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

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

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

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

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

Keeping health facilities safe: one way of strengthening the interaction between disease-specific programmes and health systems.

The debate on the interaction between disease-specific programmes and health system strengthening in the last few years has intensified as experts seek to tease out common ground and find solutions and synergies to bridge the divide. Unfortunately, the debate continues to be largely academic and devoid of specificity, resulting in the issues being irrelevant to health care workers on the ground. Taking the theme 'What would entice HIV- and tuberculosis (TB)-programme managers to sit around the table on a Monday morning with health system experts', this viewpoint focuses on infection control and health facility safety as an important and highly relevant practical topic for both disease-specific programmes and health system strengthening. Our attentions, and the examples and lessons we draw on, are largely aimed at sub-Saharan Africa where the great burden of TB and HIV ⁄ AIDS resides, although the principles we outline would apply to other parts of the world as well. Health care infections, caused for example by poor hand hygiene, inadequate testing of donated blood, unsafe disposal of needles and syringes, poorly sterilized medical and surgical equipment and lack of adequate airborne infection control procedures, are responsible for a considerable burden of illness amongst patients and health care personnel, especially in resource-poor countries. Effective infection control in a district hospital requires that all the components of a health system function well: governance and stewardship, financing,infrastructure, procurement and supply chain management, human resources, health information systems, service delivery and finally supervision. We argue in this article that proper attention to infection control and an emphasis on safe health facilities is a concrete first step towards strengthening the interaction between disease-specific programmes and health systems where it really matters – for patients who are sick and for the health care workforce who provide the care and treatment

“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

A Cost-Effectiveness Analysis of a Home- Based HIV Counselling and Testing Intervention versus the Standard (Facility Based) HIV Testing Strategy in Rural South Africa

Introduction There is growing evidence concerning the acceptability and feasibility of home-based HIV testing. However, less is known about the cost-effectiveness of the approach yet it is a critical component to guide decisions about scaling up access to HIV testing. This study examined the cost-effectiveness of a home-based HIV testing intervention in rural South Africa. Methods Two alternatives: clinic and home-based HIV counselling and testing were compared. Costs were analysed from a provider’s perspective for the period of January to December 2010. The outcome, HIV counselling and testing (HCT) uptake was obtained from the Good Start home-based HIV counselling and testing (HBHCT) cluster randomised control trial undertaken in KwaZulu-Natal province. Cost-effectiveness was estimated for a target population of 22,099 versus 23,864 people for intervention and control communities respectively. Average costs were calculated as the cost per client tested, while cost-effectiveness was calculated as the cost per additional client tested through HBHCT

Assessment of the multi-sectoral approach to tobacco control policies in South Africa and Togo

The ANPPA study was funded by the International Development Research Centre (IDRC) grant number 107209–001 through the Africa Population Health Research Center in Nairobi, Kenya. Publication charges were also paid by the IDRC. Publication charges were paid by the International Development Research Centre.Tobacco use is the world’s leading preventable cause of illness and death and the most important risk factor for non-communicable diseases (NCDs), particularly cardiovascular and chronic respiratory diseases (heart attack, stroke, congestive obstructive pulmonary disease, and lung cancer). Tobacco control is one of the World Health organization’s “best-buys” interventions to prevent NCDs. This study assessed the use of a multi-sectoral approach (MSA) in developing and implementing tobacco control policies in South Africa and Togo