gestión educativa descentralizada
(FORGE, 2017) Sempé, Lucas
Building the capacity of community health workers to support health and social care for dependent older people in Latin America: a pilot study in Fortaleza, Brazil
(BioMed Central, 2021-10-02) Neto, João Bastos Freire; de Moraes, Gerídice Lorna Andrade; de Souza Aredes, Janaína; Giacomin, Karla Cristina; de Melo, Luciane Ponte; Sempé, Lucas; Lloyd-Sherlock, Peter
Background Brazil is seeing rapid population ageing, which is leading to new demands on primary health care services. There is a need to develop and assess the effectiveness of new interventions to build the capacity of staff, including community health workers, to meet the needs of groups such as care-dependent older people and their care-givers. This study examines the feasibility of a small training intervention piloted in the Brazilian city of Fortaleza. Methods The study evaluated participants’ own assessments of key knowledge and skills related to the needs of care-dependent older people, both before and after the training intervention. It also assessed their capacity to implement a simple screening tool of geriatric risk factors. Results The participant self-assessments indicate significant improvements in their perceived knowledge and capacity in responding to the health needs of care-dependent older people. Additionally, participants were able to successfully conduct the home visits and screening for risk factors. Conclusions The study demonstrates the feasibility of developing interventions to enhance the capacity of community health workers to meet the needs of dependent older people in countries like Brazil. The evidence of effectiveness, though limited and subjective, provides justification for a larger, formally evaluated intervention. The experience of Fortaleza provides valuable lessons for other cities and countries in the region which are facing similar challenges.
Diseño de un sistema de seguimiento de egresados y una estrategia para la implementación de dicho sistema
(Mejoramiento de la Calidad de la Educación Superior PROCALIDAD, 2018-01-02) Mori Valenzuela, Jorge; Sempé, Lucas; Colquehuanca Achulli, Raymundo; Guerrero Ortiz, Luis; Andrade Pacora, Patricia; Gargurevich Valdéz, José; Silva Martínez, José
El documento caracteriza y describe el proceso del Seguimiento a Egresados en Instituciones de Educación Superior - IES, y sus vínculos con los mecanismos de toma de decisiones que favorezcan a los egresados en su inserción y trayectoria laboral, así como con los procesos institucionales de diseño curricular y de formación académica de la IES. La consultoría fue realizado por el consorcio conformado entre ENACCION y la Universidad Marcelino Champagnat.
Does vaccine ageism amount to gerontocide? [Correspondence]
(Elsevier, 2021-09-11) Lloyd-Sherlock, Peter; Lasco, Gideon; McKee, Martin; Perianayagam, Arokiasamy; Sempé, Lucas
The effects of an innovative integrated care intervention in Brazil on local health service use by dependent older people
(BioMed Central, 2022-02-11) Lloyd-Sherlock, Peter; Giacomin, Karla; Sempé, Lucas
Background Since 2011, the Brazilian city of Belo Horizonte has been operating an innovative scheme to support care-dependent older people in disadvantaged communities: Programa Maior Cuidado (PMC – Older Person’s Care Program). This paper examines two potential associations between inclusion in PMC on types of outpatient health service utilization by dependent older people. The first is that being in PMC is associated with a higher frequency of outpatient visits for physical rehabilitation. The second is that being in PMC is associated with a higher frequency of planned versus unplanned outpatient visits. Methods We apply a quasi-experimental design to a unique set of health administrative data recording visits to outpatient health services. We focus on comparisons of the universe of visits, transformed to ratios of planned/unplanned visits and rehabilitation/other reasons for visiting the outpatient service. First, we preprocess our sample through different matching techniques such as ‘coarsened exact matching’ (CEM), ‘nearest neighbor’ based on logit scores (NN), ‘optimal pair’ (OP) and ‘optimal full’ (OF) methods. Second, we estimate marginal effects of being in PMC on our outcomes of interest. We use Poisson regressions controlling for individual and community factors and use robust standard errors. Our results are presented as the comparative incidence ratio of PMC on rehabilitation and planned visits. Results We find significant positive incidence rates for belonging to PMC for both outcomes of interest under all matching specifications. Poisson models using CEM shows a higher incidence rate for planned visits in comparison to unplanned visits, 1.3 (95% CI 1.1–1.4), by PMC patients compared to the non-PMC controls, and a higher proportion of visits for rehabilitation, 3.4 (95% CI 1.7–6.8). Similar positive results are found across other matching methods and models. Conclusions Our analysis reveals significant positive associations between older people included in PMC and a matched set of controls for a greater ratio of making outpatient visits that were planned, rather than unplanned. We find similar associations for the proportion of visits made for rehabilitation, as opposed to other reasons. These findings indicate that PMC influences some elements of outpatient health service utilization by dependent older people.
