33 research outputs found
The Trade-Off between Banking Outreach And Profitability: Evidence From selected South African Development Countries
Get PDFIn this paper, the fixed effects method known as the least squares dummy variable (LSDV) technique was applied to investigate the possibility of a trade-off between bank profitability indicators and banking outreach (expanding access to banking services) by analysing a panel of 10 South African Development Countries (SADC). Of the fifteen SADC member countries (Angola, Botswana, Democratic Republic Of Congo, Lesotho, Madagascar, Malawi, Mauritius, Mozambique, Namibia, Seychelles, South Africa, Swaziland, United Republic Of Tanzania, Zambia, and Zimbabwe), five (Botswana, Congo, Lesotho, Malawi and Zimbabwe) had to be excluded for lack of consistent data throughout our period of analysis. The author investigates whether expanding banking access and pursuing profitability are complementary goals in the same direction or are two conflicting goals. For estimation robustness, two indicators of profitability were used namely return on average assets (ROAA) and return on average equity (ROAE). IMF Financial Access Survey (FAS) data for each country namely, deposit accounts per capita and the number of bank branches per 1000 km2 were used as indicators of bank outreach or access. Operational inefficiency, insolvency risk and credit risk were found to exert a negative impact on both ROA and ROE. Net interest margin a proxy for interest based services and off-balance sheet activities were statistically significant and positively related with bank profitability. Central to the study was that expanding banking access was found to exert a statistically significant and positive impact on profitability for some SADC countries. However, contrary to the author`s expectation, for some countries, the indicator of outreach was inversely related with the chosen indicators of profitability. The researcher however, argues that any form of intervention aimed at improving the state of access to those financially excluded cannot be evaluated from a cost or profit perspective alone but must be all-inclusive taking into account the social and economic benefits to the society as a whole. The major purpose of financial inclusion is to reach the poor and disadvantaged segments of the population. Hence, the author cautions that although attaining high profitability is an important policy objective for ensuring sustainability and financial stability, it is certainly not the only priority. Access to banking services, social inclusion and consumer protection are equally important policy priorities. There is therefore need for government support and a general holistic stakeholder approach to the problem of banking exclusion in order to generate solutions that achieve both profitability and outreach in a balanced fashion
Preventing cardiovascular disease in rural South Africa
No full textA Thesis Submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfillment of the requirements for the degree of Doctor of Philosophy, Jphannesburg October 2018Background: The epidemiological, nutritional and demographic transitions occurring in developing countries, have resulted in an unprecedented rise in noncommunicable diseases, in particular, cardiovascular disease (CVD). Consequently, CVD are contributing significantly to disease burden in populations where infectious diseases and maternal and perinatal conditions still persist. Rural areas which are least equipped to deal with this burden are no exception; recent evidence points towards a similar trend of increased CVD, particularly stroke. Understanding the disease burden and cost-effective strategies for prevention is therefore of critical importance. Such information should assist policymakers to justify policy decisions on interventions to prevent cardiovascular disease.
Aims: To better understand the epidemiological profile and pattern of stroke and its risk factors in rural South Africa so as to select interventions that are effectively targeted, are cost-effective, and have the potential to reduce the cardiovascular disease burden in key populations.
Methods: The study utilised two methodological approaches to address the research aims. First, existing validated methods and epidemiological tools were used. The Global Burden of Disease Study approach was the framework for analysing years lost due to premature mortality (YLL), years lived with disability (YLD) and disability adjusted life years (DALYs). The mathematical tool - Dismod II - was used to estimate the disease incidence. The World Health Organization’s comparative risk assessment framework was used to estimate burden attributable to metabolic risk factors; namely high blood pressure, raised blood glucose and excess body mass index. All data for the analyses were derived from the Agincourt health and sociodemographic surveillance system, which covers a population of over 100,000 individuals in rural North-east, South Africa, adjacent to Southern Mozambique. Extrapolation to ‘mostly rural’ South Africa was based on the conservative assumption that all municipalities that are considered ‘mostly rural’ share an epidemiological profile similar to that of Agincourt sub-district; thus only population figures (by age and sex) adjusted the incidence and DALYs. Second, an economic model to assess the cost-effectiveness of CVD prevention interventions was developed, customised for the Agincourt sub-district population. This is a Markov model which simulates disease progression in a cohort of people, starting from a healthy (disease-free) state until death or 100 years of age by accounting for changing risk factor profiles in each age-sex cohort. The application of the model is illustrated by estimating the cost-effectiveness of alternative pharmaceutical interventions for CVD prevention. Interventions are targeted to groups with varying degrees of absolute CVD risk over the next 10 years of ‘<10%’ (low risk), ‘≥10% & <20%’ (medium risk) and ‘≥20%’ (high risk). A fourth target group was individuals with untreated stage 2 hypertension.
