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Olago A, Suharlim C, Hussein S, Njuguna D, Macharia S, Muñoz R, Opuni M, Castro H, Uzamukunda C, Walker D, Birse S, Wangia E, Gilmartin C. The costs and financing needs of delivering Kenya's primary health care service package. Front Public Health 2023; 11:1226163. [PMID: 37900028 PMCID: PMC10613057 DOI: 10.3389/fpubh.2023.1226163] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 09/19/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction For many Kenyans, high-quality primary health care (PHC) services remain unavailable, inaccessible, or unaffordable. To address these challenges, the Government of Kenya has committed to strengthening the country's PHC system by introducing a comprehensive package of PHC services and promoting the efficient use of existing resources through its primary care network approach. Our study estimated the costs of delivering PHC services in public sector facilities in seven sub-counties, comparing actual costs to normative costs of delivering Kenya's PHC package and determining the corresponding financial resource gap to achieving universal coverage. Methods We collected primary data from a sample of 71 facilities, including dispensaries, health centers, and sub-county hospitals. Data on facility-level recurrent costs were collected retrospectively for 1 year (2018-2019) to estimate economic costs from the public sector perspective. Total actual costs from the sampled facilities were extrapolated using service utilization data from the Kenya Health Information System for the universe of facilities to obtain sub-county and national PHC cost estimates. Normative costs were estimated based on standard treatment protocols and the populations in need of PHC in each sub-county. Results and discussion The average actual PHC cost per capita ranged from US$ 9.3 in Ganze sub-county to US$ 47.2 in Mukurweini while the normative cost per capita ranged from US$ 31.8 in Ganze to US$ 42.4 in Kibwezi West. With the exception of Mukurweini (where there was no financial resource gap), closing the resource gap would require significant increases in PHC expenditures and/or improvements to increase the efficiency of PHC service delivery such as improved staff distribution, increased demand for services and patient loads per clinical staff, and reduced bypass to higher level facilities. This study offers valuable evidence on sub-national cost variations and resource requirements to guide the implementation of the government's PHC reforms and resource mobilization efforts.
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Affiliation(s)
- Agatha Olago
- Kenya Ministry of Health, Department of Primary Health Care, Nairobi, Kenya
| | - Christian Suharlim
- Management Sciences for Health, Medford, MA, United States
- Management Sciences for Health, Health Economics and Financing, Arlington, VA, United States
| | - Salim Hussein
- Kenya Ministry of Health, Department of Primary Health Care, Nairobi, Kenya
| | - David Njuguna
- Kenya Ministry of Health, Health Economist, Nairobi, Kenya
| | - Stephen Macharia
- Kenya Ministry of Health, Director of Planning, Chief Economist and Head of Planning, Nairobi, Kenya
| | | | | | - Hector Castro
- Management Sciences for Health, Medford, MA, United States
- Management Sciences for Health, Health Economics and Financing, Arlington, VA, United States
| | - Clarisse Uzamukunda
- Management Sciences for Health, Medford, MA, United States
- Independent Consultant, Kigali, Rwanda
| | - Damian Walker
- Management Sciences for Health, Medford, MA, United States
- Management Sciences for Health, Health Economics and Financing, Arlington, VA, United States
| | - Sarah Birse
- Management Sciences for Health, Medford, MA, United States
- Management Sciences for Health, Health Economics and Financing, Arlington, VA, United States
| | - Elizabeth Wangia
- Kenya Ministry of Health, Department of Health Financing, Nairobi, Kenya
| | - Colin Gilmartin
- Management Sciences for Health, Medford, MA, United States
- Management Sciences for Health, Health Economics and Financing, Arlington, VA, United States
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Reynolds T, Wilkinson T, Bertram MY, Jowett M, Baltussen R, Mataria A, Feroz F, Jama M. Building implementable packages for universal health coverage. BMJ Glob Health 2023; 8:e010807. [PMID: 37197791 PMCID: PMC10201243 DOI: 10.1136/bmjgh-2022-010807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 02/08/2023] [Indexed: 05/19/2023] Open
Abstract
Since no country or health system can provide every possible health service to everyone who might benefit, the prioritisation of a defined subset of services for universal availability is intrinsic to universal health coverage (UHC). Creating a package of priority services for UHC, however, does not in itself benefit a population-packages have impact only through implementation. There are inherent tensions between the way services are formulated to facilitate criteria-driven prioritisation and the formulations that facilitate implementation, and service delivery considerations are rarely well incorporated into package development. Countries face substantial challenges bridging from a list of services in a package to the elements needed to get services to people. The failure to incorporate delivery considerations already at the prioritisation and design stage can result in packages that undermine the goals that countries have for service delivery. Based on a range of country experiences, we discuss specific choices about package structure and content and summarise some ideas on how to build more implementable packages of services for UHC, arguing that well-designed packages can support countries to bridge effectively from intent to implementation.
