The HEU carries out policy-relevant health economics and health systems research. See brief outlines of long-term and short-term projects below.
XTEND: Xpert MTB/RIF for diagnosis of tuberculosis in South Africa – evaluating impact and cost-effectiveness in routine roll-out
The aim of this study is to evaluate the impact and cost-effectiveness of Xpert MTB/RIF in the investigation of TB and its impact on patient and programme outcomes and transmission at a population level, and thus inform policy on the scale up of Xpert MTB/RIF in low- and middle-income countries. The project runs from 2011 to 2014. The HEU is partnering with the Aurum Institute, the National Health Laboratory Services, National Department of Health, London School of Hygiene and Tropical Medicine and the World Health Organization. It is funded by the Gates Foundation.
XPHACTOR: Xpert MTB/RIF for people attending HIV care: an interventional cohort study to guide rational implementation
This study will identify an evidence-based algorithm, which is feasible to implement within HIV clinics, to guide the utilisation of TB investigations. It also looks at how the effectiveness and cost-effectiveness of Xpert MTB/RIF are influenced by how many and which patients are selected to undergo testing. The results will complement the XTEND study, and provide evidence to guide the rational use of Xpert MTB/RIF in national roll-out in South Africa and other settings where HIV and TB are both prevalent. The project runs from 2012 to 2014 and the HEU is partnering with the London School of Hygiene and Tropical Medicine, the Aurum Institute and the National Health Laboratory Services. The Gates Foundation is funding this project.
Global Network for Health Equity
The Global Network for Health Equity (GHNE) will enable comparative and collaborative work across three continents to advance equitable universal health coverage. It draws on 3 existing networks: EQUITAP (Equity in Asia-Pacific Health systems, an Asia-Pacific Research Partnership); LANET (The Latin American and Caribbean Research Network on Financial Protection and Health Observatory); SHIELD (Strategies for Health Insurance for Equity in Less Developed Countries, an African network). It is funded by the IDRC.
The UNITAS project will focus on monitoring and evaluating policy formulation and implementation processes aimed at achieving universal health coverage in South Africa and Tanzania. The project will undertake monitoring mainly at the district level, with some monitoring and evaluation at the national level. It aims to support implementation processes and will establish an ‘early warning system’ of implementation difficulties. The project runs from 2011 to 2015 and is funded by the European Union. It is a collaborative project with partners from the London School of Hygiene and Tropical Medicine, Ifakara Health Institute (in Tanzania), Institute of Tropical Medicine Antwerp (in Belgium), Centre for Health Policy, University of Witwatersrand and the Africa Centre in South Africa.
The Consortium for Health Policy and Systems Analysis in Africa (CHEPSAA) is an African-European network that supports capacity development in the field health policy and systems analysis. Activities include curriculum development, staff development and engagement with policy makers in national and regional levels, as well as building a network among the organisational partners. CHEPSAA builds on earlier activities funded by the Ford Foundation. It brings together 11 organisational partners from South Africa, Tanzania, Ghana, Kenya, Nigeria, UK, Sweden and Switzerland for the period 2011 to 2014, and is funded by the European Commission.
Resilient and Responsive Health Systems (RESYST) is a Consortium that is undertaking health policy and systems research (with a focus on financing, health workers and governance) in a set of African and Asian settings, including India, Kenya, Nigeria, South Africa, Thailand, Tanzania and Vietnam. Funded by DfID, the consortium began in 2011 and will run until 2016.
This programme of research is funded by the Department of Science and Technology and administered by the National Research Foundation’s South African Research Chair Initiative over the period 2008-2011. The overall research focus of the Chair is on the inter-play of health and wealth in the South African context and the impact of a range of government policies on health. Information on bursaries and fellowships.
The main aim of the research is to critically evaluate patterns of health care financing and benefits from the use of health services in Uganda and Zambia, to provide an evidence base for promoting equitable health systems in these countries. The project was implemented in 2010 and will continue until 2012 with funding by the International Development Research Centre (IDRC). The HEU will work with 2 other partners: the HealthNet Consult in Uganda and the Department of Economics at the University of Zambia. The main role of the HEU is to provide research and technical support.
