Research

Donald S. Shepard
Funder:  Abbot Global Diagnostics

Rwanda has recently initiated a new model of providing essential primary health care services within a 30-minute walk of all Rwandans' homes: Second Generation Health Posts (SGHPs). These health posts bring accessible, affordable, and enhanced quality health services to rural communities in Rwanda and improve patient outcomes and quality of life, while decreasing the risks of complications from delays in obtaining care.

This study aims to quantify the costs of SGHPs from both the societal and healthcare sector perspectives.  The intervention costs include the cost of building and equipping the SCHPs, which will be provided by global healthcare company Abbott.  As SGHPs are expected to increase the number of patients being treated, the operational costs will be obtained by assembling monthly operational costs from the newly established SGHPs to assess the costs of serving these patients.  Other costs related to seeking care, such as travel costs and productivity loss for both patients and their caretakers, will be based on interviews.

The study will also estimate the benefits of the SGHPs.  The expected health outcomes (number of deaths averted) cannot be observed directly due to limited sample size.  Instead, we will estimate the benefits indirectly, based on the effectiveness of each service, such as prenatal care or facility-based delivery.

We will also examine the financial sustainability of SGHPs to their operators who must cover their expenses by billing Rwanda’s national insurance system.  We will present a cost-effectiveness analysis and recommendations for scale-up.  An incremental cost-effectiveness ratio in terms of cost per quality-adjusted life year (QALY) gained will be estimated for determining the cost-effectiveness of the program.  Additionally, we will examine the affordability of scale up to the Rwanda national insurance system.

Diana Bowser
Funder:  Global Fund

In collaboration with Pharos Global Health Advisors, this Global Fund project aims to identify integration opportunities for Haiti’s HIV, TB, and malaria response programs. Currently these programs largely operate in silos that lead to inefficiencies which are both costly and potentially detrimental to patient care. Given a global decline in donor financing, Prof. Bowser's work in identifying these integration opportunities and recommending actions to mobilize them are paramount to informing both the Haitian government and the Global Fund’s response. Ultimately, it is hoped the resulting efficiency gains will not only help the response to the three diseases become more sustainable, but also improve the quality of care at the patient level.

Gary Gaumer, Diana Bowser
Funder: Office of the U.S. Global AIDS Coordinator and Health Diplomacy

Since its inception, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR)’s program has been instrumental in funding HIV/AIDS programs in many countries and has played a critical role in responding to the global HIV/AIDS epidemic. The Office of the U.S. Global AIDS Coordinator and Health Diplomacy (OGAC) has recognized the importance of accelerating treatment as a key to stemming and winning the war against HIV/AIDS. With constrained budgets and increasing performance targets, PEPFAR has increasingly turned its attention to ways in which to increase the efficiency of resource use. Since there is limited data to help drive efficiency improvements of HIV/AIDS service delivery and inform PEPFAR programming and national HIV/AIDS spending, OGAC funded the establishment of an Analytics Hub to conduct economic analysis and create the evidence needed to inform decisions around programmatic investments as well as inform dialogue with countries on sustaining the response in the future.

 The Analytics Hub at the Heller School is analyzing DHS data on HV prevalence and wealth inequality measures. Specifically, the team is examining the data using the technique of Inverse Probability Weighting (IPW). The use of IPW in the analysis accounts for possible selection bias in original sampling by using lower weights for oversampled individuals, depicting a closer estimation of prevalence of HIV seropositivity across socio-demographic groups. The literature suggests a pattern of prevalence with wealth, but analyses using IPW suggest there is not such a consistent association.

The researchers will also begin work on a new research question focusing on the geographic alignment of PEPFAR program support with prevalence rates, and levels of inequality in wealth.

Additionally, the Analytics Hub will be part of an effort to support a multi-country effort to put in place a system that will provide regular information of the cost of HIV/AIDS activities. This effort will use the approach of activity-based costing, and the Brandeis team will play a central role in providing technical support to implement and analyze this costing method globally.