Macroeconomics and health: Understanding the impact of a declining economy on health outcomes of children and young adults in South Africa

Background: The current covid-19 economic crisis continues to weaken economic growth in South Africa. This study was designed to show how a declining economic state affects the mental health conditions, metabolic risk factors, communicable conditions, and non-communicable conditions of adolescent (18-year cohorts) and adult (25-year cohorts) population groups comparatively. Study design: This was a panel analysis using secondary data issued by Statistic South Africa. Methods: The author used a Two-stage Least Squared Model (2SLS) to quantify the impact of the declining economy on mental health conditions (depression and traumatic stress), non-communicable conditions (cancer and diabetes), metabolic risk factors (alcohol abuse and hypertension), and communicable conditions (influenza, diarrhea, dry cough) of both adolescent and young adult population groups. Each group comprised a treatment and a control group. Results: The declining economic state of 2008–2014 worsens the mental health conditions, metabolic risk factors, and non-communicable conditions of adolescent and young adult populations. However, the declining economy reduced cases of communicable conditions. The impact of the declining economy worsens mental health conditions, metabolic risk factors, and non-communicable conditions more in urban settings than in rural regions. Men abuse alcohol more than women during economic decline, triggering worsening mental health conditions, hypertension, and non-communicable conditions, especially in the adult population residing in urban settings. Conclusions: Economic decline worsen mental health conditions, metabolic risk factors, and non-communicable conditions. The South African government may want to prioritize these conditions as covid-19 economic shocks continue to backslide economic growth

The impact of national health promotion policy on stillbirth and maternal mortality in South Africa

OBJECTIVES : In 2015, the South African government implemented the national health promotion policy (NHPP), intending to reduce stillbirth and maternal mortality. This study was designed to quantify the impact of the NHPP on stillbirth and maternal mortality in both the South African population and immigrant citizens. STUDY DESIGN : This was a panel analysis using secondary data issued by Statistic South Africa-Vital Statistics. METHODS : The author exploited the changes in smoking status that the NHPP exerted between 2015 and 2017. The author then builds credible control and treatment groups based on smoking status for both groups. Women who quitted smoking post-NHPP implementation were considered as the treatment group. Women who persisted with smoking post-NHPP implementation were classified as the control group. The author then used a Two-stage Least Squared Model to quantify the impact of the NHPP on stillbirth and maternal mortality in both the South African and immigrant populations. RESULTS : The model shows that NHPP averts stillbirths by 8.36% in the South African population residing in the urban areas and by 2.84% in the rural segments of the country. NHPP averts South African maternal mortalities by 20.88% in urban areas and by 15.60% in the rural segments of the country.Regarding the immigrant population, the model shows that NHPP averts immigrant's stillbirths by 7.61% in the urban areas and by 2.79% in the rural segments of the country. In addition, NHPP averts immigrant maternal mortalities by 19.22% in the urban areas and by 13.04% in the rural segments of the country. CONCLUSIONS : NHPP reduces stillbirth and maternal mortality outcomes slightly biased toward the South African population. These inequalities reflect immigrant's lack of response to the NHPP framework and inadequate access to the South African health system.The University of Twentehttp://www.elsevier.com/locate/puhehj2022Business Managemen

Does social pension buy improved mental health and mortality outcomes for senior citizens? Evidence from South Africa\u27s 2008 pension reform

In South Africa, men were traditionally eligible to receive government pensions at 65 years. However, that eligibility criterion was changed in 2008 to allow men to receive a pension payout at 60 years. This study is designed to quantify the impact of the 2008 pension reform on mental health outcomes (depression and traumatic stress) and deaths among 60-year-old men from disadvantaged households without advanced education. This analysis used secondary data issued by Statistic South Africa- General Household Survey. Men who reported earning a pension at 60 years from 2008 to 2014 were exposed to the 2008 pension reform and thus were classified as the treatment group. The 60-year-old men during 2002–2007 were ineligible to earn the pension, therefore considered the control group. We then used a Two-stage Least Squared Model (2SLS) to quantify the impact of the 2008 pension reform on healthcare utilization, depression cases, traumatic stress cases, and deaths among 60-year-old men. The model shows that the 2008 pension reform improved healthcare utilization by 3 % in the cohorts of men who benefitted from the 2008 reform. The 2008 pension reform averted depression cases, traumatic stress cases, and deaths among 60-year-old men by 3 %, 4 %, and 5 %, respectively. The impact of the 2008 pension reform in averting deaths among 60-year-old men was higher in urban regions than rural regions. We concluded that the 2008 pension reform successfully bought improved mental health outcomes and prevented depression, traumatic stress, and deaths among 60-year-old men

The cost and intermediary cost-effectiveness of oral HIV self-test kit distribution across 11 distribution models in South Africa.