An emergency strategy for managing COVID-19 in long-term care facilities in low and middle-income countries: the CIAT Framework (Version 2*)
(2020-11-24) Lloyd-Sherlock, Peter; Giacomin, Karla; Duarte, Meirelayne; Frank, Monica; Redondo, Nelida; Sempé, Lucas; Geffen, Leon; Kelly, Gabrielle; Montes de Oca, Veronica; Vivaldo, Marissa; Ocejo Rojo, Almudena; Sasat, Siriphan
An emergency strategy for managing COVID-19 in long-term care facilities in low and middle-income countries: the CIAT Framework (Version 3*)
(2021-07-20) Lloyd-Sherlock, Peter; Bastos, João; Duarte, Meirelayne; Frank, Monica; Geffen, Leon; Giacomin, Karla; Kelly, Gabrielle; Montes de Oca, Veronica; Rojo, Almudena Ocejo; Redondo, Nelida; Saddi, Fabiana; Sasat, Siriphan; Sempé, Lucas; Vivaldo, Marissa
Estimation of all-cause excess mortality by age-specific mortality patterns for countries with incomplete vital statistics: a population-based study of the case of Peru during the first wave of the COVID-19 pandemic
(Elsevier, 2021-08-20) Sempé, Lucas; Lloyd-Sherlock, Peter; Martínez, Ramón; Ebrahim, Shah; McKee, Martin; Acosta, Enrique
Background All-cause excess mortality is a comprehensive measure of the combined direct and indirect effects of COVID-19 on mortality. Estimates are usually derived from Civil Registration and Vital Statistics (CRVS) systems, but these do not include non-registered deaths, which may be affected by changes in vital registration coverage over time. Methods Our analytical framework and empirical strategy account for registered mortality and under-registration. This provides a better estimate of the actual mortality impact of the first wave of the COVID-19 pandemic in Peru. We use population and crude mortality rate projections from Peru's National Institute of Statistics and Information (INEI, in Spanish), individual-level registered COVID-19 deaths from the Ministry of Health (MoH), and individual-level registered deaths by region and age since 2017 from the National Electronic Deaths Register (SINADEF, in Spanish). We develop a novel framework combining different estimates and using quasi-Poisson models to estimate total excess mortality across regions and age groups. Also, we use logistic mixed-effects models to estimate the coverage of the new SINADEF system. Findings We estimate that registered mortality underestimates national mortality by 37•1% (95% CI 23% - 48•5%) across 26 regions and nine age groups. We estimate total all-cause excess mortality during the period of analysis at 173,099 (95% CI 153,669 - 187,488) of which 108,943 (95% CI 96,507 - 118,261) were captured by the vital registration system. Deaths at age 60 and over accounted for 74•1% (95% CI 73•9% - 74•7%) of total excess deaths, and there were fewer deaths than expected in younger age groups. Lima region, on the Pacific coast and including the national capital, accounts for the highest share of excess deaths, 87,781 (95% CI 82,294 - 92,504), while in the opposite side regions of Apurimac and Huancavelica account for less than 300 excess deaths. Interpretation Estimating excess mortality in low- and middle-income countries (LMICs) such as Peru must take under-registration of mortality into account. Combining demographic trends with data from administrative registries reduces uncertainty and measurement errors. In countries like Peru, this is likely to produce significantly higher estimates of excess mortality than studies that do not take these effects into account.
Evaluación de uso de informes de la Evaluación Censal de Estudiantes en la escuela
(FORGE, 2017-04) Sempé, Lucas; Andrade, Patricia
Informe final del estudio cualitativo del uso de evaluaciones de aprendizajes, específicamente de la evaluación censal de estudiantes (ECE) en la escuela peruana.
