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ArticlePublication 2023Estimated Travel Time & Staffing Constraints to Accessing the Ethiopian Healthcare System: Two-Step Floating Catchment Area Analysis
This study investigates disparities in health care access across different income levels and geographic locations …
This study investigates disparities in health care access across different income levels and geographic locations in Ethiopia. Employing a two-step floating catchment area method, the research estimates variations in spatial access to health care and staffing levels at facilities. Average travel time from population centers is calculated and adjusted with provider-to-population ratios. Spearman's rank tests are applied to test hypotheses about the roles of travel time versus staffing in access variations. Results reveal regional disparities,…
Health Systems | Health/Medicine | Sub-Saharan Africa -
ArticlePublication 2023Out-of-Pocket Expenditures & Financial Risks Associated with Treatment of Vaccine-Preventable Diseases in Ethiopia
This study investigates out-of-pocket (OOP) expenditures and associated catastrophic health expenditures (CHEs) for vaccine-preventable diseases …
This study investigates out-of-pocket (OOP) expenditures and associated catastrophic health expenditures (CHEs) for vaccine-preventable diseases (VPDs) in Ethiopia. Through a cross-sectional costing analysis, data on OOP direct medical and nonmedical expenditures were collected from 995 households in 54 health facilities nationwide. The study focuses on VPDs in children under 5 years for pneumonia, diarrhea, measles, and pertussis, and in children under 15 years for meningitis. Mean OOP expenditures per disease episode ranged from $5·6 to…
Costing Methods | Mathematical Models | Cost-Effectiveness Analysis | Child/Nutrition | Chronic Disease/Risk | Health/Medicine | Sub-Saharan Africa -
ArticlePublication 2022Hospitalization Costs for COVID-19 in Ethiopia: Empirical Data and Analysis from Addis Ababa's Largest Dedicated Treatment Center
This study examines the comprehensive costs of hospitalization for COVID-19 disease at Ekka Kotebe COVID-19 …
This study examines the comprehensive costs of hospitalization for COVID-19 disease at Ekka Kotebe COVID-19 treatment center in Addis Ababa, Ethiopia, the largest dedicated hospital for COVID-19 patient care in the country. Through retrospective collection and analysis of clinical and cost data from March to November 2020, including personnel time, drugs, medical supplies, and facility utilities, the study estimates the cost per treated COVID-19 episode stratified by disease severity. Over the study period, 2,543 COVID-19…
Costing Methods | Infectious Diseases | Health/Medicine | Sub-Saharan Africa -
ArticlePublication 2022Modeling the Relative Risk of Incidence and Mortality of Select Vaccine-Preventable Diseases
Immunization is one of the most effective public health interventions, saving millions of lives every …
Immunization is one of the most effective public health interventions, saving millions of lives every year. Ethiopia has seen gradual improvements in immunization coverage and access to child health care services; however, inequalities in child mortality across wealth quintiles and regions remain persistent. This paper models the relative distributional incidence and mortality of four vaccine-preventable diseases (VPDs) (rotavirus diarrhea, human papillomavirus, measles, and pneumonia) by wealth quintile and geographic region in Ethiopia. The authors approach…
Priority Setting/Ethics | Evidence Synthesis | Infectious Diseases | Social Determinants | Health/Medicine | Sub-Saharan Africa -
ArticlePublication 2022Potential Distributional Health & Financial Benefits of Increased Tobacco Taxes in Ethiopia: Findings from a Modeling Study
This study evaluates the potential impacts of Ethiopia's tobacco tax increase in 2020, which raised …
This study evaluates the potential impacts of Ethiopia's tobacco tax increase in 2020, which raised cigarette prices by approximately 67%. Employing parameters such as price elasticity of demand and smoking prevalence, the analysis utilizes existing literature and secondary data to model the effects of the reform on various outcomes, focusing on life years, tax revenues, cigarette expenditures, and catastrophic health expenditures (CHE). Concentrating solely on male smokers due to low female smoking rates, the results…
Health Outcomes | Mathematical Models | Cost-Effectiveness Analysis | Policy/Regulation | Health/Medicine | Sub-Saharan Africa -
