Elias Asfaw | University of KwaZulu-Natal (original) (raw)
Papers by Elias Asfaw
Health policy and planning, 2014
Formalized task shifting structures have been used to rapidly scale up antiretroviral service del... more Formalized task shifting structures have been used to rapidly scale up antiretroviral service delivery to underserved populations in several countries, and may be a promising mechanism for accomplishing universal health coverage. However, studies evaluating the quality of service delivery through task shifting have largely ignored the patient perspective, focusing on health outcomes and acceptability to health care providers and regulatory bodies, despite studies worldwide that have shown the significance of patient satisfaction as an indicator of quality. This study aimed to measure patient satisfaction with task shifting of antiretroviral services in hospitals and health centres in four regions of Ethiopia. This cross-sectional study used data collected from a time-motion study of patient services paired with 665 patient exit interviews in a stratified random sample of antiretroviral therapy clinics in 21 hospitals and 40 health centres in 2012. Data were analyzed using f-tests ac...
SSRN Electronic Journal, 2012
Objective: To estimate the cost difference associated with anti-retroviral therapy (ART) task shi... more Objective: To estimate the cost difference associated with anti-retroviral therapy (ART) task shifting in a limited resource setting in Ethiopia, and to analyze the determinant factors for length and the cost of a visit. Method: A stratified random sample of health facilities across four regions of Ethiopia (Addis Ababa, Amhara, Benishangul Gumuz and Oromia) was surveyed. An ordinary least square (OLS) regression model was employed. The dependent variables were "cost of visit" and "length of visit", while independent variables include the type of profession (physician, health officers, and nurses), health facility (hospitals, health centers) and visit (follow-up, initiation). Result: A total of 79 health facilities were covered during the survey. Of the 665 interviews, the majority of patients (77.0%) were seen by a nurse, while 19.6% and 3.5% were seen by health officers and doctors, respectively (p<0.01). The average time spent by patients in ART services wa...
Malaria Journal, 2020
An amendment to this paper has been published and can be accessed via the original article.
On September 13, 2013 the Federal Ministry of Health (FMoH) of Ethiopia and UNICEF announced that... more On September 13, 2013 the Federal Ministry of Health (FMoH) of Ethiopia and UNICEF announced that Ethiopia has successfully reduced the under-five mortality rate by two thirds between 1990 and 2012, which is the target for achieving Millennium Development Goal-4. In 1990, the under-five mortality rate in Ethiopia was one of the highest in the world at 205/1,000 live births. However, by 2012, this rate had declined to 68/1,000 live births with an average annual rate of decline of 5.0%. This exceeded the 4.3% annual rate of decline needed to reach MDG4 and was significantly higher than the decline rates observed in many sub-Saharan African countries and even other low and middle-income countries. In an effort to understand the story behind Ethiopia’s remarkable achievement of MDG-4, EPHI has conducted this in-depth Case Study which is supported by Countdown to 2015. The findings are believed to generate valuable lessons and guidance for other low-income countries in their quest for ac...
PLoS ONE, 2021
Background Ethiopia launched the Health Extension Program (HEP) in 2004, aimed at ensuring equita... more Background Ethiopia launched the Health Extension Program (HEP) in 2004, aimed at ensuring equitable community-level healthcare services through Health Extension Workers. Despite the program’s being a flagship initiative, there is limited evidence on whether investment in the program represents good value for money. This study assessed the cost and cost-effectiveness of HEP interventions to inform policy decisions for resource allocation and priority setting in Ethiopia. Methods Twenty-one health care interventions were selected under the hygiene and sanitation, family health services, and disease prevention and control sub-domains. The ingredient bottom-up and top-down costing method was employed. Cost and cost-effectiveness were assessed from the provider perspective. Health outcomes were measured using life years gained (LYG). Incremental cost per LYG in relation to the gross domestic product (GDP) per capita of Ethiopia (US$852.80) was used to ascertain the cost-effectiveness. A...
Current Developments in Nutrition
Objectives In Ethiopia, standards for fortifying edible oil with vitamin A (VA) exist; they are n... more Objectives In Ethiopia, standards for fortifying edible oil with vitamin A (VA) exist; they are not yet mandatory. This study assessed inadequate VA intake among children 6–35 months of age and women of reproductive age (WRA), modeled the potential impacts of VA-fortified edible oil on dietary VA adequacy and number of young lives saved, and estimated the cost-effectiveness of this program. Methods Using an adapted 1-day version of the National Cancer Institute method, we analyzed national dietary intake data from the Ethiopian National Food Consumption Survey to estimate usual VA intake and calculate prevalence of inadequate intake (proportion below the Estimated Average Requirement). The Lives Saved Tool (LiST) was used to predict the number of lives saved among children. Program costs were estimated using an activity-based approach and applied to calculate cost-effectiveness of the oil fortification program. Results Nationally, the prevalence of inadequate VA intake was high (∼80...
