Angela Kairu - Academia.edu (original) (raw)
Papers by Angela Kairu
Cost Effectiveness and Resource Allocation, Feb 13, 2023
Essential Emergency and Critical Care (EECC) is a novel approach to the care of critically ill pa... more Essential Emergency and Critical Care (EECC) is a novel approach to the care of critically ill patients, focusing on firsttier, effective, low-cost, life-saving care and designed to be feasible even in low-resourced and low-staffed settings. This is distinct from advanced critical care, usually conducted in ICUs with specialised staff, facilities and technologies. This paper estimates the incremental cost of EECC and advanced critical care for the planning of care for critically ill patients in Tanzania and Kenya. The incremental costing took a health systems perspective. A normative approach based on the ingredients defined through the recently published global consensus on EECC was used. The setting was a district hospital in which the patient is provided with the definitive care typically provided at that level for their condition. Quantification of resource use was based on COVID-19 as a tracer condition using clinical expertise. Local prices were used where available, and all costs were converted to USD2020. The costs per patient day of EECC is estimated to be 1 USD, 11 USD and 33 USD in Tanzania and 2 USD, 14 USD and 37 USD in Kenya, for moderate, severe and critical COVID-19 patients respectively. The cost per patient day of advanced critical care is estimated to be 13 USD and 294 USD in Tanzania and USD 17 USD and 345 USD in Kenya for severe and critical COVID-19 patients, respectively. EECC is a novel approach for providing the essential care to all critically ill patients. The low costs and lower tech approach inherent in delivering EECC mean that EECC could be provided to many and suggests that prioritizing EECC over ACC may be a rational approach when resources are limited.
Sexually transmitted infections (STIs) remain a global public health concern. Together with bacte... more Sexually transmitted infections (STIs) remain a global public health concern. Together with bacterial vaginosis (BV), the association with HIV acquisition through genital inflammation in women poses a challenge towards the control of HIV/AIDS, more so in asymptomatic cases. Diagnosis of asymptomatic women using a genital inflammation screening tool, the cytokine biomarker rapid test, reduces the cases of untreated women. However, as a newly developed screening tool, there are no prior cost estimates to advocate for its funding and implementation. This study estimated the costs of genital inflammation screening of women (15-49 years) and, assessed the budget impact of providing this screening service in primary health facilities in South Africa in 2016. This thesis is a sub-study of the GIFT project (Genital Inflammation Test for HIV Prevention) whose main objective is HIV prevention through improved control of sexually transmitted infections (STIs). The micro-costing approach was used to calculate the unit cost per patient screened from a provider’s perspective at the Desmond Tutu HIV Foundation youth clinic (DTHF), and, the University of Cape Town Student Wellness Service (UCT SWS), over a 1 year period. The unit cost estimates were used to analyse the budget impact of scaling-up and providing the screening service in primary health facilities countrywide. . Sensitivity analyses were carried out to determine the robustness of the study findings. The results demonstrated that the cost per woman screened for genital inflammation was 24.26atDTHFand24.26 at DTHF and 24.26atDTHFand14.32 at UCT SWS. The scaled up costs ranged from 107,183,655to107,183,655 to 107,183,655to183,062,066 in South Africa. The screening intervention accounted for a significant amount of the available funds. The cost estimates were sensitive to the personnel costs, clinic utilization rates and population coverage rates. According to this study, it can be concluded that, the cost estimates of screening are high, and its implementation may not be affordable within the current budget. However, this screening tool will increase the cases detected, contributing towards better STIs management and control. Additionally, it will reduce the risk of HIV acquisition among women
BMJ Global Health
The financing of public health facilities influences their performance. A key feature that define... more The financing of public health facilities influences their performance. A key feature that defines health facility financing is the degree of financial autonomy. Understanding the factors that influence public health facility financial autonomy is pertinent to developing strategies to addressing challenges that arise from constrained autonomy. In this paper, we apply a complexity lens to draw on a body of research that we have conducted in Kenya over the past decade, from the onset of devolution reforms, to unpack the determinants of public health facility financial autonomy in a context of decentralisation and provide suggestions for pertinent considerations when designing interventions to address financial autonomy challenges. We find that the factors that affect public health facility autonomy are not only structural, but also procedural, and political and interact in complex ways. These factors include; the public finance management (PFM) laws, sense-making by actors in the heal...
