Public Health, Health Economics, Health System Research

Background: In India, availability of low cost generic drugs to reduce out-of-pocket expenditures on medicines by households has been a challenge over the decades. To address this issue, the Government of India revamped the existing Jan Aushadhi Scheme (JAS) launched in 2008, as the Prime Minister's Peoples Medicine Scheme in 2014.Objectives: This study analyses the cost difference of cancer and diabetes medicines under the scheme with its branded counterpart as well as issues related to availability of these medicines in western India. Methodology: It's a cross-sectional study. Telephonic interviews and email correspondence with pharmacists of JAS stores in Mumbai and Thane region. Secondary data from JAS and Medguide India websites has been analysed. Primary data was collected to study the availability of medicines in these stores. Percentage difference, average and standard deviation have been computed. Findings: The findings showed that some medicines for both cancer and diabetes listed under the scheme were available at a cheaper rate in the branded market. Also, prices were not found to be uniform in all JAS stores and supply of cancer medicines was found to be poor. Conclusions: This study highlights the need for a more effective procurement process under the scheme to bring down medicine prices and increase their availability. Price discrepancy for some of the medicines in JAS stores is also a matter of concern. Visibility of these stores needs to be increased to create awareness for accessing these low-cost medicines. Recommendation: This study has four recommendations for a more effective impact of this scheme to reduce the OOP expenditure on medicines in India.

Payment of user-fees for healthcare has negative consequences including catastrophic expenditures and reduction in utilization of healthcare services. Conversely, health insurance provides a means to protect against the financial risk associated with healthcare. This paper primarily investigates the effect of out-of-pocket payments (OPP) on the utilization of health services and the likelihood of exposure to catastrophic expenditure. Data was obtained from a household survey conducted in the Ga South Municipality. In all, 117 households consisting of 530 individuals were interviewed. In 55% of the households surveyed, at least one member had a valid health insurance policy against 45% with no insurance. Our finding from the multivariate regression shows that enrolment in health insurance has a negative and significant effect on out-of-pocket payment. Other significant pre-dictors of OPP were utilization and household per capita expenditure. Surprisingly, insurance status did not have a significant impact on utilization, as there was no significant difference between the insured and uninsured. However, per capita expenditure had a significant effect on utilization. Moreover, OPP and per capita expenditure had a significant effect on catastrophic expenditure. The paper concludes that health insurance is important in reducing out-of-pocket payments for healthcare but does not influence utilization of health services and exposure to catastrophic spending. JEL codes: I11; I13; I14

Economics evaluation, frequently in the form of cost-effectiveness analysis, is becoming an important tool in health financing policy. However, in the past its application has been limited to developed countries and the little applications in LMICs. If any it is limited to small trials that have less impact on health policy. The WHO and World bank are taking a leading role in applying and insisting on economics evaluations in designing regional and global guidelines aimed to further advance global health objectives. This review takes a look at some of the economics considerations in the form of rising cost of providing healthcare, scarcity of resources relative to demand, and the relevance of health sector in the form of its contribution to national economies. These factors coupled with the health system's broader objective of maximizing health gains and cutting costs necessitates the use of economics evaluation. At the end, we look at the most recent efforts that use economics analysis within the broader context of health financing system, and also discuss how the methods are incorporated. We also highlighted on an application of economics evaluation that goes beyond population health to financial protection; an important principle in achieving universal health coverage (UHC). We concluded that economic evaluation is gaining more prominence in the global health arena and its application is becoming important in designing health interventions targeting LMICs.

Despite  recent  progress,  Liberia  still  experiences  poor  child  and  maternal  health indicators due to: inadequate resources, low awareness of preventive measures, and a lack of access to health services, amongst other factors. With an aim to improve health conditions  and  to  increase  access  to  a  package  of  basic  Reproductive  Maternal Neonatal and Child Health (RMNCH) services, BRAC Liberia’s health programme expanded operations in 2013. This Intermediary Assessment Report aims to assess the impact of the RMNCH programme in Liberia to date.

