Reduction in Child mortality in Niger

The Article by Agbessi Amouzou and colleagues1 is a welcome effort to document the successful reduction in the under-5 mortality rate (U5MR) in Niger. Amouzou and colleagues suggest that universal access to primary health care, mass campaigns, and nutrition programmes are the main strategies responsible for these changes. However, there remain some unanswered questions which would benefit from a more in-depth analysis to explain the drivers of changes in child mortality in this country.Department of HE and Training approved lis

The cost and cost-effectiveness of a text-messaging based intervention to support management of hypertension in South Africa

This project assessed the cost and cost-effectiveness of hypertension management in South Africa within the context of a text messaging-based intervention (StAR* study) conducted in an urban public-sector clinic in Cape Town. The StAR* study is a community randomized trial that investigated the effect of adherence support via short messaging service (SMS) on treatment adherence and patient outcomes for the management of hypertension at Vanguard CHC in Cape Town (Bobrow et al. 2016). Patients received behavioral text messages as reminders for them to collect and take their medication on time. The StAR* study, consisted of three arms that ran in parallel: participants in the control arm received unrelated messages; patients in the information-only arm received one-way information messages twice a week; and patients in the interactive arm received interactive SMS-texts at the same frequency as those in the information only arm (Bobrow et al. 2016). Patients in the interactive arm could respond to the messages and trigger a response from the healthcare provider. The text messaging based intervention was shown to improve hypertension outcomes over a 12-month period in hypertension patients by improving adherence and retention in care. The study showed, in the one-way intervention arm an improvement in adherence (measured by medication refill rates) and a small reduction in systolic blood pressure (2.2mm Hg reduction over 12months) (Bobrow et al. 2016). In this study, we assessed the cost and cost effectiveness of the StAR* intervention under routine care management at Vanguard CHC. We also assessed the cost of hypertension management from the health system perspective and the cost of accessing hypertension care from the patient perspective. A combination of the ingredients approach and step-down costing was used to cost hypertension care from a health system perspective while a questionnaire was administered to 250 patients to estimate patient costs. The primary outcomes were the average cost of hypertension care and the incremental cost of the text message-based adherence intervention (StAR* intervention), compared to usual care, per millimetre of mercury (mmHg) reduction in systolic blood pressure. Results of the study show that the average health system cost for hypertension management is R262 per visit and the patient cost of accessing hypertension care is R172 per visit. The text messaging based intervention was found to have low implementation costs in this pilot phase. The monthly incremental cost of the text messaging based intervention cost was R4 per person. The incremental cost-effectiveness ratio of the intervention was R22 per mm Hg reduction. This study provides the first contemporary assessment of hypertension management costs and the cost-effectiveness of mobile-based hypertension adherence support in South Africa. Future work will seek to estimate the long-term cost-effectiveness of this intervention and the cost of scaling it to the provincial and national levels

Monitoring and evaluation in global HIV/AIDS control - weighing incentives and disincentives for coordination among global and local actors

This paper discusses coordination efforts of both donors and recipient countries in the monitoring and evaluation (M&E) of health outcomes in the field of HIV/AIDS. The coordination of M&E is a much underdeveloped area in HIV/AIDS programming in which, however, important first steps towards better synchronisation have already been taken. In this paper, we review the concepts and meanings commonly applied to M&E, and approaches and strategies for better coordination of M&E in the field of HIV/AIDS. Most importantly, drawing on this analysis, we examine why the present structure of global health governance in this area is not creating strong enough incentives for effective coordination among global and local actors. Copyright © 2010 John Wiley & Sons, Ltd

Dollar value of disability-adjusted life years in South Africa in 2019

Background To date, no study has estimated the dollar value of DALYs lost from a wide range of diseases and conditions in South Africa. The specific objectives of this study were: (a) to estimate the dollar value of disability-adjusted life-years (DALYs) lost in South Africa in 2019, and (b) to forecast the reductions in the dollar value of DALY losses assuming the United Nations Sustainable Development Goal 3 (SDG3) five disease-specific targets are attained by 2030. Methods The study employs the human capital approach to convert the DALYs lost from all causes into their International Dollar (Int$) equivalents. The DALYs data used in the analysis was from the Institute for Health Metrics and Evaluation (IHME) Database, per capita GDP data from the International Monetary Fund (IMF) Database, and current health expenditure per person from the Global Health Expenditure Database of the World Health Organization (WHO). Results South Africa lost 26.6 million DALYs in 2019 with a total value of Int$ 313.5 billion and an average value of Int$11,791.6 per DALY. Approximately Int$ 155.6 billion (50%) was attributed to communicable, maternal, neonatal, and nutritional diseases (CMNND); Int$120.4 billion (38$ 37.4 billion (12%) to injuries (INJ). The health conditions related to SDG3 targets 3.1 (maternal mortality), 3.2 (neonatal mortality), 3.3 (CMNND), 3.4 (NCD) and 3.6 (INJ) resulted in DALY losses with a value of 256.4 billion, i.e. 82% of the total monetary value of DALYs lost in 2019. Therefore, achieving the five SDG targets would potentially save South Africa Int$ 139.7 billion per year. Conclusions Health development policy-makers should employ this type of evidence when making a case for increased investments into the national health-related systems to bridge the extant gap in the universal health service coverage index for South Africa

