Health financing reform in Kenya- assessing the social health insurance proposal

Kenya has had a history of health financing policy changes since its   independence in 1963. Recently, significant preparatory work was done on a new Social Health Insurance Law that, if accepted, would lead to universal health coverage in Kenya after a tr&nsition period. Questions of economic  feasibility and political acceptability continue to be discussed, with   stakeholders voicing concerns on design features of the new proposal   submitted to the  Kenyan parliament in 2004. For economic, social, political and organisational reasons a transition period will be  necessary, which is likely to last more than a decade. However, important objectives such as access to health care  and avoiding impoverishment due to direct health care payments should be recognised from the start so that  steady progress towards effective universal coverage can be planned and achieved

Cost Effectiveness of Implementing Integrated Management of Neonatal and Childhood Illnesses Program in District Faridabad, India.

INTRODUCTION:Despite the evidence for preventing childhood morbidity and mortality, financial resources are cited as a constraint for Governments to scale up the key health interventions in some countries. We evaluate the cost effectiveness of implementing IMNCI program in India from a health system and societal perspective. METHODS:We parameterized a decision analytic model to assess incremental cost effectiveness of IMNCI program as against routine child health services for infant population at district level in India. Using a 15-years time horizon from 2007 to 2022, we populated the model using data on costs and effects as found from a cluster-randomized trial to assess effectiveness of IMNCI program in Haryana state. Effectiveness was estimated as reduction in infant illness episodes, deaths and disability adjusted life years (DALY). Incremental cost per DALY averted was used to estimate cost effectiveness of IMNCI. Future costs and effects were discounted at a rate of 3%. Probabilistic sensitivity analysis was undertaken to estimate the probability of IMNCI to be cost effective at varying willingness to pay thresholds. RESULTS:Implementation of IMNCI results in a cumulative reduction of 57,384 illness episodes, 2369 deaths and 76,158 DALYs among infants at district level from 2007 to 2022. Overall, from a health system perspective, IMNCI program incurs an incremental cost of USD 34.5 (INR 1554) per DALY averted, USD 34.5 (INR 1554) per life year gained, USD 1110 (INR 49,963) per infant death averted. There is 90% probability for ICER to be cost effective at INR 2300 willingness to pay, which is 5.5% of India's GDP per capita. From a societal perspective, IMNCI program incurs an additional cost of USD 24.1 (INR 1082) per DALY averted, USD 773 (INR 34799) per infant death averted and USD 26.3 (INR 1183) per illness averted in during infancy. CONCLUSION:IMNCI program in Indian context is very cost effective and should be scaled-up as a major child survival strategy

Effect of implementation of integrated management of neonatal and childhood illness programme on treatment seeking practices for morbidities in infants: cluster randomised trial.

OBJECTIVE: To determine the effect of implementation of the Integrated Management of Neonatal and Childhood Illness strategy on treatment seeking practices and on neonatal and infant morbidity. DESIGN: Cluster randomised trial. SETTING: Haryana, India. PARTICIPANTS: 29,667 births in nine intervention clusters and 30,813 births in nine control clusters. MAIN OUTCOME MEASURES: The pre-specified outcome was the effect on treatment seeking practices. Post hoc exploratory analyses assessed morbidity, hospital admission, post-neonatal infant care, and nutritional status outcomes. INTERVENTIONS: The Integrated Management of Neonatal and Childhood Illness intervention included home visits by community health workers, improved case management of sick children, and strengthening of health systems. Outcomes were ascertained through interviews with randomly selected caregivers: 6204, 3073, and 2045 in intervention clusters and 6163, 3048, and 2017 in control clusters at ages 29 days, 6 months, and 12 months, respectively. RESULTS: In the intervention cluster, treatment was sought more often from an appropriate provider for severe neonatal illness (risk ratio 1.76, 95% confidence interval 1.38 to 2.24), for local neonatal infection (4.86, 3.80 to 6.21), and for diarrhoea at 6 months (1.96, 1.38 to 2.79) and 12 months (1.22, 1.06 to 1.42) and pneumonia at 6 months (2.09, 1.31 to 3.33) and 12 months (1.44, 1.00 to 2.08). Intervention mothers reported fewer episodes of severe neonatal illness (risk ratio 0.82, 0.67 to 0.99) and lower prevalence of diarrhoea (0.71, 0.60 to 0.83) and pneumonia (0.73, 0.52 to 1.04) in the two weeks preceding the 6 month interview and of diarrhoea (0.63, 0.49 to 0.80) and pneumonia (0.60, 0.46 to 0.78) in the two weeks preceding the 12 month interview. Infants in the intervention clusters were more likely to still be exclusively breast fed in the sixth month of life (risk ratio 3.19, 2.67 to 3.81). CONCLUSION: Implementation of the Integrated Management of Neonatal and Childhood Illness programme was associated with timely treatment seeking from appropriate providers and reduced morbidity, a likely explanation for the reduction in mortality observed following implementation of the programme in this study.Trial registration Clinical trials NCT00474981; ICMR Clinical Trial Registry CTRI/2009/091/000715

Probability of IMNCI Program to be cost effective at varying willigness to pay thresholds per DALY averted.

<p>Probability of IMNCI Program to be cost effective at varying willigness to pay thresholds per DALY averted.</p

Change in costs at different levels on account of IMNCI program.

<p>Change in costs at different levels on account of IMNCI program.</p

Decision Model for Cost-effectiveness of IMNCI in Haryana, India.

<p><b>Note</b>: DH = District Hospital, CHC = Community health centre, FRU = First referral unit, PHC = Primary health centre, SC = sub-centre, ASHA = Accredited social health activist, AWW = Anganwadi worker. Cycle repeated for 15 birth cohorts (2008–2022).</p

Distribution of incremental program implementation and monitoring costs as a result of IMNCI.

<p>Distribution of incremental program implementation and monitoring costs as a result of IMNCI.</p

Outcome Model for Cost-effectiveness of IMNCI in Haryana, India.

<p><b>Note</b>: In continuation to the model 1, outcome model describes the probable scenarios after a neonatal or post-neonatal infant had been treated or not (irrespective of type of health facility). YLD = Years of life lived with disability, YLL = Years of life lost due to premature mortality, DALY = Disability adjusted life years.</p