BRAC Liberia’s Independent Research and Evaluation Unit (REU-LIB) conducted an assessment in seven counties in Liberia, (comprised of four treatment counties and three control counties), to collect information on health seeking behaviour and health outcomes. The survey followed a cross sectional design and utilised data from households with at least one child under five years old. The total sample size consisted of 1,960 households (980 treatment households and 980 control households).

The survey revealed that the RMNCH programme in Liberia is making visible progress towards mostly output indicator targets in the treatment areas, overall there is little statistical difference between outcome level indicators when compared to the control group. For instance, the survey found higher awareness about signs and symptoms of common childhood diseases namely; malaria, diarrheoa and pneumonia among women in the treatment areas, children under five in the treatment areas were 13% more likely to receive antimalarial drugs to treat malaria within 24 hours.

Concerning outcome indicators, Programme had pronounced impact on contraceptive use among women; use of modern family planning services was reported 9% more among sexually active women aged 15 – 49 in the treatment than women in the control areas area during the past year prior to data collection. Also women and men in the treatment  areas  expressed  improved  attitudes  towards  HIV/AIDs.  Although  not statistically different, the survey found a minor (5%) difference in the proportion of babies who were exclusively breast fed during the first six months in treatment areas, which indicates gradual progress within the programme.

At the same time the results show that there is no statistically significant difference between  the  treatment  and  control  groups  for  most  of  the  outcome  indicators.

Programme is challenged by lack of availability of certain health products due to Government of Liberia’s policy restrictions, not for CHPs to be availed with drugs, as a result the survey found inadequate knowledge and management of common childhood diseases using the most effective treatment (both ORS and Zinc, and ACTs) to treat children U5 of diarrhea and malaria, respectively in both study areas.

Programmatic Procedure to operate within 4km radius from the branch office also seems to  inhibit  Programme’s progress.  For  instance majority of  the  mothers  (86%  in the treatment and 87% in the control areas) who had a live birth one year preceding the survey in both study areas attended ANC (4 checks plus), and high proportions of mothers who delivered one year before the survey received PNC (75% in the treatment and 76% in the control areas). This implies a concentration of Programme operations in urban areas, which eases accessibility to health services in both areas.

The impact of Ebola crisis is another major reason responsible for slowing down Programme’s success. The crisis led to a halt in Programme activities, a shortage and minimised acceptance of health workers to take care of the mothers, as well as mistrust for health facilities among mothers to seek health services due to fear of being infected. The survey found live births during the past one year in the treatment areas were 8% less likely to have been delivered by a skilled health provider. In addition, PNC coverage within one week after delivery was below average (45% and 42%) in the treatment and control areas, respectively.

In addition, the Ebola crisis presented opportunities which made the population adopt improved hygiene practices and acquire improved general health knowledge. Therefore programme  couldn’t  obtain  measurable  difference  in  the  treatment  areas  regarding proper hand washing practice and knowledge related to Pregnancy and related care (PRC).

However, financial constraints, long distances to the health facilities, poor transport and having to seek permission to go and seek health care could have obstructed the programme from achieving significant effects related to maternal health outcomes.

The survey also highlighted the male gender as another challenge for Programme to achieve visible impact. For example within the treatment area the use of modern family

planning methods was 13% less among men compared to women and men generally practiced poor hand washing practices (76% men compared to 89% women).

In addition the survey clearly showed that adolescent girls (aged 15 – 19) and single mothers were disadvantaged in all maternal and child health outcomes. The survey captured a 19% variation in knowledge about signs and symptoms of children U5 among adolescent girls compared to adult women. Single mothers were 8% less likely to have attended ANC (4 checks plus) and to have received PNC promptly (within one week) after delivery (38% compared to 50% of the married women).

It is advised that Programme should focus on the promotion of ACTs, and Zinc to increase treatment coverage outcomes among children, expand its activities to distant areas (beyond the 4kms radius), to reach the most underserved. The RMNCH programme requires further strengthening of referral linkages to improve health professionals’ care towards mothers and should consider social protection measure to enhance affordability of health services and health seeking behavior. Further, greater male  involvement  should  be  considered  important  for  Programme  to  deal  with  the gender differentials, as well as pay attention to targeting adolescent girls and single mothers in order to better realise the significant differences from the control.

