A rise of more than 100 percent in the price of antiretroviral drugs is likely to put the life-prolonging medication beyond the reach of hundreds of thousands of Zimbabweans living with HIV. Pharmacists in Zimbabwe's second city of Bulawayo increased the price of a monthly course of ARVs from an average of Z$30,000 (US$120 at the official exchange rate) to between Z$80,000 (US$320) and Z$100,000 (US$400), telling IRIN the price hike was an inevitable response to the country's economic woes, which has seen inflation surge to 1,281 percent, and foreign currency become a scarce item.
Resource allocation and health financing
Zimbabwe: Costs of ARVs spiral
Integrated Regional Information Network, 25 January 2007
Improving the use of research evidence in guideline development: 11. Incorporating considerations of cost-effectiveness, affordability and resource implications
Tan-Torres Edejer T: Health Research Policy and Systems 4:23, 5 December 2006
The World Health Organization (WHO), like many other organisations around the world, has recognised the need to use more rigorous processes to ensure that health care recommendations are informed by the best available research evidence. This is the 11th of a series of 16 reviews that have been prepared as background for advice from the WHO Advisory Committee on Health Research to WHO on how to achieve this. Objectives We reviewed the literature on incorporating considerations of cost-effectiveness, affordability and resource implications in guidelines and recommendations.
The cost-effectiveness of Antiretroviral Treatment in Khayelitsha, South Africa - A primary data analysis
Cleary SM, McIntyre D, Boulle AM: Cost Effectiveness and Resource Allocation 2006, 4:20, 6 December 2006
Given the size of the HIV epidemic in South Africa and other developing countries, scaling up antiretroviral treatment (ART) represents one of the key public health challenges of the next decade. Appropriate priority setting and budgeting can be assisted by economic data on the costs and cost-effectiveness of ART. The objectives of this research were therefore to estimate HIV healthcare utilisation, the unit costs of HIV services and the cost per life year (LY) and quality adjusted life year (QALY) gained of HIV treatment interventions from a provider's perspective. This article presents baseline cost-effectiveness data from one of the longest running public healthcare antiretroviral treatment programmes in Africa that could assist in enhancing efficient resource allocation and equitable access to HIV treatment.
The impact of micro health insurance on Rwandan health centre costs
Schneider P, Hanson K: Health Policy and Planning (Online), 8 December 2006
This study exploits the opportunities created by a pilot study of micro health insurance with capitation in Rwanda to address this issue. Using cross-sectional data collected in 52 health centres, the paper employs an econometric cost function with payer-specific outputs to assess the cost impact of two provider payment mechanisms: (1) user fees for care paid by the uninsured, and (2) capitation payment paid by informal insurance schemes for the insured. Findings point to significant differences in cost between the two payment forms. For both payment types there are important short-run economies of scale, which could be exploited through more intensive use of idle resources in health centres.
Accountability for reasonableness framework could improve transparency and effectiveness of Global Fund projects
Kapiriri L, Martin D: Bulletin of the World Health Organization (WHO): the International Journal of Public Health, 2006
This article argues that the suspension of funding to Uganda from the Global Fund could have been avoided. The article outlines how the Global Fund to fight AIDS, Tuberculosis and Malaria (Global Fund) suspended five grants to Uganda following an audit report that exposed gross mismanagement in the Project Management Unit. The authors argue that this could have been avoided if a legitimate and fair decision-making process was used and that this lesson should be applied to other countries.
Have pro-poor health policies improved the targeting of spending and the effective delivery of health care in South Africa?
Burget R, Swanepoel C: United Nations Economic Commission for Africa, October 2006
South Africa’s apartheid health system was grossly ineffective. Private and public health spending combined was among the highest in the world at 8.4% of GDP, yet inequalities in provision, poor efficiency of spending and other factors impacting on health status meant that the country was not among the top 60 in terms of health status indicators (Goudge, 1999). In an attempt to remove obstacles to access to health services, the government introduced free primary health care in 1996. The paper attempts to gauge the impact of these changes. The focus falls on changes in the incidence of South African public health spending.
South Africa: New social grants plan cautiously welcomed
IRIN Plus News, 23 November 2006
South Africa's Department of Health confirmed on Thursday that a new social grant system was on the cards for chronically ill people, including those living with HIV/AIDS. At present, government policy stipulates that HIV positive grant recipients be deregistered once antiretroviral (ARV) treatment restores them to good health and they are able to start seeking work. However, local AIDS activists charged that with national unemployment estimated at around 35 percent, most beneficiaries were usually jobless and too ill to work before they started receiving the monthly stipend. The article describes these issues raised.
The impact of social health protection on access to health care, health expenditure and impoverishment: A comparative analysis of three African countries
Jutting J, Scheil-Adlung X: World Institute for Development Research (WIDER), 2006
Recently, there has been an increasing focus on social health protection through health insurance as a potentially promising way to better deal with health risks in developing countries. However, the empirical basis for a profound analysis of the effects of health insurance is still very weak. This paper summarises the results of three individual research projects measuring the impact of membership in a health insurance scheme in three African countries: Kenya, Senegal and South Africa.
The political economy of health care finance
Moreno-Ternero JD, Roemer JE: World Institute for Development Research (WIDER), 2006
The authors present a model of political competition, in a multi-dimensional policy space and with policy-oriented candidates, to analyse the problem of health care finance. In this model, health care is either financed publicly (by means of general taxation) or privately (by means of a co-payment). The extent of these two components (as well as the overall tax schedule in the country) is the outcome of the process of political competition. The model shows that, in equilibrium, parties propose policies that implement the latest (and most expensive) medical techniques available.
Cost-effectiveness analysis of HIV chemoprophylaxis
Grant R, Lama J, Goicochea P, et al: The Sixteenth International AIDS Conference, August 2006
Ethical guidelines require that research on effectiveness of HIV chemoprophylaxis be performed in populations where the intervention would be feasible if the trials demonstrate efficacy with acceptable safety. Population effects and cost effectiveness were simulated using a mathematical model that considers heterosexual and homosexual transmission, higher infectiousness in early and late infection, age and sex effects on susceptibility, risk behavior variation, condom replacement, known age-sex partner preferences, and primary and secondary drug resistance. The article describes the findings and relevant conclusions drawn.