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Applied Health Economics and Health Policy

, Volume 15, Issue 1, pp 33–43 | Cite as

Economic Evaluation in Ethiopian Healthcare Sector Decision Making: Perception, Practice and Barriers

  • Elias Asfaw ZegeyeEmail author
  • Josue Mbonigaba
  • Sylvia Blanche Kaye
  • Thomas Wilkinson
Original Research Article

Abstract

Background

Globally, economic evaluation (EE) is increasingly being considered as a critical tool for allocating scarce healthcare resources. However, such considerations are less documented in low-income countries, such as in Ethiopia. In particular, to date there has been no assessment conducted to evaluate the perception and practice of and barriers to health EE.

Objective

This paper assesses the use and perceptions of EE in healthcare decision-making processes in Ethiopia.

Methods

In-depth interview sessions with decision makers/healthcare managers and program coordinators across six regional health bureaus were conducted. A qualitative analysis approach was conducted on three thematic areas.

Results

A total of 57 decision makers/healthcare managers were interviewed from all tiers of the health sector in Ethiopia, ranging from the Federal Ministry of Health down to the lower levels of the health facility pyramid. At the high-level healthcare decision-making tier, only 56 % of those interviewed showed a good understanding of EE when explaining in terms of cost and consequences of alternative courses of action and value for money. From the specific program perspective, 50 % of the prevention of mother-to-child transmission of HIV/AIDS program coordinators indicated the relevance of EE to program planning and decision making. These respondents reported a limited application of costing studies on the HIV/AIDS prevention and control program, which were most commonly used during annual planning and budgeting.

Conclusion

The study uncovered three important barriers to growth of EE in Ethiopia: a lack of awareness, a lack of expertise and skill, and the traditional decision-making culture.

Keywords

Economic Evaluation Health Sector Program Coordinator Healthcare Decision Health Economic Evaluation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

We would like to acknowledge the Health Economics and HIV/AIDS Economics Research Division (HEARD) at the University of KwaZulu-Natal for its supplementary financial/stipend assistance. The Federal Ministry of Health, Ethiopian Public Health Institute, Federal HIV/AIDS Prevention and Control Office, Addis Ababa City Administration Health Bureau, Dire Dawa City Administration Health Bureau, Amhara Regional Health Bureau, Oromia Regional Health Bureau, SNNP Regional Health Bureau and Harari Regional Health Bureau facilitated the data collection and provided the required evidence. We also appreciate the continuous support with English language editing services by Carol Brammage.

Author contributions

Elias Asfaw Zegeye designed the study, prepared the data collection tools, developed the analysis framework, led the data collection, analyzed the data, and drafted and revised the manuscript. Josue Mbonigaba oversaw the data collection, commented on the analysis plan, and reviewed and revised the article. Sylvia Blanche Kaye oversaw the data collection, commented on the analysis plan, and reviewed and revised the manuscript. Thomas Wilkinson commented on the overall qualitative method and revised the article.

Compliance with Ethical Standards

This research was funded by an African Doctoral Dissertation Research Fellowship award offered by the African Population and Health Research Centre (APHRC) in partnership with the International Development Research Center (IDRC). Elias Asfaw Zegeye, Josue Mbonigaba, Sylvia Blanche Kaye and Thomas Wilkinson have no conflicts of interest to disclose.

Supplementary material

40258_2016_280_MOESM1_ESM.docx (82 kb)
Supplementary material 1 (DOCX 81 kb)

