Includes bibliographical references (leaves 124-129 ). / The purpose of this study was to estimate the costs and human resource requirements of scaling up PMTCT to the proposed targets. Estimates are compared with the proposed 2006-2008 medium term expenditure estimates and projected staffing levels to ascertain the feasibility of reaching the proposed targets.

Bibliography: leaves 104-115. / In 1993 the government of Tanzania introduced user fees in health care services. The poor, children under five, Maternal and Child Health/Family Planning and maternity services are among the groups exempted from fees. However, it is observed that the fee exemption system in public health facilites is not functioning. According to the media and gender activists, the introduction of user fees in primary health care services was reported to have impacted negatively on vulnerable groups, particularly poor women. This study aims at exploring how user fees for health care impacted on poor Tanzanian women. In order to have a clear understanding of the issues, the study establishes the impact of user fees on poor women as perceived by poor women in urban and rural areas, and by key stakeholders involved in user fee policy development. Further, the study looks at efforts made by diferent stakeholders to take into account a gender perspective in the design and implementation of the policy. Finally, the study examines whether the policy process took into consideration the potential negative effects on poor women after its implementation.

When constructing a health economic decision model, it is critical to select a sensitivity analysis approach appropriate for the decision context. This point is particularly salient to Middle-Income Countries (MICs), where there is relatively heightened resource scarcity and increased opportunity-cost. MICs face acute shortages of accessible as well as highquality evidence, resulting in a frequent imputing of data from external jurisdictions. Conversely, there are also shortages in skills and research capacity, creating a strong complementary need to consider the contextual feasibility of applying more resource demanding sensitivity analysis methodologies. Given the above, it is therefore critical to establish whether and when the technical benefits of complex and resource demanding methods result in real-world value. We apply a comparative case study using a comprehensive approach to decision-modelling, implemented in the R and JAGS languages. Specifically, the case study replicates a deterministic model originally used to inform the cost-effectiveness of adding a bivalent Human Papilloma Virus (HPV) vaccine to South Africa's public health care cervical cancer screening programme. Crucially, the case study provides critical insight into the pros and cons of implementing more complex sensitivity analysis techniques within MIC climates. Our findings indicate that the benefits of more advanced sensitivity analysis methods are nuanced; are therefore contextually beneficial according to a case-by-case basis; and, moreover, choosing a sensitivity analysis method should be guided by a conceptual ‘fruitfulness' (i.e. a bang-for-buck), more than a mere desire to reduce model complexity. To aid analysts in this process, from our comparative case study we provide a framework with three core concept areas namely Decision-Maker Preferences (Decision Power, Investment, Risk Aversion), Analytical Considerations (Available resources, Indirect Evidence) and Policy Context (Knowledge of Topic, Technical Expertise). The framework intends to encourage more judicious selection of sensitivity analysis methods; help reduce the methodological variation apparent in MIC settings; and simultaneously provide decision-makers with greater methodological transparency in the selection of sensitivity analysis methods.

Includes bibliographical references. / Public health and safety are compromised by the effects of alcohol addiction. Some of the consequences include transmission of infectious diseases, disproportionate use of medical and social services, traffic accidents, and street crimes. Additionally, when dealing with alcohol addiction, many expenses are incurred by public services such as the criminal justice system, emergency medical care centers, foster home placement centers, employee assistance programs and family violence centers. The clinical and economic benefits of addiction treatment are therefore clear. The aim of this study was to investigate Cape Town's alcohol addiction treatment center public-private mix and to determine quality of care and access. Document review and semi-structured interviews were the methods used. Provider reporting on quality of care and the limited number of sites interviewed were the main research limitations. Nevertheless, the thesis reached its objectives and contributed to the limited information on alcohol addiction treatment public-private mix, quality of care and access in South Africa. It is notable that there were few differences in the quality of care reported by public, public-private mix, private registered and private unregistered facilities. Quality of care was found to be good across sectors. Public and public-private mix facilities provided superior access in terms of income. Private facilities had the shortest wait-time. Geographic access was a pronounced issue for the poor population that resides in the Southern suburbs, far from affordable primary care alcohol addiction treatment services. Both horizontal and vertical inequities were identified in terms of access to primary care alcohol addiction treatment services in the Cape Town metropole. A strong case is made for involving more of the private sector in public-private partnerships in order to scale up alcohol addiction treatment within the South African setting. This will allow quality of care to be maintained while improving access.

Includes bibliographical references. / This study intends to give new insights into community perceptions on policy changes in 1st-line treatment for uncomplicated malaria in Kenya and the contributions of such perceptions on the uptake of recommended malaria drugs. It also intends to promote effective communication and implementation of malaria treatment policies and highlight public concerns about drug policy changes, and finally, add to the literature on malaria control and contribute to policy debates from a community perspective.

