OpenUCT :: Browsing by Department "Health Economics Unit"

Browsing by Department "Health Economics Unit"

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Open Access
A new methodology for assessing health policy and systems research and analysis capacity in African universities
(2014-10-08) Lê, Gillian; Mirzoev, Tolib; Orgill, Marsha; Erasmus, Ermin; Lehmann, Uta; Okeyo, Stephen; Goudge, Jane; Maluka, Stephen; Uzochukwu, Benjamin; Aikins, Moses; de Savigny, Don; Tomson, Goran; Gilson, Lucy
Abstract Background The importance of health policy and systems research and analysis (HPSR + A) has been increasingly recognised, but it is still unclear how most effectively to strengthen the capacity of the different organisations involved in this field. Universities are particularly crucial but the expansive literature on capacity development has little to offer the unique needs of HPSR + A activity within universities, and often overlooks the pivotal contribution of capacity assessments to capacity strengthening. Methods The Consortium for Health Policy and Systems Analysis in Africa 2011–2015 designed and implemented a new framework for capacity assessment for HPSR + A within universities. The methodology is reported in detail. Results Our reflections on developing and conducting the assessment generated four lessons for colleagues in the field. Notably, there are currently no published capacity assessment methodologies for HPSR + A that focus solely on universities – we report a first for the field to initiate the dialogue and exchange of experiences with others. Second, in HPSR + A, the unit of assessment can be a challenge, because HPSR + A groups within universities tend to overlap between academic departments and are embedded in different networks. Third, capacity assessment experience can itself be capacity strengthening, even when taking into account that doing such assessments require capacity. Conclusions From our experience, we propose that future systematic assessments of HPSR + A capacity need to focus on both capacity assets and needs and assess capacity at individual, organisational, and systems levels, whilst taking into account the networked nature of HPSR + A activity. A genuine partnership process between evaluators and those participating in an assessment can improve the quality of assessment and uptake of results in capacity strengthening.
Open Access
Absorptive capacity to finance HIV/AIDS treatment in South Africa: Where are the bottlenecks?
(2010) Irurzun Lopez, Maria Teresa; Sinanovic, Edina; Booysen, Frikkie
This research investigates absorptive capacity in South Africa's public health sector in relation to scaling up financing for HIV/AIDS treatment. The thesis constructs a conceptual framework, which follows the flow of public funding for HIV/AIDS treatment. The study combines a quantitative budget analysis, which looks at expenditure and spending patterns, with qualitative in-depth interviews with key stakeholders exploring causes and consequences, which are the main pillar of the primary research. The study applies the conceptual framework nationally, as well as in the Free State and Western Cape provinces. The contributions of the thesis are two-fold: At the conceptual level, the study defines and constructs an analytical framework of absorptive capacity and related bottlenecks in the context of funding for HIV/AIDS treatment in the public health sector. It identifies five major areas where bottlenecks may arise: financial, human, infrastructural, institutional (within the health system) and structural (outside the health system). At the empirical level, the study assesses and compares absorptive capacity and major bottlenecks encountered nationally and in the Free State and Western Cape provinces in respect of the public sector funding for the HIV/AIDS treatment programme. The results confirm that absorptive capacity is not merely about spending funding. Spending should not compromise other programs or elements of the public health system, and it should be efficient, equitable and sustainable. The findings show that South Africa's absorptive capacity was constrained by several obstacles, such as poor practices and a shortage of human resources, insufficient financial capacity and demanding requirements of conditional funding, inadequate infrastructure, and inadequate national leadership. To overcome these obstacles, the mere injection of even more funding would be an insufficient response. Consequently, the study indicates which other reforms are required, including: further integrating antiretroviral treatment services within the public health structures; further decentralising antiretroviral treatment towards primary health care; task shifting; iii balancing the conditional grant and equitable share; and enhancing coordination between the National and Provincial Departments of Health and with Treasury.