References

  1. 1.
    O’Brien B. Principles of economic evaluation for health care programs. J Rheumatol. 1995;22(7):1399–402.PubMedGoogle Scholar
  2. 2.
    Eddama O, Coast J. A systematic review of the use of economic evaluation in local decision-making. Health Policy. 2008;86(2–3):129–41.CrossRefPubMedGoogle Scholar
  3. 3.
    Ross J. The use of economic evaluation in health care: Australian decision makers’ perceptions. Health Policy. 1995;31(2):103–10.CrossRefPubMedGoogle Scholar
  4. 4.
    Bryan S, Williams I, McIver S. Seeing the NICE side of cost-effectiveness analysis: a qualitative investigation of the use of CEA in NICE technology appraisals. Health Economics. 2007;16(2):179–93.CrossRefPubMedGoogle Scholar
  5. 5.
    Brousselle A, Lessard C. Economic evaluation to inform health care decision-making: promise, pitfalls and a proposal for an alternative path. Soc Sci Med. 2011;72(6):832–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Drummond M, Brandt A, Luce B, Rovira J. Standardizing methodologies for economic evaluation in health care: practice, problems, and potential. Int J Technol Assess Health Care. 1993;9(01):26–36.CrossRefPubMedGoogle Scholar
  7. 7.
    Drummond M. Economic evaluation and the rational diffusion and use of health technology. Health Policy. 1987;7(3):309–24.CrossRefPubMedGoogle Scholar
  8. 8.
    Yothasamut J, Tantivess S, Teerawattananon Y. Using economic evaluation in policy decision-making in Asian countries: mission impossible or mission probable? Value Health. 2009;12(SUPPL. 3):S26–30.CrossRefPubMedGoogle Scholar
  9. 9.
    Gavaza P, Rascati KL, Oladapo AO, Khoza S. The state of health economic evaluation research in Nigeria. Pharmacoeconomics. 2010;28(7):539–53.PubMedGoogle Scholar
  10. 10.
    Gavaza P, Rascati KL, Oladapo AO, Khoza S. PHP46 The state of health economic evaluation in South Africa: a systematic review. Value Health. 2011;14(3):A19.CrossRefGoogle Scholar
  11. 11.
    Gavaza P, Rascati KL, Lawson KA, Brown CM, Mann T. PHP48 The state of health economics and pharmacoeconomics evaluation research in Zimbabwe. Value Health. 2008;11(3):A43.CrossRefGoogle Scholar
  12. 12.
    Gavaza P, Rascati K, Oladapo AO, Khoza S. PHP80 The state of health economics and pharmaceoconomics evaluation research in Nigeria: a systematic review. Value Health. 2010;13(3):A96.CrossRefGoogle Scholar
  13. 13.
    Lessard C, Contandriopoulos AP, Beaulieu MD. The role (or not) of economic evaluation at the micro level: can Bourdieu’s theory provide a way forward for clinical decision-making? Soc Sci Med. 2010;70(12):1948–56.CrossRefPubMedGoogle Scholar
  14. 14.
    Williams I, McIver S, Moore D, Bryan S. The use of economic evaluations in NHS decision-making: a review and empirical investigation. Clin Gov Int J. 2008;13(3).Google Scholar
  15. 15.
    Hoffmann C, von der Schulenburg JMG. The influence of economic evaluation studies on decision making: a European survey. Health Policy. 2000;52(3):179–92.CrossRefPubMedGoogle Scholar
  16. 16.
    Merlo G, Page K, Ratcliffe J, Halton K, Graves N. Bridging the gap: exploring the barriers to using economic evidence in healthcare decision making and strategies for improving uptake. Appl Health Econ Health Policy. 2015;13(3):303–9.CrossRefPubMedGoogle Scholar
  17. 17.
    Fasawe O, Avila C, Shaffer N, Schouten E, Chimbwandira F, Hoos D, et al. Cost-effectiveness analysis of option B+ for HIV prevention and treatment of mothers and children in Malawi. PloS one. 2013;8(3):e57778.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Shah M, Johns B, Abimiku AL, Walker DG. Cost-effectiveness of new WHO recommendations for prevention of mother-to-child transmission of HIV in a resource-limited setting. Acquir Immune Defic Syndr. 2011;25(8):1093–102.Google Scholar
  19. 19.
