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Biomedical subjects

Kara Hanson

Publications and source records attributed to Kara Hanson.

28 records · Page 2Linked to original sources
PubMed2003

Cost-effectiveness of social marketing of insecticide-treated nets for malaria control in the United Republic of Tanzania.

OBJECTIVE: To assess the costs and consequences of a social marketing approach to malaria control in children by means of insecticide-treated nets in two rural districts of the United Republic of Tanzania, compared with no net use. METHODS: Project cost data were collected prospectively from accounting records. Community effectiveness was estimated on the basis of a nested case-control study and a cross-sectional cluster sample survey. FINDINGS: The social marketing approach to the distribution of insecticide-treated nets was estimated to cost 1560 US dollars per death averted and 57 US dollars per disability-adjusted life year averted. These figures fell to 1018 US dollars and 37 US dollars, respectively, when the costs and consequences of untreated nets were taken into account. CONCLUSION: The social marketing of insecticide-treated nets is an attractive intervention for preventing childhood deaths from malaria.

Bedding and Linens↗
PubMed2003

Methods for studying private sector supply of public health products in developing countries: a conceptual framework and review.

The private sector is an important supplier of public health products (PHPs) in developing countries. Although there are concerns about the quality and affordability of these products, private providers also offer possibilities for expanding access to key commodities. This paper proposes a conceptual framework for understanding the public health implications of private sales of PHPs. It reviews methods for studying these sales, together with their advantages and shortcomings. Ten methods are identified which can be used for studying the behaviour of providers and consumers. The effects of seasonal variation are discussed, together with the challenges of creating a sampling frame and studying illicit behaviour. We conclude that relatively little is known about the sales of PHPs, that more is known about contraceptives and drugs than about the newer products, and that the demand side of the market has been studied in greater depth than the behaviour of suppliers. The existing toolbox is biased towards formal providers, and thus, probably towards understanding the provision of PHPs to those who are better off. Methods for studying the supply of PHPs in outlets used by poor people is a priority area for further methodological development.

Commerce↗
PubMed2003

Who buys insecticide-treated nets? Implications for increasing coverage in Nigeria.

OBJECTIVES: To investigate the determinants of purchase of insecticide-treated nets (ITNs) and explore the policy implications of the findings for ITN programmes. METHODS: Two surveys were conducted 1 month apart in three villages. The first survey was used to determine stated willingness to pay (WTP) and respondent practices regarding untreated nets and ITNs. The second survey was accompanied by actual sales of ITNs. Pre-tested interviewer-administered questionnaires using three contingent valuation method (CVM) question formats, namely the bidding game (BG), binary with follow up (BWFU) and a structured haggling technique (SH), were administered to different sub-samples of the respondents. The nets were sold at a price of 350 Naira (US dollars 1 = 110 Naira). Bivariate analysis and logistic regression were used to investigate the factors that explain actual WTP. FINDINGS: While 15/158 (9.5%), 21/166 (12.7%) and 35/144 (24.3%) of the respondents in the BG, BWFU and SH stated WTP amounts that were equal to or greater than the price of the net, 19.6%, 24.7% and 24.3% of respondents actually purchased the nets in the three groups respectively. Lower socioeconomic groups were less likely to purchase the nets, while households with a recent attack of malaria and those that stated higher WTP amounts were more likely to purchase nets. Stated WTP was positively associated with actual WTP (p < 0.01). Increased distance of the respondents to the ITNs sales point decreased net purchases (p < 0.05). CONCLUSIONS: Stated WTP was a good predictor of actual WTP. ITNs distribution strategies that will decrease time and travel costs to households are needed to increase net coverage. Also, ITNs financing mechanisms are needed that will ensure that lower socioeconomic groups and those at greater risk of malaria are protected. Governments and donors should take the lead to ensure that ITNs programmes are equitable.

Adult↗
PubMed2002

Improving the health of the global poor.

We analyzed the technical basis for a major global program to reduce disease among the poor. Effective interventions exist against the few diseases which most account for excess mortality among the poor. Achieving high coverage of effective interventions requires a well-functioning health system, as well as overcoming a set of financial and nonfinancial constraints. The annual incremental cost would be between $40 billion and $52 billion by 2015 in 83 low-income and sub-Saharan African countries. Such a program is feasible and would avoid millions of child, maternal, and adult deaths annually in poor countries.