Results: Baseline burden of CVD was substantial: crude stroke incidence rate was 244 per 100,000 person years in Agincourt sub-district. An estimated 33, 500 strokes occurred in 2011 in “predominantly” rural municipalities of South Africa, a population of some 13,000,000 people. Crude stroke mortality was 114 per 100,000 personyears in 2007–11 in Agincourt sub-district whilst 1,070 DALYs (CI 750 - 1680) were lost due to stroke. Preventable risk factors were responsible for a significant proportion of the stroke burden: Among males, 40% of the stroke burden was attributable to high blood pressure. Similarly, 38% of the stroke burden in females was attributable to high blood pressure. There was marked variation in stroke burden attributable to excess body mass index (BMI) by gender. Approximately 11.4% of the stroke burden in males was attributable to excess BMI compared to 22.5% in females. Despite some uncertainty, it appears that diabetes plays a relatively small contributory role to the overall CVD burden. Furthermore, it has been assumed that cholesterol does not play an important role in this setting based on previously published data. By combining actual health care utilization estimates from the Agincourt sub-district with incidence and prevalence data, we estimated that direct costs of stroke treatment comprised 1-3% of the sub-district expenditure in 2013. Average costeffectiveness ratios (ACERs) for all pharmacotherapies, across all target groups, fell in the range of US156 (combination of β-blocker and diuretic) and US373 (polypill – a single tablet containing a statin and three antihypertensive agents) per DALY averted for the high-risk group. ICERs indicate the additional cost needed to avert an additional DALY as successively less cost-effective strategies are adopted. The same interventions were cost-effective for the medium-risk group and patients with stage 2 hypertension. The optimal treatment pathway for low risk individuals (10-year risk of <10%) included low-dose diuretic with an ICER of US228; combination of β-blocker and diuretic (ICER: US683 per DALY averted) and ACE-I/diuretic combination which yielded an ICER of US4.06 million, US$6.28 million respectively.
Conclusions: The burden of stroke in Agincourt HDSS as estimated in this study is considerable and is currently propelled by, amongst other risk factors, the high prevalence of hypertension and obesity. If we assume similar prevalence and distribution of risk factors for the other 69 rural municipal areas, then the effect on rural South Africa is equally substantial. By applying the custom-built economic model, we show that several pharmaceutical options are potentially cost-effective and affordable in reducing CVD. Furthermore, the cost-effectiveness modelling showed that a total risk factor approach is more cost-effective than a single risk factor approach. The model, which is an output of this thesis can be applied across other health and socio-demographic surveillance sites to build an augmented dataset that will assist in better profiling of CVD prevention across other sub-Saharan African sites.XL201
Economic burden of stroke in a rural South African setting
No full textBackground: Stroke is the second leading cause of mortality and leading cause of disability in South Africa yet published data on the economic costs of stroke is lacking particularly in rural settings.
Methods: We estimate the total direct costs of stroke in 2012 from a health system perspective using a prevalence-based, bottom-up costing approach. Direct costs include diagnosis, inpatient and outpatient care. Analysis is based on the Agincourt health and socio-demographic surveillance system, which covers approximately 90,000 people. Published data from the SASPI study, Tintswalo Hospital Stroke register, and national cost databases were used. Sensitivity analysis was carried out to account for the variability in the data used.
Results: The total direct costs of stroke were estimated to be R2.5–R4.2 million (US485,000) in 2012 or 1.6–3% of the sub-district health expenditure. Of this, 80% was attributed to inpatient costs. Total costs were most sensitive to the underlying incidence rates and to assumptions regarding service utilisation.