BACKGROUND: Countries around the world seek innovative ways of closing their remaining gaps towards the target of 95% of people living with HIV (PLHIV) knowing their status by 2030. Offering kits allowing HIV self-testing (HIVST) in private might help close these gaps. METHODS: We analysed the cost, use and linkage to onward care of 11 HIVST kit distribution models alongside the Self-Testing AfRica Initiative's distribution of 2.2 million HIVST kits in South Africa in 2018/2019. Outcomes were based on telephonic surveys of 4% of recipients; costs on a combination of micro-costing, time-and-motion and expenditure analysis. Costs were calculated from the provider perspective in 2019 US$, as incremental costs in integrated and full costs in standalone models. RESULTS: HIV positivity among kit recipients was 4$4.87 (sex worker model) and $18.07 (mobile integration model), with differences largely driven by kit volumes. HIVST kit costs (at$2.88 per kit) and personnel costs were the largest cost items throughout. Average costs per outcome increased along the care cascade, with the sex worker network model being the most cost-effective model across metrics used (cost per kit distributed/recipient screening positive/confirmed positive/initiating ART). Cost per person confirmed positive for HIVST was higher than standard HIV testing. CONCLUSION: HIV self-test distribution models in South Africa varied widely along four characteristics: distribution volume, HIV positivity, linkage to care and cost. Volume was highest in models that targeted public spaces with high footfall (flexible community, fixed point and transport hub distribution), followed by workplace models. Transport hub, workplace and sex worker models distributed kits in the least costly way. Distribution via index cases at facility as well as sex worker network distribution identified the highest number of PLHIV at lowest cost

Costs of integrating HIV self-testing in public health facilities in Malawi, South Africa, Zambia and Zimbabwe.

INTRODUCTION: As countries approach the UNAIDS 95-95-95 targets, there is a need for innovative and cost-saving HIV testing approaches that can increase testing coverage in hard-to-reach populations. The HIV Self-Testing Africa-Initiative distributed HIV self-test (HIVST) kits using unincentivised HIV testing counsellors across 31 public facilities in Malawi, South Africa, Zambia and Zimbabwe. HIVST was distributed either through secondary (partner's use) distribution alone or primary (own use) and secondary distribution approaches. METHODS: We evaluated the costs of adding HIVST to existing HIV testing from the providers' perspective in the 31 public health facilities across the four countries between 2018 and 2019. We combined expenditure analysis and bottom-up costing approaches. We also carried out time-and-motion studies on the counsellors to estimate the human resource costs of introducing and demonstrating how to use HIVST for primary and secondary use. RESULTS: A total of 41 720 kits were distributed during the analysis period, ranging from 1254 in Zimbabwe to 27 678 in Zambia. The cost per kit distributed through the primary distribution approach was $4.27 in Zambia and$9.24 in Zimbabwe. The cost per kit distributed through the secondary distribution approach ranged from $6.46 in Zambia to$13.42 in South Africa, with a wider variation in the average cost at facility-level. From the time-and-motion observations, the counsellors spent between 20% and 44% of the observed workday on HIVST. Overall, personnel and test kit costs were the main cost drivers. CONCLUSION: The average costs of distributing HIVST kits were comparable across the four countries in our analysis despite wide cost variability within countries. We recommend context-specific exploration of potential efficiency gains from these facility-level cost variations and demand creation activities to ensure continued affordability at scale

The Impact and Spillover Effects of HIV Self-Test Technology on HIV Outcomes of the South African Working Class

Background: South Africa recently adopted HIV self-test technology (HIVST) to improve HIV testing and encourage earlier treatment initiation in working populations with a low uptake of conventional testing approaches. This study investigates the impact of HIVST on testing outcomes, focusing on both frequent and infrequent working-class testers. The paper also examines the spillover effect of HIVST on antiretroviral (ART) treatment initiation. To identify these effects, the author focused on South Africa and exploited the HIVST distribution data of 6259 beneficiaries of HIVST. Methods: The author used a two-stage least-squared model to quantify the impact of the HIVST on these vulnerable working populations. Results: The results show that HIVST fosters a 27.6% higher testing uptake in infrequently testing workers compared to frequently testing workers, and that the uptake of HIVST is 11.5% higher in rural regions than in urban settings, as well as 14.5% more prominent in infrequent male testers than infrequent female testers. Notably, the positive effects of HIVST are also confirmed by the presence of positive spillover effects in workers screening positive for HIV. The paper documents a 7.6% increase in ART initiation in infrequent testers. Conclusions: There is a case for adopting this technology to improve the uptake of HIV testing and ART initiation as the country seeks to attain the UNAIDS 95–95–95 targets by 203

Tribal-Run Health Systems

Jessica Bylander (Apr 2017) reported on the desire of the Rosebud Sioux Tribe in South Dakota to run their health system independently from the Indian Health Service. Bylander mentioned as an example of an “impressive success story” and an inspiration to the Rosebud Sioux the health systems of Alaska Native tribes—which adopted tribal governance in 1998.1However, data from the Alaska Department of Health and Social Services show poor health outcomes for Alaska Native people despite the tribal takeover. For example, during the period 2000–15, infant mortality worsened by 80 percent,2 while alcohol-induced mortalities increased by 22 percent.3 During the same period there was a 22 percent increase in adults claiming that cost was a barrier to health care.4 In light of these unsatisfactory health outcomes, it appears that the Alaska Native tribes’ health systems cannot be considered impressive success stories of tribal-run health systems