Health Economics

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EDUCATION-MALARIA CONTROL NEXUS: THE CASE OF GHANA
(University of Ghana , Legon, 2011-06-06) ADJEI, DAVID SEFA
Malaria is a global public health issue as well as a national one in Ghana. It is the number one cause of under-five mortality in Ghana. Several attempts have been made to curb the negative effects of this disease which include the use of Insecticide-Treated Nets (ITNs), anti-malarial drugs, indoor-residual spraying, etc. In Ghana, major stakeholders have ensured the provision of ITNs at highly subsidized rates and even in some cases, distributed free of charge. Alongside these interventions, there has been information, education and communication of activities to help Ghanaians understand the malaria burden and its various means of control. Despite these efforts, there has been marginal decline in malaria cases and mortality rates. Usage of ITNs still falls below the 80% coverage of the vulnerable population as recommended by the WHO. Thus, this study sought to investigate the role and extent to which education influences the ownership of ITNs by households and the usage of ITNs by under-five children. Using a Probit Model and a Negative Binomial Distribution Model, the study examined the role of formal and informal education on the usage of ITNs by under-five children and number of ITNs owned by households in Ghana using data gathered from the Ghana Demographic and Health Survey (GDHS, 2008). The study revealed that household heads with higher education had a positive effect on the use of ITNs by under-five children as well as the number of ITNs owned by households. Health workers and community volunteers also played a positive role in the ownership and usage of ITNs by households and under-five children respectively. Results from the study implied that much attention should be paid to the training of health workers and community volunteers to aid them to effectively disseminate information regarding malaria and its means of control. Efforts should also be directed at ensuring high enrolment and completion of basic education which serves as a foundation for attainment of higher education in Ghana. Formal education aids in comprehension of the malaria burden and its means of control.
Household Choice of Diarrhea Treatments for Children under the Age of Five in Kenya
(University of Nairobi, 2012-11-06) MURIITHI, GRACE NJERI
Childhood diarrhea is one of the leading causes of under-5 deaths in developing countries, including Kenya. Although it is one of the most easily prevented and managed childhood illnesses, it is the third leading cause of under-5 mortality and kills about 86 children in Kenya every day. The World Health Organization recommends the use of oral rehydration therapy (ORT) to manage diarrhea once it occurs as well as the use of zinc supplements to reduce the severity and future recurrence of the illness. This study investigated the factors that influence the household choice of treatments for children suffering from diarrhea across the country using a multinomial logit approach. A sample of 771 under-5 children was drawn from the 2008/2009 Kenya Demographic and Health Survey. It was found that 29.86 percent of the children were not administered with any sort of treatment for their diarrhea. Besides ORT and zinc, other treatments such as antibiotic drugs, antimotility drugs, and herbal medicines were used to manage childhood diarrhea. It was surprising to note that only 4 of the affected children were given zinc supplements. The study also found that prior knowledge/experience of oral rehydration salts, mother’s education level, and place of residence were key determining factors of the use of recommended treatments to manage diarrhea. Factors such as household wealth, mother’s age at birth and number of births in a span of five years were equally important for other treatments. Given the inadequate and low usage of ORT and zinc respectively, the study recommends strengthening awareness on childhood diarrhea and the recommended treatments that can be used to manage it as well as increasing the availability and accessibility of zinc supplements.