Adult↗
PubMed2002

Towards improving hospital performance in Uganda and Zambia: reflections and opportunities for autonomy.

Hospitals have been relatively neglected although their high resource consumption implies that gains from improving the services they deliver may be substantial. Nevertheless, the challenges posed by hospital reforms are great. Hospital autonomy usually consists of both decentralisation, and a greater measure of exposure to market forces. In Uganda and Zambia, more traditional 'decentralisation' of authority to district level authorities includes district hospitals; and some measure of 'autonomy' (known as 'self-accounting status' in Uganda) has been applied to some or all second and third level referral hospitals. The hospital policies pursued in both countries present opportunities to tackle their hospital sectors. In Zambia, purchasing of services means that new incentives and policy mechanisms can come into play. Little advantage has been taken of these opportunities to date. In Uganda, there is no financial link between districts and higher levels of the system, but decentralisation of control over personnel is more advanced. These two components--the alignment of incentives (to promote access and quality for those intended to be covered by the public budget) and the effective decentralisation of control over key resources--seem to us the key tools to address the stubborn problems of hospitals.

Efficiency, Organizational↗
PubMed2002

What can be done about the private health sector in low-income countries?

A very large private health sector exists in low-income countries. It consists of a great variety of providers and is used by a wide cross-section of the population. There are substantial concerns about the quality of care given, especially at the more informal end of the range of providers. This is particularly true for diseases of public health importance such as tuberculosis, malaria, and sexually transmitted infections. How can the activities of the private sector in these countries be influenced so that they help to meet national health objectives? Although the evidence base is not good, there is a fair amount of information on the types of intervention that are most successful in directly influencing the behaviour of providers and on what might be the necessary conditions for success. There is much less evidence, however, of effective approaches to interventions on the demand side and policies that involve strengthening the purchasing and regulatory roles of governments.

Consumer Advocacy↗
PubMed2002

What can be done about the private health sector in low-income countries?

A very large private health sector exists in low-income countries. It consists of a great variety of providers and is used by a wide cross-section of the population. There are substantial concerns about the quality of care given, especially at the more informal end of the range of providers. This is particularly true for diseases of public health importance such as tuberculosis, malaria, and sexually transmitted infections. How can the activities of the private sector in these countries be influenced so that they help to meet national health objectives? Although the evidence base is not good, there is a fair amount of information on the types of intervention that are most successful in directly influencing the behaviour of providers and on what might be the necessary conditions for success. There is much less evidence, however, of effective approaches to interventions on the demand side and policies that involve strengthening the purchasing and regulatory roles of governments.

Communicable Disease Control↗
PubMedDate not supplied

Markets for hospital services in Zambia.

Hospital reforms involving the introduction of measures to increase competition in hospital markets are being implemented in a range of low and middle-income countries. However, little is understood about the operation of hospital markets outside the USA and the UK. This paper assesses the degree of competition for hospital services in two hospital markets in Zambia (Copperbelt and Midlands), and the implications for prices, quality and efficiency. We found substantial differences among different hospital types in prices, costs and quality, suggesting that the hospital service market is a segmented market. The two markets differ significantly in their degree of competition, with the high cost inpatient services market in Copperbelt relatively more competitive than that in the Midlands market. The implications of these differences are discussed in terms of the potential for competition to improve hospital performance, the impact of market structure on equity of access, and how the government should address the problem of the mine hospitals.

Catchment Area, Health↗
PubMedDate not supplied

Achieving universal coverage with health interventions.

Cost-effective public health interventions are not reaching developing country populations who need them. Programmes to deliver these interventions are too often patchy, low quality, inequitable, and short-lived. We review the challenges of going to scale, building on known, effective interventions to achieve universal coverage. One challenge is to choose interventions consistent with the epidemiological profile of the population. A second is to plan for context-specific delivery mechanisms effective in going to scale, and to avoid uniform approaches. A third is to develop innovative delivery mechanisms that move incrementally along the vertical-to-horizontal axis as health systems gain capacity in service delivery. The availability of sufficient funds is essential, but constraints to reaching universal coverage go well beyond financial issues. Accurate estimates of resource requirements need a full understanding of the factors that limit intervention delivery. Sound decisions need to be made about the choice of delivery mechanisms, the sequence of action, and the pace at which services can be expanded. Strong health systems are required, and the time frames and funding cycles of national and international agencies are often unrealistically short.

Cost-Benefit Analysis↗