Health Impact and Social Value of Interventions, Services, and Policies: A Methodological Discussion of Health Impact Assessment and Social Return on Investment Methodologies

Self-administered sexual health testing in an open prison setting: a pilot health impact assessment and social return on investment analysis

PURPOSE

The sexual health of the male prison population is often among the poorest in a country. This paper aims to identify the wider health impacts and social value of a sexual health self-sampling programme offered to male prisoners in an open prison setting in Wales.

DESIGN/METHODOLOGY/APPROACH

This study applied a unique pilot approach of using Health Impact Assessment and Social Return on Investment Frameworks in tandem. Key stakeholder groups affected by the intervention were identified, and engaged with through workshops, interviews and questionnaires to identify and quantify the health impacts and wider outcomes. Outcomes were then valued using proxy financial values to present the overall estimated social value of the self-sampling service.

FINDINGS

Based on a small sample, results indicate that for every £1 spent on the self-sampling service in the prison, a potential value of £4.14 was created. This resulted in a ratio of £4.14:£1. Approximately one-third of the value created (£1,517.95) was categorised as monetarily returnable, whereas the remaining value (£3,260.40) was purely illustrative social value, for example improved mental well-being.

ORIGINALITY/VALUE

This unique pilot study demonstrates the health impacts and wider social value of providing a self-sampling sexual health service to prisoners within an open prison setting. By innovatively testing the feasibility of using a Health Impact Assessment process alongside Social Return on Investment analyses, this paper has outlined how the frameworks can be used in synergy to illustrate not just direct return on investment but also the social value of providing such a service.

Economic analysis of a health system strengthening program in the Democratic Republic of the Congo

INTRODUCTION

Due to the Democratic Republic of the Congo’s (DRC) precarious health system that provides only limited access to health care, the European Union, via Memisa Belgium, implemented a program to strengthen provision of and access to health care (known as PRO DS) in the provinces of Kongo Central and Ituri. This program took a holistic approach, seeking to improve equitable access and combat malnutrition.

METHODS

To measure the program’s social return on investment and to estimate the cost per capita and effectiveness per euro invested (efficiency), a 61-month (1 July 2017 to 31 July 2022) cost-effectiveness evaluation with a societal perspective was carried out. The double-difference method was used to compare the results of PRO DS and non-PRO DS zones. The social return on investment was assessed via the ratio of effectiveness to costs.

RESULTS

Analyses revealed the program cost between 3.72 and 3.96 euros per capita per year (2022) in Kongo Central, and between 3.12 and 3.36 euros in Ituri. Importantly, it was cost-effective in the areas of reproductive health, nutrition, and the use of health and nutrition services.

CONCLUSIONS

The program’s strong nutritional component and overall holistic vision may explain why it was so efficient. PRO DS stands out from other programs that focus solely on one specific problem or population. Although the program has some limitations, it would be worthwhile for the government to invest in it.

Advancing the social return on investment framework to capture the social value of public health interventions: semistructured interviews and a review of scoping reviews

OBJECTIVES

Investment in public health has far-reaching impacts, not only on physical health but also on communities, economies and the environment. There is increasing demand to account for the wider impact of public health and the social value that can be created, which can be captured through the use of the social return on investment (SROI) framework. This study aims to explore the application of SROI and identify areas of advancement for its use in public health.

STUDY DESIGN AND METHODS

Publically available SROI studies of public health interventions previously identified through published systematic scoping reviews were examined through a methodological lens. This was complemented by semistructured interviews with key public health academic experts with experience in the field of SROI. The results were thematically analysed and triangulated.

RESULTS

In total, 53 studies and nine interviews were included in the analysis. All interviewees agreed that SROI is a suitable framework to demonstrate the social value of public health interventions. Developmental aspects were also identified through the analysis. This included a more systematic use of SROI principles and methodological developments. Lastly, it was identified that further advancements were needed to promote awareness of SROI and how it can be used to generate investment.

CONCLUSION

By identifying key areas for advancement, the results from this study can be used to further refine the SROI framework for use within the speciality to promote investment in services and interventions that demonstrate maximum value to people, communities, economies and the environment.