Open Access
Acceptability of access to child health care, in the rural area around Zithulele Hospital in the Eastern Cape
(2011) Shillington, Lucy; Honda, Ayako
This study is from the perspective of rural South Africa using the case of Zithulele Hospital as an area of interest. The research is qualitative in nature and will make use of both focus group discussions and key informant inter-views, in order to assess the access to child health care provided at Zithulele Hospital. The focus will be on the acceptability of access to child health care and more specifically, the acceptability of treatment for diarrhoeal disease.
Open Access
Access barriers to antiretroviral therapy (ART) in Zimbabwe: a case study of Chivhu Hospital
(2012) Siduna, Willie; Cleary, Susan
Access to healthcare is one of the basic social goods which ensures that individuals lead healthy and long lives. There is an increased need towards ensuring access to health care for all, which has led to the question of how access is defined. Access in this study is defined as the degree of fit between the health care system and patients. It involves an interaction between the system and patients in a way which removes access barriers to care. A comprehensive framework was used to measure access in this study. The framework allows for a systematic approach to the concept of access and measures access in three dimensions namely affordability, availability and acceptability. Using this framework, the study looked into the factors affecting access to antiretroviral therapy (ART) by patients at Chivhu Hospital in Zimbabwe. Chivhu was chosen because it has a mixed population of urban and rural patients which represents the typical Zimbabwean population. A cross sectional study design was adopted for this study.
Open Access
Achieving universal health care coverage: Current debates in Ghana on covering those outside the formal sector
(BioMed Central Ltd, 2012) Abiiro, Gilbert; McIntyre, Di
BACKGROUND: Globally, extending financial protection and equitable access to health services to those outside the formal sector employment is a major challenge for achieving universal coverage. While some favour contributory schemes, others have embraced tax-funded health service cover for those outside the formal sector. This paper critically examines the issue of how to cover those outside the formal sector through the lens of stakeholder views on the proposed one-time premium payment (OTPP) policy in Ghana.DISCUSSION:Ghana in 2004 implemented a National Health Insurance Scheme, based on a contributory model where service benefits are restricted to those who contribute (with some groups exempted from contributing), as the policy direction for moving towards universal coverage. In 2008, the OTPP system was proposed as an alternative way of ensuring coverage for those outside formal sector employment. There are divergent stakeholder views with regard to the meaning of the one-time premium and how it will be financed and sustained. Our stakeholder interviews indicate that the underlying issue being debated is whether the current contributory NHIS model for those outside the formal employment sector should be maintained or whether services for this group should be tax funded. However, the advantages and disadvantages of these alternatives are not being explored in an explicit or systematic way and are obscured by the considerable confusion about the likely design of the OTPP policy. We attempt to contribute to the broader debate about how best to fund coverage for those outside the formal sector by unpacking some of these issues and pointing to the empirical evidence needed to shed even further light on appropriate funding mechanisms for universal health systems.SUMMARY:The Ghanaian debate on OTPP is related to one of the most important challenges facing low- and middle-income countries seeking to achieve a universal health care system. It is critical that there is more extensive debate on the advantages and disadvantages of alternative funding mechanisms, supported by a solid evidence base, and with the policy objective of universal coverage providing the guiding light.