Cloud computing is emerging as a new paradigm in health care information technology strategies and the growth of the industry. Despite reports emerging as early as the 1950s hinting at the potential of this approach, the strength of this is only now being realized in the health care sector. This is a simple principle of service-orientated architecture delivering a service around data rather than a product. The main enabling technology for cloud computing is virtualization. Virtualization is the ability to allow the system to operate independently of the hardware from the cloud via the Internet, so one can provide information to other users of hardware or software. In addition, resources can be shared within and between organizations to improve economies of scale. Data can be transferred in a computer network that is able to compartmentalize your needs.

The main purpose of this study was to examine the impact of public health expenditure on health outcomes (infant and under five mortality rate) in Tanzania over the period 1995 to 2013. Per capital GDP as an indicator of income level and improved sanitation facilities were used as explanatory variables. A full Bayesian time series approach based on Markov Chain Monte Carlo (MCMC) was used to estimate the impact of public health expenditure on health outcomes (infant and under five mortality). The results shows that, despite changing patterns on government health expenditure over the period 1995 to 2013, still government health expenditure had no impact on health outcomes (infant and under five mortality) in Tanzania. The results further shows that, the mean for income levels represented by (GDP per capital) had positive significant effect on both infant and under-five mortality decline. The failure to bring impact on health outcomes (infant and under five mortality) was probably due to its low level of public health spending. The paper recommends the policy that aim to increase GDP per capital and public health expenditure. Since public health expenditure is still low, re-prioritisation is also needed in the public expenditure system for resource allocation during budgeting to favour health budget to be given first priority.

OBJECTIVE: To determine the clinical and epidemiological characteristics of prison inmates with active tuberculosis in HIV-positive prison populations.
MATERIALS AND METHODS: We conducted a cohort study in HIV-infected subjects in a prison in Mexico City, with the aim of determining clinical and epidemiological characteristics of cases with active TB.
RESULTS: We detected 172 HIV infected inmates and TB in 28 of them (16.3%) - 21 (12.2) with pulmonary TB - with an incidence rate of 7.7/100 persons/year for active TB and 4.7/100 persons/year for pulmonary TB. No drug resistance was found. Two clusters (4 and 2 subjects) were observed after RFLP-typing of 18 isolates, with a transmission rate of 11% by molecular and clinical analysis.
CONCLUSIONS: The prevalence of active TB was found to be a thousand times greater than in the general population. Evidence of transmission inside the prison was also found.

Key words: tuberculosis; prisons; HIV; epidemiology; Mexico.

Objective: To estimate the direct and indirect costs of meningitis to households in the Kassena-Nankana District of Ghana. Methods: A Cost of illness (COI) survey was conducted between 2010 and 2011. The COI was computed from a retrospective review of 80 meningitis cases answers to questions about direct medical costs, direct non-medical costs incurred and productivity losses due to recent meningitis incident. Results: The average direct and indirect costs of treating meningitis in the district was GH¢152.55 (US$101.7) per household. This is equivalent to about two months minimum wage earned by Ghanaians in unskilled paid jobs in 2009. Households lost 29 days of work per meningitis case and thus those in minimum wage paid jobs lost a monthly minimum wage of GH¢76.85 (US$51.23) due to the illness. Patients who were insured spent an average of GH¢38.5 (US$25.67) in direct medical costs whiles the uninsured patients spent as much as GH¢177.9 (US$118.6) per case. Patients with sequelae incurred additional costs of GH¢22.63 (US$15.08) per case. The least poor were more exposed to meningitis than the poorest. Conclusion: Meningitis is a debilitating but preventable disease that affects people living in the Sahel and in poorer conditions. The cost of meningitis treatment may further lead to impoverishment for these households. Widespread mass vaccination will save households' an equivalent of GH¢175.18 (US$117) and impairment due to meningitis.

