File Name: health and health related indicators ethiopia 2018 .zip
As literacy and socioeconomic status improves in Ethiopia, the demand for quality service is also increasing. Besides, changes in the demographic trends, epidemiology and mushrooming urbanization require more comprehensive services covering a wide range and quality of curative, promotive and preventive services.
This study assessed the cost and cost-effectiveness of HEP interventions to inform policy decisions for resource allocation and priority setting in Ethiopia. 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. The unit cost estimates of HEP interventions are crucial for priority-setting, resource mobilization, and program planning. This study found that the program is very cost-effective in delivering community health services. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the paper and its Supporting Information files. Competing interests: The authors declare that they have no competing interests. This does not alter our adherence to PLOS one policies on sharing data and materials. Ethiopia has a three-tier healthcare delivery system, with primary, secondary, and tertiary level units. The primary health care unit is the lowest level of the tier system, comprising primary hospitals, health centers, and their satellite health posts, all linked by a referral network.
Health posts are the most peripheral units, providing mainly preventive care and selected curative services [ 1 , 2 ]. Over the past years there was a steady increase in the number of health posts, from 6, in to 17, in [ 3 ]. It was introduced in with the primary objective of achieving universal health coverage UHC through the provision of equitable health care to the community within a context of limited resources.
The HEP package was updated in with more interventions. The HEP has five main components comprising 16 packages: disease prevention and control DPC , family health, hygiene and environmental sanitation, health education and communication, and first aid.
Health Extension Workers HEWs provide the health service packages through three modalities: static e. After a year of pre-service training, HEWs are deployed in each district or kebele the lowest administrative unit in Ethiopia to deliver the HEP services [ 5 ].
Ethiopia has made substantial improvements in health outcomes: for example, the maternal mortality ratio MMR decreased from deaths per , in to in Under-five mortality per 1, live births decreased from in to 59 in leading to an average life expectancy at birth of HIV, Tuberculosis TB , and malaria-related morbidity and mortality have significantly decreased in the last decades [ 2 ]. Although the HEP is a flagship program in Ethiopia, there is limited evidence available for whether the investment in the HEP provides good value for money.
Previous cost-effectiveness studies on the HEP packages are very few in number and lack a detailed evaluation of the various HEP components.
Therefore, a broader assessment of health impacts beyond specific packages would capture the positive contribution of community-based programs in different areas of health services.
The aim of this study is to estimate the cost and cost-effectiveness of selected HEP interventions to assist decision-makers and program managers in identifying interventions representing the best value for money as well as in prioritizing the allocation of scarce resources.
Both primary and secondary data were used. Primary data were collected from health posts, 54 health centers and 57 district health offices from June 7 to July 1, The following 21 interventions were selected based on the availability of cost data, effectiveness measures, and interventions, mostly implemented by HEWs Table 1.
Costing was conducted from a provider perspective, where the costs incurred by the government were included [ 10 ]. The bottom-up ingredient and top-down costing methods was applied. The bottom-up ingredient costing method specifies activities under each intervention, measures the resources used for the activities i. The top-down costing method considers overall spending at a central level to allocate some of the costs to each intervention [ 11 ].
All cost inputs from both methods were crosschecked and accounted for to avoid double-counting. The cost items that last for more than one year were treated as capital and those used within a year were considered recurrent. The capital inputs include pre-service and in-service training, the building of health posts, and equipment.
The recurrent inputs include supplies, personnel, supervision, and review meetings. The cost components include personnel, medicine, supplies, infrastructure, capacity building, and equipment Table 2. To estimate personnel costs, the number and salaries of HEWs with level 3 and 4 career certifications were obtained [ 12 ].
The average HEW salary per minute was then calculated based on 8 working hours per day and 22 working days per month. The total supply costs per service include the cost of items, the pharmaceutical management supply cost, and vaccination wastage. The cost of supervision and review meetings at the national and sub-national levels was estimated per health post per year. Health posts are made from hollow brick, stone, and wood, with an average service life of 30, 20, and 15 years, respectively.
The average cost of the three types of buildings was calculated and subsequently annualized. Similarly, 5 life-years for equipment, 10 for pre-service training, and 5 for in-service training were considered. The capital and recurrent costs except personnel were distributed to each service using the total number of people served per health post as an allocation base. The cost per intervention was then estimated by adding the unit costs to the recurrent and capital costs. To estimate costs per client for services requiring more than one visit, the number of visits was multiplied by the cost per service.
Similarly, the cost per couple year of protection CYP was estimated for family-planning services. We then estimated the total annual cost of delivering selected HEP interventions at health posts by multiplying the unit cost of selected HEP interventions by the number of clients served.
