We call on all African health economists and health policy analysts, those working in Africa or on research of relevance to Africa to submit abstracts for the Second Conference of the African Health Economics and Policy Association (AfHEA), which will be held in Dakar, Senegal from 15th to 19th March 2011 (Note: these dates are provisional). The overall theme of this conference is “Toward universal health coverage in Africa”.  Universal coverage is understood to mean providing financial protection against health care costs for all, as well as ensuring access to quality health care for all when needed.

Abstracts are particularly encouraged for research related to the sub-themes of the conference:

Health care financing for universal financial protection in Africa, including issues around:

• user fee removal
• strategies for improved *domestic public* funding of health care (through general taxes and/or mandatory health insurance)
• strategies to extend financial protection coverage to those outside the formal employment sector
• reducing fragmentation across funding pools
• the role of global funding in achieving universal coverage

Promoting universal access to needed health services, including issues around:

• Purchasing of health services (benefit packages and provider payment mechanisms, including performance-based financing)
• Identifying and addressing health service access barriers

Strategies and tactics for key steps to move towards universal coverage, including issues around:

• Getting universal coverage onto the health policy agenda
• Ensuring the acceptability of policy proposals to different actors
• Managing key actors in implementing universal coverage policies

The above sub-themes are not exhaustive and individuals are encouraged to submit abstracts on interesting or topical research, especially on any aspect of the health system that could contribute to universal coverage.

Abstracts may be submitted in English or French and must be structured as follows:

• Title of paper
• Name, institutional affiliation and e-mail address of presenting author
• Names of co-authors
• 400 word maximum abstract which indicates the aim and objectives of the paper, the methods used and the key findings.

Abstracts must be submitted by 31 August 2010 to john.ataguba@uct.ac.za.

They will be reviewed by the AfHEA conference Scientific Committee, which includes representatives  from a wide range of African countries and is chaired by Prof. Di McIntyre of the Health Economics Unit, University of Cape Town.  Those submitting abstracts will be informed of the outcome by the end of October 2010.

Principle Investigators from McMaster University and the Centre for Health Policy attended this writing, planning and dissemination workshop.

Phase 1 of the project has been completed and dissemination activities are underway, including workshops for health workers and meetings for government officials.

The World Health Organization (WHO) has encouraged countries to move towards achieving universal coverage – equity in access and guaranteed financial risk protection – where prepayment and pooling of resources and risks are the basic principles.

• Download brochure that provides more information about REACH
• Download brochure outlining the key findings

Comments, questions? Email helen.schneider@uct.ac.za

Detailed case studies were undertaken in Bushbuckridge (Mpumalanga), Mitchell’s Plain (Western Cape), Soweto Region D of the City of Johannesburg (Gauteng) and Hlabisa (KwaZulu-Natal).

The first phase investigated who the users of services were and assessed whether they reflected the population in need (socio-economically, gender, race, citizenship etc). Phase 1 also analysed the access challenges they experience with respect to availability, affordability and acceptability.

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The call for abstracts from the World Health Organisation and partners for the First Global Symposium on Health Systems Research is now open, until the 30 April 2010!

Researchers, policy-makers, representatives of donor and multinational organizations, and other stakeholders representing diverse constituencies will gather in Montreux, Switzerland to share evidence, identify significant knowledge gaps, and set a research agenda aimed at accelerating universal health coverage.  While experience from all countries is sought, travel support for selected abstracts from low- and middle-income countries will be available. Visit http://www.hsr-symposium.org/

In developing countries, where health insurance is not a commonly purchased financial instrument,recent debates have revolved around extending health insurance coverage to a wider range of the population, primarily via compulsory insurance schemes. However, these debates rarely consider the competing demands placed on the family budget, which will influence the acceptability of the program by the populace. In this paper, we draw on data from the 2000 income and expenditure survey to examine treatment effects associated with household insurance status, providing a detailed examination of expenditure substitution patterns within South Africa.

This commentary takes a different perspective on the equity/efficiency trade-off through focusing on how the cost-effectiveness of the chosen treatment strategy has an influence on the costs of scaling up as well as the constraints of going to scale, and ultimately on coverage or equitable access for all in need. These ideas are illustrated with reference to the case of HIV treatment (where HIV treatment is defined to include treatment and prophylaxis of opportunistic infections and events including tuberculosis treatment if required with some form of antiretroviral treatment—ART) in the South African public health care system.

For those who have to plan and budget resources, it is important to find out as much as possible about the costs of providing HIV health care and how these change over time. However, few studies have investigated these costs, particularly those incurred before an individual starts taking ART.

Recent research has analysed the direct costs of treating more than 100,000 HIV-infected adults enrolled in a private HIV care programme in South Africa from 3 years before they started ART until up to 5 years after ART initiation. Within this programme, individuals began to receive ART when their CD4 cell count fell below 350 cells/ml. The ART initiation criteria used in the private sector study setting is thus the same as the recently adjusted criterion in the public sector.

Findings from the study have policy implications:

To reduce early costs of ART:

Start ART at higher CD4 cell counts.

Results suggest that starting ART once the patient is severely immune compromised (e.g. at CD4<50 cells/µl) is bad for the patient and bad for the budget. Recent policy announcements about when to start ART implies that more patients in South Africa will get treatment, and there could be a reduction in the early costs of ART programmes. However, starting ART earlier is likely to lead to overall cost increases in the long run as patients could live for longer.

Identify HIV infection at an earlier stage.

To reduce later costs of ART:

Invest in systems to monitor ART adherence and implement effective interventions if patients do not take their drugs regularly.

This blog is based on a journal article  titled “Early and Late Direct Costs in a Southern African Antiretroviral Treatment Programme: A Retrospective Cohort Analysis”  published in PLoS Medicine 6(12) in 2009 and is freely available online at: www.plosmedicine.org.

Alternatively, download the policy brief based on this article.