REGIONAL VARIATIONS IN CHILDHOOD MORTALITY IN ZAMBIA
(University of Zimbabwe, 2016-09-22) MICHELO, TOBIAS
Although Zambia has experienced reductions in childhood mortality over the years, wide gaps in childhood mortality rates still exist across the provinces within the country, warranting for a call for an equity focused approach to reducing child mortality. Motivated by this discrepancy, and guided by the Mosley and Chen (1984) conceptual framework, this dissertation aimed at establishing the socioeconomic, demographic and cultural factors that influence childhood mortality in Zambia, as well as the extent to which these factors possibly explain the observed regional variations in childhood mortality across the country. The study established that a number of factors significantly influence childhood mortality rates in the country. The chances of a child dying increased for a child born from: a non-Christian mother, a mother in the age category “45-49”, a mother who was not attended to by a midwife during delivery, and for the child whose mothers used “Pit latrines” or “bush” as their toilet facility. However, the chances of dying reduced for a child born in the rural area, or one in which the spacing between them and the previous sibling was 24 months or longer. In analyzing factors influencing childhood mortality rates in individual provinces, the study revealed that factors associated with child deaths were not homogenous, but differed from province to province. Finally, the study established that factors that have higher magnitudes in terms of their effects on child mortality in Zambia were significant and predominant in high mortality regions. Particularly, these included Religion, Attendence by midwife, Birth Interval, Literacy and Type of residence. And these were more influential in Eastern, Luapula, Northern, Muchinga, Lusaka and Western Provinces. The study therefore concluded that these socio economic, demographic and cultural factors are important in explaining the variations in childhood mortality observed among the different provinces of the country. The implication of these findings demonstrated the fact that ultimately, addressing the problem of childhood mortality effectively in Zambia calls for disaggregated analysis of individual regional problems.
Out-of-Pocket Health Expenditure and Savings Nexus: Evidence from the Economic Community of West African States (ECOWAS
(UNIVERSITY OF BOSTWANA, 2019-06-03) Adika, GAMELI
Borrowing, sale of assets and the use of current income and savings constitute the major sources of health care financing in West Africa. Consequently, a large proportion of health care financing in the sub region consists of Out of Pocket health expenditure. Specifically, between 2000 and 2016, Out of Pocket health care expenditure accounted for 50.2 percent of current health expenditure in ECOWAS. This phenomenon could have implications for achieving Universal Health Care as well as households’ capacity to save. This study employed the Panel Dynamic Ordinary Least Square to examine the relationship between Out of Pocket health expenditure and savings in ECOWAS. The empirical estimates of an endogenously derived savings model established that there exists a long run negative relationship between out of pocket health care expenditure and domestic savings rate in ECOWAS. Specifically, a one percent increase in Out of Pocket health expenditure is associated with a long run reduction in the savings rate by approximately 0.1 percentage points. The study, therefore, recommends that any agenda for increasing domestic savings in ECOWAS must necessarily incorporate a strategy for reducing the proportion of Out of Pocket health care payments in the region.
Measuring Technical Efficiency of Central Hospitals in Zimbabwe: Application of Data Envelopment and Stochastic Frontier Analysis using Panel Data (2009-2014)
(University of Zimbabwe, 2019-07-26) Mildred Shantell Mapani, Mildred Shantell
Zimbabwe is lacking resources to advance the country’s health sector needs. The country is off-track the achievement of Millennium Development Goals that are health related in their totality. Central hospitals, the core of the hospital referral system, had been marred with congestion, and overburdened with patients. There had been therefore frequent calls, from the public, for the need to improve the delivery of service at public hospitals. Amidst fiscal constraints, efficient use of resources had been cited as the key, relevant and important aspect of improving the healthcare delivery system. This study was undertaken to determine the extent to which the country can improve health outcomes through efficiency improvement. Two efficiency measurement approaches were used to evaluate the efficiency levels of central hospitals in Zimbabwe using data set for the years 2009 to 2013; the two efficiency measurement approaches are the Data Envelopment Analysis and the Stochastic Frontier Analysis. On average hospitals were found to exhibit inefficiency levels of about 37-39%. The DEA calculated Malmquist indices indicated that total factor productivity improved by 2% between 2009 and 2014 largely driven by improvements in scale efficiency. The study proposed that hospital output can be improved by about 38% without increasing inputs. This will be achieved through improved hospital operating system, improved management of resources or close monitoring of human resources and adequate loss control systems.
