This article, published in BMJ Open, aims to estimate the household economic burden and incidence of catastrophic health expenditures (CHE) incurred as a result of HIV and TB care across income quintiles in Ethiopia. The economic burden of HIV and TB care is estimated looking at direct and indirect costs, whereas the incidence of CHE is determined using direct costs that exceed 10% of the household income threshold. HIV and TB are found to cause substantial economic burden and CHE, inequitably affecting those in the poorest income quintile. Broadening health policies to encompass interventions that reduce the high cost of HIV and TB care, particularly for the poor, is urgently needed.
This article, published in Tropical Medicine & International Health, aims to identify the spatial and temporal trends, and epidemiologic correlates, of HIV clusters in Ethiopia. The authors use biomarker and survey data from the 2005, 2011, and 2016 Ethiopia Demographic and Health Surveys (DHS), and the spatial-temporal distribution of HIV is estimated using the Kulldorff spatial scan statistic, a likelihood-based method for determining clustering. The study results indicate that in Ethiopia, geographic HIV clusters are driven by different risk factors. Decreasing the HIV burden will therefore require targeted interventions.
This article, published in the Journal of Global Oncology, utilizes primary data from the Addis Ababa population-based cancer registry, as well as supplementary cancer data from six Ethiopian regions to estimate the incidence rates of the most common forms of cancer diagnosed in Ethiopia. The study finds that cancer, most prominently breast cancer, poses a substantial public health threat in Ethiopia. The fight against cancer calls for the expansion of population-based registry sites to improve quantifying cancer burden in Ethiopia and requires both increased investment and application of existing cancer control knowledge across all segments of the Ethiopian population.
This article, published in BMJ Global Health, quantifies household out-of-pocket (OOP) expenditure for treatment of childhood pneumonia and diarrhoea and estimates its impact on poverty for different socioeconomic groups in Ethiopia. The study finds that wealthier and urban households have higher OOP payments, but poorer and rural households are more likely to be impoverished due to medical payments. The present circumstances call for revisiting the existing health financing strategy for high-priority services that place a substantial burden of payment on households at the point of care.
This article, published in BMC Medicine, utilizes a cost and epidemiological model to propose an assessment of the burden of medical impoverishment in Ethiopia (i.e., the number of households crossing a poverty line due to out-of-pocket (OOP) direct medical expenses). Among 20 leading causes of mortality, the authors estimate the burden of medical impoverishment to be around 350,000 poverty cases, with the top three causes of medical impoverishment attributed to diarrhea, lower respiratory infections, and road injury. In Ethiopia, medical impoverishment is found to be associated with illness occurrence and health services utilization. Although currently used estimates are sensitive to health services utilization, a systematic breakdown of impoverishment due to OOP direct medical costs by cause can provide important information for the design of health policies toward universal health coverage, reduction of direct OOP payments, and poverty alleviation.
This article, published in BMC Health Services Research, aims to measure changes in inequality in access to maternal and child health (MCH) interventions and the effect of primary health care (PHC) facilities expansion on the inequality in access to care in Ethiopia. The authors utilize Demographic and Health Survey datasets from Ethiopia (2005 and 2011) to calculate changes in utilization of MCH interventions and child morbidity and estimate concentration and horizontal inequity indices. The findings suggest that expansion of PHC facilities in Ethiopia might have an important role in narrowing the urban-rural and rich-poor gaps observed in health service utilization for selected MCH interventions.
This article, published in BMJ Open, aims to illustrate the size and distribution of benefits due to the treatment and prevention of diarrhoea (i.e., rotavirus vaccination) in Ethiopia. The authors use an economic model to examine the impacts of universal public finance (UPF) of diarrhoeal treatment alone, as opposed to diarrhoeal treatment along with rotavirus vaccination using extended cost-effectiveness analysis (ECEA). The study finds that diarrhoeal treatment paired with rotavirus vaccination is more cost effective than diarrhoeal treatment alone for the examined metrics (deaths and private expenditures averted). Policymakers should consider multiple benefit streams as well as their scale and incidence when considering public financing of health interventions.
This article, published in the Lancet Global Health, aims to evaluate the health and financial risk protection benefits of selected interventions that could be publicly financed by the government of Ethiopia. The authors used an extended cost-effectiveness analysis (ECEA) to assess the health gains (deaths averted) and financial risk protection afforded (cases of poverty averted) by a bundle of nine interventions that the Government of Ethiopia aims to make universally available. This approach incorporates financial risk protection into the economic evaluation of health interventions and therefore provides information about the efficiency of attainment of both major objectives of a health system: improved health and financial risk protection. It is especially relevant for the design and sequencing of universal health coverage to meet the needs of poor populations.