The current study aims to estimate to what extent economic performance is affected by different types of
diseases. Particularly, we intend to examine the impact of diseases such as dengue, TB and HIV on GDP per
capita in selected Southeast Asian countries. The panel data analysis and cointegration estimation technique are
adopted to achieve the objectives of the study. The findings reveal that the variables move together in the
long-run, and the results confirmed by three cointegration tests: Johansen-Fisher, Kao and Pedroni. Additionally,
the coefficients estimated using FMOLS and confirmed by DOLS. Most importantly, it has been shown that
shocks to human capital (diseases) have a large adverse impact on economic performance, especially; dengue,
TB and HIV. The second major finding was that the role of human capital is found to be very crucial expressed
by education and labor. The findings of this study suggest that reduction of diseases can lead to considerable
improvement in economic performance.

Malaria and Pneumonia are major killers of children underfive. However, fever and cough are major signs of Malaria and Pneumonia respectively and hence making proper management of fever and cough indispensable in the fight against underfive mortality. This study therefore investigated the factors that influence the choice of first healthcare provider for children with fever or cough in Ghana. The study used the 2014 Ghana Demographic and Health Survey (GDHS) as the main source of data. By employing the multinomial probit model, the study found that urban children, children with higher birth rank, older children, children from the Ga/Dangme, Akan, Mole-Dagbani, Ewe, Mande and Gurma ethnicity and children of mothers with big problems with regards to permission and distance to seek self-medical care were more likely to be given self-medication or to be sent to a traditional practitioner initially for fever or cough. Contrary , mothers with health insurance, aging mothers and wealthy households were less likely to first resort to self-medication or a traditional practitioner in order to seek care for children with fever or cough. The study therefore concludes that ethnicity, residence, permission and distance to seek medical care by mother, mother's health insurance, household wealth, child's age, mother's age and birth order are the factors that influence the choice of first healthcare provider for children with fever or cough in Ghana.

Introduction:
Although investment in HIV/AIDS prevention has increased worldwide, it remains uncertain how the additional resources can be most efficiently allocated to maximize the number of infections averted, especially at the country, regional and local levels.

Methods:
Data from developing countries in Africa, Asia and Latin America were reviewed on the allocation of HIV/AIDS prevention funds in relation to the prevalence of infection, as well as budgetary allocations for specific population groups at high risk of infection, such as sex workers, intravenous drug users and men who have sex with men. The variation in unit costs of voluntary counselling and testing in five countries was also examined.

Results:
Evidence was found of three distinct sources of inefficiency in the allocation of HIV/AIDS prevention resources: inefficiency in the mix of interventions selected; inefficient targeting of key populations; and technical inefficiency in the production of HIV prevention services.

Conclusion:
A general conceptual framework for evaluating the efficiency of HIV/AIDS prevention programmes at the country, regional and local levels is proposed. This framework stresses three equally important components of programme efficiency: cost-effectiveness (the choice of the mix of interventions); targeting (the choice of the mix of target populations); and technical efficiency (the delivery of prevention services at least cost).

One of the best ways of Preventing Measles and Yellow fever which are dangerous killers of children is through vaccination. Therefore given the absence of research to the best of our knowledge on the factors that affect demand for Measles and Yellow fever vaccines among children in Ghana, this study investigated the socioeconomic , demographic and geographic factors that affect the demand for Measles and Yellow fever vaccines among children in Ghana. By using data from the 2014 Ghana Demographic and Health Survey and the binary probit model, the study among other findings revealed that, Children in the Western region were less likely to have received both the Measles 1 and Yellow fever vaccines. Also urban children and children with unemployed mothers were found to be less likely to have received the Measles 1, Measles 2 and Yellow fever vaccines relative to rural children and children with employed mothers respectively. Also Traditional/Spiritualist/No religion faith children were found to be less likely to have received the Yellow fever vaccine. Further, uneducated mothers, mothers without health insurance and non-wealthy households were found to be less likely to demand the Measles 2 vaccine for their children. This study therefore concludes that SocioEconomic , Demographic and Geographic Factors are relevant determinants of demand for measles and yellow fever vaccines among children in Ghana.