SOCIAL DETERMINANTS OF HEALTH STATUS IN UGANDA
(Makerere University, 2019-12-06) ATUGONZA, RASHID
Health status of individuals of great significance both because of the direct utility that health can provide and the productivity gain as a result of good health. The purpose of the study was to empirically establish the key factors influencing health status in Uganda. Specifically, examining the relationship between health status and socio-demographic, economic, lifestyle and environmental factors. Government of Uganda has been investing in health through acting on key Social Determinants of Health (SDH) such as household income and infrastructure as marked in the HSDP 2015/16-2019/20. However, evidence shows heavy burden of disease. The relationship between health status and the above SDH is not clear. Therefore, this necessitated the need to investigate the SDH. The study used Uganda National Household Survey (UNHS) 2016/17 data. The study was based on the SDH framework to examine SDH Status. Four logistic regressions models were estimated i.e. model I, II, III and IV focusing on individuals aged 0-5, 6-14,15-59 and 60+ years respectively. The study used adjusted Wald test to test for individual Statistical significance of the regression coefficients and Hosmer-Lemeshow (HL) test, to assess the goodness of fit. In reference to demographic factors the study establishes that Females aged 6-14, 15-59 and 60+ years were 1.29, 1.25, and 1.4 times more likely to be in poor health when compared to the males at P< 0.01 respectively. Individuals aged 6-14 from male headed household were 1.2 times more likely to be in poor health at P< 0.01 when compared to those from femaleheaded households. Rural residents aged 0-5, 6-14 and 15-59 were 1.5, 1.52, and 1.3 times more likely to be in poor health when compared to urban residents at P< 0.01 respectively. Likewise, the married aged 15-56 and 60+ years were 1.6 and 1.7 times more likely to be in poor health when compared with individuals not married at P< 0.01 respectively. Concerning economic factors, individuals with no formal education aged 6-14 years were 1.2 times more likely to be in poor health at P< 0.01 when compared to individuals with secondary level of education. Similarly, individuals aged 6-14 whose mothers have no formal education were 1.1 times more likely to be in poor when compared to those whose mothers have attained secondary level of education at P< 0.01. At P< 0.05 the unemployed aged 60+ were 1.6 times more likely to be in poor health when compared to those employed. Regarding lifestyle factors, current and past alcohol consumers aged 15-59 were 1.3 and 1.9 times likely to be in poor health at P< 0.01 when compared to individuals that do not consume alcohol respectively. Current smokers above 15-59 and 60+years were 1.8 and 1.4 times more likely to be in poor health when compared to the non-smokers at P< 0.01 respectively. As for environmental factors, individuals aged 0-5- and 6-14 using water from unimproved sources were 1.3 and 1.2 times more likely to be in poor health when compared to those that use water from improved sources at P< 0.01 and P< 0.05 respectively. Individuals aged 0-5 using poor and intermediate quality toilet facilities were 1.7 and 1.5 times more likely to be in poor health when compared to those that use high quality toilet facilities at P< 0.01 and P< 0.05 respectively. Individuals aged 6-14 residing in mad and poles houses and houses whose floor material made of earth were 1.2 and 1.3 times more likely to be in poor health when compared to those that reside in brick houses and houses whose floor material made of cement at P< 0.01 respectively. The study findings show that females above 6 years are more likely to be in poor health when compared the males. Therefore, considerable emphasis should be put on health interventions for women. Education of girls and employment opportunities for women will also promote gender equality and more broadly improve upon their health. Interventions to prevent people from smoking and alcohol consumption must also be undertaken or strengthened. More efforts should also be put in promoting health lifestyles especially among the young people. Also, policies should be aimed at closing the gap in health conditions between urban and rural inhabitants through balanced economic and social development to increase the level of income, education and decreasing unemployment amongst people living in the rural areas. From the results, children aged 6 to 14 years whose mothers have no formal education are more likely to be in poor health. Therefore, education especially for the girls should be a priority to enable mothers gain knowledge and skills to be able to make better healthy choices. To address the health problem among unemployed individuals aged 60+ years, it is necessary to put in place insurance scheme for the elderly to ease their access to health care. Regarding the environmental factors, there should be establishment of clear institutional responsibility and specific budget lines for water & sanitation, and ensuring that public sector agencies working in health, in water resources and other utility services work together better to enhancing quality infrastructure (piped water to homes, toilets connected to sewers or septic tanks).