Return on investments in the Health Extension Program in Ethiopia

BACKGROUND

Since 2003, the government of Ethiopia has trained and deployed more than 42,000 Health Extension Workers across the country to provide primary healthcare services. However, no research has assessed the return on investments into human resources for health in this setting. This study aims to fill this gap by analyzing the return on investment within the context of the Ethiopian Health Extension Program.

METHODS

We collected data on associated costs and benefits attributed to the Health Extension Program from primary and secondary sources. Primary sources included patient exit interviews, surveys with Health Extension Workers and other health professionals, key informant interviews, and focus groups conducted in the following regions: Amhara, Oromia, Tigray, and the Southern Nations Nationalities and Peoples' Region. Secondary sources consisted of financial and administrative reports gathered from the Ministry of Health and its subsidiaries, as well as data accessed through the Lives Saved Tool. A long-run return on investment analysis was conducted considering program costs (personnel, recurrent, and capital investments) in comparison to benefits gained through improved productivity, equity, empowerment, and employment.

FINDINGS

Between 2008-2017, Health Extension Workers saved 50,700 maternal and child lives. Much of the benefits were accrued by low income, less educated, and rural women who had limited access to services at higher level health centers and hospitals. Regional return ranged from $1.27 to $6.64, with an overall return on investment in the range of $1.59 to $3.71.

CONCLUSION

While evidence of return on investments are limited, results from the Health Extension Program in Ethiopia show promise for similar large, sustainable system redesigns. However, this evidence needs to be contextualized and adapted in different settings to inform policy and practice. The Ethiopian Health Extension Program can serve as a model for other nations of a large-scale human resources for health program containing strong economic benefits and long-term sustainability through successful government integration.

Assessing a digital technology-supported community child health programme in India using the Social Return on Investment framework

An estimated 5.0 million children aged under 5 years died in 2020, with 82% of these deaths occurring in sub-Saharan Africa and southern Asia. Over one-third of Mumbai's population has limited access to healthcare, and child health outcomes are particularly grave among the urban poor. We describe the implementation of a digital technology-based child health programme in Mumbai and evaluate its holistic impact. Using an artificial intelligence (AI)-powered mobile health platform, we developed a programme for community-based management of child health. Leveraging an existing workforce, community health workers (CHW), the programme was designed to strengthen triage and referral, improve access to healthcare in the community, and reduce dependence on hospitals. A Social Return on Investment (SROI) framework is used to evaluate holistic impact. The programme increased the proportion of illness episodes treated in the community from 4% to 76%, subsequently reducing hospitalisations and out-of-pocket expenditure on private healthcare providers. For the total investment of Indian Rupee (INR) 2,632,271, the social return was INR 34,435,827, delivering an SROI ratio of 13. The annual cost of the programme per child was INR 625. Upskilling an existing workforce such as CHWs, with the help of AI-driven decision- support tools, has the potential to extend capacity for critical health services into community settings. This study provides a blueprint for evaluating the holistic impact of health technologies using evidence-based tools like SROI. These findings have applicability across income settings, offering clear rationale for the promotion of technology-supported interventions that strengthen healthcare delivery.

The economics of the COVID-19 pandemic: economic evaluation of government mitigation and suppression policies, health system innovations, and models of care

Background

The COVID-19 pandemic has impacted the scope of health economics literature, which will increasingly examine value beyond health care interventions such as government policy and broad health system innovations.

Aim

The study analyzes economic evaluations and methodologies evaluating government policies suppressing or mitigating transmission and reducing COVID-19, broad health system innovations, and models of care. This can facilitate future economic evaluations and assist government and public health policy decisions during pandemics.

Methods

The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) was used. Methodological quality was quantified using the scoring criteria in European Journal of Health Economics, Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 Checklist and the National Institute for Health and Care Excellence's (NICE) Cost Benefit Analysis Checklist. PUBMED, Medline, and Google Scholar were searched from 2020-2021.

