Biomedical subjects

J M Kirigia

Publications and source records attributed to J M Kirigia.

8 recordsLinked to original sources

PubMed2001

Technical efficiency of public clinics in Kwazulu-Natal Province of South Africa.

BACKGROUND: In sub-Saharan Africa (SSA) much of the attention of policy makers, health care managers, health systems researchers and donors is focussed almost solely on mobilising additional resources and not on efficiency in their use. OBJECTIVE(S): To investigate the technical inefficiencies among 155 primary health care clinics in Kwazulu-Natal Province of South Africa; and to draw policy implications. DESIGN: Cross-sectional provincial health clinic survey. SELLING: Kwazulu-Natal Provincial Department of Health Clinics survey, 1996. SUBJECTS: The analysis is based on 155 public clinics. INTERVENTIONS: Non-intervention Data Envelopment Analysis (DEA) study. MAIN OUTCOME MEASURES: Technical and scale efficiency scores. RESULTS: Forty seven (30%) were found to be technically efficient. Among the 108 (70%) technically inefficient facilities, 16% had an efficiency score of 50% or less. The presence of inefficiencies indicates that a clinic has excess inputs or insufficient outputs compared to those clinics on the efficiency frontier. To achieve technical efficiency, Kwazulu-Natal clinics would, in total have to decrease inputs by 417 nurses and 457 general staff. Alternatively, outputs would have to be increased by 115,534 antenatal visits, 1,010 births (deliveries), 179,075 child care visits, 5,702 dental visits, 121,658 family planning visits, 36,032 psychiatric visits, 56,068 sexually transmitted disease visits and 34,270 tuberculosis visits. CONCLUSION: There is need for more detailed studies in a number of the relativdy efficient clinics to determine why they are efficient with a view of documenting attributes of 'best practise' that other clinics can emulate. The potential benefit of replicating this kind of study in other provinces, and indeed, other SSA countries cannot be overemphasised.

Community Health Centers↗

PubMed2001

How to develop an operational plan for health.

BACKGROUND: About 88%, 8%, 36% and 28% of the ministries of health in African countries do not have long-term health plans (LTHPs), health policies (HPs), strategic plans (SPs), and operational plans (OPs), respectively. Eight per cent, 38% and 54% of the countries with OPs rated their formulation as 'excellent', 'satisfactory' and 'needs improvement', respectively. OBJECTIVE(S): To provide a rationale for an OP; to describe its contents; and to explain the process of developing it. DESIGN: Descriptive study. SETTING: Operational plans in the WHO African Region. INTERVENTIONS: Non-intervention descriptive study. MAIN OUTCOME MEASURES: Operational plan (OP) for health. RESULTS: An OP framework and process that could be adapted by countries is proposed. CONCLUSION: An adequately formulated OP will contain objectives, targets, expected results, activities, required resources, and a monitoring and evaluation plan (consisting of responsibilities, monitoring indicators, evaluation indicators, data sources - for verifying indicators, and periodicity). In the next two decades, we envision that all the UN agencies and other health partners working in Africa will cooperate with individual countries to develop (or strengthen) LTHPs, HPs, SPs, and OPs of the Ministries of Health (national, provincial and district level).

Africa↗

PubMed2001

Evaluation of health-related programmes in Africa: a vision for 2020.

BACKGROUND: Whereas systematic evaluation practice is over five decades old in economically developed continents (DCs), that culture has not yet taken root in Africa. OBJECTIVE(S): To provide an overview of the current situation of health-related evaluation in the African Region; to envision an appropriate evaluation framework for the next two decades; and to provide overviews of what formative (FE) and summative (SE) evaluations are and how they could be conducted. DESIGN: Descriptive study. SETTING: Health policies and plans evaluation in the WHO African Region. SUBJECTS OR PARTICIPANTS: WHO Country Representatives for 25 African Countries. INTERVENTIONS: Non-intervention descriptive study. MAIN OUTCOME MEASURES: Availability and quality of long-term health plan (LTHP), health policy (HP), strategic plan (SP), operational plan (OP), and an evaluation culture. RESULTS: The study found that: 88%, 8%, 36%, 28% and 48% of the countries in the Region do not have LTHP, HP, SP, OP and evaluation culture. A conceptual evaluation framework, tools for formative and summative evaluations are proposed. CONCLUSION: It is envisioned that all partners for health development in Africa will cooperate with individual countries to develop (or strengthen) LTHPs, HPs, SPs, and Ministries of Health OPs (national, provincial and district level); and to make complementary investments in building technical and administrative capacity for evaluating implementation of District Operational Plans (DOPs).

Africa↗

PubMed1999

Health knowledge and smoking among South African women.

While several studies of developed countries have attempted to understand individual smoking using economic models, no such studies have been conducted in South Africa. The purpose of this paper is to identify which factors influence individual South African women's choice to smoke cigarettes and their knowledge of the health risks of smoking. To allow for the implied correlation between the unobservable components of the reduced form equations for these health inputs the model is estimated as a bivariate probit. In order to identify those women who are most at risk of becoming smokers and those who are most likely to benefit from health education, the results show how the probability of being an uninformed non-smoker or an uninformed smoker vary across different socio-economic groups.

Adult↗

PubMed1999

Predictors of women's decision to ask new partners to use condoms to avoid HIV/AIDS in South Africa.