Open Access
Alcohol addiction treatment in Cape Town: Exploratory investigation of the public-private mix
(2010) Fleming, Laura; Sinanovic, Edina
Public health and safety are compromised by the effects of alcohol addiction. Some of the consequences include transmission of infectious diseases, disproportionate use of medical and social services, traffic accidents, and street crimes. Additionally, when dealing with alcohol addiction, many expenses are incurred by public services such as the criminal justice system, emergency medical care centers, foster home placement centers, employee assistance programs and family violence centers. The clinical and economic benefits of addiction treatment are therefore clear. The aim of this study was to investigate Cape Town's alcohol addiction treatment center public-private mix and to determine quality of care and access. Document review and semi-structured interviews were the methods used. Provider reporting on quality of care and the limited number of sites interviewed were the main research limitations. Nevertheless, the thesis reached its objectives and contributed to the limited information on alcohol addiction treatment public-private mix, quality of care and access in South Africa. It is notable that there were few differences in the quality of care reported by public, public-private mix, private registered and private unregistered facilities. Quality of care was found to be good across sectors. Public and public-private mix facilities provided superior access in terms of income. Private facilities had the shortest wait-time. Geographic access was a pronounced issue for the poor population that resides in the Southern suburbs, far from affordable primary care alcohol addiction treatment services. Both horizontal and vertical inequities were identified in terms of access to primary care alcohol addiction treatment services in the Cape Town metropole. A strong case is made for involving more of the private sector in public-private partnerships in order to scale up alcohol addiction treatment within the South African setting. This will allow quality of care to be maintained while improving access.
Open Access
Analysing unofficial user fees in government and non-government hospitals in Uganda
(2003) Sonko, Rita Najjemba; Thomas, Stephen
Unofficial fees are a common feature in Ugandan health facilities and exist in different forms. This study explores the forms of unofﬁcial fees existing in Ugandan hospitals and compares ﬁndings from government and non-governmental hospitals in both rural and urban areas. It also investigates the reasons for or causes of such fees as well as the relationship between unofficial fees and other factors such as quality of care within the hospitals. The overall aim of the study is to analyze the magnitude and impact of unofﬁcial fees on patients' expenditure and thereby make recommendations for improvement in efﬁciency and equity with regards to out-of-pocket funding. Both qualitative and quantitative interview methods are used to obtain data from service providers and patients in each hospital and a comparison of ﬁndings obtained using the two methods is made. The main ﬁndings from the study are that unofﬁcial fees are rampant in government hospitals and can be classiﬁed into four categories; fees for commodities such as drugs; fees for access to services; fees for services such as laboratory, radiology and surgery and gratuity payments. The latter category is the commonest form reported in non- government hospitals while all the others are rare. Estimates of unofﬁcial fees amount to a signiﬁcant percentage of patients' expenditure, especially in the cases where surgery and radiology are required especially for rural-based patients. It's also found that most of the patients attending government hospitals pay at least one form of unofficial fees. Unofficial fees were found to be closely associated with poor quality of care in that the latter enhanced an informal economy, which resulted in the fees being charged/paid. The study shows that efﬁciency and equity (access to quality care and ability to pay) are negatively affected by the practice of collecting unofficial fees. Recommendations for policy makers to address the problem are made as well as suggestions for the best-suited methodology for analysing unofficial fees in the Ugandan context.
Open Access
An analysis of adherence & equity in access to TB services in Mitchell's Plain, South Africa
(2012) Docrat, Sumaiyah; Cleary, Susan
The control of tuberculosis (TB) in South Africa has fallen short of the targets outlined by the World Health Organization and without improvement; TB is expected to have grave consequences for both the mortality and morbidity of South Africans as well as crippling financial consequences for the public health system. While services in the public sector are free at the point of use, little is known about overall access barriers and their implications for treatment adherence. This paper explores these barriers from the perspective of TB patients enrolled in Directly Observed Treatment, Short-Course (DOTS) in Mitchell's Plain, South Africa. Using a comprehensive framework of access, in-depth interviews were conducted with 334 TB patients across five facilities in Mitchell's Plain, to assess barriers across the dimensions of availability, affordability and acceptability. Summary statistics were computed and comparisons of access barriers between adherent and non-adherent groups, and between socioeconomic groups were explored using bivariate, multivariate linear and logistic regressions. Among the respondents, 244 (73.05%) met the criteria for adherence (i.e. reported that they had never missed a dose of TB medication) while 90 (26.95%) met the criteria for non-adherence. Marital status, age, birth province, costs of self-care and costs of other providers were found to be significantly associated with adherence (P-values <0.05). There was no significant evidence of inequalities in access by socioeconomic status (all P-values > 0.05). Nonetheless, the results revealed that the poor face increased costs of accessing TB-services, compared to the rich, though this association was not deemed to be significant.