Evaluación del protocolo de visitas domiciliarias de Pensión 65 durante COVID-19
(Universidad Católica San Pablo, Arequipa, 2021) Sempé, Lucas; Lloyd-Sherlock, Peter
El año 2020 ha estado marcado por la expansión del COVID-19 en el país, al igual que por los esfuerzos realizados por el Estado Peruano para hacer frente a las consecuencias de esta pandemia. Esto ha obligado a las distintas entidades y programas públicos -entre ellas, Pensión 65- a modificar, actualizar y adaptar sus procesos operacionales para atender las necesidades de sus usuarios de la forma más adecuada y eficaz posible dentro de un difícil contexto que afecta tanto a la salud, lazos sociales y economía de las familias, especialmente de aquellos más vulnerables. Considerando que la morbilidad a causa de la pandemia alcanza índices desproporcionados especialmente dentro de la población adulta mayor -hecho conocido con anterioridad en países como Italia y España-, donde a la fecha de la presente investigación (21 de diciembre de 2020), el 70% de los fallecidos oficialmente reconocidos en nuestro país corresponde justamente a los adultos mayores 1 ; por este motivo, resulta de mayor relevancia estudiar las acciones propuestas por el Programa Pensión 65 con la finalidad de enfrentar los efectos del COVID-19. Este estudio se desarrolló como resultado del XXI Concurso Anual de Investigación CIES 2019, con el auspicio del Ministerio de Economía y Finanzas. Esta investigación también se encuentra dentro del repositorio REPEC
Financing care for Severe Stigmatizing Skin Diseases (SSSDs) in Liberia: challenges and opportunities
(BMC, 2022-11-14) Smith Jr, John Solunta; Diaconu, Karin; Witter, Sophie; Weiland, Stefanie; Zaizay, F. Zeela; Theobald, Sally; McCollum, Rosalind; Kollie, Karsor; Kollie, Jerry; Berrian, Hannah; Hotopf, India; Sempé, Lucas; Tate, Wede; Dean, Laura
Introduction Neglected tropical diseases (NTDs) are an important global health challenge, however, little is known about how to effectively finance NTD related services. Integrated management in particular, is put forward as an efficient and effective treatment modality. This is a background study to a broader health economic evaluation, seeking to document the costs of integrated case management of NTDs versus standard care in Liberia. In the current study, we document barriers and facilitators to NTD care from a health financing perspective. Methods We carried out key informant interviews with 86 health professionals and 16 national health system policymakers. 46 participants were active in counties implementing integrated case management and 40 participants were active in counties implementing standard care. We also interviewed 16 patients and community members. All interviews were transcribed and analysed using the thematic framework approach. Findings We found that decentralization for NTD financing is not yet achieved – financing and reporting for NTDs is still centralized and largely donor-driven as a vertical programme; government involvement in NTD financing is still minimal, focused mainly on staffing, but non-governmental organisations (NGOs) or international agencies are supporting supply and procurement of medications. Donor support and involvement in NTDs are largely coordinated around the integrated case management. Quantification for goods and budget estimations are specific challenges, given the high donor dependence, particularly for NTD related costs and the government’s limited financial role at present. These challenges contribute to stockouts of medications and supplies at clinic level, while delays in payments of salaries from the government compromise staff attendance and retention. For patients, the main challenges are high transportation costs, with inflated charges due to fear and stigma amongst motorbike taxi riders, and out-of-pocket payments for medication during stockouts and food/toiletries (for in-patients). Conclusion Our findings contribute to the limited work on financing of SSSD services in West African settings and provide insight on challenges and opportunities for financing and large costs in accessing care by households, which is also being exacerbated by stigma.
Integrating health and social care in Brazil
(Oxford University Press, 2020-09-30) Sempé, Lucas; Lloyd-Sherlock, Peter
Integrating health and social care is now a high priority for public health policy in high-income countries. It has received much less attention in low and middle-income country (LMIC) settings. There is particular value in assessing the potential to integrate care services for older adults, given the speed of population ageing in LMICs. The presentation provides findings of process and impact evaluations of novel local government initiatives to integrate care for older people in Brazil (drawing on a study co-funded by the UK MRC and CONFAP Brazil). Programa Maior Cuidado (PMC) was established in the Brazilian city of Belo Horizonte in 2011. It is jointly managed by the departments of health and of social assistance and involves close community-level collaboration between health posts and neighbourhood social service centres. A key element of PMC is the provision of paid trained lay carers to support family care for dependent older people in socially vulnerable families. We will present findings on the implementation process and operation of PMC, as well as its effects on the following outcomes of interest: reduced unnecessary hospitalisations, enhanced health status for older people and reduced care burden for family carers. Quasi-experimental analysis using spatial-based Propensity Score Matching shows promising results in terms of increasing planned attentions as well as access to rehabilitation services, which confirms the ability of the Program to improve interface with health services avoiding unplanned unnecessary attentions We will examine the implementation of similar interventions in other Brazilian cities, including Fortaleza and Contagem, and will study the role of national and international processes in dissemination, knowledge sharing and agenda-setting.
Introducción: Causas y desaf́ıos de la segregación educativa / Introduction: Causes and challenges of educational segregation [Editorial]
(2021-12-27) Amat, Luciana Reátegui; Sempé, Lucas
Meeting the complex challenge of health and social care provision for rapidly-ageing populations: introducing the concept of “avoidable displacement from home”
(SciELO - Scientific Electronic Library Online, 2020-04-03) Lloyd-Sherlock, Peter; Billings, Jenny; de Souza Aredes, Janaína; Freire Neto, João Bastos; Camarano, Ana Amélia; Macedo Coelho Filho, João; Firmo, Josélia Oliveira Araújo; Kalache, Alexandre; Macinko, James; Sempé, Lucas; Giacomin, Karla Cristina
The increasing numbers of people at very old ages pose specific policy challenges for health and social care and highlight the need to rethink established models of service provision. The main objective of this paper is to introduce the concept of “avoidable displacement from home” (ADH). The study argues that ADH builds on and adds value to existing concepts, offering a holistic, person-centered framework for integrated health and social care provision for older people. It also demonstrates that this framework can be applied across different levels, ranging from macro policymaking to organizational and individual decision-making. The paper pays attention to the Brazilian context but argues that ADH is a universally applicable concept.
