Southern Africa is the region with the highest rates of HIV infection in the world. An estimated 9.4 million of the total population of 97 million were HIV-positive in 1999. What impact will the HIV/AIDS epidemic have on the provision of health services in the region? Is there any scope for improving access to highly active antiretroviral therapy (HAART) in low-income countries? A study by the International Monetary Fund warns that health services in southern Africa are already over-stretched. The current cost of providing health services to HIV patients accounts for a very large proportion of total health expenditure for most countries in the region. As the number of AIDS patients increases, the situation will deteriorate.
Public-Private Mix
Article: Insurance Benefit Preferences of the Low-income Uninsured
Marion Danis, MD, Andrea K. Biddle, PhD, Susan Dorr Goold, MD. Journal of General Internal Medicine
Volume 17 Issue 2 Page 125 - February 2002. A frequently cited obstacle to universal insurance is the lack of consensus about what benefits to offer in an affordable insurance package. This study was conducted to assess the feasibility of providing uninsured patients the opportunity to define their own benefit package within cost constraints.
Further details: /newsletter/id/29182
International Law and Global Infectious Disease Control
D. Fidler, CMH Working Paper Series Paper No. WG2: 18, 2002. At the beginning of the 21 st century, the global public good of infectious disease control is increasingly under-produced. The World Health Organization (WHO) warned of a global infectious disease crisis in 1996, and the crisis has deepened in succeeding years. The HIV/AIDS pandemic continues to devastate the developing world; and old scourges such as tuberculosis, malaria, cholera, and pneumonia continue to cause morbidity and mortality around the world.2 The anthrax attacks on the United States in 2001 raise the terrifying reality of bioterrorism and its threat to national and global public health. Attention to improving production of the global public good of infectious disease control has become imperative. The paper is also available online as PDF file.
Social capital, class gender and race conflict, and population health
Bowling Alone. The collapse and revival of American community. RD Putnam. New York: Simon & Schuster, 2000, pp.544, ISBN: 0 684 83283 6. Carles Muntanera, Department of Behavioral and Community Health, and Department of Epidemiology and Preventive Medicine, University of Maryland-Baltimore, USA. John Lynchb, Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor Michigan, USA. International Journal of Epidemiology Vol;31:261-267 - 2002. The authors present an overview of Putnam's claims, their supporting evidence, and several consequences of the BA hypothesis for epidemiology and public health. They argue that the omission of class, race and gender relations and political variables from research on community trust and norms of reciprocity limits the usefulness of social capital as framework for social epidemiology. Next, they link the current theoretical emphasis on social cohesion to earlier social science attempts at advancing the beneficial effects of lack of conflict in Europe and the US.
South African agreement extends Public-Private Partnership
US Secretary of Health Tommy G. Thompson signed a cooperative agreement that will provide nearly $1 million from the Centers for Disease Control and Prevention to fight HIV/AIDS in a public-private partnership in South Africa. The agreement with the American Center for International Labor Solidarity reflects the department's commitment to continue the HIV/AIDS employee outreach programme at the Ford Motor Company's operations in South Africa. The signing of the agreement came during Thompson's week-long trip to Africa that included stops in Mozambique, South Africa, Botswana and Cote d'Ivoire. Thompson's visit builds upon the Bush administration's strong support for the Global Fund to Fight AIDS, Tuberculosis and Malaria. For more information, please contact Richard Delate.
Contact: rdelate@un.org.za
What can be done about the private health sector in low-income countries?
Anne Mills, Health Policy Unit, London School of Hygiene and Tropical Medicine. Ruairi Brugha, Kara Hanson, Barbara McPake. Bulletin of the World Health Organization 2002;80(4):325-330. April 2002. Available on PDF. 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.
Health financing: designing and implementing pro-poor policies
Sara Bennett, Lucy Gilson
DFID Health Systems Resource Centre
UK Department for International Development, 2001
Health financing reforms are a core part of health sector development in low and middle income countries.The current focus of the international debate is on the need to move away from excessive reliance on out-of-pocket payment towards a system which incorporates a greater element of risk pooling (for example through health insurance) and thus affords a greater protection for the poor. This paper summarises what is known about the effects of the main health care financing systems, and how they can be designed and implemented to be 'pro-poor'.
Further details: /newsletter/id/29090
Criteria for evaluating evidence on public health interventions
Public health interventions tend to be complex, programmatic, and context dependent. The evidence for their effectiveness must be sufficiently comprehensive to encompass that complexity. This paper asks whether and to what extent evaluative research on public health interventions can be adequately appraised by applying well established criteria for judging the quality of evidence in clinical practice. It is adduced that these criteria are useful in evaluating some aspects of evidence. However, there are other important aspects of evidence on public health interventions that are not covered by the established criteria. The evaluation of evidence must distinguish between the fidelity of the evaluation process in detecting the success or failure of an intervention, and the success or failure of the intervention itself. Moreover, if an intervention is unsuccessful, the evidence should help to determine whether the intervention was inherently faulty (that is, failure of intervention concept or theory), or just badly delivered (failure of implementation). Furthermore, proper interpretation of the evidence depends upon the availability of descriptive information on the intervention and its context, so that the transferability of the evidence can be determined. Study design alone is an inadequate marker of evidence quality in public health intervention evaluation.
Private Health Insurance Schemes in Africa
Health Systems Trust will be publishing a couple of chapters and indicators covering this area in the upcoming South African Health Review (2001) - but this will only be available at the end of March. Meanwhile you may wish to look at previous editions which also cover the topic.
Further details: /newsletter/id/29040
Report on Survey Methods for the Community Tracking Study’s Final Report
November 2001
Richard Strouse, Barbara Carlson, John Hall, Center for Studying Health System Change, Washington, DC Peter Cunningham, Mathematica Policy Research, Inc. Princeton, NJ
In this report, the authors describe site selection, sample design, instrumentation and survey preparation, data collection methods, response rates, and sample weights. The Community Tracking Study (CTS) addresses two broad questions that are important to public and private health decision makers:
1. How is the health system changing? How are hospitals, health plans, physicians, safety net providers, and other provider groups restructuring, and what key forces are driving organizational change?
2. How do these changes affect people? How are insurance coverage, access to care, use of services, health care costs, and perceived quality of health care changing over time?