ArticlePublication 2022Trauma Care in Public and Private Hospitals in Addis Ababa, Ethiopia: Cross-Sectional Observational Study
This study examines the financial risks associated with seeking trauma care for road traffic injuries …
This study examines the financial risks associated with seeking trauma care for road traffic injuries in Addis Ababa, Ethiopia. Conducting a cross-sectional survey from December 2018 to February 2019 in three public and one private hospital, the research analyzes out-of-pocket (OOP) expenditures related to trauma care. Data from 452 trauma cases are collected, encompassing both medical and non-medical costs. Catastrophic health expenditures, defined as OOP health expenditures exceeding 10% of total household expenditures, are assessed,…
Cost-Effectiveness Analysis | Injuries/Accidents | Health/Medicine | Sub-Saharan Africa -
ArticlePublication 2021Cost-Effectiveness & Equitable Access to Vaccines in Ethiopia: Overview and Evidence Synthesis
This article explores the gaps in vaccine coverage and the resulting burden of vaccine-preventable diseases …
This article explores the gaps in vaccine coverage and the resulting burden of vaccine-preventable diseases (VPDs) among poorer households in Ethiopia, despite the introduction of new vaccines and improved access to immunization services. It provides an overview of vaccine economics in Ethiopia, examining cost-effectiveness analysis, the cost of illness related to VPDs, equitable vaccine access, and immunization financing. The paper highlights significant disparities in vaccine access based on geographic location, socioeconomic status, and maternal education.…
Policy/Regulation | Health/Medicine | Sub-Saharan Africa -
ArticlePublication 2021Health Benefit Package Design
Policymakers face difficult choices over which health interventions to publicly finance. This article presents an …
Policymakers face difficult choices over which health interventions to publicly finance. This article presents an approach to health benefits package design that accommodates explicit tradeoffs between improvements in health and provision of financial risk protection. The authors designed a mathematical optimization model to balance gains in health and financial risk protection across candidate interventions when publicly financed. The optimal subset of interventions selected for inclusion was determined with bi-criterion integer programming conditional on a budget…
Priority Setting/Ethics | Mathematical Models | Global -
ArticlePublication 2021Health Gains and Financial Protection from HPV Vaccination
High out-of-pocket medical expenses for cervical cancer can lead to catastrophic health expenditures and medical …
High out-of-pocket medical expenses for cervical cancer can lead to catastrophic health expenditures and medical impoverishment in many low-resource settings. This article uses a static cohort model that captures the main features of HPV vaccines and population demographics to project health and economic outcomes associated with routine HPV vaccination in Ethiopia. The findings show that, assuming 100% vaccine efficacy against HPV-16/18 and 50% vaccination coverage, routine HPV vaccination could avert up to 970 000 cases…
Priority Setting/Ethics | Microsimulation | Infectious Diseases | Sub-Saharan Africa -
ArticlePublication 2021Incorporating Equity in Infectious Disease Modeling: Measles
Deterministic compartmental models of infectious diseases like measles typically reflect biological heterogeneities in the risk …
Deterministic compartmental models of infectious diseases like measles typically reflect biological heterogeneities in the risk of infection and severity to characterize transmission dynamics. Given the known association of socioeconomic status and increased vulnerability to infection and mortality, it is also critical that such models further incorporate social heterogeneities. This article explores the influence of integrating income-associated differences in parameters of traditional dynamic transmission models. The authors developed a measles “SIR” model, in which the
Priority Setting/Ethics | Dynamic Transmission -
ArticlePublication 2021Toward Universal Health Coverage Post-COVID-19
During the COVID-19 pandemic and beyond, advancement toward universal health coverage will become more difficult …
During the COVID-19 pandemic and beyond, advancement toward universal health coverage will become more difficult for many countries, demonstrating that locally led priority setting is urgently needed to provide health services with appropriate financial protection to all. Resources are limited and no national constituency can provide an unlimited number of services to their whole population in a sustainable manner, so rationing and setting priorities for the selection of interventions to be included in a defined…
