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.

What drives costs during the early and late phases of ART in South Africa?

The research describes the direct health care costs in a South African private-sector HIV/AIDS programme and examines the drivers of the costs of HIV health care around the time of ART initiation and during later phases of ART.