Open Access
Analysis of agency relationships in the design and implementation process of the equity fund in Madagascar
(BioMed Central, 2015-02-04) Honda, Ayako
Background: There are large gaps in the literature relating to the implementation of user fee policy and fee exemption measures for the poor, particularly on how such schemes are implemented and why many have not produced expected outcomes. In October 2003, Madagascar instituted a user fee exemption policy which established "equity funds" at public health centres, and used medicine sales revenue to subsidise the cost of medicine for the poor. This study examines the policy design and implementation process of the equity fund in Madagascar in an attempt to explore factors influencing the poor equity outcomes of the scheme. Methods: This study applied an agency-incentive framework to investigate the equity fund policy design and implementation practices. It analysed agency relationships established during implementation; examined incentive structures given to the agency relationships in the policy design; and considered how incentive structures were shaped and how agents responded in practice. The study employed a case-study approach with in-depth analysis of three equity fund cases in Madagascar's Boeny region. Results: Policy design problems, triggering implementation problems, caused poor equity performance. These problems were compounded by the re-direction of policy objectives by health administrators and strong involvement of the administrators in the implementation of policy. The source of the policy design and implementation failure was identified as a set of principal-agent problems concerning: monitoring mechanisms; facility-based fund management; and the nature and level of community participation. These factors all contributed to the financial performance of the fund receiving greater attention than its ability to financially protect the poor. Conclusion: The ability of exemption policies to protect the poor from user fees can be found in the details of the policy design and implementation; and implications of the policy design and implementation in a specific context determine whether a policy can realise its objectives. The equity fund experience in Madagascar, which illustrates the challenges of beneficiary identification, casts doubts on the application of the 'targeting' approach in health financing and raises issues to be considered in universal health policy formulation. The agency framework provides a useful lens through which to examine policy process issues.
Open Access
Analysis of equity in the pattern of health care utilisation in South Africa
(2009) Olabimpe, Oboirien Kafayat; Okorafor, Okore
The study seeks to assess South Africa’s health care utilisation pattern in the post apartheid era. This is based on the equity driven policy objectives of the health care system that were meant to have impact on individuals’ health care utilisation patterns. A framework of factors influencing health care utilisation is outlined to explain the determinants of health care utilisation. It gives some insights into the socio-economic and racial differences influencing the use and choice of health care in South Africa. It also attempts to investigate how these factors have changed and whether the pattern of health care utilisation among those with higher need has changed over time.
Open Access
An analysis of expenditure on HIV/AIDS patients in Zambia
(2006) Kaliki, Chipalo; Cleary, Susan
According to the 2000/2001 Zambia Demographic and Health Survey (ZDHS), HIV/AIDS prevalence is 16% and is expected to be higher in the next five years. The disease is quite pervasive across all sectors of economic activity, but the impact is especially acute on the Zambian health sector, which is faced with increasing demands on healthcare for not only HIV/AIDS but other diseases such as malaria, tuberculosis, cholera, diarrhoea, to mention but a few. It is therefore essential that expenditure on HIV-related care among different health care systems be analysed so as to determine areas of relatively greater need. It is against this background that this study entitled, "An analysis of expenditure on HIVIAIDS patients in Zambia", was conducted. The main objective of the study is to analyse expenditure on HIV-related care and treatment among the different health care systems and geographical localities in Zambia. The study used utilisation data on total and HIV-related outpatient visits and inpatient days collected from the country's facility based database called the Health Management Information System (HMIS); and HIV-prevalence data compiled from the Central Statistics Office's report on Epidemiological Projections. Expenditure data on the other hand was compiled from the National Health Accounts (NHA) report for 1999-2002 and separate data on HIV/AIDS expenditure was collected from the District Health Boards reports for 2003. Utilisation and HIV-prevalence data were then combined with expenditure data to estimate the overall utilisation of services by HIV-positive patients and the annual expenditure required to meet the burden of HIV/AIDS. Both utilisation and expenditure statistics were analysed and compared according to different levels of healthcare and geographical localities. Data analysis was exploratory and descriptive.