Costs were inflated to rates using the Ethiopian consumer price index. The cost analysis was carried out on an Excel spreadsheet [ 16 ]. Health outcomes were measured in LYG and estimated using Spectrum software. Three steps were used to calculate the number of LYG due to the HEP to estimate the number of lives saved by an intervention at a given coverage. Second, by using scientific literature on impact studies, we created counterfactual scenarios of what would have happened to the health system coverage in were there is no HEP i.
Baseline coverage was presumed to be similar for both steps and was extracted from the and EDHS [ 17 , 18 ]; linear interpolation was then made between baseline and current coverage for the two steps Table 3. As a third step, the difference in the number of lives saved between the health system coverage Health system with HEP and the counterfactual health system without the HEP was calculated as the number of lives saved due to the HEP.
The mathematical formula to estimate the number of lives saved due to an intervention is: 1. Remaining life expectancy was calculated by weighing the number of male and female children below five years old and averaging the remaining years of life. Likewise, the weighted average life expectancy is calculated for women of reproductive age. The life years gained were calculated as: 2.
The Lives Saved Tool is a mathematical modelling tool used to estimate the effect of changes in coverage on mortality in low-and middle-income countries. The FamPlan model estimates the number of lives saved by considering family planning needs, the mix of methods, the contraceptive prevalence rate, and other criteria. TIME is an epidemiological compartmental transmission model that projects the drug-susceptible and multidrug-resistant TB burden.
Since the founding of the HEP in , the health system has incurred additional costs of health services. This additional cost to the health system will bring additional benefits to the community. We calculated the total incremental cost of a health service intervention due to the HEP by multiplying the additional number of the population covered due to the HEP and the unit cost of the selected intervention.
The incremental cost-effectiveness ratio ICER is calculated as the ratio of the additional costs of intervention divided by the additional benefit of the intervention due to the HEP. A one-year time horizon was applied. One-way sensitivity analysis was performed by varying the unit costs, the discount rate, the lifetime duration of equipment, buildings, pre-service and in-service training, and the salary of HEWs and others to check for the robustness of the findings when those parameters are changed.
Personnel and capacity-building costs were the only cost centers for the hygiene and environmental sanitation package. The remaining share of the expenditure was contributed by capacity building, including start-up and monitoring and evaluation.
The cost-effectiveness results, ranked from the most cost-effective intervention to the least are presented in Fig 3. Similarly, the provision of zinc and ORS for diarrheal case management, malaria case management, pneumococcal vaccination, TB treatment follow-up i.
Figs 4 and 5 present the results of the sensitivity analysis, which was conducted by varying the various parameters, such as unit cost, discounting LYG, life-years of capital items, pre-service and in-service training, and salary scale. Although changes in the rate used for age discounting do affect the ICER for the lower This study has estimated the cost and cost-effectiveness of providing selected HEP packages. The incremental cost per LYG was The unit costs and cost-effectiveness of the HEP based on health need and supply constraints provide contextual evidence for decision-makers to prioritize healthcare interventions and allocate resources efficiently in order to improve population health.
The cost of DPC interventions has a higher variability in their unit cost than family health services costs. Although the total costs depend on the interventions included in the community health program, the estimates for family health and DPC services are similar to the average cost estimated in Ghana [ 30 ].
A study conducted in Ethiopia estimated that district-based IRS would cost more than community-based IRS, both in terms of cost per district and in terms of cost per person protected [ 33 ].
Drugs and supplies were the key cost drivers of the program, unlike in the previous study in Ghana, where staff costs accounted for the largest proportion of unit costs. This may be attributed to the difference in the average number of workers per health facility, the difference in the estimation of staff time, or the variation in the wage scale between the two studies [ 30 ]. Thus, the HEP leads to a higher proportion of lives saved and a more cost-effective approach to delivering essential health services to rural and vulnerable communities, where access to qualified staff is limited.
Similarly, previous studies and systematic reviews of the cost-effectiveness of community health workers have indicated that providing essential healthcare services through community health workers is a cost-effective or very cost-effective strategy [ 35 , 36 ].
Our study, however, found that the HEP is a very cost-effective program. In this study, the difference in ICER i. Moreover, the implementation period of the HEP that we used is longer than the previous study i. The study indicated that community health programs represent an attractive and low-cost investment that increases the coverage of key child interventions and decreases child mortality. A previous study conducted in Bangladesh compared community healthcare with home-based care for maternal and neonatal interventions.
Although it is difficult to make a realistic comparison of ICER data due to the variability of time horizons, settings, perspectives of the studies, the disease burden and range of interventions, aggregate evidence from other studies provide insights and the genuine lesson that community health programs are a cost-effective or a very cost-effective strategy.
The provision of health care services through the HEP, however, is not a standalone strategy, but a complementary approach to other mechanisms of delivering healthcare services in the country. The following limitations apply to this study. First, although this study considered a wide range of HEP interventions, it excluded interventions with an absence of clear cost and outcome measures; this could affect the findings of this study.