International Journal of Public Health, Jun 28, 2022
Objective: To estimate the economic impact of border closure and social distancing by estimating ... more Objective: To estimate the economic impact of border closure and social distancing by estimating the decline of gross domestic product (GDP) in Kenya, Singapore and Thailand. Methods: We analysed secondary data retrospectively. To calculate impact of NPIs on GDP, the relationship between GDP and stock market index was examined using ordinary least squares (OLS). Then, autoregressive and moving averages (ARMA) model was used to examine the impact of NPI on stock market index. The change in GDP due to NPIs was derived by multiplying coefficients of OLS and ARMA models. Results: An increase in stock market index correlated with an increase in GDP, while both social distancing and border closure negatively correlated with stock market index. Implementation of NPIs correlated with the decline in GDP. Thai border closure had a greater decline in GDP than social distancing; Kenya exhibited the same trends; Singapore had the opposite trend. Conclusion: We quantified the magnitude of economic impact of NPIs in terms of GDP decline by linking stock market index and GDP. This approach may be applicable in other settings.
Essential Emergency and Critical Care (EECC) is a novel approach to the care of critically ill pa... more Essential Emergency and Critical Care (EECC) is a novel approach to the care of critically ill patients, focusing on first-tier, low-cost care and designed to be feasible even in low-resourced and low-staffed settings. This is distinct from advanced critical care, usually conducted in ICUs with specialised staff, facilities and technologies. This paper estimates the incremental cost of EECC and advanced critical care for the planning of care for critically ill patients in low resource settings with Kenya and Tanzania as case studies.The incremental costing took a health systems perspective. A normative approach based on the ingredients defined through the recently published global consensus on EECC was used. The setting was a district hospital in which the patient is provided with the definitive care typically provided at that level for their condition. Quantification of resource use was based on COVID-19 as a tracer condition using clinical expertise. Local prices were used where a...
2021 World Congress on Health Economics, Jul 13, 2021
This dataset contains the costs of direct ancillary services (outputs) for TB, as estimated in th... more This dataset contains the costs of direct ancillary services (outputs) for TB, as estimated in the Value TB project. Data was collected in 78 health facilities across five countries (including Kenya, Ethiopia, India, Philippines, and Georgia). Data contains the total cost incurred at the facility level, the total quantity of outputs delivered at each facility during the costing period, and the unit cost of delivering one output. Total and unit costs are detailed by input (including staff time, building space, capital, equipment, supplies, etc).
BMJ Global Health, 2021
ObjectivesCOVID-19 has altered health sector capacity in low-income and middle-income countries (... more ObjectivesCOVID-19 has altered health sector capacity in low-income and middle-income countries (LMICs). Cost data to inform evidence-based priority setting are urgently needed. Consequently, in this paper, we calculate the full economic health sector costs of COVID-19 clinical management in 79 LMICs under different epidemiological scenarios.MethodsWe used country-specific epidemiological projections from a dynamic transmission model to determine number of cases, hospitalisations and deaths over 1 year under four mitigation scenarios. We defined the health sector response for three base LMICs through guidelines and expert opinion. We calculated costs through local resource use and price data and extrapolated costs across 79 LMICs. Lastly, we compared cost estimates against gross domestic product (GDP) and total annual health expenditure in 76 LMICs.ResultsCOVID-19 clinical management costs vary greatly by country, ranging between <0.1%–12% of GDP and 0.4%–223% of total annual hea...