Multidisciplinary interventions for reducing the avoidable displacement from home of frail older people: a systematic review
(BMJ Publishing Group, 2019-11-02) Sempé, Lucas; Billings, Jenny; Lloyd-Sherlock, Peter
Objectives To synthesise existing literature on interventions addressing a new concept of avoidable displacement from home for older people with multimorbidity or frailty. The review focused on home-based interventions by any type of multidisciplinary team aimed at reducing avoidable displacement from home to hospital settings. A second objective was to characterise these interventions to inform policy. Design A systematic search of the main bibliographic databases was conducted to identify studies relating to interventions addressing avoidable displacement from home for older people. Studies focusing on one specific condition or interventions without multidisciplinary teams were excluded. A narrative synthesis of data was conducted, and themes were identified by using an adapted thematic framework analysis approach. Results The search strategy was performed using the following electronic databases: the American National Library of Medicine and the National Institutes of Health (PubMed), Scopus, Cochrane Library (Central and CDRS), CINAHL, Social Care Online, Web of Science as well as the database of the Latin American and Caribbean Health Sciences Literature. The database search was done in September 2018 and completed in October 2018. Overall 3927 articles were identified and 364 were retained for full text screening. Fifteen studies were included in the narrative review. Four themes were identified and discussed: (1) types of interventions, (2) composition of teams, (3) intervention effectiveness and (4) types of outcomes. Within intervention types, three categories of care types were identified; transitional care, case-management services and hospital at home. Each individual article was assessed in terms of risk of bias following Cochrane Collaboration guidelines. Conclusions The review identified some potential interventions and relevant topics to be addressed in order to develop effective and sustainable interventions to reduce the avoidable displacement from home of older people. However the review was not able to identify robust impact evidence, either in terms of quantity or quality from the studies presented. As such, the available evidence is not sufficiently robust to inform policy or interventions for reducing avoidable displacement from home. This finding reflects the complexity of these interventions and a lack of systematic data collection.
Peace of mind: A quasi-experimental, mixed-method evaluation of a community-based mental health intervention for persons affected by Neglected Tropical Diseases
(Public Library of Science, 2025-09-04) Seekles, Maaike L.; Nganda, Motto; Kadima, Jacob; Sempé, Lucas; Kim, Joy; Omumbu, Pierre; Kukola, Junior; Ngenyibungi, Stephanie M.; Ngondu, Florent; Sabuni, Louis; Dean, Laura
Evidence consistently shows high levels of mental distress amongst populations affected by skin NTDs. Self-help groups are thought to be a key intervention strategy to support affected persons. However, to date, self-help interventions have largely been concerned with physical improvements as opposed to psychological outcomes. This paper provides an evaluation of the impact of the ‘Peace of Mind’ intervention in Kasai Province, DRC. Peace of Mind was a community-based, peer-led mental health intervention, combining lay counselling, mutual support, self-care, and income generation activities within a self-help group model to address health, psychosocial and economic impacts of skin-NTDs. This mixed-methods study used a quasi-experimental difference-in-difference approach. A survey measured levels of depression, anxiety, and stigma before and after intervention. To facilitate data matching, machine learning was used to predict (based on age, sex, health zone and disability status) which participants in the baseline would have attended the self-help groups. In addition, qualitative and participatory methods including photovoice, in-depth interviews and key informant interviews were completed to elicit the experiences of group members and health staff. Our findings show that after 6 months of intervention this holistic approach was effective at reducing levels of depression (PHQ-9 score reduction ranging on average from -3.5 to -6.7 points, p < .05) and anxiety (GAD-7 score reduction from -2.0 to -3.3 points, p < .05) in persons affected by skin NTDs. However, the prevalence of depression (64%) and anxiety (52%) remained high with suicidal thoughts reported by 35% of respondents at endline. Whilst we found no impact on stigma scores, qualitative data indicated improvements to self-esteem and ability to take part in community life. To our knowledge, this is the first study in the DRC to evaluate the impact of a community-based, peer-led intervention on mental health outcomes of persons affected by skin-NTDs. Holistic self-help groups have the potential to serve as a key component of integrated NTD/mental health service provision at community-level. However, this should be accompanied by the integration of stigma-reduction strategies, the strengthening of primary health care capacities, and the establishment of mental health services at secondary and tertiary care levels.