The Health Economics Unit has been involved in EQUINET (the Regional network for Equity in health in east and southern Africa) since soon after its establishment in 1998. EQUINET is a network of health professionals, civil society members, academics, policy makers, state officials and others within the region who have come together as an equity catalyst, to promote and realise shared values of equity and social justice in health. The HEU has particularly contributed to work around equitable financing of health systems and equitable allocation of health care resources. Over the years, we have worked with countries such as Namibia, Tanzania, Zambia, Zimbabwe and more recently Mozambique, to develop resource allocation strategies based on the relative need for health care in each district.
Cost-effectiveness analysis of MVA85A vaccine: a new TB vaccine candidate
This project focuses on estimating the potential cost-effectiveness of adding the MVA85A vaccine to the BCG vaccine in HIV negative children from the perspective of the South African government. It is funded by the Oxford-Emergent Tuberculosis Consortium (OETC).
Cost analysis of an integrated community-based approach for drug-resistant tuberculosis care
This study aims to estimate the cost of decentralized drug-resistant TB management model developed by the MSF in partnership with the City of Cape Town and the Provincial Government of the Western Cape. Costs will be estimated from both the health services perspective and a societal perspective. The study is funded by the MSF.
Implementing and scaling up a community health policy in Kenya
The project focuses on community health policy in Kenya; the HEU is working with Japanese Aid and the Kenyan Ministry of Health to analyse issues related to implementing a health promotion programme with Community Health Workers. The project will end until the end of January 2014.
The SHIELD project aimed to identify the major equity challenges in the health systems of three African countries (Ghana, Tanzania and South Africa) through an understanding of financing and benefit incidence. The project was implemented from 2006 to 2010 and was partly funded by the International Development Research Centre (IDRC) and the European Union. Knowledge generated will form the basis for considering alternate approaches to health insurance within these countries as a mechanism for addressing health system equity challenges and contributing to the achievement of the Millennium Development Goals. See the SHIELD research output.
A project on public engagement in health care systems change in South Africa was launched by Black Sash (a South African civil society organisation) in collaboration with the Health Economics Unit (HEU) at the University of Cape Town and the Health-e News Service. Each of South Africa’s nine provinces played host to a 2-day consultation workshop with civil society groups to consider public views on the values communities would like to underpin the South African health system and key issues that need to be addressed in restructuring the health system. The HEU was involved in documenting and critically assessing the deliberation processes occurring in the workshops in order to draw methodological implications for public engagement in health care policy. In the second phase of the project, the HEU will undertake a discrete choice experiment (DCE) to elicit the community’s preferences in health care delivery. The project ran from 2010-2011.
The HEU was part of a consortium of research groups from South Africa, Nigeria, Kenya, Tanzania, India and Thailand under the leadership of the London School of Hygiene and Tropical Medicine with funding from the United Kingdom Government Department for International Development. The consortium aimed to increase knowledge on how to strengthen health systems in ways that preferentially benefit the poorest and to strengthen the capacity of partners to support local and global policy development. Work under the four themes of health sector reform, financial risk protection, workforce performance and scaling up began in 2005 and continued until 2010. See the CREHS website.
REACH – Researching Equity in Access to Health Care
This integrated program of research, capacity building and knowledge translation focuses on how health systems could contribute more effectively to achieving development goals by actively promoting equitable access to health care. This will be explored through the case of South Africa’s health system, focusing on three tracer health interventions of particular relevance to the Millennium Development Goals and which are crucial to addressing the burden of ill-health in South Africa. These are maternal health services and tuberculosis and HIV care. The HEU collaborates with the Center for Health Policy at the University of Witwatersrand and McMaster University in Canada in this Teasdale-Corti funded project which runs from 2007 to 2012.
Retaining health professionals in Mozambique’s public health sector
The HEU is working on a multi-partner project funded by the EU that is using Discrete Choice Experiment methodologies to elicit health professionals’ preferences for staying on in the public health sector of Mozambique. The project runs until the end of March 2013.
Strengthening health policy analysis research and training through a focus on approaches to comparative and synthesis analyses
Professor Lucy Gilson coordinates this project to develop the methods for synthesising health policy analysis work, and existing empirical studies around key themes. The project runs from 2009 to 2011 and is funded by the Alliance for Health Policy and Systems Research.
The aim of this project is to strengthen health policy analysis training in Africa and involves curriculum development and short courses training in partnership with six research organisations in Africa. Professor Lucy Gilson is the leader of the first phase of this programme of work that runs from 2008 to 2011, with funding from the Ford Foundation.