THE IMPACT OF HEALTH FINANCING SOURCES ON CHILD MORTALITY IN KENYA
(UNIVERSITY OF MALAWI, 2020-08-29) KARANJA, MARTIN KURIA
In Kenya health financing as a percentage of GDP has increased over the years although health outcomes especially child mortality seem to have not followed the same trend. The aim of the study was to determine the impact of public, private and donor health financing on childhood mortalities in Kenya. The study approach was based on (Grossman, 1972) theoretical model that applies a vector of inputs in production of health outcomes. The study used time series data from 1980-2014 applying an ARDL analysis method. The empirical findings revealed that in the shortrun health financing, Per capita GDP, Doctors population, Measles immunization and Women’s literacy level had no influence on infant mortality but in the long-run public health financing, Per capita GDP and Doctor’s population improved infant mortality. Analysis of under-five mortality model revealed that in the short-run health financing, Per capita GDP, Doctors population, Measles immunization and Women’s literacy level had no influence on under five mortality rates but in long run child immunization against measles, Women’s literacy level and per capita GDP improved under five mortality. Based on the findings the study recommends an increase in the allocation of funds by the government to the health sector, improve socio-economic status of Women and government to educate the populace on the importance of child immunization to reduce childhood mortalities in Kenya.
AN EXPLORATION OF FACTORS THAT INFLUENCE HEALTH INSURANCE PARTICIPATION BY URBAN HIGH-DENSITY HOUSEHOLDS IN ZIMBABWE: CASE OF BUDIRIRO 1
(UNIVERSITY OF ZIMBABWE, 2020-09-24) ARCHFORD, GANDIDZANWA
The purpose of this study was to investigate factors that influence the decision to participate in health insurance by urban high density households in Zimbabwe using primary data from Budiriro 1 suburb in Harare. This came in the wake of deteriorating health standards and nonparticipation in health insurance schemes on the part of most Zimbabweans. Specifically, the study investigated the major drivers causing majority of healthcare users to rely on out-of-pocket expenditure rather than purchasing medical insurance and examined the influence of socioeconomic and demographic factors such as household income, education level, employment status, religion and gender of household head on the probability of health insurance participation. From the target population, a sample of 120 households were randomly selected and interviewed. A self-administered questionnaire was used to collect data between February and March 2018. Given the discrete nature of health insurance participation, data presentation and analysis was done using both descriptive statistics and the probit model. The study established that the motives for households’ reliance on out-of-pocket were lack of awareness, chronic illness and the existence of tariff impasse between medical insurance schemes and healthcare providers. Probit regression results show that the household head’s level of education, household income, employment status, and religion positively affect health insurance participation whereas gender was found to negatively influence participation in health insurance. Age and health insurance participation were found to have a quadratic relationship of a concave form. To improve participation in health insurance, the study argues for the health insurance industry to claim greater involvement in the nation’s educational achievements and productivity stimulating endeavours. The study also recommends educating all healthcare users, regardless of religion or age on the importance of being insured so as to increase coverage across all age groups as well as on apostolic health care users.
CHOICE OF HEALTH CARE SERVICES-CASE OF BUDIRIRO 4 HIGH DENSITY SUBURBS, HARARE
(UNIVERSITY OF ZIMBABWE, 2020-09-25) RANGANAI, MUNERI
The study investigated the factors that determine patients’ choice of health care provider in Zimbabwe, using data collected from Budiririro 4 by way of questionnaires. A sample of 150 people who reported having been sick within the last 12 months was collected. A multinomial logistic model was employed, further which marginal effects were calculated. The findings were that being male increases the probability of choosing Private and mission clinics/hospitals and decreases the probability of choosing public facilities and spiritual/ religious providers. As income increases, patients shun spiritual/religious providers and move to demand services from private clinics/hospitals. Increase in household size causes patients to move away from private clinics/hospital and demand services from religious/spiritual healers. Members of the apostolic sect are predisposed to choose spiritual/religious healers and have a lower probability of choosing private clinics/hospitals. Patients suffering from perceived severe illness have a lower probability of choosing public clinics/hospitals. An increase in user fees is associated with an increased probability of choosing private, mission and spiritual healers, a very surprising result. Perceived high quality in private and spiritual providers is associated with an increase probability that they are chosen by patients. The major recommendations were that the government should fully incorporate the private providers, formal and informal, into the system so as to improve access and health care utilization in Zimbabwe. The public provider should avail family discounts to improve access by large families. The government should intensify awareness campaigns to encourage members of apostolic sect to seek formal health care services. The Zimbabwean heath system should endeavor to eliminate the impasse that exists between health care funders and provider
HEALTH EXPENDITURE AND HEALTH OUTCOMES IN EAST AND SOUTHERN AFRICA: DOES GOVERNANCE MATTER?