Conclusions: Our study provides a snapshot of costs incurred on stroke in rural South Africa. We show that stroke is a disease with high economic costs. Further studies that assess the lifetime costs of stroke are needed to better understand savings accrued from intervening at different stages of the disease
Economic consequences for households of illness and of paying health care in Zimbabwe: A case study
No full textIncludes bibliographical references.This study investigates the economic consequences of illness and of paying for health care in Zimbabwe. It explores the incidence of out-of-pocket (OOP) payments, catastrophic health expenditure (CHE), impoverishment and the factors, (particularly socio-economic factors) associated with them. In addition, this study determines the strategies that households employ to cope with the financial burden of OOP payments in Zimbabwe. Data was collected from 499 households in Harare urban and Seke rural districts of Zimbabwe. Total monthly household OOP health expenditure was defined as 'catastrophic' if it exceeded the threshold level of 40% of a household's monthly capacity to pay. Logistic regression analysis was used to identify the factors that influence the incidence of CHEs. A non-poor household was impoverished by OOP health expenditure if its total household expenditure after deducting OOP payments was lower than the subsistence expenditure. The results of this study indicated that, the incidence of CHEs was very high amongst the study population. Households at all levels of wealth incurred catastrophic health expenditures, and the proportion of households incurring CHEs was similar across the asset quintiles. Out-of-pocket payments precipitated impoverishment of non-poor households. Poor households, households with members above 65 years, female headed households, households with member(s) suffering from chronic illness and households with greater use of health services were at higher risk of incurring CHEs. On the contrary, households with a disabled member were less likely to incur CHEs. Besides 'avoiding seeking care', selling of assets and borrowing were the 2 most popular strategies used to cope with OOP health care payments. An analysis of these results suggests that, targeted exemption of vulnerable households, as well as provision of subsidised health services could reduce the economic impact of illness on households. The results of this study also point out to the need for strengthening risk pooling mechanisms through the implementation of community based health insurance schemes and enhancing tax collection. In addition, other strategies that extend beyond the health sector such as economic empowerment of women could be effective in mitigating the economic impact of illness amongst female headed households in Zimbabwe
A hidden menace: Cardiovascular disease in South Africa and the costs of an inadequate policy response
Get PDFThe cardiovascular disease (CVD) burden in South Africa (SA) is increasing amongst all age groups and is predicted to become the prime contributor to overall morbidity and mortality in the over 50-year age group. Several factors contribute to this – an epidemiological transition, which has seen a rise in chronic non-communicable disease, and a demographic transition with much reduced fertility and a growing proportion of the population above 60 years. In parallel with unfolding urbanisation, the population burden of vascular risk factors namely hypertension, hypercholesterolemia, diabetes and obesity has increased. The scale of CVD burden poses a threat to the health system and calls for timely intervention. This paper discusses the burden of CVD in SA and current initiatives to address it. Evidence is presented from studies that focus on prevention including salt reduction and trans-fatty acids legislation. The economic and clinical impact of an inadequate private and public sector response is summarised. The paper documents lessons from other countries and proposes health systems strengthening measures that could improve care of patients with CVD
MOESM2 of Economic evaluations of interventions to reduce neonatal morbidity and mortality: a review of the evidence in LMICs and its implications for South Africa
Get PDFAdditional file 2: Table S1. Economic evaluation studies of interventions tox` reduce neonatal morbidity and mortality in LMICs (2000â2013)
Disease burden of stroke in rural South Africa : an estimate of incidence, mortality and disability adjusted life years
No full textBackground: In the context of an epidemiologic transition in South Africa, in which cardiovascular disease is increasing, little is known about the stroke burden, particularly morbidity in rural populations. Risk factors for stroke are high, with hypertension prevalence of more than 50%. Accurate, up-to-date information on disease burden is essential in planning health services for stroke management. This study estimates the burden of stroke in rural South Africa using the epidemiological parameters of incidence, mortality and disability adjusted life year (DALY) metric, a time-based measure that incorporates both mortality and morbidity. Methods: Data from the Agincourt health and socio-demographic surveillance system was utilised to calculate stroke mortality for the period 2007-2011. Dismod, an incidence-prevalence-mortality model, was used to estimate incidence and duration of disability in Agincourt sub-district and 'mostly rural' municipalities of South Africa. Using these values, burden of disease in years of life lost (YLL), years lived with disability (YLD) and DALYs was calculated for Agincourt sub-district. Results: Over 5 years, there were an estimated 842 