    Söderlund N, Zwi K, Kinghorn A, Gray G. Prevention of vertical transmission of HIV: analysis of cost effectiveness of options available in South Africa. BMJ. 1999;318(7199):1650–6.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Ciaranello AL, Perez F, Maruva M, Chu J, Engelsmann B, Keatinge J, et al. WHO 2010 guidelines for prevention of mother-to-child HIV transmission in Zimbabwe: modeling clinical outcomes in infants and mothers. PloS One. 2011;6(6):e20224.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Kuznik A, Lamorde M, Hermans S, Castelnuovo B, Auerbach B, Semeere A, et al. Evaluating the cost-effectiveness of combination antiretroviral therapy for the prevention of mother-to-child transmission of HIV in Uganda. Bull World Health Organ. 2012;90(8):595–603.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Ministry of Finance and Economic Development (MoFED). The Federal Democratic Republic of Ethiopia: Growth and Transformation Plan (GTP) 2010/11–2014/15. Addis Ababa: Ethiopia Ministry of Finance and Economic Development; 2010.Google Scholar
  23. 23.
    Federal Ministry of Health (FMOH). Health Sector Transformation Plan (HSTP) 2015/16–2019/20. Addis Ababa: Ethiopia Federal Ministry of Health; 2015.Google Scholar
  24. 24.
    Federal Ministry of Health (FMOH). Health Sector Development Programme (HSDP IV) 2010/11–2014/15. Addis Ababa: Ethiopia Federal Ministry of Health; 2010.Google Scholar
  25. 25.
    World Health Orgnization. WHO. Geneva: World Health Statistics, World Health Organization; 2014.Google Scholar
  26. 26.
    Wang H, Ramana GNV. Ethiopia—Universal health coverage for inclusive and sustainable development: country summary report: Washington DC; 2014.Google Scholar
  27. 27.
    Koblinsky M, Tain F, Gaym A, Karim A, Carnell M, Tesfaye S. Responding to the maternal health care challenge: the Ethiopian Health Extension Program. Ethiop J Health Dev. 2010;24(1).Google Scholar
  28. 28.
    Federal Ministry of Health (FMOH). Health Management Information System (HMIS) Information User Guide. Addis Ababa: Ethiopia Federal Ministry of Health; 2013.Google Scholar
  29. 29.
    European AIDS treatment group (EATG). News:Globl Fund and Financial Slack and proposed cuts. 2010.http://www.eatg.org/news/154866/Evidence_grows:_Global_Fund_financial_slack_and_proposed_cuts_to_PEPFAR_are_hurting_progress_against_AIDS. Accessed 12 May 2014.
  30. 30.
    Federal Ministry of Health (FMOH). Ethiopia’s Fifth National Health Accounts 2010/2011. Addis Ababa: Ethiopia Federal Ministry of Health; 2014.Google Scholar
  31. 31.
    Organisation of African Unity (OAU). Abuja declaration on HIV/AIDS, tuberculosis, and other related infectious diseases. OAU/SPS/ Abuja/3: New York. United Nations; 2001.Google Scholar
  32. 32.
    Bikilla AD, Jerene D, Robberstad B, Lindtjorn B. Cost estimates of HIV care and treatment with and without anti-retroviral therapy at Arba Minch Hospital in southern Ethiopia. Cost Eff Resour Alloc. 2009;7(6):1.Google Scholar
  33. 33.
    Kombe G, Galaty D, Gadhia R, Decker C. Human and financial resource requirements for scaling up HIV/AIDS services in Ethiopia. Bethesda MD: The Partners for Health Reform plus Project Abt Associates Inc; 2004.Google Scholar
  34. 34.
    Johns B, Asfaw E, Wong W, Bekele A, Minior T, Kebede A, et al. Assessing the costs and effects of antiretroviral therapy task shifting from physicians to other health professionals in Ethiopia. Acquir Immune Defic Syndr. 2014;65(4):140–7.CrossRefGoogle Scholar
  35. 35.
    Asfaw E, Tushune K,Abdosh B, Pedro Paulo MC. Cost effectiveness analysis of PMTCT service delivery modalities in Addis Ababa (using decision models). Soc Sci Res Netw. http://dx.doi.org/10.2139/ssrn.2180719. Accessed 02 May 2014.
  36. 36.
    Bikilla AD, Jerene D, Robberstad B, Lindtjørn B. Cost-effectiveness of anti-retroviral therapy at a district hospital in southern Ethiopia. Cost Eff Resour Alloc. 2009;7(13):1.Google Scholar