Priority Setting/Ethics | Policy/Regulation | Global -
ArticlePublication 2021Using Health Management Information System Data: Case Study and Verification of Institutional Deliveries in Ethiopia
This article investigates the quality of Health Management Information Systems (HMIS) data in Ethiopia through …
This article investigates the quality of Health Management Information Systems (HMIS) data in Ethiopia through a data verification study, aiming to enhance its utility in research and policy. By linking HMIS data to the 2016 Emergency Obstetric and Newborn Care Assessment, the study compares reported delivery and caesarean section (C-section) visits in HMIS to source documents from 2,425 health facilities across Ethiopia. Findings indicate that two-thirds of facilities exhibit 'good' HMIS reporting for deliveries, with…
Maternal/Reproductive Health | Health Systems | Health/Medicine | Sub-Saharan Africa -
ArticlePublication 2020Burden of Household OOP Health Expenditures
This article, published in Health Policy and Planning, estimates the incidence of catastrophic and impoverishing …
This article, published in Health Policy and Planning, estimates the incidence of catastrophic and impoverishing health expenditures using data from the 2015/16 Ethiopian household consumption and expenditure and welfare monitoring surveys. The authors compute the incidence of catastrophic health expenditures (CHE) at 10% and 25% thresholds of total household consumption and 40% threshold of household capacity to pay. Impoverishing health expenditures (IHE) are calculated using Ethiopia's national poverty line (ETB 7184 per adult per year).…
Cost-Effectiveness Analysis | Health Systems | Health/Medicine | Sub-Saharan Africa -
ArticlePublication 2020Economic Evaluation of HBV Birth Dose Vaccination
This article, published in Cost Effectiveness and Resource Allocation, examines the cost-effectiveness of a birth …
This article, published in Cost Effectiveness and Resource Allocation, examines the cost-effectiveness of a birth dose of HBV vaccine in a medical setting in Ethiopia. The authors construct a decision analytic model with a Markov process to estimate the costs and effects of a birth dose of HBV vaccine, compared with current practices in Ethiopia. Based on the cost-effectiveness findings, introducing a birth dose of HBV vaccine in Ethiopia would likely be highly cost-effective. Such…
Cost-Effectiveness Analysis | Infectious Diseases | Health Systems | Health/Medicine | Sub-Saharan Africa -
ArticlePublication 2020Financial Burden of HIV and TB
This article, published in BMJ Open, aims to estimate the household economic burden and incidence …
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…
Cost-Effectiveness Analysis | Infectious Diseases | Health Systems | Health/Medicine | Sub-Saharan Africa -
ArticlePublication 2020Health Gains & Financial Risk Protection Afforded by Public Financing of Selected Malaria Interventions in Ethiopia: An ECEA
This article, published in the Malaria Journal, aims to estimate the expected health and financial …
This article, published in the Malaria Journal, aims to estimate the expected health and financial risk protection (FRP) benefits of universal public financing of key malaria interventions in Ethiopia. An extended cost-effectiveness analysis (ECEA) is used to estimate the potential health and FRP benefits of publicly financing a 10% increase in artemisinin-based combination therapy (ACT), long-lasting insecticide-treated bed nets (LLIN), indoor residual spraying (IRS), and a hypothetical malaria vaccine. The results indicate that ACT, LLIN,…
Priority Setting/Ethics | Cost-Effectiveness Analysis | Infectious Diseases | Social Determinants | Health Systems | Health/Medicine | Sub-Saharan Africa -
ArticlePublication 2019CEA of Maternal and Neonatal Health Interventions
This article, published in Health Policy and Planning, examines the cost-effectiveness of several maternal and …
This article, published in Health Policy and Planning, examines the cost-effectiveness of several maternal and neonatal health (MNH) interventions in an Ethiopian setting. The authors employ a static life table model to estimate the health impact of a 20% increase in intervention coverage relative to baseline. The results indicate that many MNH interventions are highly cost-effective. This evidence can be useful to inform the ongoing essential health services package revision in Ethiopia.