BMJ Global Health, 2021
BackgroundUser fees have been reported to limit access to services and increase inequities. As a ... more BackgroundUser fees have been reported to limit access to services and increase inequities. As a result, Kenya introduced a free maternity policy in all public facilities in 2013. Subsequently in 2017, the policy was revised to the Linda Mama programme to expand access to private sector, expand the benefit package and change its management.MethodsAn interrupted time-series analysis on facility deliveries, antenatal care (ANC) and postnatal care (PNC) visits data between 2012 and 2019 was used to determine the effect of the two free maternity policies. These data were from 5419 public and 305 private and faith-based facilities across all counties, with data sourced from the health information system. A segmented negative binomial regression with seasonality accounted for, was used to determine the level (immediate) effect and trend (month-on-month) effect of the policies.ResultsThe 2013 free-maternity policy led to a 19.6% and 28.9% level increase in normal deliveries and caesarean s...
PharmacoEconomics, 2020
In the original version of this article, Fig. 3 was published in an incorrect format. The correct... more In the original version of this article, Fig. 3 was published in an incorrect format. The correct figure is published with this correction.
ABSTRACTIntroductionVaccines are considered the path out of the COVID-19 pandemic. The government... more ABSTRACTIntroductionVaccines are considered the path out of the COVID-19 pandemic. The government of Kenya is implementing a phased strategy to vaccinate the Kenyan population, initially targeting populations at high risk of severe disease and infection. We estimated the financial and economic unit costs of procuring and delivering the COVID-19 vaccine in Kenya across various vaccination strategies.MethodsWe used an activity-based costing approach to estimate the incremental costs of COVID-19 vaccine delivery, from a health systems perspective. Document reviews and key informant interviews (n=12) were done to inform the activities, assumptions and the resources required. Unit prices were derived from document reviews or from market prices. Both financial and economic vaccine procurement costs per person vaccinated with 2-doses, and the vaccine delivery costs per person vaccinated with 2-doses were estimated and reported in 2021USD.ResultsThe financial costs of vaccine procurement pe...
The International Journal of Tuberculosis and Lung Disease, 2021
BACKGROUND: The reduction of Kenya´s TB burden requires improving resource allocation both to and... more BACKGROUND: The reduction of Kenya´s TB burden requires improving resource allocation both to and within the National TB, Leprosy and Lung Disease Program (NTLD-P). We aimed to estimate the unit costs of TB services for budgeting by NTLD-P, and allocative efficiency analyses for future National Strategic Plan (NSP) costing.METHODS: We estimated costs of all TB interventions in a sample of 20 public and private health facilities from eight counties. We calculated national-level unit costs from a health provider´s perspective using bottom-up (BU) and top-down (TD) approaches for the financial year 2017–2018 using Microsoft Excel and STATA v16.RESULTS: The mean unit cost for passive case-finding (PCF) was respectively US$38 and US$60 using the BU and TD approaches. The unit BU and TD costs of a 6-month first-line treatment (FLT) course, including monitoring tests, was respectively US$135 and US$160, while those for adult drug-resistant TB (DR-TB) treatment was respectively US$3,230.28 ...
ABSTRACTBackgroundCase management of symptomatic COVID-19 patients is a key health system interve... more ABSTRACTBackgroundCase management of symptomatic COVID-19 patients is a key health system intervention. The Kenyan government embarked to fill capacity gaps in essential and advanced critical care needed for the management of severe and critical COVID-19. However, given scarce resources, gaps in both essential and advanced critical care persist. This study assessed the cost-effectiveness of investments in essential and advanced critical care to inform the prioritization of investment decisions.MethodsWe employed a decision tree model to assess the incremental cost-effectiveness of investment in essential care (EC) and investment in both essential and advanced critical care (EC+ACC) compared to current health care provision capacity (status quo) for COVID-19 patients in Kenya. We used a health system perspective, and an inpatient care episode time horizon. Cost data was obtained from primary empirical analysis while outcomes data was obtained from epidemiological model estimates. We ...
PharmacoEconomics
Background There is a need for easily accessible tuberculosis unit cost data, as well as an under... more Background There is a need for easily accessible tuberculosis unit cost data, as well as an understanding of the variability of methods used and reporting standards of that data. Objective The aim of this systematic review was to descriptively review papers reporting tuberculosis unit costs from a healthcare provider perspective looking at methodological variation; to assess quality using a study quality rating system and machine learning to investigate the indicators of reporting quality; and to identify the data gaps to inform standardised tuberculosis unit cost collection and consistent principles for reporting going forward. Methods We searched grey and published literature in five sources and eight databases, respectively, using search terms linked to cost, tuberculosis and tuberculosis health services including tuberculosis treatment and prevention. For inclusion, the papers needed to contain empirical unit cost estimates for tuberculosis interventions from low- and middle-inc...