incident cases of stroke in Agincourt sub-district, a crude stroke incidence rate of 244 per 100,000 person years. We estimate that 1,070 DALYs are lost due to stroke yearly. Of this, YLDs contributed 8.7% (3.5 - 10.5%) in sensitivity analysis). Crude stroke mortality was 114 per 100,000 person-years in 2007-11 in Agincourt sub-district. Burden of stroke in entire rural South Africa, a population of some 13,000,000 people, was high, with an estimated 33, 500 strokes occurring in 2011. Conclusions: This study provides the first estimates of stroke burden in terms of incidence, and disability in rural South Africa. High YLL and DALYs lost amongst the rural populations demand urgent measures for preventing and mitigating impacts of stroke. Longitudinal surveillance sites provide a platform through which a changing stroke burden can be monitored in rural South Africa
Measuring, valuing and including forgone childhood education and leisure time costs in economic evaluation : methods, challenges and the way forward
Get PDFEconomic evaluations carried out to inform the allocation of finite public funds ought to take into account all relevant costs and benefits. When such evaluations adopt a societal perspective, it is important that they include ‘time-related’ costs arising from productivity and leisure time losses due to receipt of care, ill health or both. For programmes that relate to children, similar costs arise from forgone time, though there is a distinct lack of insights into how such costs should be identified, measured and valued. We set out to explore how forgone time—including absence from formal education and childhood leisure time—can be estimated and incorporated into economic evaluations. To do so, we look at theories and approaches to time valuation proposed in different disciplines and we discuss their suitability for use in health economics research. We find that, while there is a sizeable literature on time valuation methods in education, labour and transportation economics, much of this is not directly applicable to economic evaluation of health care interventions for children. We identify gaps in existing methods and practice, we outline challenges in moving forwards and we provide a list of considerations aiming to assist researchers in deciding whether, and how, to include foregone time-related costs in economic evaluation
Surveillance of people with previously successfully treated diabetic macular oedema and proliferative diabetic retinopathy by trained ophthalmic graders : cost analysis from the EMERALD study
Get PDFBackground/aims: Surveillance of people with previously successfully treated diabetic macular oedema (DMO) and proliferative diabetic retinopathy (PDR) adds pressure on ophthalmology services. This study evaluated a new surveillance pathway entailing multimodal imaging reviewed by trained ophthalmic graders and compared it with the current standard care (face-to-face evaluation by an ophthalmologist).
Methods: Cost analysis of the new ophthalmic grader pathway, compared with the standard of care, from the perspective of the UK National Health Service, based on evidence from the Effectiveness of Multimodal imaging for the Evaluation of Retinal oedema And new vesseLs in Diabetic retinopathy study. Resource use data were prospectively obtained including times to undertake each procedure. Effectiveness was assessed in terms of sensitivity and specificity of referral decisions in the grader pathway. Costs (SDs) were analysed per 100 patients separately for DMO and PDR at 2018/2019 costs.
Results: For DMO, where sensitivity was very high (97%), the cost difference (savings) for the grader’s pathway would be £1390 per 100 patients. For PDR, the cost would be reduced by £461 for seven-field Early Treatment for Diabetic Retinopathy Study (ETDRS) images and by £1889 for ultrawide field images, per 100 patients. Ultrawide images required less time to be obtained and read than seven-field ETDRS. The real savings would be in ophthalmologist time, which could be then redirected to the evaluation of people at high risk of visual loss.
Conclusions: Surveillance of people with previously successfully treated DMO and PDR by trained ophthalmic graders can achieve satisfactory results and release ophthalmologist time.
Trial registration numbers: NCT03490318, ISRCTN10856638
Pattern and Epidemiology of Poisoning in the East African Region: A Literature Review
No full textThe establishment and strengthening of poisons centres was identified as a regional priority at the first African regional meeting on the Strategic Approach to International Chemicals Management (SAICM) in June 2006. At this meeting, the possibility of a subregional poisons centre, that is, a centre in one country serving multiple countries, was suggested. The WHO Headquarters following consultation with counterparts at the WHO Regional Office for Africa (AFRO) and the SAICM Africa Regional Focal Point successfully submitted a proposal to the SAICM Quick Start Programme (QSP) Trust Fund Committee for a feasibility study into a subregional poisons centre in the Eastern Africa subregion. However, before such a study could be conducted it was deemed necessary to carry out a literature review on the patterns and epidemiology of poisoning in this region so as to inform the feasibility study. The current paper presents the results of this literature review. The literature search was done in the months of June and July 2012 by two independent reviewers with no language or publication date restrictions using defined search terms on PUBMED. After screening, the eventual selection of articles for review and inclusion in this study was done by a third reviewer
