Sustaining Gains in Health Programs: Technical Efficiency and its Determinants in Malaria Programs in Sub-Saharan Africa

Identifying and prioritizing inefficiency causes in Iran's health system

BACKGROUND

Enhancing efficiency is crucial in addressing the escalating scarcity of healthcare resources. It plays a pivotal role in achieving Universal Health Coverage (UHC), with the ultimate goal of ensuring health equity for all. A fundamental strategy to bolster efficiency involves pinpointing the underlying causes of inefficiency within the healthcare system through empirical research. This study aimed to determine and prioritize the causes of inefficiency in Iran's health system.

METHODS

This mixed-method study comprised three phases. The initial phase involved identifying the causes of inefficiency through a comprehensive literature review of relevant studies published between January 1, 2010, to January 1, 2021. The causes were then aligned and prioritized using criteria derived from the literature and expert opinion. Finally, the identified causes were ranked based on their significance using Multiple-Criteria Decision Analysis (MCDA).

RESULTS

From an initial pool of 307 causes of inefficiency, they were reduced to 121 causes in the first round of screening which were categorized into 13 thematic topics. The second screening process further narrowed the list to 48 causes. Among these, the leading causes of inefficiency included the inadequate supply and unequal distribution of hospital beds, the overuse of health services, and the mismanagement of the health workforce. In contrast, the use of traditional treatment methods was determined to be the least significant factor contributing to inefficiency.

CONCLUSION

This study identified key inefficiencies in Iran's health system, such as resource misallocation, overuse of services, and workforce mismanagement. Addressing these issues is essential for optimizing resource utilization, enhancing service delivery, and achieving UHC. The findings suggest that policymakers should prioritize reforms in hospital bed distribution, implement strategies to reduce unnecessary health service use, and strengthen human resource management. Additionally, targeted policies that focus on decentralizing healthcare decision-making and enhancing primary care could significantly improve system-wide efficiency. Future research should evaluate the effectiveness of these interventions and explore the role of digital health solutions in mitigating identified inefficiencies.

Health system productivity in sub-Saharan Africa: tuberculosis control in high burden countries

BACKGROUND

Sixteen of the 30 countries with a high tuberculosis (TB) burden are in Sub-Saharan Africa (SSA). Over 25% of TB deaths occur in the Africa region. This study aims to estimate the productivity changes of TB programs in 16 SSA countries where TB is endemic.

METHODS

We used Hicks-Moorsteen index to compute and decompose Total factor productivity (TFP), and the β-convergence and σ-convergence tests to check for convergence patterns among SSA countries.

RESULTS

We found that technological change has been the main driver of the TFP growth, and that increasing technical efficiency may be the first objective in efforts to improve TFP of TB programs. Moreover, the convergence tests reveal significant homogeneity in terms of TFP change between SSA countries studied.

CONCLUSION

The findings suggest that improving technical efficiency of TB programs mainly calls for better resource allocation, capacity building in governance and management of programs, improved training of the health providers and stronger prevention policies. Policymakers must design models for integration of TB treatment under the universal health insurance schemes.

Efficiency and management factors: finding the balance in Thalassaemia care centres

BACKGROUND

Optimizing efficiency has become increasingly critical with the growing demand for finite healthcare resources driven by population growth and an ageing society. Hence, policymakers are urgently finding more efficient ways to deliver health services. Thalassemia is a complex inherited blood disorder with significant prevalence in Malaysia. The high number of patients put substantial strain on the healthcare system. This study aims to evaluate the technical efficiency of thalassaemia care centres throughout Malaysia and the determinants that affect the efficiency.

METHOD

Data from 30 public hospitals with thalassaemia care centres were collected. A double bootstrap data envelopment analysis (DEA) approach is used with the assumption of input-oriented and variable-to-scale DEA models to generate technical efficiency scores. Bootstrap truncated regression was later conducted to identify the factors affecting the efficiency scores.

RESULTS

The mean bias-corrected technical efficiency score has improved to 0.75 in 2017 from 0.71 in 2016. In both years, more than 50% of thalassaemia care centres showed good efficiency scores (0.8-1.0). Management factors that affect the efficiency scores include separation of patient management (β = 0.0653) and budget (β = 0.0843), where they are found to positively affect the efficiency scores. In contrast, having longer operating hours is found to inversely influence the performance levels (β = - 0.4023).