ATHENS JOURNAL OF HEALTH
The present study attempts to estimate cost differences associated with anti-retroviral therapy (... more The present study attempts to estimate cost differences associated with anti-retroviral therapy (ART) task shifting in a limited resource setting in Ethiopia, and to analyze the determinant factors for length and cost of a visit. A stratified random sample of health facilities was surveyed. An ordinary least square (OLS) regression model was employed. The average time spent by patients in ART services was estimated to be 8.5 minutes (Range: 1 to 60 minutes). The OLS model estimated that the median cost per visit for doctors was 15% higher than for the nurses, when controlling for type of facility and type of visit. We found that ART services were less costly when delivered by nurses and health officers, compared with doctors. Since task-shifting to less specialized health-care workers yields additional economic benefits, the expansion of ART task-shifting should be considered by healthcare policy makers and stakeholders in a limited resource settings.
PloS one, 2017
Voluntary medical male circumcision is an integral part of the South African government's res... more Voluntary medical male circumcision is an integral part of the South African government's response to the HIV and AIDS epidemic. However, there remains a limited body of economic analysis on the cost of VMMC programming, and the demand creation activities used to mobilize males, especially among adolescent boys in school. This study addresses this gap by presenting the costs of a VMMC program which adopted two demand creation strategies targeting school-going males in South Africa. Cost data was collected from a VMMC program in the KwaZulu-Natal province of South Africa. A retrospective, micro-costing ingredient approach was applied to identify, measure and value resources of two demand creation strategies targeting young males. The program circumcised 4987 young males between May 2011 and February 2013, at a cost of $127.68 per circumcision. Demand creation activities accounted for 32% of the total cost, HCT contributing 10% with the medical circumcision procedure accounting fo...
American Journal of Public Health
ABSTRACT
Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research, 2016
Policymakers in high-, low-, and middle-income countries alike face challenging choices about res... more Policymakers in high-, low-, and middle-income countries alike face challenging choices about resource allocation in health. Economic evaluation can be useful in providing decision makers with the best evidence of the anticipated benefits of new investments, as well as their expected opportunity costs-the benefits forgone of the options not chosen. To guide the decisions of health systems effectively, it is important that the methods of economic evaluation are founded on clear principles, are applied systematically, and are appropriate to the decision problems they seek to inform. The Bill and Melinda Gates Foundation, a major funder of economic evaluations of health technologies in low- and middle-income countries (LMICs), commissioned a "reference case" through the International Decision Support Initiative (iDSI) to guide future evaluations, and improve both the consistency and usefulness to decision makers. The iDSI Reference Case draws on previous insights from the Wor...
JAIDS Journal of Acquired Immune Deficiency Syndromes, 2014
Objective: To evaluate the effects, costs, and cost-effectiveness of different degrees of antiret... more Objective: To evaluate the effects, costs, and cost-effectiveness of different degrees of antiretroviral therapy task shifting from physician to other health professionals in Ethiopia.
Health policy and planning, 2014
Formalized task shifting structures have been used to rapidly scale up antiretroviral service del... more Formalized task shifting structures have been used to rapidly scale up antiretroviral service delivery to underserved populations in several countries, and may be a promising mechanism for accomplishing universal health coverage. However, studies evaluating the quality of service delivery through task shifting have largely ignored the patient perspective, focusing on health outcomes and acceptability to health care providers and regulatory bodies, despite studies worldwide that have shown the significance of patient satisfaction as an indicator of quality. This study aimed to measure patient satisfaction with task shifting of antiretroviral services in hospitals and health centres in four regions of Ethiopia. This cross-sectional study used data collected from a time-motion study of patient services paired with 665 patient exit interviews in a stratified random sample of antiretroviral therapy clinics in 21 hospitals and 40 health centres in 2012. Data were analyzed using f-tests ac...
Background: Identification of cost-effective modalities of PMTCT service delivery is the priority... more Background: Identification of cost-effective modalities of PMTCT service delivery is the priority area to decrease the HIV transmission from mother to child.
Methodology: The study employed both primary and secondary data to analyse the parameters in the decision model.
Result: Cost effectiveness analysis among the three alternatives (no interventions, opt-in and opt-out approach) showed that the opt-out approach would be the most cost effective approach; which would costs 9,597,906 birr ($972,038) and avert 640 cases at CER of 1,989 birr ($201). On the other hand, adopting the opt-in approach would avert 397 and cost 9,318,723 birr ($943,763) at CER of 2,504 birr ($253).
Recommendation: Opt-out approach of PMTCT service delivery modality would be the more cost effective strategy as compared to opt-in approach in Addis Ababa. Decisions on recommending particular PMTCT service delivery from economic perspective should be based on the local HIV prevalence, acceptance of VCT and VCT costs.
