Includes bibliographical references. / ACTs have been shown to be effective in treating malaria and are currently recommended as first-line drugs for the treatment of uncomplicated malaria in Nigeria because of resistance of malaria to chloroquine (CQ) and sulphadoxine pyrimethamine (SP). However, very little is known about malaria and treatment-seeking patterns and the use of ACTs since the adoption of the treatment policy more than 6 years ago in Nigeria.

Includes bibliographical references (leaves 57-62). / Changes in Antimalarial Drug Policies are intended to improve case management and reduce both social and financial burden associated with malaria. To achieve this providers have to translate the policy into practice since they have the privilege of being the primary contact to those affected by malaria. The main aim of this study is to examine the extent of implementation of the change in antimalarial drug policy in Uganda, from chloroquine monotherapy to combination therapy of CQ+SP for management of uncomplicated malaria. Prescribing practice of health personnel in selected health facilities in Rakai and Kampala Districts is used as a measure of level of adherence to the change in policy.

Includes bibliographical references. / In this thesis, equality is considered as the absence of differences in utilization among individuals of different socioeconomic status while equity is taken to mean that individuals in equal need of health care should use the same amount of care, irrespective of their socioeconomic status. Using the above definitions, this thesis, examines equity/inequality in the utilization of public health care in Zambia. Concentration curves, concentration indices and horizontal equity indices were used for this purpose. This thesis focuses specifically on public health care that is subsidized by the Government. It is anticipated that the findings of this thesis will broaden the knowledge base on health care utilization inequities in Africa.

Bibliography: leaves 75-79. / In the face of rising health care costs and reductions imposed by budgetary cuts, many governments in developing countries are considering alternatives, other than general tax revenue, to finance their health services. The most popular options, so far adopted, include user fees, community pre-payment schemes, and health insurance. Social Health Insurance has been identified, by policy-makers in Uganda, as a potential source of extra funding for the health sector. As the establishment of the feasibility and viability is a formidable task, this study was restricted to the evaluation of one of the aspects that needs to be investigated before the introduction of social health insurance. The main aim of this study was to explore employees' willingness to pay for Social Health Insurance (SHI), and to identify the factors that influence their willingness to contribute to a SHI scheme. Through the study I was also interested in establishing the extent to which employees' socio-economic characteristics and the SHI attributes affect their willingness to pay.

Includes abstract. / Includes bibliographical references. / Access to healthcare is one of the basic social goods which ensures that individuals lead healthy and long lives. There is an increased need towards ensuring access to health care for all, which has led to the question of how access is defined. Access in this study is defined as the degree of fit between the health care system and patients. It involves an interaction between the system and patients in a way which removes access barriers to care. A comprehensive framework was used to measure access in this study. The framework allows for a systematic approach to the concept of access and measures access in three dimensions namely affordability, availability and acceptability. Using this framework, the study looked into the factors affecting access to antiretroviral therapy (ART) by patients at Chivhu Hospital in Zimbabwe. Chivhu was chosen because it has a mixed population of urban and rural patients which represents the typical Zimbabwean population. A cross sectional study design was adopted for this study.

Background: A South African report, Saving Babies 2010-2011, reports 32,178 still births in a 2 year period of January 2010 to December 2011 within the 94% of the total hospitals who provide data to a Perinatal Problem Identification programme (PPIP). In order to deal with perinatal mortality, specifically Intra-Uterine Growth there is needed to equip the primary health care (PHC) with technology for monitoring. An instrument called the Umbiflow Doppler ultrasound machine has been developed and there is need to test its economic impact in the PHC. Methods: A cross- sectional analytical study was conducted in the Tygerberg Eastern Health District of the Metro Region of Western Cape, South Africa at two primary health care (PHC) facilities, one secondary level hospital, and one tertiary hospital namely Kraaifontein Community Health Centre (CHC), Durbanville Day Clinic, Karl Bremmer District Hospital, and Tygerberg Hospital respectively. The aim of the research was to conduct a cost analysis in the introduction of an Umbiflow Doppler machine in the primary health care with the major goal being to reduce the number of perinatal deaths in the public health system. A societal perspective was adopted. The cost analysis study was carried out on the already approved sample size of 139 patients stemming from the Umbiflow Clinical study. The inclusion criteria for patient participation was poor SF growth and late bookers >28 weeks attending Kraaifontein Community Health Care Centre and Durbanville Clinic for antenatal services.

South Africa is facing a health care worker shortage which is contributing to poor health outcomes, especially in mother-to-child transmission of HIV. In order for Prevention of Mother to Child Transmission (PMTCT) programmes to achieve success, coverage needs to be dramatically increased. This paper aims to provide specifics on the costs of integrating a Lay Health Worker (LHW) into a clinic to improve patient uptake and retention of PMTCT services, in what was previously the Motheo district, Free State.