The co-existence of under- and over-nutrition, termed the double burden of malnutrition (DBM), is associated with a high prevalence of both communicable and non-communicable diseases and is becoming a large public health concern. In general, DBM development is associated with populations undergoing a nutrition transition and urbanisation. DBM can exist at a population, household or individual level. The household form is particularly difficult to target with interventions, because households, and particularly mother-child pairs, are often consuming the same foods. For example, frequent consumption of energy dense and nutrient poor ('junk’) foods can concurrently result in overweight adults, but underweight children. Although, household DBM is linked with poverty and food insecurity and its prevalence is steadfastly increasing it is yet to be investigated in South Africa, despite this country being one of the most inequitable in the world. In addition, South Africa has a high prevalence of obesity (34% of adult females obese), undernutrition (9% of children underweight) and poverty (25% unemployment). with a high prevalence of poverty and food insecurity. Therefore, this study aims to estimate the prevalence, and examine the associated factors of DBM, in South African households. Using the nationally representative data from 2014, South Africa National Income Dynamic Survey wave 4, , the prevalence of household DBM pairs (overweight/obese mother and underweight/stunted child) was estimated. Multivariate logistic regression was applied to examine the relationship between mother-child DBM pairs and (i) socioeconomic status (per capita household income, number of household residents, and mother’s race, education, marital status, household head status), (ii) food security (per capita food expenditure), and (iii) potentially important confounders (mother’s age and urban/rural household). The regression was adjusted for mother’s age as a potential confounder. Mother-child DBM prevalence was 11% in this nationally representative sample of South Africa. Mother’s characteristics of being African (adjusted odds [aOR]: 1.3; 95% confidence intervals [95%CI]: 1.0-1.7) and married (aOR: 1.4, 95%CI: 1.1-1.6) were associated with increased odds of DBM. In contrast mother’s having tertiary education (aOR: 0.7, 95%CI: 0.5-1.0) and greater household per capita income (aOR: 0.9, 95%CI: 0.8-1.0) were protective against DBM. This South African household DBM prevalence is higher than most other developing countries and is associated with mother’s being African, married and having less education; as well as households with less per capita income. This high prevalence warrants urgent attention by policy makers to further investigate this issue in South Africa. Moreover, interventions such as Brazil’s “Green my Favela” should be considered to reduce the cost and increase the supply of nutritious foods to impoverishes households of South Africa.

This study assessed the financial impact of the CDU [Chronic Dispensing Unit] on a household and provincial level, and determined whether job satisfaction of health professionals has been improved.

Includes abstract. / 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.

Bibliography: leaves 94-99. / Since 1994, there has been a lot of attention drawn on the World Trade Organization (WTO) Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) as the most important international instrument ever negotiated in this area. TRIPS establishes minimum universal standards in all areas of intellectual property and the intention is to implement these standards globally through a strong enforcement mechanism established in WTO. These standards affect pharmaceuticals, which many countries had previously excluded from patent protection in order to produce drugs at reduced prices and hence contribute to the improvement of public health. But now any Member State must comply with these minimum standards since failure to do so will result to the WTO dispute settlement system. No extensive review of the practical implications of the TRIPS Agreement has taken place at the global and national levels. The main objective of this paper is to examine the likely impact of this agreement on anti-malarial drugs in Mozambique. Given the persistence of the malaria epidemic in the country and the resistance to the drugs being utilized for this disease there is an acknowledged need for a new drug to eradicate the problem. The problem is that this new drug is likely to be under patent and this country has relied on generic drugs for all its existence and being a Member of the WTO Agreement they now have to wait until patents on the required drugs have expired or be submissive to the more expensive original brand. To accomplish this objective and to ascertain the end result of the above situation, past experiences were a major tool. By reviewing experiences of less developed countries in relation to patent protection and pharmaceuticals, some conclusions were made possible. In order to narrow down the conclusions drawn from these country experiences, a study was done in the Mozambican public sector by reviewing and analyzing the existing laws and regulations pertaining to pharmaceuticals and patent protection. This was done through questionnaires and interviews of the main stakeholders in this area. With this information the researcher was able to describe where Mozambique stands in relation to patents and how this might affect the pharmaceutical industry as a Member of the WTO agreement in the long run. This study therefore, relies heavily on secondary data.

Bibliography: leaves 85-87. / The primary aim of this study is to identify the major determinants of health status in Nigeria. This is done with a view to inform policy making in the health sector. Because of time and financial constraints, the study was limited to a particular geographic area Nsukka L.G.A. The study makes use of regression-based analysis to determine those factors that affect health status of individuals. Health status was measured as a categorical variable with a finite number of outcomes; this necessitated the use of the logit and multinomial logit models for estimation of the models used in the study. The selection of potential health determining factors included in the study is based on international literature on the subject. The literature supporting the study cut across different disciplines, such as: Epidemiology, Social Sciences, Economics and Health economics. The study is unique in the sense that it not only takes into account the effect of individual and household choices on health status, but also the effects of government intervention. In this light, some of the variables used for the study measure the effect of individual choices, some household, and the rest, government policies. The study is organised in seven chapters. The first chapter gives a brief introduction to the subject, an overview of Nigeria and the specific objectives of the study. Chapter 2 reviews international literature on 'determinants of health' and related subjects. The third chapter provides a detailed discussion on the development of the models used in the study and the problems associated with the measurement of health status. In addition to developing models to estimate health status, a model is developed to attempt to identify the factors that influence the incidence of water-borne diseases. Chapter 4 describes the data collection process, and the methods employed to achieve this. The fifth chapter provides descriptive statistics of the data collected from the sample site. The results of the models used for the study are presented in chapter 6. The results suggest that age, place of residence (urban or rural) and education for the younger members of the population have the most effect on health status of any individual within the sample location. Interestingly, the results show that increases in age and years of education for children aged 0 -18 years has a positive effect on their health, while an increase in age for those over 18 years of age has a negative effect on their health. Secondly, those who live in the rural areas are healthier than those who live in the urban areas. Also, the results show that people who get their drinking water from natural sources are more likely to suffer from a water-borne disease than those provided with potable drinking water. The results of the general models - to explain health status - also show that the government intervention had little or no impact on the health status of the people in the area. Chapter 7 reviews the past and current health policy thrust of the Nigerian health sector. The current health policy in Nigeria is very broad, and covers just about all the major health issues. The areas of priority in health are the prevention of HIV/AIDS, and the immunisation of infants/children. The results of this research suggest that the encouragement of enrolment of younger members of the population into schools, improvement of the living conditions in the urban areas and the provision of safe water to those people who depend on natural sources of water should be included as priority areas in policy-making in order to effect the efficient and effective improvement of the health status of the Nigerian population.