Browsing by Author "Rehnberg, Clas"

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    Determinants of health in Nigeria : a case study of Nsukka L.G.A., Enugu state
    (2001) Okorafor, Okore Apia; Rehnberg, Clas; Leibbrandt, Murray
    The primary aim of this study is to identify the major determinants of health status in Nigeria. This is done with a view to inform policy making in the health sector. Because of time and financial constraints, the study was limited to a particular geographic area Nsukka L.G.A. The study makes use of regression-based analysis to determine those factors that affect health status of individuals. Health status was measured as a categorical variable with a finite number of outcomes; this necessitated the use of the logit and multinomial logit models for estimation of the models used in the study. The selection of potential health determining factors included in the study is based on international literature on the subject. The literature supporting the study cut across different disciplines, such as: Epidemiology, Social Sciences, Economics and Health economics. The study is unique in the sense that it not only takes into account the effect of individual and household choices on health status, but also the effects of government intervention. In this light, some of the variables used for the study measure the effect of individual choices, some household, and the rest, government policies. The study is organised in seven chapters. The first chapter gives a brief introduction to the subject, an overview of Nigeria and the specific objectives of the study. Chapter 2 reviews international literature on 'determinants of health' and related subjects. The third chapter provides a detailed discussion on the development of the models used in the study and the problems associated with the measurement of health status. In addition to developing models to estimate health status, a model is developed to attempt to identify the factors that influence the incidence of water-borne diseases. Chapter 4 describes the data collection process, and the methods employed to achieve this. The fifth chapter provides descriptive statistics of the data collected from the sample site. The results of the models used for the study are presented in chapter 6. The results suggest that age, place of residence (urban or rural) and education for the younger members of the population have the most effect on health status of any individual within the sample location. Interestingly, the results show that increases in age and years of education for children aged 0 -18 years has a positive effect on their health, while an increase in age for those over 18 years of age has a negative effect on their health. Secondly, those who live in the rural areas are healthier than those who live in the urban areas. Also, the results show that people who get their drinking water from natural sources are more likely to suffer from a water-borne disease than those provided with potable drinking water. The results of the general models - to explain health status - also show that the government intervention had little or no impact on the health status of the people in the area. Chapter 7 reviews the past and current health policy thrust of the Nigerian health sector. The current health policy in Nigeria is very broad, and covers just about all the major health issues. The areas of priority in health are the prevention of HIV/AIDS, and the immunisation of infants/children. The results of this research suggest that the encouragement of enrolment of younger members of the population into schools, improvement of the living conditions in the urban areas and the provision of safe water to those people who depend on natural sources of water should be included as priority areas in policy-making in order to effect the efficient and effective improvement of the health status of the Nigerian population.
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    The effect of removing tariffs and domestic taxes on insecticide treated nets (ITNs), netting materials and insecticides in Zimbabwe
    (2002) Shamu, Shepherd; Rehnberg, Clas
    The use of Insecticide Treated Nets (ITNs) has already proved to be a cost effective way of malaria vector control. The important emphasis now should therefore be on how to increase the accessibility and utilization of the mosquito nets through devising viable financing and promotional mechanisms that are sustainable and equitable in the long run. One way of financing ITNs that has been propounded by the Roll Back Malaria (REM) has been the issue of the reduction or elimination of tariffs and domestic taxes on ITNs and their inputs. The purpose of this study was to look at how and in what way this RBM financing policy on eliminating tariffs and domestic taxes on ITNS and their inputs would benefit the consumer given the complex nature of ITN industry operations and the consumer behaviour. The study concentrated on information gathered from net manufacturers and insecticide providers, wholesalers and retailers and some key personnel in the overall ITN industry to gather information on production, sales and marketing trends. The analysis revealed that there are indeed gains to be realized by both the consumer and the private sector if tariffs and taxes are removed, in terms of the increase in demand and supply of the product. The elimination of the 15% tariff on ITN input prices in Zimbabwe, ceteris paribus, would lead to the retail price of ITNs falling by between 4% and 12%. This would result in consumer purchases increasing by between 2% and 11%. The elimination of both taxes, other things constant, would lead to the price falling by between 4% and 23 %, leading to retail purchases increasing by between 2% and 21%. Depending on the price elasticities of demand and supply, the fall in retail prices and the consequent increase in retail purchases are quite substantial in a developing country context where incomes are very low. Sensitivity analysis using different demand and supply elasticities also showed that the elimination of tariffs and taxes on ITNs and their inputs would lead to a substantial fall in retail purchases resulting in retail purchases increasing.