BMC Health Services Research
Background How health facilities are financed affects their performance and health system goals. ... more Background How health facilities are financed affects their performance and health system goals. We examined how health facilities in the public sector are financed in Kenya, within the context of a devolved health system. Methods We carried out a cross-sectional study in five purposely selected counties in Kenya, using a mixed methods approach. We collected data using document reviews and in-depth interviews (no = 20). In each county, we interviewed county department of health managers and health facility managers from two and one purposely selected public hospitals and health center respectively. We analyzed qualitive data using thematic analysis and conducted descriptive analysis of quantitative data. Results Planning and budgeting: Planning and budgeting processes by hospitals and health centers were not standardized across counties. Budgets were not transparent and credible, but rather were regarded as “wish lists” since they did not translate to actual resources. Sources of fu...
Sexually Transmitted Diseases
Value in Health Regional Issues
The International Journal of Health Planning and Management
IntroductionCase management for COVID-19 patients is one of key interventions in country response... more IntroductionCase management for COVID-19 patients is one of key interventions in country responses to the pandemic. Countries need information on the costs of case management to inform resource mobilization, planning and budgeting, purchasing arrangements, and assessments of the cost-effectiveness of interventions. We estimated unit costs for COVID-19 case management for patients with asymptomatic, mild to moderate, severe, and critical COVID-19 disease in Kenya.MethodsWe estimated per patient per day unit costs of COVID-19 case management for patients that are asymptomatic and those that have mild to moderate, severe, and critical symptoms. For asymptomatic and mild to moderate patients, we estimated unit costs for home-based care and institutional (hospitals and isolation centers). We used an ingredients approach, adopted a health system perspective and patient episode of care as our time horizon. We obtained data on inputs and their quantities from COVID-19 case management guidel...
Cost Effectiveness and Resource Allocation, Feb 13, 2023
Essential Emergency and Critical Care (EECC) is a novel approach to the care of critically ill pa... more Essential Emergency and Critical Care (EECC) is a novel approach to the care of critically ill patients, focusing on firsttier, effective, low-cost, life-saving care and designed to be feasible even in low-resourced and low-staffed settings. This is distinct from advanced critical care, usually conducted in ICUs with specialised staff, facilities and technologies. This paper estimates the incremental cost of EECC and advanced critical care for the planning of care for critically ill patients in Tanzania and Kenya. The incremental costing took a health systems perspective. A normative approach based on the ingredients defined through the recently published global consensus on EECC was used. The setting was a district hospital in which the patient is provided with the definitive care typically provided at that level for their condition. Quantification of resource use was based on COVID-19 as a tracer condition using clinical expertise. Local prices were used where available, and all costs were converted to USD2020. The costs per patient day of EECC is estimated to be 1 USD, 11 USD and 33 USD in Tanzania and 2 USD, 14 USD and 37 USD in Kenya, for moderate, severe and critical COVID-19 patients respectively. The cost per patient day of advanced critical care is estimated to be 13 USD and 294 USD in Tanzania and USD 17 USD and 345 USD in Kenya for severe and critical COVID-19 patients, respectively. EECC is a novel approach for providing the essential care to all critically ill patients. The low costs and lower tech approach inherent in delivering EECC mean that EECC could be provided to many and suggests that prioritizing EECC over ACC may be a rational approach when resources are limited.