Health policy and planning, 2014
Formalized task shifting structures have been used to rapidly scale up antiretroviral service del... more Formalized task shifting structures have been used to rapidly scale up antiretroviral service delivery to underserved populations in several countries, and may be a promising mechanism for accomplishing universal health coverage. However, studies evaluating the quality of service delivery through task shifting have largely ignored the patient perspective, focusing on health outcomes and acceptability to health care providers and regulatory bodies, despite studies worldwide that have shown the significance of patient satisfaction as an indicator of quality. This study aimed to measure patient satisfaction with task shifting of antiretroviral services in hospitals and health centres in four regions of Ethiopia. This cross-sectional study used data collected from a time-motion study of patient services paired with 665 patient exit interviews in a stratified random sample of antiretroviral therapy clinics in 21 hospitals and 40 health centres in 2012. Data were analyzed using f-tests ac...
SSRN Electronic Journal, 2012
Objective: To estimate the cost difference associated with anti-retroviral therapy (ART) task shi... more Objective: To estimate the cost difference associated with anti-retroviral therapy (ART) task shifting in a limited resource setting in Ethiopia, and to analyze the determinant factors for length and the cost of a visit. Method: A stratified random sample of health facilities across four regions of Ethiopia (Addis Ababa, Amhara, Benishangul Gumuz and Oromia) was surveyed. An ordinary least square (OLS) regression model was employed. The dependent variables were "cost of visit" and "length of visit", while independent variables include the type of profession (physician, health officers, and nurses), health facility (hospitals, health centers) and visit (follow-up, initiation). Result: A total of 79 health facilities were covered during the survey. Of the 665 interviews, the majority of patients (77.0%) were seen by a nurse, while 19.6% and 3.5% were seen by health officers and doctors, respectively (p<0.01). The average time spent by patients in ART services wa...
Malaria Journal, 2020
An amendment to this paper has been published and can be accessed via the original article.
On September 13, 2013 the Federal Ministry of Health (FMoH) of Ethiopia and UNICEF announced that... more On September 13, 2013 the Federal Ministry of Health (FMoH) of Ethiopia and UNICEF announced that Ethiopia has successfully reduced the under-five mortality rate by two thirds between 1990 and 2012, which is the target for achieving Millennium Development Goal-4. In 1990, the under-five mortality rate in Ethiopia was one of the highest in the world at 205/1,000 live births. However, by 2012, this rate had declined to 68/1,000 live births with an average annual rate of decline of 5.0%. This exceeded the 4.3% annual rate of decline needed to reach MDG4 and was significantly higher than the decline rates observed in many sub-Saharan African countries and even other low and middle-income countries. In an effort to understand the story behind Ethiopia’s remarkable achievement of MDG-4, EPHI has conducted this in-depth Case Study which is supported by Countdown to 2015. The findings are believed to generate valuable lessons and guidance for other low-income countries in their quest for ac...
PLoS ONE, 2021
Background Ethiopia launched the Health Extension Program (HEP) in 2004, aimed at ensuring equita... more Background Ethiopia launched the Health Extension Program (HEP) in 2004, aimed at ensuring equitable community-level healthcare services through Health Extension Workers. Despite the program’s being a flagship initiative, there is limited evidence on whether investment in the program represents good value for money. This study assessed the cost and cost-effectiveness of HEP interventions to inform policy decisions for resource allocation and priority setting in Ethiopia. Methods Twenty-one health care interventions were selected under the hygiene and sanitation, family health services, and disease prevention and control sub-domains. The ingredient bottom-up and top-down costing method was employed. Cost and cost-effectiveness were assessed from the provider perspective. Health outcomes were measured using life years gained (LYG). Incremental cost per LYG in relation to the gross domestic product (GDP) per capita of Ethiopia (US$852.80) was used to ascertain the cost-effectiveness. A...
Current Developments in Nutrition
Objectives In Ethiopia, standards for fortifying edible oil with vitamin A (VA) exist; they are n... more Objectives In Ethiopia, standards for fortifying edible oil with vitamin A (VA) exist; they are not yet mandatory. This study assessed inadequate VA intake among children 6–35 months of age and women of reproductive age (WRA), modeled the potential impacts of VA-fortified edible oil on dietary VA adequacy and number of young lives saved, and estimated the cost-effectiveness of this program. Methods Using an adapted 1-day version of the National Cancer Institute method, we analyzed national dietary intake data from the Ethiopian National Food Consumption Survey to estimate usual VA intake and calculate prevalence of inadequate intake (proportion below the Estimated Average Requirement). The Lives Saved Tool (LiST) was used to predict the number of lives saved among children. Program costs were estimated using an activity-based approach and applied to calculate cost-effectiveness of the oil fortification program. Results Nationally, the prevalence of inadequate VA intake was high (∼80...