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    Is contracting out an efficient means of delivering health support services? : a case study of a public hospital in Uganda
    (2001) Kiwanuka, Julie; Rehnberg, Clas
    Health reforms that advocate for more private sector involvement in the provision and financing of health services are increasingly being considered as a means of ensuring more efficient provision of health related services. Though such reforms may be designed, funded and implemented it does not imply that the conditions necessary for them to yield the intended results do exist. One such reform is contracting out. The only national referral hospital Uganda has a long history of contracting out health support services, but there is hardly any empirical evidence of the resultant efficiency gains. To study the contractual arrangements in the hospital a theoretical framework based on what determines contract performance was used as the basis for the analysis. Several methodology approaches were used, which included in-depth structured interviews with the hospital administrator and key government officials on the entire contractual process and to establish the regulations and policies underlying the contracting out policy in the country. In addition a detailed documentary review was done for the contract design and implementation and other issues pertaining to the cleaning and security services. Cost data was obtained from the hospital’s expenditure and accounts records. Quality of the services data was collected using a quantitative interview schedule that required consumers to indicate their satisfaction with the security and cleaning services when they are provided in-house as opposed to when they are provided by contractors. One of the major findings is that while it was cheaper to provide cleaning services through contracting out, it was actually more costly to provide security services through contracting out than in-house provision. Therefore there is no clear pattern to support the hypothesis that health support services can be provided at a lower cost than direct provision of services. This is because contract costs are a function of service complexity, contestability and management capacity. Services that are hard to specify involve uncertainty about the nature and costs of production itself, which is likely to increase total contract costs both during contract negotiations and the post contract stage. Secondly, contractors had succeeded in providing better quality services than in-house provision. One pertinent issue of contract design is that is key to contract success is the detailed specifications of the expected outcome in terms of both quantity and quality for this greatly eases the enforcement and monitoring process and is likely to a positive impact on the quality of services that the contractors provide, for both parties will have a clear picture of what was expected. The study highlights a number of factors that contribute to the success of contracts: First, governments needs cost and quality information on its own services for this should be the basis upon which decisions to contract out should be made. Secondly, award and renewal of contracts requires regular and detailed evaluation of provider performance and of the market situation especially in low contestability and competition. Thirdly, there is need to have incentives within the management of contracts efficient monitoring. Lastly, contract failure was attributed more to the government bureaucratic and centralised systems that often resulted in delays in awarding contracts and paying contractors.
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    The likely impact of trade-related aspects of intellectual property rights (TRIPS) in Mozambique : the case of anti-malarial drugs
    (2002) Matsinhe, Tania Romana; Rehnberg, Clas
    Since 1994, there has been a lot of attention drawn on the World Trade Organization (WTO) Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) as the most important international instrument ever negotiated in this area. TRIPS establishes minimum universal standards in all areas of intellectual property and the intention is to implement these standards globally through a strong enforcement mechanism established in WTO. These standards affect pharmaceuticals, which many countries had previously excluded from patent protection in order to produce drugs at reduced prices and hence contribute to the improvement of public health. But now any Member State must comply with these minimum standards since failure to do so will result to the WTO dispute settlement system. No extensive review of the practical implications of the TRIPS Agreement has taken place at the global and national levels. The main objective of this paper is to examine the likely impact of this agreement on anti-malarial drugs in Mozambique. Given the persistence of the malaria epidemic in the country and the resistance to the drugs being utilized for this disease there is an acknowledged need for a new drug to eradicate the problem. The problem is that this new drug is likely to be under patent and this country has relied on generic drugs for all its existence and being a Member of the WTO Agreement they now have to wait until patents on the required drugs have expired or be submissive to the more expensive original brand. To accomplish this objective and to ascertain the end result of the above situation, past experiences were a major tool. By reviewing experiences of less developed countries in relation to patent protection and pharmaceuticals, some conclusions were made possible. In order to narrow down the conclusions drawn from these country experiences, a study was done in the Mozambican public sector by reviewing and analyzing the existing laws and regulations pertaining to pharmaceuticals and patent protection. This was done through questionnaires and interviews of the main stakeholders in this area. With this information the researcher was able to describe where Mozambique stands in relation to patents and how this might affect the pharmaceutical industry as a Member of the WTO agreement in the long run. This study therefore, relies heavily on secondary data.
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    Pharmaceutical pricing : assessing the impact of factors influencing HIV/AIDS and AIDS related medicine prices in Zimbabwe
    (2002) Mutsago, Alither R; Rehnberg, Clas
    HIV IAIDS death and mortality rates have proven to be one of the largest threats to the economies of many developing countries, in particular Zimbabwe. Twenty five percent of the adult population in Zimbabwe is HIV positive and it is estimated that at least 2000 people die every week of the disease. Consequently, there is an urgent need to find means and ways of reducing the number of premature deaths due to AIDS. Access to affordable drugs will have great impact on reducing these premature deaths in the country. However high AIDS and opportunistic infections drug prices have rendered these medicines unaffordable and inaccessible to the vast majority of the population infected with the virus. Moreover the majority of the population has to meet most of its drug cost through out of pocket payments.
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    Survey on retail prices of prescription drugs in Uganda : an inter-regional comparison
    (2003) Morries, Seru; Rehnberg, Clas
    The main concern of this study was to detemine factors that are responsible for disparities in retail prices of prescription drugs in Uganda. The study also came out with methods that can be used to minimise these disparities and to control retail prices of prescription drugs in Uganda.