Includes bibliographical references. / Background: The World Health Assembly Resolution in 2005 urges Member States to introduce and/or strengthen universal coverage policy in order to offer financial risk protection (FRP) to households in order to avoid catastrophic health expenditures and impoverishment from seeking care. The other goal of universal coverage is to ensure equitable access to healthcare based on relative need, irrespective of ability to make health care payments, social status or geographical location. The two prepaid financing mechanisms that guarantee universal coverage are social health insurance and general tax revenue. Aim: To undertake a comparative analysis of selected OECD countries with universal coverage to derive lessons that could inform the development of universal coverage policy in low-to-middle income (LMICs) countries. Methods: Empirical evidence from the OECD was sourced through an extensive review of published literature from print and electronic sources. Selection sought to include a range of countries in different continents and health systems with a long history as universal systems. Most universal systems are in OECD countries. OECD countries were selected because of availability of quality and credible data. The data for the analysis is drawn from the OECD Health Data 2008 dataset. Kutzin's conceptual framework is the analytical tool for the critical analysis of evidence, including OECD data, to evaluate the functionality of each health system based on the concepts of equity, sustainability, efficiency and feasibility. Results: Findings from the analysis show that publicly funded (primarily tax-funded) systems have lower out-of-pocket expenditures and offer greater financial risk protection. Systems with a single risk pool and a single payer tend to be more administratively efficient than multiple pools and payers. Allocating health resources based on a needs-based allocation formula is more equitable than historical budgeting. Capitation provider payment promotes greater efficiency than fee-for-service. A purchaser-provider split can improve efficiency.

Includes bibliographical references. / Tuberculosis (TB) remains a major public health concern. The BCG vaccine is, currently, the only vaccine against TB and, although it provides some protection against disseminated forms of TB, its effectiveness in preventing primary infection and disease progression to pulmonary TB is highly varied. A number of potential new TB vaccine candidates have been identified and are, currently, undergoing clinical trials. One such candidate is MVA85A. This study aims to assess the potential cost-effectiveness of a new TB vaccine, the MVA85A vaccine. The study compares two TB vaccine strategies, from the perspective of the South African Government: i. BCG, given at birth, which is the current standard of care in South Africa; and ii BCG, given at birth, together with a booster vaccine (MVA85A) given at 4 months, which is the potential new strategy. The study employs Decision Analytical Modelling, through the use of a Markov model, to estimate the costs and outcomes of the two strategies. The cumulative costs and outcomes of each intervention are used to calculate the cost-effectiveness ratio (CER) (i.e. the cost per TB case averted and the cost per TB death averted) for each intervention. These two cost-effectiveness ratios are compared using an incremental cost-effectiveness ratio (ICER), which represents the additional cost per additional benefit received. The results of the cost-effectiveness analysis indicate that the MVA85A strategy is both more costly and more effective – there are fewer TB cases and deaths from TB – than BCG alone. The Government would need to spend an additional USD 1,105 for every additional TB case averted and USD 284,017 for every additional TB death averted. Given the disappointing results of the MVA85A vaccine clinical trial – showing an efficacy of only 17.3%, this study will predominantly contribute to establishing an efficacy threshold for future vaccines. Our research also contributes to the body of knowledge on economic evaluations involving new TB vaccines as - to the best of our knowledge - this is the first cost-effectiveness analysis conducted using trial data involving a novel TB vaccine and providing a direct comparison with BCG vaccination. Furthermore, it provides a standardized Markov model, which is relatively simple to adapt to local settings and, which could be used in the future, to estimate the potential cost-effectiveness of new TB vaccines in children between the ages of 0–10 years.

Includes bibliographical references. / Much research has examined the relationship between social capital and self-rated health in developed countries. Few studies, however, have investigated this important relationship in developing countries. This study examined this research gap using data from the National Income Dynamics Study (NIDS), the first nationally representative panel study in South Africa. Information regarding social capital - norms of reciprocity, association activity, trust and group membership - was assessed in NIDS. Self-rated health was collected at Wave 1 in 2008, and Wave 2 in 2010 - 2011. The final sample consisted of 8866 respondents. Mixed effects models were fitted to predict self-rated health in Wave 2, using lagged covariates (from Wave 1). The results indicated that individual personalised trust, individual community service group membership and neighbourhood personalised trust were beneficial to self-rated health. Reciprocity, associational activity and other types of group memberships were not found to be significantly associated with self-rated health. Results indicate that both individual- and contextual-level social capital are associated with self-rated health. Policy makers in South Africa may want to consider social capital, in addition to other well-known social determinants of health, when implementing policies to improve the health of its population.