CONCLUSIONS

The study provides a pioneering framework to evaluate the technical efficiency of thalassaemia treatment centres in public healthcare settings and could provide a useful guide for policymaker and thalassaemia care centre managers to improve efficiency in service delivery to thalassaemia patients and their caregivers without compromising quality of care.

Extension of mandatory health insurance to informal sector workers in Togo

BACKGROUND

About 90.4% of Togolese workers operate in the informal sector and account for between 20 and 30% of Togo's Gross Domestic Product. Despite their importance in the Togolese economy, informal sector workers (ISW) do not have a health insurance scheme. This paper aims to estimate the willingness-to-pay (WTP) of ISW in order to have access to Mandatory Health Insurance (MHI), and to analyze the main determinants of WTP.

METHODS

This study used data from the Community-Based Monitoring System (CBMS) project implemented in 2015 by the Partnership for Economic Policy (PEP). It focusses on 4,296 ISW (2,374 in urban areas and 1,922 in rural areas, respectively). The contingent valuation method was used to determine the WTP for the MHI while the Tobit model is used to analyze its determinants.

RESULTS AND DISCUSSION

Findings indicate that about 92% of ISW agreed to have access to MHI, like for formal sector workers. Overall, ISW are willing to pay 2,569 FCFA (USD 4.7) per month. ISW in the poorest quintiles are willing to allocate a higher proportion of their income (15%) to the premium than the richest quintiles (2.5%). Generally, women are more interested in MHI than men, although men are willing to pay higher premiums (3,168.9 FCFA or USD 5.8) than women (2,077 FCFA or USD 3.8). Women's lower WTP can be explained by their low levels of education and income, and a lack of employment opportunities compared to men. The gender of the head of the household, the size of the household and the education and income levels are the main determinants of WTP.

CONCLUSION

We conclude that it is possible to extend MHI to ISW as long as their premiums are subsidized. The annual subsidy is estimated at 4.1% of the state current general budget or 96% of the health sector budget. In setting the premium, policy makers should take into account the MHI benefits package, subsidies from the government, and information about the WTP. It is important to emphasize that resource mobilization and management, as well as health services delivery, would be effective only in a context of improved governance.

The challenge of rapid management of fever in children under 5 in Guinea

In 2013, the Guinean health authority had to reorganise and run a national response against malaria as a priority. The review of the National Strategic Plan to fight malaria in Guinea was carried out and one of its critical components was the prevention and rapid management of fever (RMF) attributable to malaria in children. The study reports on the demographic and health determinants of this rapid management in children under 5. The participants were 4786 children from 2874 representative households. RMF was defined in terms of recourse to primary care. The recourse was defined by child's reference for the treatment of fever which led or not to treatment of malaria. We found that 1491 children (31.2%) had a bout of fever within the 2 weeks that preceded the survey. The prevalence of malaria was 45.4% among those children who have a bout of fever. The recourse to traditional healers was estimated at 9.6% and the use of health facilities was estimated at 71.5%. Overall, 74.9% of children with fever received treatment within the recommended timeliness (24 h), with regional disparity in this rapid response. The high proportion of recourse to traditional healers is still a matter of concern. New control and prevention strategies should be extended to traditional healers for their training and involvement in directing febrile children to health facilities.

Design, synthesis, and antiprotozoal evaluation of new 2,9-bis[(substituted-aminomethyl)phenyl]-1,10-phenanthroline derivatives

A series of new 2,9-bis[(substituted-aminomethyl)phenyl]-1,10-phenanthroline derivatives was synthesized, and the compounds were screened in vitro against three protozoan parasites (Plasmodium falciparum, Leishmania donovani, and Trypanosoma brucei brucei). Biological results showed antiparasitic activity with IC₅₀ values in the μm range. The in vitro cytotoxicity of these molecules was assessed by incubation with human HepG2 cells; for some derivatives, cytotoxicity was observed at significantly higher concentrations than antiparasitic activity. The 2,9-bis[(substituted-aminomethyl)phenyl]-1,10-phenanthroline 1h was identified as the most potent antimalarial candidate with ratios of cytotoxic-to-antiparasitic activities of 107 and 39 against a chloroquine-sensitive and a chloroquine-resistant strain of P. falciparum, respectively. As the telomeres of the parasite P. falciparum are the likely target of this compound, we investigated stabilization of the Plasmodium telomeric G-quadruplexes by our phenanthroline derivatives through a FRET melting assay. The ligands 1f and 1m were noticed to be more specific for FPf8T with higher stabilization for FPf8T than for the human F21T sequence.