(UNIVERSITY OF BOSTWANA, 2020-12-07) Njoroge, Cecilia Wambui
Good health is important at both individual and macroeconomic levels, and improving health outcomes remains a noble goals as enshrined in Sustainable Development Goals. Generalized Method of Moments is used to examine the relationship between health expenditure and health outcomes and the role of governance in the effectiveness of health expenditure on health outcomes in 18 East and Southern African countries. The study results indicate that total, private and public health expenditure significantly reduce infant mortality, maternal mortality and under-five mortality rate, but increase in life expectancy significantly. Both public health expenditure and private health expenditure have the same impact on health outcomes. However, public health expenditure has a higher impact on health outcomes compared to private health expenditure. In addition, the study results show that poor governance adversely affects health outcomes, and also undermines the effectiveness of public health expenditure on health outcomes. The results suggest the need for governments to increase health spending levels to improve populace health.
Household Characteristics and Child Health Nexus.
(University of Zimbabwe, 2021-02-21) Mabodo, Eltone
This study was carried out with the main aim of finding ways of improving the health of children under the age of five in Zimbabwe. Under-five mortality and undernutrition were the two health indicators used in this study. The study used cross-sectional data collected during the 2015 Zimbabwe Demographic and Health Survey, with permission granted by the ICF International. Data analysis was carried out using Stata® 15. Two separate regression models were estimated, one for the determinants of undernutrition and the other for the determinants of child survival. For the determinants of undernutrition, an ordered logistic regression model was estimated and for child survival, survival analysis was carried out using the Cox Proportional Hazards Model. On the causes of undernutrition, the study find factors such as short birth interval, being a male child, maternal education below tertiary level, premature birth, urban residence and being born to a mother following the apostolic sect religious doctrine contributing to poor nutrition stock of the children. On the other hand, factors such as safe drinking water, single births, improved toilet facility and clean cooking power all contributing to the child having good nutrition stock. In addition, survival analysis has revealed factors such as maternal alcohol consumption, healthcare services accessibility, improved toilet facility, maternal age, premature birth, single birth and religious doctrine as the contributing factors increasing the probability of the child dying before their fifth birthday. Hence the study advocates that targeting these variables, that is, maternal characteristics (alcohol consumption, age and education), household characteristics (urban residence, cooking fuel and apostolic sect religious doctrine followers), child specific characteristics (male child, premature births, single births and children with shorter birth interval) and water, sanitation and health variables (improving toilet facilities, providing safe drinking water and enhancing the accessibility of healthcare services) will improve the health of children under the age of five in Zimbabwe.
DISAGGREGATED HEALTH FINANCING, GOVERNANCE AND INFANT MORTALITY IN SUB-SAHARAN AFRICA
(University of Cape Coast, 2021-05-06) GAMETTE, PIUS
Despite evidence on the importance of disaggregated components of health financing (public, private and external health aid), little is known about the role governance performs in the relationship between disaggregated health financing components and infant mortality. Using panel data of 42 sub-Sahara African countries (SSA) for the period 2000-2016, this study analyses the differential effect of disaggregated components of health financing on infant mortality in SSA as well as across its sub-regional groups. The study also examines the confounding effect of governance in the relationship between disaggregated components of health financing and infant mortality. The study uses the Generalised Method of Moment (System-GMM) technique along with the Principal Component Analysis (CPA) to construct a governance index from three governance indicators (government effectiveness, control of corruption and regulatory quality). The study finds that each disaggregated component of health financing has a significant negative effect on infant mortality in SSA, albeit there exists regional disparities across SSA. The study also finds that governance has negative and significant confounding effects on the relationship between each disaggregated health-financing component and infant mortality in SSA. In terms of policy recommendations, Ministries of Health in respective SSA countries should strengthen partnership with foreign donors in the fight against infant mortality. Moreover, audit departments of Ministries of Health in respective SSA countries should strengthen regulations that guide health expenditure to have higher reduction in infant mortality level.

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