Developing countries face imminent choices for introducing needed, effective but expensive new vaccines, given the substantial immunization resources now available from international donors. Cost-effectiveness analysis (CEA) is a tool that decision-makers can use for efficiently allocating expanding resources. However, although CEA has been increasingly applied in developing-country settings since the 1990’s, its use lags behind that in industrialized countries. This thesis explored how CEA could be made more relevant for decision-making in developing countries through 1) identifying the limitations for using CEA in developing countries 2) identifying guidelines for CEA specific to developing countries 3) identifying the impact of donor funding on CEA estimation 4) identifying areas for enhancement in the 1996 “Reference Case” (a standard set of methods) recommended by the US Panel on Cost-Effectiveness in Health and Medicine, and 5) better understanding the decision-making environment in developing countries. Focusing on pediatric immunization in developing countries, thematic analysis was used to distill key concepts from 157 documents spanning health economics, clinical epidemiology and health financing. 11 key informants, researchers active in developing countries, were also interviewed to explore the production and use of evidence in public health decision-making. Results showed a divergence between industrialized and developing nations in the emphases of methodological difficulties, in the general application of CEA, and the types of guidelines available. Explicitly considering donor funding costs and effects highlighted the need to specify an appropriate perspective and address policy-related issues of affordability and sustainability. Key informant interviews also revealed that opinion-makers, international organizations and the presence of local vaccine manufacturing have significant influence on decision-making. It is suggested that CEA could be more useful with a broadened reference case framework that included multiple perspectives, sensitivity analysis exploring differential discount rates (upper limits exceeding 10% for costs, declining from 3% for benefits) and supplemental reports to aid decision-making (budgetary and sustainability assessments). This study has implications for improving health outcomes globally in the context of public-private collaborative health funding. Further research could explore defining an extra-societal (multi-country) perspective to aid in efficient allocation of immunization resources among countries.

Developing countries face imminent choices for introducing needed, effective but expensive new vaccines, given the substantial immunization resources now available from international donors. Cost-effectiveness analysis (CEA) is a tool that decision-makers can use for efficiently allocating expanding resources. However, although CEA has been increasingly applied in developing-country settings since the 1990’s, its use lags behind that in industrialized countries. This thesis explored how CEA could be made more relevant for decision-making in developing countries through 1) identifying the limitations for using CEA in developing countries 2) identifying guidelines for CEA specific to developing countries 3) identifying the impact of donor funding on CEA estimation 4) identifying areas for enhancement in the 1996 “Reference Case” (a standard set of methods) recommended by the US Panel on Cost-Effectiveness in Health and Medicine, and 5) better understanding the decision-making environment in developing countries. Focusing on pediatric immunization in developing countries, thematic analysis was used to distill key concepts from 157 documents spanning health economics, clinical epidemiology and health financing. 11 key informants, researchers active in developing countries, were also interviewed to explore the production and use of evidence in public health decision-making. Results showed a divergence between industrialized and developing nations in the emphases of methodological difficulties, in the general application of CEA, and the types of guidelines available. Explicitly considering donor funding costs and effects highlighted the need to specify an appropriate perspective and address policy-related issues of affordability and sustainability. Key informant interviews also revealed that opinion-makers, international organizations and the presence of local vaccine manufacturing have significant influence on decision-making. It is suggested that CEA could be more useful with a broadened reference case framework that included multiple perspectives, sensitivity analysis exploring differential discount rates (upper limits exceeding 10% for costs, declining from 3% for benefits) and supplemental reports to aid decision-making (budgetary and sustainability assessments). This study has implications for improving health outcomes globally in the context of public-private collaborative health funding. Further research could explore defining an extra-societal (multi-country) perspective to aid in efficient allocation of immunization resources among countries.

Successive Canadian federal governments have officially indicated their support of human rights in foreign policy, including as they relate to aid-giving. This thesis quantitatively tests this rhetoric with the actual practice of bilateral aid-giving in two time periods – 1998-2000 and 2007-2009. This, however, revealed that Canada has actually tended to give more bilateral aid to countries with poorer human rights records. A deeper quantitative analysis identifies certain multilateral memberships – notably with the Commonwealth, NATO, and OECD – and the geo-political and domestic considerations of Haiti as significant and confirms a recipient state’s human rights performance is not a consideration. These multilateral relationships reflect state self-interests, historical connections, security, and a normative commitment to poverty reduction. It is these factors that those promoting a human rights agenda need to contemplate if recipient state performance is to become relevant in bilateral aid decisions. Thus, it is necessary to turn to international relations theory, in particular liberal institutionalism, to explain Canada’s bilateral aid-giving in these periods. / vi, 141 leaves ; 29 cm

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<p>Eritreans have been subjected to limited and unequal education provision. throughout their hundred years of colonial history. It was expected that in post-independence Eritrea education provision would be equitably provided to all the regions and ethnic groups in the country. The focus of the thesis is on understanding disparities in provision in primary schooling with particular emphasis on ethno-regional disparities and what precipitate these inequalities. This thesis presents an account of the state of primary schooling in Eritrea between 1992 and 2001.</p>

The global burden of road traffic casualties is estimated at US$5l8 billion in direct economic costs. Road traffic crashes are now preventable and predictable as demonstrated by the existence of many proven and cost effective intervention strategies, a result of three decades of research and development in high income countries. While remarkable progress has been made towards the provision of safe, sustainable and affordable means of transport in high income countries where road traffic deaths are on a declining trend, the global road traffic safety situation is however expected to get worse by 2020, in view of increasing deaths in the low to middle income countries, due to rapid motorization against the background of inadequate road infrastructure with poorly maintained roads, passive traffic law enforcement and corruption, inadequate health services, lack of funds, and inadequate data collection and research. These countries have thus experienced little or no success in resolving the problem of road traffic safety. Since South Africa falls into this latter category, this paper supports the thesis that the issue with road traffic deaths and injuries is a global problem requiring national capacity to be part of a global cooperation and responsibility. Given the recent institutionalized framework for planning, organizing and implementing the strategy for road safety management (the Road to Safety 20012005), the relatively high mortality rate of 27 per 100000 population and the R13.8 billion in direct social costs to the economy, remains the challenge to build a strong political advocacy to enable the achievement of conditions for a sustainable national road safety capacity to manage road traffic safety. This calls for a comprehensive set of cost effective countermeasures. Most country successes have had a good political will complemented by a systems approach. Despite a good start with the Road to Safety 2001-2005, successes and mistakes made in high income countries as well as in low to middle income countries, can benefit South Africa in the design and implementation of a multisectoral national road safety strategy with the health sector playing a major role, in order to achieve significant reductions in road traffic deaths and injuries on our roads. / Thesis (M.Com.)-University of KwaZulu-Natal, 2005.

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