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 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 PLOS ONE, conducts an extended cost-effectiveness analysis (ECEA) of two fully publicly financed interventions in Ethiopia: pneumococcal vaccination for newborns and pneumonia treatment for under-five children. The authors apply ECEA methods and estimate the program impact on: (1) government program costs; (2) pneumonia and pneumococcal deaths averted; (3) household expenses related to pneumonia/pneumococcal disease treatment averted; (4) prevention of household medical impoverishment; and (5) distributional consequences across the wealth strata of the population. The results indicate that vaccine and treatment interventions for children can bring large health and financial benefits to households in Ethiopia, most particularly among the poorest socio-economic groups.
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.