Results

Cost utility analysis (CUA) and cost benefit analysis (CBA) analyzing mortality, morbidity, quality adjusted life year (QALY) gained, national income loss, and value of production effectively evaluate government policies suppressing or mitigating COVID-19 transmission, disease, and impacting national income loss. The WHO's pandemic economic framework facilitates economic evaluations of social and movement restrictions. Social return on investment (SROI) links benefits to health and broader social improvements. Multi-criteria decision analysis (MCDA) can facilitate vaccine prioritization, equitable health access, and technology evaluation. Social welfare function (SWF) can account for social inequalities and population-wide policy impact. It is a generalization of CBA, and operationally, it is equal to an equity-weighted CBA. It can provide governments with a guideline for achieving the optimal distribution of income, which is vital during pandemics. Economic evaluations of broad health system innovations and care models addressing COVID-19 effectively use cost effectiveness analysis (CEA) that utilize decision trees and Monte Carlo models, and CUAs that effectively utilize decision trees and Markov models, respectively.

Conclusion

These methodologies are very instructive for governments, in addition to their current use of CBA and the value of a statistical life analytical tool. CUA and CBA effectively evaluate government policies suppressing or mitigating COVID-19 transmission, disease, and impacts on national income loss. CEA and CUA effectively evaluate broad health system innovations and care models addressing COVID-19. The WHO's framework, SROI, MCDA, and SWF can also facilitate government decision-making during pandemics.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10389-023-01919-z.

Study Protocol on Social Return on Investment (SROI) Project of the Surgical Waiting List Management System

In Andalusia, the right to maximum waiting times for healthcare clashes with the available supply, leading to an increase in demand in the form of waiting lists. To address this situation, the activity of private centers has been created for certain diagnostic tests. The Social Return on Investment (SROI) model evaluates an intervention from an economic and stakeholder perspective. However, there are no studies on the suitability of waiting lists using SROI, which is why it is intended to be studied as a decision-making tool for the clinical and healthcare management of waiting lists. This research protocol is designed to determine the quality of life gained, with the EuroQol-5D-5L questionnaire, and its social assessment, with the specific survey of the SROI method, and, thus, analyze the social return on investment and determine the suitability of the intervention (diagnostic endoscopy activity arranged in a contracted center). After the study, we will know the economic (cost in public health centers and the incremental cost of extraordinary health resources), social (quality of life with health), and environmental scenarios of the concerted activity intervention in order to adjust waiting list times.

Exploring the social value of Public Health Institutes: An international scoping survey and expert interviews

Introduction

Making the case for investing in preventative public health by illustrating not only the health impact but the social, economic and environmental value of Public Health Institutes is imperative. This is captured by the concept of Social Value, which when measured, demonstrates the combined intersectoral value of public health. There is currently insufficient research and evidence to show the social value of Public Health Institutes and their work across the life course, population groups and settings, in order to make the case for more investment.

Methods

During July 2021, a quantitative online self-administered questionnaire was conducted across international networks. Semi-structured interviews were also carried out with nine representatives to gain a deeper understanding. A thematic analysis was undertaken on the data collected.

Results

In total, 82.3% (n = 14) were aware of the terminology of social value and 58.8% (n = 10) were aware of the economic method of Social Return on Investment. However, only two Institutes reported capturing social and community impacts within their economic analysis and only 41.2% (n = 7) currently capture or measure the social value of their actions. Interviews and survey responses indicate a lack of resources, skills and buy-in from political powers. Finally, 76.5% (n = 12) wanted to do more to understand and measure wider outcomes and impact of their actions. It was noted this can be achieved through enhancing political will, developing a community of best practice and tools.

Conclusion

This research can inform future work to understand how to measure the holistic social value of Public Health Institutes, in order to strengthen institutional capacity and impact, as well as to achieve a more equitable society, and a more sustainable health system and economy, making the case for investing in public health, as we recover from COVID-19.

Accounting for Emotional Value: A Review in Disability Organizations

The aim of this paper is to examine how disability organizations account for the emotional value they create for their stakeholders. Based on a review of the literature on emotional value measurement in third sector organizations working in the disability sector, we investigate to what extent emotional value is considered in their social accounting process and what type of value variables, indicators and proxies are used. The results reveal that the analysis of some quality of life domains provides appropriate evidence to represent the emotional value generated by these organizations but that there is a great dispersion in applied instruments and methodologies. The study improves the knowledge and understanding of existing approaches to capture the emotional component of social value creation and contributes to its standardization. Our analysis has implications for the management of disability organizations that can use social accounting to evaluate their performance and improve their effectiveness and efficiency, showing a more complete picture of the social value generated. Likewise, it can be an instrument to make the contribution and social benefits of these organizations visible in all their breadth, improving transparency and legitimacy.