The cost-effectiveness of intervening in low and high HIV prevalence areas in South Africa

This research compared the cost-effectiveness of a set of HIV/AIDS interventions in a low HIV prevalence area (LPA) and in a high HIV prevalence area (HPA) in South Africa. The rationale for this analysis was to assess the interaction dynamics between a specific HIV/AIDS intervention and an area of implementation and the effects of these dynamics on the cost-effectiveness of such an HIV/AIDS intervention. A pair of Markov models was evaluated for each intervention; one model for a HPA and another for an LPA and the cost-effectiveness of that intervention was compared across an LPA and a HPA. The baseline costs and health outcomes in each area were collected from the literature. To depict interaction dynamics between an HIV/AIDS intervention and an area of implementation, baseline health outcomes collected in each area, were adjusted over time based on the patterns of the projections observed in the AIDS model of the Actuarial Society of South Africa (ASSA2008). The study found that the VCT and treatment of STDs were equally cost-effective in an LPA and in a HPA while PMTCT and HAART were more cost-effective in an LPA than in a HPA. As a policy proposal, resources earmarked to non-ARV based interventions (VCT and treatment of STDs) should  be equally shared across an LPA and a HPA while  more of the resources reserved for ARV-based interventions (PMTCT and HAART) should go in an LPA in order to increase efficiency

The Role of Economic Factors in the Choice of Medical Providers in Rwanda

The purpose of this paper is to investigate the role of economic factors in choosing alternative service providers and to recommend suitable measures that could be taken to improve the use of health services in Rwanda. The study uses a multinomial logit framework and employs the Integrated Household Living Conditions Survey (EICV2) conducted in 2005 by the National Institute of Statistics of Rwanda (NISR). To handle the problem of endogeneity, we estimate a structural model. The results indicate that health insurance is an important factor in the choice of health facilities. User fees are major financial barriers to health care access in Rwanda. The results suggest that as household income increases, patients shift from public to private health facilities where quality is assumed to be high. A number of policy recommendations emerge from these findings. First, as insurance is an important factor in choosing a health care facility, policies that reduce health care costs to patients would substantially increase the use of health services. Second, since an increase in income allows the patient to shift to private facilities, the government should consider subsidizing private health facilities to enable access to care in private sector facilities by low-income households. Finally, since distance affects access to health care in Rwanda, there is a need to improve geographical accessibility to health facilities across regions by upgrading and expanding transportation and health infrastructures

An Assessment Of The Performance Of The Cameroon Water Corporation For The Period 1967 To 2013

This paper assesses the performance of the Cameroon Water Corporation (CWC) in delivering services after four decades of existence (1967-2013) and relates that performance to organization theories. It uses secondary data on services provision and primary data on users’ perceptions of the CWC’s performance. The assessment is conducted using descriptive as well as inferential methods of data analysis. The paper observes that despite political, technical, managerial, and financial constraints that impaired the efficient delivery of drinking water and sanitation services in the country over the years, the company registered modest successes that attracted the financial support of domestic and worldwide development partners. However, more than half of the population is sceptical about better future services delivery by the CWC. Classical organization theory (COT) explains most of the failure in the operating environment of the CWC, while the formulations in modern organization theory (MOT) are found to be relevant to the improvement of water services. As a policy recommendation, the CWC should focus on MOT, while maintaining some aspects of COT to improve performance

Human Capital in the Sub Saharan African Countries: Productivity and the Policy Implications

The paper investigates the contribution of Human capital to productivity in SSA countries. Human capital in this paper was viewed concurrently from the perspective of enrolment and graduates of higher education. While adopts panel data of 30 countries for 1980 to 2015 to estimate the paper’s models, a systematic procedure involving fixed effect Least Square Dummy Variable (LSDV) and system Generalized Methods of Moments (GMM) were used to test the hypothesis in this paper. Findings from this paper indicates that the impacts of higher education (both HEE and HEG) on TFP appear mixed. Higher education human capital proxied by enrollment and graduates consistently shows negative and positive signs in both methods of estimation. The human capital effects on TFP among the SSA countries flow from positive to negative as the regression moves from HEE to HEG. Quality HEG is recommended so that innovation and skills acquisition add value to SSA higher education. We can also conclude that the level of investment in SSA higher education is grossly inadequate. This implies that these countries’ higher education sectors suffer from inadequate human capital

Does the increase in foreign investments in HIV/AIDS interventions reduce out-of-pocket expenditure (OOPE) on health care in Africa?

Current policy proposals about moving away from HIV/AIDS-specific funding towards responding to HIV/AIDS within a broader health system are taking place alongside policy proposals about abolishing OOPE as a source for financing health care. This implies however, a policy dilemma in the context of Africa for two reasons. First, the possibility that the response to HIV/AIDS within a broader health system is likely to a decrease in investments specific to HIV/AIDS interventions, which in turn is likely to cause an increase in OOPE on health care. Second, increasing the use of OOPE on health care is fundamentally in opposition to the international policy agenda of moving towards universal health coverage. To avoid the dilemma in policymaking, estimates of the relationships between foreign investments in HIV/AIDS interventions and OOPE, articularly in Africa, are needed to advise policy makers. To this end, this paper uses static and dynamic fixed-effect regression models on data collected over the period 2000-2012 to determine whether foreign investments in HIV/AIDS interventions in Africa have increased or decreased OOPE on health care. The results indicate that these investments have decreased OOPE on health care. Therefore, to be consistent with other international policy goals such as moving towards universal health care coverage, policies that target the response to HIV/AIDS and that contribute to the reduction of the need to use OOPE should be maintained

Economic Costs of Patients Attending the Prevention of Mother-to-Child Transmission of HIV/AIDS (PMTCT) Services in Ethiopia: Urban - Rural Settings

Economic analyses of patients’ costs are pertinent to improve effective healthcare services including the prevention of mother-to-child HIV/AIDS transmission (PMTCT). This study assessed the direct and non-direct medical costs borne by pregnant women attending PMTCT services in urban (high-HIV prevalence) and rural (low-HIV prevalence) settings, in Ethiopia. Patient-level direct medical costs and direct non-medical data were collected from HIV-positive pregnant women in six regions. The cost estimation was classified as direct medical (service fee, drugs and laboratory) and direct non-medical (food, transportation and accommodation). The mean direct medical expense per patient per year was Ethiopian birr (ETB) 746 (US$38) in the urban settings, as compared to ETB 368 (US$ 19) in the rural settings. On average, a pregnant woman from urban and rural catchments incurred direct non-medical costs of ETB 6,435 (US$327) and ETB 2,154 (US$ 110) per year, respectively. On average, non-medical costs of friend/relative/guardian were ETB 2,595 (US$132) and ETB 2,919 (US$ 148.39) in the urban and rural settings, respectively. Although the PMTCT service is provided free of charge, HIV-positive pregnant women and infant pairs still face a substantial amount of out-of-pocket spending due to direct medical and non-medical costs. &nbsp