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Affiliation(s)
- Teri Reynolds
- Department of Integrated Health Services, World Health Organization, Geneva, Switzerland
| | | | - Melanie Y Bertram
- Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland
| | - Matthew Jowett
- Health Financing and Governance, World Health Organization, Geneva, Switzerland
| | - Rob Baltussen
- Department for Health Evidence, Radboudumc, Nijmegen, The Netherlands
| | - Awad Mataria
- Department of Universal Health Coverage/Health Systems, World Health Organisation Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Ferozuddin Feroz
- Islamic Republic of Afghanistan Ministry of Public Health, Kabul, Afghanistan
| | - Mohamed Jama
- Federal Government of Somalia, Mogadishu, Somalia
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McDaid D, Park AL. Making an economic argument for investment in global mental health: The case of conflict-affected refugees and displaced people. Glob Ment Health (Camb) 2023; 10:e10. [PMID: 37854391 PMCID: PMC10579650 DOI: 10.1017/gmh.2023.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 12/04/2022] [Accepted: 01/24/2023] [Indexed: 03/06/2023] Open
Abstract
Mental health expenditure accounts for just 2.1% of total domestic governmental health expenditure per capita. There is an economic, as well as moral, imperative to invest more in mental health given the long-term adverse impacts of mental disorders. This paper focuses on how economic evidence can be used to support the case for action on global mental health, focusing on refugees and people displaced due to conflict. Refugees present almost unique challenges as some policy makers may be reluctant to divert scarce resources away from the domestic population to these population groups. A rapid systematic scoping review was also undertaken to identify economic evaluations of mental health-related interventions for refugees and displaced people and to look at how this evidence base can be strengthened. Only 11 economic evaluations focused on the mental health of refugees, asylum seekers and other displaced people were identified. All but two of these intervention studies potentially could be cost-effective, but only five studies reported cost per quality-adjusted life year gained, a metric allowing the economic case for investment in refugee mental health to be compared with any other health-focused intervention. There is a need for more consistent collection of data on quality of life and the longer-term impacts of intervention. The perspective adopted in economic evaluations may also need broadening to include intersectoral benefits beyond health, as well as identifying complementary benefits to host communities. More use can be also made of modelling, drawing on existing evidence on the effectiveness and resource requirements of interventions delivered in comparable settings to expand the current evidence base. The budgetary impact of any proposed strategy should be considered; modelling could also be used to look at how implementation might be adapted to contain costs and take account of local contextual factors.
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Affiliation(s)
- David McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - A-La Park
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
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Gaudin S, Raza W, Skordis J, Soucat A, Stenberg K, Alwan A. Using costing to facilitate policy making towards Universal Health Coverage: findings and recommendations from country-level experiences. BMJ Glob Health 2023; 8:bmjgh-2022-010735. [PMID: 36657806 PMCID: PMC9853124 DOI: 10.1136/bmjgh-2022-010735] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 12/17/2022] [Indexed: 01/20/2023] Open
Abstract
As countries progress towards universal health coverage (UHC), they frequently develop explicit packages of health services compatible with UHC goals. As part of the Disease Control Initiative 3 Country Translation project, a systematic survey instrument was developed and used to review the experience of five low-income and lower-middle-income countries-Afghanistan, Ethiopia, Pakistan, Somalia and Sudan-in estimating the cost of their proposed packages. The paper highlights the main results of the survey, providing information about how costing exercises were conducted and used and what country teams perceived to be the main challenges. Key messages are identified to facilitate similar exercises and improve their usefulness. Critical challenges to be addressed include inconsistent application of costing methods, measurement errors and data reliability issues, the lack of adequate capacity building, and the lack of integration between costing and budgeting. The paper formulates four recommendations to address these challenges: (1) developing more systematic guidance and standard ways to implement costing methodologies, particularly regarding the treatment of health systems-related common costs, (2) acknowledging ranges of uncertainty of costing results and integrating sensitivity analysis, (3) building long-term capacity at the local level and institutionalising the costing process in order to improve both reliability and policy relevance, and (4) closely linking costing exercises to public budgeting.
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Affiliation(s)
| | - Wajeeha Raza
- Centre for Health Economics, University of York, York, UK
| | - Jolene Skordis
- Centre for Global Health Economics, University College London, London, UK
| | - Agnès Soucat
- Division of Health and Social Protection, French Development Agency (AFD), Paris, France
| | - Karin Stenberg
- Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland,Swiss Tropical and Public Health Institute, Allschwil, Switzerland,University of Basel, Basel, Switzerland
| | - Ala Alwan
- DCP3 Country Translation Project, London School of Hygiene & Tropical Medicine, London, UK
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Mayer S, Łaszewska A, Simon J. Unit Costs in Health Economic Evaluations: Quo Vadis, Austria? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:117. [PMID: 36612439 PMCID: PMC9819362 DOI: 10.3390/ijerph20010117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/15/2022] [Accepted: 12/19/2022] [Indexed: 06/17/2023]
Abstract
Evidence-informed healthcare decision-making relies on high quality data inputs, including robust unit costs, which in many countries are not readily available. The objective of the Department of Health Economics' Unit Cost Online Database, developed based on systematic reviews of Austrian costing studies, is to make conducting economic evaluations from healthcare and societal perspectives more feasible with publicly available unit cost information in Austria. This article aims to describe trends in unit cost data sources and reporting using this comprehensive database as a case study to encourage relevant national and international methodological discussions. Database analysis and synthesis included publication/study characteristics and costing reporting details in line with the Consolidated Health Economic Evaluation Reporting Standards (CHEERS 2022) with the year of the database launch as the cut-off point to assess how the methods have developed over time. Forty-two full economic evaluations and 278 unit costs were analyzed (2004-2016: 34 studies/232 unit costs, 2017-2022: 8 studies/46 unit costs). Although the reporting quality of costing details including the study perspective, unit cost sources and years has improved since 2017, the unit cost estimates and sources remained heterogeneous in Austria. While methodologically standardized national-level unit costs would be the gold standard, a systematically collated list of unit costs is a first step towards supporting health economic evaluations nationally.
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Affiliation(s)
- Susanne Mayer
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090 Vienna, Austria
| | - Agata Łaszewska
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090 Vienna, Austria
| | - Judit Simon
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090 Vienna, Austria
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK
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