Browsing by Person "Gama, Elvis"

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Cost-effectiveness of community-based practitioner programmes in Ethiopia, Indonesia and Kenya
(World Health Organization, 2015-08-03) McPake, Barbara; Edoka, Ijeoma P.; Witter, Sophie; Kielmann, Karina; Taegtmeyer, Miriam; Dieleman, Marjolein; Vaughan, Kelsey; Gama, Elvis; Kok, Maryse; Datiko, Daniel; Otiso, Lillian; Ahmed, Rukhsana; Squires, Neil; Suraratdecha, Chutima; Cometto, Giorgio
Objective To assess the cost-effectiveness of community-based practitioner programmes in Ethiopia, Indonesia and Kenya. Methods Incremental cost-effectiveness ratios for the three programmes were estimated from a government perspective. Cost data were collected for 2012. Life years gained were estimated based on coverage of reproductive, maternal, neonatal and child health services. For Ethiopia and Kenya, estimates of coverage before and after the implementation of the programme were obtained from empirical studies. For Indonesia, coverage of health service interventions was estimated from routine data. We used the Lives Saved Tool to estimate the number of lives saved from changes in reproductive, maternal, neonatal and child health-service coverage. Gross domestic product per capita was used as the reference willingness-to-pay threshold value. Findings The estimated incremental cost per life year gained was 82 international dollars ($)in Kenya, $999 in Ethiopia and $3396 in Indonesia. The results were most sensitive to uncertainty in the estimates of life-years gained. Based on the results of probabilistic sensitivity analysis, there was greater than 80% certainty that each programme was cost-effective. Conclusion Community-based approaches are likely to be cost-effective for delivery of some essential health interventions where community-based practitioners operate within an integrated team supported by the health system. Community-based practitioners may be most appropriate in rural poor communities that have limited access to more qualified health professionals. Further research is required to understand which programmatic design features are critical to effectiveness.
The evolving two tier systems in Malawi.
(2009) Gama, Elvis; McPake, Barbara
Malawi is one of a few countries experiencing extreme crises of both human resources and HIV/AIDS, all of them in sub-Saharan Africa (McCoy et al., 2008). Overall expenditure on the health system has been rising, supported by a growing public sector in turn supported by growing external assistance (WHOSIS). This has implications for the nature and shape of the public health system. It is highly stressed, in particular in relation to human resource availability. In principle it is focused on the provision of an essential health package (EHP), focused on mainly infectious diseases that account for the greatest burden of disease which is the priority of external funding channelled through the national sector wide approach process. Although only recently included in the EHP, much external assistance has been channelled to an antiretroviral treatment programme which has been considered an 'island of excellence' in an otherwise very basic public health system (McCoy et al., 2008 ). For relatively wealthy Malawians who are not HIV positive or currently eligible for antiretroviral treatment, the public health system is likely to offer little. WHOSIS data also indicate stagnation of private expenditure on health in international (purchasing power parity) dollar terms while other data indicate a growing private health care sector in Malawi. The number of private health services providers as recorded by the business registrar has increased from 40 in 1995 to 78 by the end of 2007. Similarly, a physical count of private health providers shows that the number of private providers has increased from 65 in 1995 to 138 by end of 2007(Business Registrar report,2007). This combination of observations is likely to imply a struggling private sector with providers moving in and out of the sector as they initially invest and often then fail to remain solvent, such as has been described in Tanzania (Tibandebage and Mackintosh, 2002 ). The implications of this category of private sector for the nature of two-tier provision are likely to differ from the implications of a more thriving and stable private sector. This paper will present evidence of the characteristics of private sector development and their consequences for the nature of two tier provision using available data concerned with: - Human resource distribution across the health system and implications for retention and motivation - Factor prices - Distribution of users of the tiers of the system in relation to income or wealth quintiles and disease profile - Distribution of benefit incidence across user groups comparing these, where internationally comparable data are available, with data from countries in which there appears a more thriving and stable private sector. The paper will inform the development of a research proposal focused on the implications of two tier provision for equitable access to health care in different types of settings.