ATHENS JOURNAL OF HEALTH
The present study attempts to estimate cost differences associated with anti-retroviral therapy (... more The present study attempts to estimate cost differences associated with anti-retroviral therapy (ART) task shifting in a limited resource setting in Ethiopia, and to analyze the determinant factors for length and cost of a visit. A stratified random sample of health facilities was surveyed. An ordinary least square (OLS) regression model was employed. The average time spent by patients in ART services was estimated to be 8.5 minutes (Range: 1 to 60 minutes). The OLS model estimated that the median cost per visit for doctors was 15% higher than for the nurses, when controlling for type of facility and type of visit. We found that ART services were less costly when delivered by nurses and health officers, compared with doctors. Since task-shifting to less specialized health-care workers yields additional economic benefits, the expansion of ART task-shifting should be considered by healthcare policy makers and stakeholders in a limited resource settings.
PloS one, 2017
Voluntary medical male circumcision is an integral part of the South African government's res... more Voluntary medical male circumcision is an integral part of the South African government's response to the HIV and AIDS epidemic. However, there remains a limited body of economic analysis on the cost of VMMC programming, and the demand creation activities used to mobilize males, especially among adolescent boys in school. This study addresses this gap by presenting the costs of a VMMC program which adopted two demand creation strategies targeting school-going males in South Africa. Cost data was collected from a VMMC program in the KwaZulu-Natal province of South Africa. A retrospective, micro-costing ingredient approach was applied to identify, measure and value resources of two demand creation strategies targeting young males. The program circumcised 4987 young males between May 2011 and February 2013, at a cost of $127.68 per circumcision. Demand creation activities accounted for 32% of the total cost, HCT contributing 10% with the medical circumcision procedure accounting fo...
American Journal of Public Health
ABSTRACT
Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research, 2016
Policymakers in high-, low-, and middle-income countries alike face challenging choices about res... more Policymakers in high-, low-, and middle-income countries alike face challenging choices about resource allocation in health. Economic evaluation can be useful in providing decision makers with the best evidence of the anticipated benefits of new investments, as well as their expected opportunity costs-the benefits forgone of the options not chosen. To guide the decisions of health systems effectively, it is important that the methods of economic evaluation are founded on clear principles, are applied systematically, and are appropriate to the decision problems they seek to inform. The Bill and Melinda Gates Foundation, a major funder of economic evaluations of health technologies in low- and middle-income countries (LMICs), commissioned a "reference case" through the International Decision Support Initiative (iDSI) to guide future evaluations, and improve both the consistency and usefulness to decision makers. The iDSI Reference Case draws on previous insights from the Wor...
JAIDS Journal of Acquired Immune Deficiency Syndromes, 2014
Objective: To evaluate the effects, costs, and cost-effectiveness of different degrees of antiret... more Objective: To evaluate the effects, costs, and cost-effectiveness of different degrees of antiretroviral therapy task shifting from physician to other health professionals in Ethiopia.
Health policy and planning, 2014
Formalized task shifting structures have been used to rapidly scale up antiretroviral service del... more Formalized task shifting structures have been used to rapidly scale up antiretroviral service delivery to underserved populations in several countries, and may be a promising mechanism for accomplishing universal health coverage. However, studies evaluating the quality of service delivery through task shifting have largely ignored the patient perspective, focusing on health outcomes and acceptability to health care providers and regulatory bodies, despite studies worldwide that have shown the significance of patient satisfaction as an indicator of quality. This study aimed to measure patient satisfaction with task shifting of antiretroviral services in hospitals and health centres in four regions of Ethiopia. This cross-sectional study used data collected from a time-motion study of patient services paired with 665 patient exit interviews in a stratified random sample of antiretroviral therapy clinics in 21 hospitals and 40 health centres in 2012. Data were analyzed using f-tests ac...
Background: Identification of cost-effective modalities of PMTCT service delivery is the priority... more Background: Identification of cost-effective modalities of PMTCT service delivery is the priority area to decrease the HIV transmission from mother to child.
Methodology: The study employed both primary and secondary data to analyse the parameters in the decision model.
Result: Cost effectiveness analysis among the three alternatives (no interventions, opt-in and opt-out approach) showed that the opt-out approach would be the most cost effective approach; which would costs 9,597,906 birr ($972,038) and avert 640 cases at CER of 1,989 birr ($201). On the other hand, adopting the opt-in approach would avert 397 and cost 9,318,723 birr ($943,763) at CER of 2,504 birr ($253).
Recommendation: Opt-out approach of PMTCT service delivery modality would be the more cost effective strategy as compared to opt-in approach in Addis Ababa. Decisions on recommending particular PMTCT service delivery from economic perspective should be based on the local HIV prevalence, acceptance of VCT and VCT costs.