Sexually transmitted infections (STIs) remain a global public health concern. Together with bacte... more Sexually transmitted infections (STIs) remain a global public health concern. Together with bacterial vaginosis (BV), the association with HIV acquisition through genital inflammation in women poses a challenge towards the control of HIV/AIDS, more so in asymptomatic cases. Diagnosis of asymptomatic women using a genital inflammation screening tool, the cytokine biomarker rapid test, reduces the cases of untreated women. However, as a newly developed screening tool, there are no prior cost estimates to advocate for its funding and implementation. This study estimated the costs of genital inflammation screening of women (15-49 years) and, assessed the budget impact of providing this screening service in primary health facilities in South Africa in 2016. This thesis is a sub-study of the GIFT project (Genital Inflammation Test for HIV Prevention) whose main objective is HIV prevention through improved control of sexually transmitted infections (STIs). The micro-costing approach was used to calculate the unit cost per patient screened from a provider’s perspective at the Desmond Tutu HIV Foundation youth clinic (DTHF), and, the University of Cape Town Student Wellness Service (UCT SWS), over a 1 year period. The unit cost estimates were used to analyse the budget impact of scaling-up and providing the screening service in primary health facilities countrywide. . Sensitivity analyses were carried out to determine the robustness of the study findings. The results demonstrated that the cost per woman screened for genital inflammation was 24.26atDTHFand24.26 at DTHF and 24.26atDTHFand14.32 at UCT SWS. The scaled up costs ranged from 107,183,655to107,183,655 to 107,183,655to183,062,066 in South Africa. The screening intervention accounted for a significant amount of the available funds. The cost estimates were sensitive to the personnel costs, clinic utilization rates and population coverage rates. According to this study, it can be concluded that, the cost estimates of screening are high, and its implementation may not be affordable within the current budget. However, this screening tool will increase the cases detected, contributing towards better STIs management and control. Additionally, it will reduce the risk of HIV acquisition among women
BMJ Global Health
The financing of public health facilities influences their performance. A key feature that define... more The financing of public health facilities influences their performance. A key feature that defines health facility financing is the degree of financial autonomy. Understanding the factors that influence public health facility financial autonomy is pertinent to developing strategies to addressing challenges that arise from constrained autonomy. In this paper, we apply a complexity lens to draw on a body of research that we have conducted in Kenya over the past decade, from the onset of devolution reforms, to unpack the determinants of public health facility financial autonomy in a context of decentralisation and provide suggestions for pertinent considerations when designing interventions to address financial autonomy challenges. We find that the factors that affect public health facility autonomy are not only structural, but also procedural, and political and interact in complex ways. These factors include; the public finance management (PFM) laws, sense-making by actors in the heal...
International Journal of Public Health, Jun 28, 2022
Objective: To estimate the economic impact of border closure and social distancing by estimating ... more Objective: To estimate the economic impact of border closure and social distancing by estimating the decline of gross domestic product (GDP) in Kenya, Singapore and Thailand. Methods: We analysed secondary data retrospectively. To calculate impact of NPIs on GDP, the relationship between GDP and stock market index was examined using ordinary least squares (OLS). Then, autoregressive and moving averages (ARMA) model was used to examine the impact of NPI on stock market index. The change in GDP due to NPIs was derived by multiplying coefficients of OLS and ARMA models. Results: An increase in stock market index correlated with an increase in GDP, while both social distancing and border closure negatively correlated with stock market index. Implementation of NPIs correlated with the decline in GDP. Thai border closure had a greater decline in GDP than social distancing; Kenya exhibited the same trends; Singapore had the opposite trend. Conclusion: We quantified the magnitude of economic impact of NPIs in terms of GDP decline by linking stock market index and GDP. This approach may be applicable in other settings.
Essential Emergency and Critical Care (EECC) is a novel approach to the care of critically ill pa... more Essential Emergency and Critical Care (EECC) is a novel approach to the care of critically ill patients, focusing on first-tier, low-cost care and designed to be feasible even in low-resourced and low-staffed settings. This is distinct from advanced critical care, usually conducted in ICUs with specialised staff, facilities and technologies. This paper estimates the incremental cost of EECC and advanced critical care for the planning of care for critically ill patients in low resource settings with Kenya and Tanzania as case studies.The incremental costing took a health systems perspective. A normative approach based on the ingredients defined through the recently published global consensus on EECC was used. The setting was a district hospital in which the patient is provided with the definitive care typically provided at that level for their condition. Quantification of resource use was based on COVID-19 as a tracer condition using clinical expertise. Local prices were used where a...
