Internal contracting of health services in Cambodia: drivers for change and lessons learned after a decade of external contracting.

Background: Since the late 1990s, contracting has been employed in Cambodia in an attempt to accelerate rural health system recovery and improve health service delivery. Special Operating Agencies (SOA), a form of 'internal contracting', was introduced into selected districts by the Cambodia Ministry of Health in 2009. This study investigates how the SOA model was implemented and identifies effects on service delivery, challenges in operation and lessons learned.

Where is Nepal in the nutrition transition?

Background And Objective: Nutrition transition is rapid in developing countries, but Nepalese transition is relatively unknown. This study aimed to describe nutrition transition in Nepal over the past 40 years by identifying the shifts in the Nepalese diets and nutritional status and the underlying shifts associated with this.

Methods And Study Design: Popkin's framework was used to identify shifts in Nepalese diet and the inter-relationship of diet with epidemiological, demographic and economic shifts.

The economic burden of HIV/AIDS on individuals and households in Nepal: a quantitative study.

Background: There have been only limited studies assessing the economic burden of HIV/AIDS in terms of direct costs, and there has been no published study related to productivity costs in Nepal. Therefore, this study explores in detail the economic burden of HIV/AIDS, including direct costs and productivity costs. This paper focuses on the direct costs of seeking treatment, productivity costs, and related factors affecting direct costs, and productivity costs.

Economic Burden of HIV/AIDS Upon Households in Nepal: A Critical Review.

Thousands of people are infected with HIV/AIDS in Nepal and most of them are adults of working age. Therefore, HIV/AIDS is a big burden in Nepal. This review was conducted to find the existing knowledge gap about the economic burden of HIV/AIDS at the household level in Nepal, the extent of economic burden exerted by the disease, and to provide policy recommendations.

Removing financial barriers to access reproductive, maternal and newborn health services: the challenges and policy implications for human resources for health.

Background: The last decade has seen widespread retreat from user fees with the intention to reduce financial constraints to users in accessing health care and in particular improving access to reproductive, maternal and newborn health services. This has had important benefits in reducing financial barriers to access in a number of settings. If the policies work as intended, service utilization rates increase.

Productivity cost due to maternal ill health in Sri Lanka.

Background: The global impact of maternal ill health on economic productivity is estimated to be over 15 billion USD per year. Global data on productivity cost associated with maternal ill health are limited to estimations based on secondary data. Purpose of our study was to determine the productivity cost due to maternal ill health during pregnancy in Sri Lanka.

Applying the net-benefit framework for analyzing and presenting cost-effectiveness analysis of a maternal and newborn health intervention.

Background: Coverage of maternal and newborn health (MNH) interventions is often influenced by important determinants and decision makers are often concerned with equity issues. The net-benefit framework developed and applied alongside clinical trials and in pharmacoeconomics offers the potential for exploring how cost-effectiveness of MNH interventions varies at the margin by important covariates as well as for handling uncertainties around the ICER estimate.

Aim: We applied the net-benefit framework to analyze cost-effectiveness of the Skilled Care Initiative and assessed relative advantages over a standard computation of incremental cost effectiveness ratios.

Applying the net-benefit framework for assessing cost-effectiveness of interventions towards universal health coverage.

In assessing the cost-effectiveness of an intervention, the interpretation and handling of uncertainties of the traditional summary measure, the Incremental Cost Effectiveness Ratio (ICER), can be problematic. This is particularly the case with strategies towards universal health coverage in which the decision makers are typically concerned with coverage and equity issues. We explored the feasibility and relative advantages of the net-benefit framework (NBF) (compared to the more traditional Incremental Cost-Effectiveness Ratio, ICER) in presenting results of cost-effectiveness analysis of a community based health insurance (CBHI) scheme in Nouna, a rural district of Burkina Faso.

A systematic review of economic evaluations of chemoprophylaxis for tuberculosis.

Since treatment of active disease remains the priority for tuberculosis control, donors and governments need to be convinced that investing resources in chemoprophylaxis provides health benefits and is good value for money. The limited evidence of cost effectiveness has often been presented in a fragmentary and inconsistent fashion. Objective.

Willingness to pay for maternal health outcomes: are women willing to pay more than men?

Background: Only a limited number of studies have specifically sought to analyse and try to understand sex differences in willingness to pay (WTP).

Objective: To identify the role of sex in determining monetary values placed upon improvements in maternal health in Burkina Faso, West Africa.

Methods: A contingent valuation survey using the bidding game method was conducted in the district of Nouna in 2005; a sample of 409 male heads of households and their spouses were asked their WTP for a reduction in the number of maternal deaths in the Nouna area.

Estimates of health care system costs of unsafe abortion in Africa and Latin America.

Context: Each year, 19 million unsafe abortions occur in developing countries, and an estimated five million women are treated for the resulting serious medical complications. Meanwhile, the economic impact of postabortion care on health care systems in Africa and Latin America is poorly understood (data for Asia are lacking).

Methods: Two main approaches were used to estimate the cost of postabortion care: calculating the average cost of care per patient, as represented in 20 empirical studies, and analyzing treatment costs using the WHO Mother-Baby Package model, which enumerates the costs of specific components of treatment related to postabortion complications.

A cost-effectiveness study of caesarean-section deliveries by clinical officers, general practitioners and obstetricians in Burkina Faso.

Background: The aim of this paper was to evaluate the effectiveness and cost-effectiveness of alternative training strategies for increasing access to emergency obstetric care in Burkina Faso.

Methods: Case extraction forms were used to record data on 2305 caesarean sections performed in 2004 and 2005 in hospitals in six out of the 13 health regions of Burkina Faso. Main effectiveness outcomes were mothers' and newborns' case fatality rates.

A game of two halves? Incentive incompatibility, starting point bias and the bidding game contingent valuation method.

The bidding game (BG) method of contingent valuation is one way to increase the precision of willingness to pay (WTP) estimates relative to the single dichotomous choice approach. However, there is evidence that the method may lead to incentive incompatible responses and be associated with starting point bias. While previous studies in health using BGs test for starting point bias, none have also investigated incentive incompatibility.

Assessing the costs and cost-effectiveness of a skilled care initiative in rural Burkina Faso.

Objectives: The objectives of this study were to assess the cost-effectiveness of a skilled attendance strategy (the Skilled Care Initiative, SCI) in enhancing maternal health care in a remote, rural district of Burkina Faso and to analyse more broadly the costs and cost patterns of maternal health provision in the intervention and comparison districts.

Methods: The approach used was to cost the standard provision of maternal care, to analyse the main cost structures, and to derive cost estimates per facility. The additional costs attributable to SCI were identified.

Costing universal access of highly active antiretroviral therapy in Benin.

The study aimed to estimate costs of provision and access to highly active antiretroviral therapy (HAART) in order to assist in planning and resource allocation regarding scaling up and sustainable access to HAART in Benin. A prospective study was carried out to collect data on costs of provision of care at the Outpatient Treatment Centre (OTC) of the National University hospital in Cotonou, Benin and on costs borne by people living with HIV/AIDS (PLWHA) and their families in accessing care. We used an Excel model, a macro costing approach and WHO guidelines for costing health services.