Cost-Effectiveness Analysis | Maternal/Reproductive Health | Child/Nutrition | Health Systems | Health/Medicine | Sub-Saharan Africa -
ArticlePublication 2019Country Contextualization of Cost-Effectiveness Studies
This article, published in BMJ Global Health, provides experiences of country contextualization of WHO-CHOICE methods …
This article, published in BMJ Global Health, provides experiences of country contextualization of WHO-CHOICE methods and models to a country level. Results from three contextualized cost-effectiveness analyses (CEAs) are presented, and the authors discuss how this evidence can inform priority setting in Ethiopia. This method of contextualized CEAs requires inclusion of national analysts and use of country-specific inputs for either costs, epidemiology, demography, baseline coverage or effects. Rank ordering of interventions by incremental cost-effectiveness ratios…
Cost-Effectiveness Analysis | Health Systems | Policy/Regulation | Clinical Care | Health/Medicine | Sub-Saharan Africa -
ArticlePublication 2019Measuring Progress Towards Universal Health Coverage
This article, published in BMJ Global Health, aims to estimate the 2015 national and subnational …
This article, published in BMJ Global Health, aims to estimate the 2015 national and subnational universal health coverage (UHC) service coverage status for Ethiopia. The UHC service coverage index is constructed from the geometric means of component indicators: first, within each of four major categories and then across all components to obtain the final summary index. The authors estimate UHC service coverage at the subnational level using a variety of surveys and routinely collected administrative…
Test Performance | Health Systems | Health/Medicine | Sub-Saharan Africa -
ArticlePublication 2019Modelling Hospital Operations from Paper Registry Data
This article, published in BMJ Global Health, aims to evaluate operations management techniques, which are …
This article, published in BMJ Global Health, aims to evaluate operations management techniques, which are underutilized in the Ethiopian health system. Previous research has outlined the limitations of paper-based patient records, but few studies have examined their potential utility for improving management of hospital operations. The authors use data collected from paper registries in an Ethiopian obstetrics ward at Addis Ababa’s Tikur Anbessa Specialized Hospital, Ethiopia’s largest university hospital, to model the ward’s operations. The…
Mathematical Models | Operations Research | Maternal/Reproductive Health | Health Systems | Health/Medicine | Sub-Saharan Africa -
ArticlePublication 2019Spatial Distribution and Characteristics of HIV
This article, published in Tropical Medicine & International Health, aims to identify the spatial and …
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…
Mathematical Models | Infectious Diseases | Health Systems | Health/Medicine | Sub-Saharan Africa -
ArticlePublication 2018Estimates of Cancer Incidence Using Registry Data
This article, published in the Journal of Global Oncology, utilizes primary data from the Addis …
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…
Chronic Disease/Risk | Health Systems | Health/Medicine | Sub-Saharan Africa -
ArticlePublication 2017Household Expenditures on Pneumonia and Diarrhoea Treatment
This article, published in BMJ Global Health, quantifies household out-of-pocket (OOP) expenditure for treatment of …
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…
Costing Methods | Infectious Diseases | Child/Nutrition | Health Systems | Health/Medicine | Sub-Saharan Africa -
ArticlePublication 2017OOP Expenditures for Cardiovascular Disease
This article, published in BMJ Global Health, aims to estimate the magnitude and intensity of …
This article, published in BMJ Global Health, aims to estimate the magnitude and intensity of catastrophic health expenditure (CHE) and factors associated with CHE for the prevention and treatment of cardiovascular disease in hospitals in Addis Ababa. Seeking prevention and treatment services for cardiovascular disease in Addis Ababa was found to pose substantial financial burden on households, affecting the poorest and those who reside outside Addis Ababa more. Economic and geographic inequalities should therefore be…
Cost-Effectiveness Analysis | Chronic Disease/Risk | Health Systems | Health/Medicine | Sub-Saharan Africa -
ArticlePublication 2016Assessing Medical Impoverishment by Cause
This article, published in BMC Medicine, utilizes a cost and epidemiological model to propose an …
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…