Second, the health outcome measure takes into account only the mortality aspect of the intervention, and the ICER reported in this study may be overestimated because it ignores morbidity effects.
Fourth, by their very nature, community-based programs function outside the formal systems, and the provider perspective does not capture all of the social costs associated with the HEP; incorporating other perspectives may yield better outcomes.
Notwithstanding a number of methodological and data-availability limitations, the study provided cost and cost-effectiveness estimates for national HEP programs and illustrated the potential effect of the program in Ethiopia.
This study assessed the cost and cost-effectiveness of HEP interventions to inform policy decisions for resource allocation and priority setting in Ethiopia. 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. The unit cost estimates of HEP interventions are crucial for priority-setting, resource mobilization, and program planning.
Kirubel M. Mishore, Nigatu A. Bekele, Tsegaab Y. Yirba, Tsion F. Drug use evaluation is a system of continuous, systematic, criteria-based drug evaluation that ensures the appropriate use of drugs. Rationalization of drug therapy in emergency medicine would be useful in managing the broad array of conditions that present for emergency care. High-quality drug utilization is associated with the use of a relatively limited number of essential medicines.
Metrics details. Quality of life can be used to measure the effect of intervention on health related conditions. Health insurance contributes positive effect on availability of medical supplies and empowerment of women and children on financial healthcare. A comparative community based cross-sectional study was employed. A descriptive summery, simple and multiple linear regression analysis was applied to describe the functional predictors of HRQoL. QoL increased by 6. The study revealed that significant difference in quality of life was found among the two groups; health insurance had positive effect on quality of life.
EFY (/). E.C. HEALTH. &. HEALTH-RELATED. INDICATORS. Federal Democratic Republic of Ethiopia. Ministry of Health.
Demonstration of hand washing during outbreak investigation in Addis Ababa, Ethiopia. CDC also supports development of workforce capacity and health systems strengthening. CDC provides technical expertise to meet national immunization goals and international resolutions to eradicate polio, eliminate measles, and strengthen the national immunization program in Ethiopia. A critical lesson learned from the COVID pandemic is how disease threats spread faster and more unpredictably than ever before. These efforts help Ethiopia reach the targets outlined in the Global Health Security Agenda GHSA , a global partnership launched in to help make the world safer and more secure from infectious disease threats. CDC provides support to improve and expand laboratory testing, epidemiology and surveillance, infection prevention and control and planning.
The Federal Ministry of Health of Ethiopia has been publishing Health and Health related indicators of the country annually since E. These indicators have been of high importance in indicating the status of health in the country in those years. In addition, there were minimal efforts to develop a model for predicting future values of Health and Health related indicators based on the current trend. The overall aim of this study was to analyze trends of and develop model for prediction of Health and Health related indicators. More specifically, it described the trends of Health and Health related indicators, identified determinants of mortality and morbidity indicators and developed model for predicting future values of MDG indicators. This study was conducted on Health and Health related indicators of Ethiopia from the year E. C to E.
Это диагностика, - сказала она, взяв на вооружение версию коммандера.
Он увидел светловолосую девушку, помогающую Дэвиду Беккеру найти стул и сесть. Беккера, по-видимому, мучила боль. Он еще не знает, что такое настоящая боль, подумал человек в такси. Девушка вытащила из кармана какой-то маленький предмет и протянула его Беккеру. Тот поднес его к глазам и рассмотрел, затем надел его на палец, достал из кармана пачку купюр и передал девушке.
Под главной клавиатурой была еще одна, меньшего размера, с крошечными кнопками. На каждой - буква алфавита. Сьюзан повернулась к. - Так скажите же мне. Стратмор задумался и тяжело вздохнул.
Обернувшись, они увидели быстро приближавшуюся к ним громадную черную фигуру. Сьюзан никогда не видела этого человека раньше. Подойдя вплотную, незнакомец буквально пронзил ее взглядом. - Кто это? - спросил. - Сьюзан Флетчер, - ответил Бринкерхофф.
Коммандер. Нет. Сьюзан словно окаменела, ничего не понимая. Эхо выстрела слилось с царившим вокруг хаосом.
Беккер оглядел затейливое убранство бара и подумал, что все, что с ним происходит, похоже на сон. В любой другой реальности было бы куда больше здравого смысла. Я, университетский профессор, - подумал он, - выполняю секретную миссию. Бармен с любезной улыбкой протянул Беккеру стакан: - A su gusto, senor. Клюквенный сок и капелька водки.
Скажи. Сьюзан словно отключилась от Хейла и всего окружающего ее хаоса. Энсей Танкадо - это Северная Дакота… Сьюзан попыталась расставить все фрагменты имеющейся у нее информации по своим местам.
И в следующую секунду все присутствующие поняли, что это было ошибкой. ГЛАВА 119 - Червь набирает скорость! - крикнула Соши, склонившаяся у монитора в задней части комнаты.
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