Open Access
An analysis of the impact of generic medicine reference pricing in a sector of the South African private healthcare insurance industry
(2015) Noble-Luckhoff, Jennifer Anne; McIntyre, Diane
Background: Pharmaceuticals are responsible for a substantial percentage of the total cost of health care and continue to exceed economic growth and inflation. Generic medicines play an important role in limiting this expenditure, and consequently there is an international drive to implement pro - generic policies particularly in high income countries. One such policy is generic medicine reference pricing (GRP). Generic reference pricing sets a fixed maximum reimbursement amount for clusters of bio - equivalent drugs without placing any restrictions on the manufacturers' price. Numerous studies have been conducted in high income countries to analyse the impact of generic reference pricing; however, the impact of this reference pricing in low - to - middle income countries (LMIC s) is not well established. Objective: This dissertation aims to address this lack of information in LMICs by providing empirical aggregated claims data on the impact of generic reference pricing on price, expenditure, utilisation and out - of - pocket (OOP) p ayments in a sector of South Africa's private health insurance industry. Methods: This time series intervention study of retrospective claim - level secondary data analyses the impact of one of several generic reference pricing models applied by various private medical insurance companies in South Africa. Criteria applied for the selection of referenced categories and sample claims data intend to maximize the data set as well as the analysis period, while minimizing confounders such as medical insurance member variation and specific managed care policies. The impact of the reference price on variables of drug price, drug expenditure, market share and out - of - pock et payment is measured by analysing changes in the originator, 'authorised generic' ('clone') and generic drugs within each cluster. (An 'authorised generic' (AG) is an exact copy of the originator, approved as a brand - name drug under a patent protection but marketed as a generic.) Results: Two referenced priced categories (Desloratadine and Clopidogrel) and a population of approximately 100,000 were identified as being eligible for inclusion. An authorised generic was launched for Clopidogrel but not for Desloratadine. The implementation of generic reference pricing appears to have had no or minimal impact on the price of the originator and authorised generic - at the end of the study period the price of the originator drugs of the two categories was 268% and 86% higher than the reference and the authorised generic of Clopidogrel was 69 % higher than the reference price. Most often the reference price appeared to be based on the price of a generic drug; however once the reference price was set other generics tended to align at or below the reference price. The implementation of generic reference pricing was associated with an overall increase in dispensed volumes and a decrease in expenditure for both categories; both categories' originator market share declined dramatically by volume (to 23% and 4%) and value (to 35% and 9 %). For Clopidogrel the authorised generic took the majority of market share (63% by volume and 68% by value); the generics only gained one third of the market, despite lower product prices and minimal co - payments. Desloratadine generics captured 80% of the market by the end of the study. For both categories there was no notable change in the total drug expenditure paid out - of - pocket across the study period. The percentage of drugs dispensed that had a co - payment decreased dramatically for Desloratadine, but were only seen to decrease marginally for Clopidogrel. Limitations: Due to the small sample and limited reference categories analysed, the findings from this study are not representative of the South African private healthcare sector and cannot be extrapolated to South Africa. In addition, any savings identified should take the expense of non - referenced alternatives into account.
Open Access
An analysis of the user-free policy for health care in Kenya : is the effort worth it?