2021 World Congress on Health Economics, Jul 13, 2021
This dataset contains the costs of direct ancillary services (outputs) for TB, as estimated in th... more This dataset contains the costs of direct ancillary services (outputs) for TB, as estimated in the Value TB project. Data was collected in 78 health facilities across five countries (including Kenya, Ethiopia, India, Philippines, and Georgia). Data contains the total cost incurred at the facility level, the total quantity of outputs delivered at each facility during the costing period, and the unit cost of delivering one output. Total and unit costs are detailed by input (including staff time, building space, capital, equipment, supplies, etc).
BMJ Global Health, 2021
ObjectivesCOVID-19 has altered health sector capacity in low-income and middle-income countries (... more ObjectivesCOVID-19 has altered health sector capacity in low-income and middle-income countries (LMICs). Cost data to inform evidence-based priority setting are urgently needed. Consequently, in this paper, we calculate the full economic health sector costs of COVID-19 clinical management in 79 LMICs under different epidemiological scenarios.MethodsWe used country-specific epidemiological projections from a dynamic transmission model to determine number of cases, hospitalisations and deaths over 1 year under four mitigation scenarios. We defined the health sector response for three base LMICs through guidelines and expert opinion. We calculated costs through local resource use and price data and extrapolated costs across 79 LMICs. Lastly, we compared cost estimates against gross domestic product (GDP) and total annual health expenditure in 76 LMICs.ResultsCOVID-19 clinical management costs vary greatly by country, ranging between <0.1%–12% of GDP and 0.4%–223% of total annual hea...
BMJ Global Health, 2021
BackgroundUser fees have been reported to limit access to services and increase inequities. As a ... more BackgroundUser fees have been reported to limit access to services and increase inequities. As a result, Kenya introduced a free maternity policy in all public facilities in 2013. Subsequently in 2017, the policy was revised to the Linda Mama programme to expand access to private sector, expand the benefit package and change its management.MethodsAn interrupted time-series analysis on facility deliveries, antenatal care (ANC) and postnatal care (PNC) visits data between 2012 and 2019 was used to determine the effect of the two free maternity policies. These data were from 5419 public and 305 private and faith-based facilities across all counties, with data sourced from the health information system. A segmented negative binomial regression with seasonality accounted for, was used to determine the level (immediate) effect and trend (month-on-month) effect of the policies.ResultsThe 2013 free-maternity policy led to a 19.6% and 28.9% level increase in normal deliveries and caesarean s...
PharmacoEconomics, 2020
In the original version of this article, Fig. 3 was published in an incorrect format. The correct... more In the original version of this article, Fig. 3 was published in an incorrect format. The correct figure is published with this correction.
ABSTRACTIntroductionVaccines are considered the path out of the COVID-19 pandemic. The government... more ABSTRACTIntroductionVaccines are considered the path out of the COVID-19 pandemic. The government of Kenya is implementing a phased strategy to vaccinate the Kenyan population, initially targeting populations at high risk of severe disease and infection. We estimated the financial and economic unit costs of procuring and delivering the COVID-19 vaccine in Kenya across various vaccination strategies.MethodsWe used an activity-based costing approach to estimate the incremental costs of COVID-19 vaccine delivery, from a health systems perspective. Document reviews and key informant interviews (n=12) were done to inform the activities, assumptions and the resources required. Unit prices were derived from document reviews or from market prices. Both financial and economic vaccine procurement costs per person vaccinated with 2-doses, and the vaccine delivery costs per person vaccinated with 2-doses were estimated and reported in 2021USD.ResultsThe financial costs of vaccine procurement pe...