OBJECTIVES: (i) to identify the key determinants of women's decision to ask a new partner to use condoms during sexual intercourse in order to reduce the probability of HIV infection. (ii) to estimate the impact of social, economic and educational factors identified above on the likelihood of a positive decision and; (iii) to explore the policy implications of the analysis. DESIGN: Cross-sectional national household sample survey. SETTING: South African Health Inequalities Survey, 1994. SUBJECTS OR PARTICIPANTS: Three thousand three hundred and thirty three South African women aged between 16 and 64 years. INTERVENTIONS: Descriptive/inferential non-intervention study. MAIN OUTCOME MEASURES: Respondent's decision to ask one's new partner to use a condom during sexual intercourse. RESULTS: The study revealed that condoms have a contraceptive benefit; AIDS epidemic is spreading rapidly across South Africa; people in ones own community are using condoms to avoid getting AIDS; and AIDS can be transmitted by having sexual intercourse with someone without using a condom were positive and statistically significant at p < or = 0.05. CONCLUSION: Equipping women with above mentioned forms of knowledge would go a long way in empowering them to exercise their rights to uncoerced choice to have safe sexual relationships.

Adolescent↗

PubMed1998

Economic evaluation in schistosomiasis: valuation of health states preferences. A research note.

Poor countries can ill-afford ineffective health care. An effective disease intervention is one which produces a net improvement in beneficiaries' quality of life and/or increases life expectancy. Unlike developed countries, very little research has been done in developing countries on the measures of the ultimate output of health care. The objectives of this study were to: (i) apply the existing health-related quality of life (HRQoL) methods in eliciting health state valuations from farmers, teachers and health professionals living and working in the schistosomiasis endemic Mwea Irrigation Scheme in Kenya; (ii) determine whether there is significant difference between average health states valuations from the three main groups of people at risk of schistosomiasis infection; and (iii) assess the relative effect of different respondent characteristics and health states prognosis on valuations. The instrument consists of seven health state descriptions-each defined along six functional dimensions: self-care, mobility, livelihood activities, energy, social participation and pain. Cardinal health state values were measured using a visual-analogue-scale (VAS). Values were elicited from three random samples of farming general public, medical professionals and teachers. The Kruskal-Wallis one-way ANOVA test showed that there is significant difference in the average health state values (for mild, moderate, severe, very severe and comatose states) obtained from the three samples. Generally, except for the valuation of the immediately following state, the other explanatory variables are not statistically significant determinants of valuations for the mild, moderate, severe and very severe states. The results suggest that VAS valuations are primarily affected by prognosis. There is urgent need for more representative and systematic HRQoL studies to test the relevance of the Western-based generic instruments in African countries contexts, with a view to developing more appropriate tool(s) if necessary.

Adult↗

PubMed1998

The cost of treating paediatric malaria admissions and the potential impact of insecticide-treated mosquito nets on hospital expenditure.

OBJECTIVE: To calculate the costs at Kilifi District Hospital (KDH) and Malindi Sub-district Hospital (MSH) of treating paediatric malaria admissions including three common presentations of severe paediatric malaria, i.e. cerebral malaria, severe malaria anaemia and malaria-associated seizures; and to estimate the implications for hospital expenditure of a reduction in paediatric malaria admissions. METHODS: Patient data were obtained from hospital records. All costs were allocated to departments that provided direct patient care by a four-stage step-down procedure. Laboratory and drug costs of treating paediatric malaria admissions were separately identified. RESULT: Unit recurrent costs per admission in KDH ranged from US $57 for 'other' paediatric malaria to US $105 for cerebral malaria, and in MSH from US $33 to US $44 for the same categories. The annual recurrent cost of treating all paediatric malaria admissions to KDH prior to the trial was estimated at US $78 900. Adjusting for preintervention differences in malaria admission rates and age between intervention and control areas, the ITBN trial found a 41% reduction in paediatric malaria admissions. The reduction in admissions resulted in an estimated saving of US $6240 in the cost of treating paediatric malaria admissions from the intervention area. CONCLUSION: There would be a substantial reduction in costs of treating paediatric malaria admissions if the intervention were introduced in the whole catchment area of the hospital. Actual savings would depend on the proportion of potential savings that can in practice be realised, and on the effectiveness of the intervention when routinely implemented.

Anemia↗

PubMed1997

Economic evaluation in schistosomiasis: using the Delphi technique to assess effectiveness.

The limited resources allocated to Schistosomiasis Control Programme in Kenya are not adequate to implement and sustain all technically efficacious interventions simultaneously. This fact has dawned upon both policy-makers and medical personnel who hitherto advocated a multi-faceted approach to 'eradicate' schistosomiasis. Given that Kenya cannot afford to implement all interventions that might conceivably be of some benefit, it is necessary to establish priorities based on considerations of both costs and benefits. An important part of the benefit of any health intervention is its effect on health (quality and quantity of life) of potential beneficiaries. The objectives of this study were to: identify relevant types of data needed in estimating impacts of schistosomiasis interventions on health status; develop an instrument which can be used to obtain subjective probabilistic impacts of interventions; test its operational feasibility; develop a conceptual framework within which impacts of interventions can be estimated; illustrate how the probabilities could be used in calculating the 'expected quality adjusted life years' (EQALY); and identify obstacles that need to be overcome within a developing country context. In this study, a 'modified Delphi' approach was used to elicit expert subjective judgements on the effectiveness of ten schistosomiasis interventions. The paper compares and contrasts the expected quality adjusted life years estimated using values obtained from two local schistosomiasis experts with those obtained from a foreign expert. The panelists appeared to be consistent in their ranking of the effectiveness of treatment vs. non-treatment options. However, there were large differences in the magnitudes of estimates obtained from the local and the foreign experts. Given that the Delphi technique has been widely and fruitfully used in industry and commerce (among other areas) in developed countries, African countries health policy-makers cannot possibly do worse (than the current practice where decisions to commit resources are based on 'what we did last time' and 'gut feelings') by using systematic decision analyses based on data from such a technique.

Cost-Benefit Analysis↗