Introducing an Ethics Framework for health priority-setting in South Africa on the path to universal health coverage

Background. South Africa (SA) has embarked on a process to implement universal health coverage (UHC) funded by National Health Insurance (NHI). The 2019 NHI Bill proposes creation of a health technology assessment (HTA) body to inform decisions about which interventions NHI funds will cover under UHC. In practice, HTA often relies mainly on economic evaluations of cost-effectiveness and budget impact, with less attention to the systematic, specific consideration of important social, organisational and ethical impacts of the health technology in question. In this context, the South African Values and Ethics for Universal Health Coverage (SAVE-UHC) research project recognised an opportunity to help shape the health priority-setting process by providing a way to take account of multiple, ethically relevant considerations that reflect SA values. The SAVE-UHC Research Team developed and tested an SA-specific Ethics Framework for HTA assessment and analysis.Objectives. To develop and test an Ethics Framework for use in the SA context for health priority-setting.Methods. The Framework was developed iteratively by the authors and a multidisciplinary panel (18 participants) over a period of 18 months, using the principles outlined in the 2015 NHI White Paper as a starting point. The provisional Ethics Framework was then tested with multi-stakeholder simulated appraisal committees (SACs) in three provinces. The membership of each SAC roughly reflected the composition of a potential SA HTA committee. The deliberations and dedicated focus group discussions after each SAC meeting were recorded, analysed and used to refine the Framework, which was presented to the Working Group for review, comment and final approval.Results. This article describes the 12 domains of the Framework. The first four (Burden of the Health Condition, Expected Health Benefits and Harms, Cost-Effectiveness Analysis, and Budget Impact) are commonly used in HTA assessments, and a further eight cover the other ethical domains. These are Equity, Respect and Dignity, Impacts on Personal Financial Situation, Forming and Maintaining Important Personal Relationships, Ease of Suffering, Impact on Safety and Security, Solidarity and Social Cohesion, and Systems Factors and Constraints. In each domain are questions and prompts to enable use of the Framework by both analysts and assessors. Issues that arose, such as weighting of the domains and the availability of SA evidence, were discussed by the SACs.Conclusions. The Ethics Framework is intended for use in priority-setting within an HTA process. The Framework was well accepted by a diverse group of stakeholders. The final version will be a useful tool not only for HTA and other priority-setting processes in SA, but also for future efforts to create HTA methods in SA and elsewhere

Performance of 4mm impact sprinklers at different spacing within acceptable pressure ranges (250-350 kPa)

Irrigation Engineers in Zimbabwe use the 12 m x 18 m spacing for the design of the sprayline, using 4 mm nozzle sprinklers. A study was conducted to determine performance and cost effectiveness of other spacings that can be used in sprinkler irrigation systems design. The main targeted spacings were a square layout of 15 m x 15 m and a rectangular layout of 15 m x 18 m. Water application uniformity and wetted diameter tests were done using the single line catch can layout method at 250 kPa, 300 kPa and 350 kPa using two locally manufactured (Toronto and Non Ferrous) and two imported (Rainbird and an Irriline) sprinklers. Highest coefficient of uniformity (CU) of 97 % and distribution uniformity (DU) of 95 % were obtained from a Rainbird sprinkler at 300 kPa. The lowest CU of 66 % and DU of 46 % were obtained from a Toronto sprinkler at 250 kPa. Highest wetted diameter (WD) of 32 m was obtained at 300 kPa from a Toronto sprinkler while lowest wetted diameter of 24 m was recorded at 250 kPa from a Toronto sprinkler. The results of CU, DU and wetted diameter showed that the 15 m x 15 m sprinkler spacing can be used in Zimbabwe under moderate wind conditions at 300 kPa, using preferably imported sprinklers for best application uniformity results.  &#160

Alkaloids isolated from indigenous South African Amaryllidaceae: Crinum buphanoides (Welw. ex Baker), Crinum graminicola (I. Verd.), Cyrtanthus mackenii (Hook. f) and Brunsvigia grandiflora (Lindl)

Screening for alkaloids produced in four indigenous South African Amaryllidaceae plants, namely, Crinum buphanoides Welw. ex Baker, Crinum graminicola I. Verd., Cyrtanthus mackenii Hook. f and Brunsvigia grandiflora Lindl, leads to the isolation of lycorine as the one metabolite produced by all the species studied. C. graminicola produced lycorine in the best yield (2.1 g/kg). Moreover, 1-O-acetyl- and 2-O-acetyl-lycorine, pratorimine, hippadine and tazettine were isolated from C. buphanoides. Haemanthidine, haemanthamine and criwelline were isolated fromC. graminicola,while tazettine and 11-hydroxyvittatinewere produced by C. mackenii. Finally, crinamine and 11-hydroxyvittatine were isolated from B. grandiflora. This is the very first report on the isolation of these alkaloids from the four South African Amaryllidaceae. Furthermore, some interesting chemosystematic evaluations are reported