(1999) Mwangi, PK; Thomas, Stephen
This study analyses the user fee policy for health care in Kenya that was introduced to try and recoup some of the costs incurred in providing care as well as rationalise the use of resources. The study aims to generate policy-related findings that are crucial to MOH policy makers in their attempt to provide quality and affordable care. In particular, factors associated with proper function or malfunction of the user fee policy are discussed. The study focussed on four hospitals located in Central province of Kenya. This province was purposefully chosen for its convenience and its high potential for cost recovery. Equity in health care consumption, efficiency, sustainability and perceived quality of care are reviewed. Both primary and secondary data were used. Quantitative and qualitative data were solicited by way of administering questionnaires. Respondents were divided into two categories: providers (staff) and consumers (patients) of health care. The latter were subdivided into inpatients and outpatients. Each of these categories had a specific questionnaire. Further, an attempt is made to estimate net revenue generated in the year 1997/98 by the facilities under study. Costs associated with fee collection were estimated on monthly basis and then projected for the whole year. There are important findings from the study; though patients are charged higher fees at hospitals than at primary levels in order to bolster the referral system, many patients are bypassing the nearby primary care facilities. This study recommends that bypassing patients should be charged higher fees than referred ones.
Open Access
Assessing access barriers to Tuberculosis (TB) and Antiretroviral (ARV) treatment in Mitchell's Plain, Cape Town South Africa
(2011) Mweemba, Chrispin; Cleary, Susan
Access to health care is a very important concept which has equally important implications to the health status of individuals. However, there have been a lot of debates among researchers and policy makers on what constitutes access, and how it can be made less conceptual and more operational. The concept of access has continued to receive increased attention because of a growing realisation of its importance in health policy. Furthermore, provision of services alone without understanding barriers individuals face in accessing services could result in less optimal outcomes. It is therefore necessary to have an understanding of what "access" entails and factors that influence it if we are to have a real chance of improving access to health services and therefore enhance health. In this thesis access is viewed as consisting of three (3) interrelated and measurable dimensions (availability, affordability and acceptability). These access dimensions are related to both the system and user characteristics. Access is therefore said to have been achieved when all the three dimensions have been satisfied. Using the above definition of access, the main focus of this thesis is on access barriers (in relation to the three access dimensions) to both Tuberculosis (TB) and Antiretroviral Treatment (ART) services in Mitchell's Plain, Cape Town South Africa. Secondary cross-sectional data was used for this purpose. Access to TB and HIV treatment has been given priority because the two diseases have had a massive and negative impact on public health in the country. In addition, patients using these services may face similar barriers to care. Findings of this thesis are expected to provide insights into the barriers TB and HIV patients face in seeking care vis-a-vis availability, affordability and acceptability of services. Findings will therefore prove valuable in as far as improving access is concerned.
Open Access
Assessing catastrophic and impoverishing effects of health care payments in Uganda
(BioMed Central, 2015-01-22) Kwesiga, Brendan; Zikusooka, Charlotte M; Ataguba, John E
Background: Direct out-of-pocket payments for health care are recognised as limiting access to health care services and also endangering the welfare of households. In Uganda, such payments comprise a large portion of total health financing. This study assesses the catastrophic and impoverishing impact of paying for health care out-of-pocket in Uganda. Methods: Using data from the Uganda National Household Surveys 2009/10, the catastrophic impact of out-of-pocket health care payments is defined using thresholds that vary with household income. The impoverishing effect of out-of-pocket health care payments is assessed using the Ugandan national poverty line and the World Bank poverty line ($1.25/day). Results: A high level and intensity of both financial catastrophe and impoverishment due to out-of-pocket payments are recorded. Using an initial threshold of 10% of household income, about 23% of Ugandan households face financial ruin. Based on both the $1.25/day and the Ugandan poverty lines, about 4% of the population are further impoverished by such payments. This represents a relative increase in poverty head count of 17.1% and 18.1% respectively. Conclusion: The absence of financial protection in Uganda’s health system calls for concerted action. Currently, out-of-pocket payments account for a large share of total health financing and there is no pooled prepayment system available. There is therefore a need to move towards mandatory prepayment. In this way, people could access the needed health services without any associated financial consequence.