Costing Methods | Health Systems | Health/Medicine | Sub-Saharan Africa -
ArticlePublication 2016Inequalities in Maternal and Child Health Utilization
This article, published in BMC Health Services Research, aims to measure changes in inequality in …
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 The 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…
Maternal/Reproductive Health | Child/Nutrition | Health Systems | Health/Medicine | Sub-Saharan Africa -
ArticlePublication 2016Prevention and Treatment of Cardiovascular Disease
This article, published in Cost Effectiveness and Resource Allocation, aims to assess the cost-effectiveness of …
This article, published in Cost Effectiveness and Resource Allocation, aims to assess the cost-effectiveness of prevention and treatment of ischemic heart disease (IHD) and stroke in an Ethiopian setting. Fifteen single interventions and sixteen intervention packages are assessed from a healthcare provider perspective. The results indicate that the escalating burden of CVD and its risk factors warrants timely action. Selected CVD intervention packages could be scaled up at a modest budget increase, but the level…
Cost-Effectiveness Analysis | Chronic Disease/Risk | Health Systems | Health/Medicine | Sub-Saharan Africa -
ArticlePublication 2015Expansion of Surgical Access in Rural Ethiopia: Extended Cost-Effectiveness Analysis
This article, published in Health Policy and Planning, utilizes an extended cost effectiveness analysis (ECEA) …
This article, published in Health Policy and Planning, utilizes an extended cost effectiveness analysis (ECEA) to examine how policies to expand access to surgery in rural Ethiopia would impact health, impoverishment, and equity. The study finds that health benefits, financial risk protection, and equity appear to be in tension in the expansion of access to surgical care. Health benefits from each of the examined policies accrue primarily among the poor, but without travel vouchers, many…
Priority Setting/Ethics | Cost-Effectiveness Analysis | Health Systems | Economics/Finance | Health/Medicine | Sub-Saharan Africa -
ArticlePublication 2015Extended Cost-Effectiveness Analysis of Treatment and Prevention of Diarrhoea in Ethiopia
This article, published in BMJ Open, aims to illustrate the size and distribution of benefits …
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…
Priority Setting/Ethics | Costing Methods | Health Outcomes | Cost-Effectiveness Analysis | Infectious Diseases | Child/Nutrition | Social Determinants | Environmental Health | Health Systems | Climate/Environment | Economics/Finance | Health/Medicine | Sub-Saharan Africa -
ArticlePublication 2015Health and Social Protection Effects of Measles Vaccination in Ethiopia: Extended CEA
Using extended cost-effectiveness analysis (ECEA), this paper evaluates the health and economic implications of different …
Using extended cost-effectiveness analysis (ECEA), this paper evaluates the health and economic implications of different vaccine delivery strategies in Ethiopia: (1) routine immunization, (2) routine immunization with financial incentives, and (3) mass campaigns, known as supplemental immunization activities (SIAs), for measles vaccination. At higher costs, SIAs reached higher levels of vaccine coverage. Routine immunization paired with financial incentives was found to increase the demand among poorer households.
Priority Setting/Ethics | Cost-Effectiveness Analysis | Infectious Diseases | Child/Nutrition | Social Determinants | Health Systems | Global Governance | Economics/Finance | Health/Medicine | Sub-Saharan Africa -
ArticlePublication 2015Health Gains & Financial Risk Protection by Public Financing in Ethiopia: An ECEA
This article, published in the Lancet Global Health, aims to evaluate the health and financial …
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…
Priority Setting/Ethics | Mathematical Models | Cost-Effectiveness Analysis | Infectious Diseases | Maternal/Reproductive Health | Child/Nutrition | Chronic Disease/Risk | Health Systems | Policy/Regulation | Health/Medicine | Sub-Saharan Africa -
ArticlePublication 2015Pneumococcal Vaccination and Pneumonia Treatment in Ethiopia: Results from Extended CEA
This article, published in PLOS ONE, conducts an extended cost-effectiveness analysis (ECEA) of two fully …
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…
Priority Setting/Ethics | Costing Methods | Cost-Effectiveness Analysis | Infectious Diseases | Child/Nutrition | Social Determinants | Health Systems | Economics/Finance | Health/Medicine | Sub-Saharan Africa
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