  37. 37.
    Federal HIV/AIDS Prevention and Control Office (FHAPCO). Facility-based anti-retroviral treatment costing study in Ethiopia. Addis Ababa: Ethiopia Federal HIV/AIDS Prevention and Control Office/Ethiopia Federal Ministry of Health; 2012.Google Scholar
  38. 38.
    Creswell JW, Clark VL. Designing and conducting mixed method research. 2nd ed. USA: SAGE Publications Inc; 2011.Google Scholar
  39. 39.
    Bryman A. Social research methods. 4th ed. New York: Oxford University Press; 2012.Google Scholar
  40. 40.
    Coast J. The appropriate uses of qualitative methods in health economics. Health Econ. 1999;8(4):345–53.CrossRefPubMedGoogle Scholar
  41. 41.
    Ethiopian Public Health Institute (EPHI). Report on the 2012 round Antenatal case based sentinel surveillance in Ethiopia. Addis Ababa: Ethiopian Public Health Institute; 2014.Google Scholar
  42. 42.
    Patton MQ. How to use qualitative methods in evaluation. SAGE Publications Inc; 1987.Google Scholar
  43. 43.
    Drummond M, Sculpher M, Torrance G, O’Brien B, Stoddart GL. Methods for the economic evaluation of health care programs. 3rd ed. New York: Oxford University Press; 2005.Google Scholar
  44. 44.
    Sax S. Health care choices and the public purse. Sydney: Allen and Unwin; 1990.Google Scholar
  45. 45.
    Federal Ministry of Health (FMOH). Human Resource Development and Management directorate. Human resource directive and incentive package document 200-8/3/6. Addis Ababa: Ethiopian Federal Ministry of Health; 2014.Google Scholar
  46. 46.
    Morrison S, Brundage S. Advancing health in Ethiopia with fewer resource, an uncertian GHI strategy, and vulnerabilities on the ground. Washington DC: Centre for Strategic and International Studies; 2012.Google Scholar
  47. 47.
    Resch S, Ryckman T, Hecht R. Funding AIDS programmes in the era of shared responsibility: an analysis of domestic spending in 12 low-income and middle-income countries. Lancet Glob Health. 2015;3(1):e52–61.CrossRefPubMedGoogle Scholar
  48. 48.
    Johnnesson M. Economic evaluation of health care and policymaking. Health Policy. 1995;33(3):179–90.CrossRefGoogle Scholar
  49. 49.
    Hoffmann C, Stoykova BA, Nixon J, Glanville JM, Misso K, Drummond MF. Do health-care decision makers find economic evaluations useful? The findings of focus group research in UK health authorities. Value Health. 2002;5(2):71–8.CrossRefPubMedGoogle Scholar
  50. 50.
    Eddama O, Coast J. Use of economic evaluation in local health care decision-making in England: a qualitative investigation. Health Policy. 2009;89(3):261–70.CrossRefPubMedGoogle Scholar
  51. 51.
    Drummond M. Economic evaluation in health care: is it really useful or are we just kidding ourselves? Aust Econ Rev. 2004;37(1):3–11.CrossRefGoogle Scholar
  52. 52.
    Wiseman V, Mitton C, Doyle-Waters MM, Drake T, Conteh L, Newall AT, et al. Using economic evidence to set healthcare priorities in low-income and lower-middle-income countries: a systematic review of methodological frameworks. Health Econ. 2016;25(S1):140–61.CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Greco G, Lorgelly P, Yamabhai I. Outcomes in economic evaluations of public health interventions in low-and middle-income countries: health, capabilities and subjective wellbeing. Health Econ. 2016;25(S1):83–94.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Elias Asfaw Zegeye
    • 1
    Email author
  • Josue Mbonigaba
    • 1
  • Sylvia Blanche Kaye
    • 2
  • Thomas Wilkinson
    • 3
  1. 1.Economics Department, School of Accounting, Economics and FinanceUniversity of KwaZulu-NatalDurbanSouth Africa
  2. 2.School of Public Management and EconomicsDurban University of TechnologyDurbanSouth Africa
  3. 3.PRICELESS SA, School of Public HealthUniversity of WitwatersrandJohannesburgSouth Africa

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