Open Access
Assessing financial management capacity for district health system development : a case study of the Mount Frere District
(1998) Morar, Reno Lance; McIntyre, Di
The specific objective of this report is the assessment and analysis of the current financial management capacity at the district level in Mount Frere. It will specifically address the assessment and analysis of financial management capacity in the Mount Frere district, Region E in the EC Province, Department of Health.
Open Access
Assessing the barriers to accessing prevention of mother-to-child transmission (PMTCT) services in Marondera Zimbabwe
(2011) Magaso, Farai Beverley; Cleary, Susan
Although Zimbabwe has invested in nationwide scale-up of prevention of mother to child transmission (PMTCT) services, high HIV-specific under-five mortality rates continue to be observed. This study aimed to document the potential reasons for low PMTCT uptake by examining factors constraining access to PMTCT services.
Open Access
Assessing the impoverishment effects of out-of-pocket healthcare payments prior to the uptake of the national health insurance scheme in Ghana
(BioMed Central, 2017-05-22) Akazili, James; Ataguba, John Ele-Ojo; Kanmiki, Edmund Wedam; Gyapong, John; Sankoh, Osman; Oduro, Abraham; McIntyre, Di
Background: There is a global concern regarding how households could be protected from relatively large healthcare payments which are a major limitation to accessing healthcare. Such payments also endanger the welfare of households with the potential of moving households into extreme impoverishment. This paper examines the impoverishing effects of out-of-pocket (OOP) healthcare payments in Ghana prior to the introduction of Ghana’s national health insurance scheme. Methods: Data come from the Ghana Living Standard Survey 5 (2005/2006). Two poverty lines ($1.25 and $2.50 per capita per day at the 2005 purchasing power parity) are used in assessing the impoverishing effects of OOP healthcare payments. We computed the poverty headcount, poverty gap, normalized poverty gap and normalized mean poverty gap indices using both poverty lines. We examine these indicators at a national level and disaggregated by urban/rural locations, across the three geographical zones, and across the ten administrative regions in Ghana. Also the Pen’s parade of “dwarfs and a few giants” is used to illustrate the decreasing welfare effects of OOP healthcare payments in Ghana. Results: There was a high incidence and intensity of impoverishment due to OOP healthcare payments in Ghana. These payments contributed to a relative increase in poverty headcount by 9.4 and 3.8% using the $1.25/day and $2.5/day poverty lines, respectively. The relative poverty gap index was estimated at 42.7 and 10.5% respectively for the lower and upper poverty lines. Relative normalized mean poverty gap was estimated at 30.5 and 6.4%, respectively, for the lower and upper poverty lines. The percentage increase in poverty associated with OOP healthcare payments in Ghana is highest among households in the middle zone with an absolute increase estimated at 2.3% compared to the coastal and northern zones. Conclusion: It is clear from the findings that without financial risk protection, households can be pushed into poverty due to OOP healthcare payments. Even relatively richer households are impoverished by OOP healthcare payments. This paper presents baseline indicators for evaluating the impact of Ghana’s national health insurance scheme on impoverishment due to OOP healthcare payments.
Open Access
Assessment of essential drug management in the public health facilities in Uganda
(2007) Nahamya, David; Sinanovic, Edina
The main aim of the study is to evaluate the management of essential drugs in thepublic health facilities in Uganda. This is a cross-sectional study carried out in the districts of Kampala and Mbale employing both qualitative and quantitative methods. Standard outcome indicators as described in the WHO Operational Package for Monitoring and Assessing the Pharmaceutical Situation in Countries are adapted and used in this study.
Open Access
Assessment of service provider preparedness and concerns in the process of implementing the National Health Insurance Scheme in Ghana : a study of the Upper West Region
(2007) Basadi, Richard Angwaasuwe; Thiede, Michael
This study focuses on assessing health provider preparedness in the move towards the implementation of national health insurance with specific reference to the Upper West Region. The paper uses both quantitative and qualitative methods to review the level of knowledge of health staff on the concept of health insurance, the availability of health professionals, essential drugs, infrastructure and equipment, which are essential for providing quality health care.