The International Journal of Tuberculosis and Lung Disease, 2021
BACKGROUND: The reduction of Kenya´s TB burden requires improving resource allocation both to and... more BACKGROUND: The reduction of Kenya´s TB burden requires improving resource allocation both to and within the National TB, Leprosy and Lung Disease Program (NTLD-P). We aimed to estimate the unit costs of TB services for budgeting by NTLD-P, and allocative efficiency analyses for future National Strategic Plan (NSP) costing.METHODS: We estimated costs of all TB interventions in a sample of 20 public and private health facilities from eight counties. We calculated national-level unit costs from a health provider´s perspective using bottom-up (BU) and top-down (TD) approaches for the financial year 2017–2018 using Microsoft Excel and STATA v16.RESULTS: The mean unit cost for passive case-finding (PCF) was respectively US$38 and US$60 using the BU and TD approaches. The unit BU and TD costs of a 6-month first-line treatment (FLT) course, including monitoring tests, was respectively US$135 and US$160, while those for adult drug-resistant TB (DR-TB) treatment was respectively US$3,230.28 ...
ABSTRACTBackgroundCase management of symptomatic COVID-19 patients is a key health system interve... more ABSTRACTBackgroundCase management of symptomatic COVID-19 patients is a key health system intervention. The Kenyan government embarked to fill capacity gaps in essential and advanced critical care needed for the management of severe and critical COVID-19. However, given scarce resources, gaps in both essential and advanced critical care persist. This study assessed the cost-effectiveness of investments in essential and advanced critical care to inform the prioritization of investment decisions.MethodsWe employed a decision tree model to assess the incremental cost-effectiveness of investment in essential care (EC) and investment in both essential and advanced critical care (EC+ACC) compared to current health care provision capacity (status quo) for COVID-19 patients in Kenya. We used a health system perspective, and an inpatient care episode time horizon. Cost data was obtained from primary empirical analysis while outcomes data was obtained from epidemiological model estimates. We ...
PharmacoEconomics
Background There is a need for easily accessible tuberculosis unit cost data, as well as an under... more Background There is a need for easily accessible tuberculosis unit cost data, as well as an understanding of the variability of methods used and reporting standards of that data. Objective The aim of this systematic review was to descriptively review papers reporting tuberculosis unit costs from a healthcare provider perspective looking at methodological variation; to assess quality using a study quality rating system and machine learning to investigate the indicators of reporting quality; and to identify the data gaps to inform standardised tuberculosis unit cost collection and consistent principles for reporting going forward. Methods We searched grey and published literature in five sources and eight databases, respectively, using search terms linked to cost, tuberculosis and tuberculosis health services including tuberculosis treatment and prevention. For inclusion, the papers needed to contain empirical unit cost estimates for tuberculosis interventions from low- and middle-inc...
BMC Health Services Research
Background How health facilities are financed affects their performance and health system goals. ... more Background How health facilities are financed affects their performance and health system goals. We examined how health facilities in the public sector are financed in Kenya, within the context of a devolved health system. Methods We carried out a cross-sectional study in five purposely selected counties in Kenya, using a mixed methods approach. We collected data using document reviews and in-depth interviews (no = 20). In each county, we interviewed county department of health managers and health facility managers from two and one purposely selected public hospitals and health center respectively. We analyzed qualitive data using thematic analysis and conducted descriptive analysis of quantitative data. Results Planning and budgeting: Planning and budgeting processes by hospitals and health centers were not standardized across counties. Budgets were not transparent and credible, but rather were regarded as “wish lists” since they did not translate to actual resources. Sources of fu...
Sexually Transmitted Diseases
Value in Health Regional Issues
The International Journal of Health Planning and Management
IntroductionCase management for COVID-19 patients is one of key interventions in country response... more IntroductionCase management for COVID-19 patients is one of key interventions in country responses to the pandemic. Countries need information on the costs of case management to inform resource mobilization, planning and budgeting, purchasing arrangements, and assessments of the cost-effectiveness of interventions. We estimated unit costs for COVID-19 case management for patients with asymptomatic, mild to moderate, severe, and critical COVID-19 disease in Kenya.MethodsWe estimated per patient per day unit costs of COVID-19 case management for patients that are asymptomatic and those that have mild to moderate, severe, and critical symptoms. For asymptomatic and mild to moderate patients, we estimated unit costs for home-based care and institutional (hospitals and isolation centers). We used an ingredients approach, adopted a health system perspective and patient episode of care as our time horizon. We obtained data on inputs and their quantities from COVID-19 case management guidel...