Association between the use of biomass fuels on respiratory health of workers in food catering enterprises in Nairobi Kenya

Introduction: Indoor air pollution from biomass fuel use has been found to be responsible for more than 1.6 million annual deaths and 2.7% ofthe global burden of disease. This makes it the second biggest environmental contributor to ill health, behind unsafe water and sanitation.Methods: The main objective of this study was to investigate if there was any association between use of bio-fuels in food catering enterprisesand respiratory health of the workers. A cross-sectional design was employed, and data collected using Qualitative and quantitative techniques.Results: The study found significantly higher prevalence of respiratory health outcomes among respondents in enterprises using biomass fuelscompared to those using processed fuels. Biomass fuels are thus a major public health threat to workers in this sub-sector, and urgent interventionis required. Conclusion: The study recommends a switch from biomass fuels to processed fuels to protect the health of the workers.Key words: Indoor air pollution, biomass fuels, health, respiratory, worker

Developing a tool to measure health worker motivation in district hospitals in Kenya

BACKGROUND: We wanted to try to account for worker motivation as a key factor that might affect the success of an intervention to improve implementation of health worker practices in eight district hospitals in Kenya. In the absence of available tools, we therefore aimed to develop a tool that could enable a rapid measurement of motivation at baseline and at subsequent points during the 18-month intervention study. METHODS: After a literature review, a self-administered questionnaire was developed to assess the outcomes and determinants of motivation of Kenyan government hospital staff. The initial questionnaire included 23 questions (from seven underlying constructs) related to motivational outcomes that were then used to construct a simpler tool to measure motivation. Parallel qualitative work was undertaken to assess the relevance of the questions chosen and the face validity of the tool. RESULTS: Six hundred eighty-four health workers completed the questionnaires at baseline. Reliability analysis and factor analysis were used to produce the simplified motivational index, which consisted of 10 equally-weighted items from three underlying factors. Scores on the 10-item index were closely correlated with scores for the 23-item index, indicating that in future rapid assessments might be based on the 10 questions alone. The 10-item motivation index was also able to identify statistically significant differences in mean health worker motivation scores between the study hospitals (p<0.001). The parallel qualitative work in general supported these conclusions and contributed to our understanding of the three identified components of motivation. CONCLUSION: The 10-item score developed may be useful to monitor changes in motivation over time within our study or be used for more extensive rapid assessments of health worker motivation in Kenya

Trace amounts? Assessing hospital costs in Zimbabwe

Hospital costs are difficult to measure when there is limited or poor quality data. Current accounting methods may miss key aspects of inefficiency. Researchers from the London School of Hygiene and Tropical Medicine find that using 'tracer' illnesses is a more effective way to assess costs in Zimbabwe's hospitals.sch_iihpub379pu

Factors influencing job preferences of health workers providing obstetric care : results from discrete choice experiments in Malawi, Mozambique and Tanzania

BACKGROUND: Task shifting from established health professionals to mid-level providers (MLPs) (professionals who undergo shorter training in specific procedures) is one key strategy for reducing maternal and neonatal deaths. This has resulted in a growth in cadre types providing obstetric care in low and middle-income countries. Little is known about the relative importance of the different factors in determining motivation and retention amongst these cadres. METHODS: This paper presents findings from large sample (1972 respondents) discrete choice experiments to examine the employment preferences of obstetric care workers across three east African countries. RESULTS: The strongest predictors of job choice were access to continuing professional development and the presence of functioning human resources management (transparent, accountable and consistent systems for staff support, supervision and appraisal). Consistent with similar works we find pay and allowances significantly positively related to utility, but financial rewards are not as fundamental a factor underlying employment preferences as many may have previously believed. Location (urban vs rural) had the smallest average effect on utility for job choice in all three countries. CONCLUSIONS: These findings are important in the context where efforts to address the human resources crisis have focused primarily on increasing salaries and incentives, as well as providing allowances to work in rural areas

“You Travel Faster Alone, but Further Together”: Learning From a Cross Country Research Collaboration From a British Council Newton Fund Grant

Abstract: Providing universal health coverage (UHC) through better maternal, neonatal, child and adolescent health (MNCAH) can benefit both parties through North–South research collaborations. This paper describes lessons learned from bringing together early career researchers, tutors, consultants and mentors from the United Kingdom, Kenya, and South Africa to work in multi-disciplinary teams in a capacity-building workshop in Johannesburg, co-ordinated by senior researchers from the three partner countries. We recruited early career researchers and research users from a range of sectors and institutions in the participating countries and offered networking sessions, plenary lectures, group activities and discussions. To encourage bonding and accommodate cross-cultural and cross-disciplinary partners, we asked participants to respond to questions relating to research priorities and interventions in order to allocate them into multidisciplinary and cross-country teams. A follow up meeting took place in London six months later. Over the five day initial workshop, discussions informed the development of four draft research proposals. Intellectual collaboration, friendship and respect were engendered to sustain future collaborations, and we were able to identify factors which might assist capacity-building funders and organizers in future. This was a modestly funded brief intervention, with a follow-up made possible through the careful stewardship of resources and volunteerism. Having low and middle-income countries in the driving seat was a major benefit but not without logistic and financial challenges. Lessons learned and follow-up are described along with recommendations for future funding of partnerships schemes