A review of national health policies in seven countries in the WHO African Region.

OBJECTIVES: This paper proposes an analytical framework for assessing compliance of national health policies with WHO/AFRO guidelines. DATA SOURCES: Data for this study was obtained from the national health policies of Botswana, Eritrea, Liberia, Namibia, Swaziland, Gambia, and Uganda. STUDY SELECTIONS: National health policies of seven of the 19 Anglophone countries of the WHO African region were selected for review using simple random sampling method. These include: Botswana, Eritrea, Liberia, Namibia, Swaziland, Gambia, and Uganda. DATA EXTRACTION: An analytical framework derived from WHO/AFRO guidelines for developing national health policies and plans was used in the review. It identifies components which are pertinent for appropriate national health policy formulation. DATA SYNTHESIS: It appears that aspects related to policy content are well addressed. In relation to the process, there is need for improving the mapping of stakeholders and specifying their roles and aspects of collaboration; and the implications for meeting broad service and impact targets. CONCLUSION: Development of health policies needs to focus on all aspects of the analytical framework with emphasis on improving the articulation for mapping out stakeholders and specifying their roles and aspects of collaboration; and the implications for meeting broad service and impact targets.

Status of health sector strategic plans in five countries of the WHO African Region.

OBJECTIVES: To assess the adequacy of the existing strategic plans and compare the format and content of health sector strategic plans with the guidelines in selected countries of the African region. DATA SOURCE: The health strategic plans for Gambia, Liberia, Malawi, Tanzania and Uganda, which are kept at the WHO/AFRO, were reviewed. DATA EXTRACTION: All health strategic plans among the Anglophone countries (Gambia, Ghana, Kenya, Liberia, Malawi, Mauritius, Tanzania, Uganda, Zambia and Zimbabwe) that were developed after the year 2000 were eligible for inclusion. Fifty percent of these countries that fitted this criterion were randomly selected. They included Gambia, Liberia, Malawi, Tanzania and Uganda. The analysis framework used in the review included situation analysis; an assessment of appropriateness of strategies that are selected; well developed indicators for each strategy; the match between the service and outcomes targets with available resources; and existence of a clear framework for partnership engagement for implementation. DATA SYNTHESIS: Most of the strategic plans identify key ill health conditions and their contributing factors. Health service and resource gaps are described but not quantified in the Botswana, Gambia, Malawi, Tanzania strategic documents. Most of the plans selected strategies that related to the situational analysis. Generally, countries' plans had clear indicators. Matching service and outcome targets to available resources was the least addressed area in majority of the plans. Most of the strategic plans identified stakeholders and acknowledged their participation in the implementation, providing different levels of comprehensiveness. CONCLUSION: Some of the areas that are well addressed according to the analysis framework included: addressing the strategic concerns of the health policies; identifying key partners for implementation; and selection of appropriate strategies. The following areas needed more emphasis: quantification of health system gaps; setting targets that are cognisant of the local resource base; and being more explicit in what stakeholders' roles are during the implementation period.

A rapid assessment of district health systems in six countries of the WHO African Region.

OBJECTIVES: This paper reviews the adequacy of inputs and processes at district level to support outputs and outcomes of service delivery at district level using a rapid assessment. The outputs included in this study are those considered essential for the attainment of the Health related Millennium Development Goals (MDGs). DATA SOURCES: A questionnaire based rapid District Health Systems assessment was conducted among six African countries during the year 2007. STUDY SELECTIONS: The study took place in a random sample of six out of 19 English speaking countries of the WHO African region. These countries are Ghana, Liberia, Namibia, Nigeria, Sierra Leone and Uganda. DATA EXTRACTION: The data was extracted from the questionnaires, entered and analysed in Excel spreadsheet. DATA SYNTHESIS: In spite of the variability in quality and completeness of reporting on the selected parameters, this paper does indicate that according to country norms and standards, the inputs and processes are insufficient to lead to acceptable outputs and outcomes, especially those related to the MDGs. An important point to note is that comparability across countries is made on the basis of individual country norms and standards. Implicit in this assessment is that country norms and standards are reasonable and are appropriate for the attainment of the MDGs. However reasonable the country norms and standard are, it is unlikely that the low resource base as well as weak organisational and managerial capacities in most countries will support effectively the attainment of the MDGs. CONCLUSION: Most countries manage to offer the essential health services at all levels of care despite the relatively low level of inputs. However, their level of quality and equity is debatable. The general trend is that provision of the essential health services is more at the higher levels of care prompting concerns for the populations served at lower levels of care. There is also a tendency to have wide variations in the performance of service delivery geographically as well as at the different levels of the health systems. This paper recommends further exploration of the impact of focusing on improving quality of existing health services while increasing quantity of service delivery points to achieve higher coverage of essential health services.

Monitoring and evaluation of health sector reforms in the WHO African Region.

OBJECTIVES: To describe a comprehensive analytical framework for assessing health sector reforms and demonstrates use of the analysis framework using cost-recovery mechanisms as a case study in the WHO African Region. DATA SOURCES: Health sector reforms published literature review. STUDY SELECTION: No selection involved. DATA EXTRACTION: This paper draws from previous published literature to describe a comprehensive framework to assess the performance of health sector reforms in the African region. Using this framework, it goes on to illustrate how it may be used to analyze cost recovery reforms as a case study. The major elements for the analysis include a description of the context, design, process and intended results. DATA SYNTHESIS: In terms of context and design of the cost recovery reform, there were gaps in the stewardship role of governments as evidenced by the lack of appropriate policies and information to monitor and/or influence the process. Regarding the cost recovery implementation, it is not clear from the literature reviewed in this paper that there was a comprehensive stakeholder coordination mechanism that catered for all who were involved. Concerning results of the expected results of implementing cost recovery reforms such as improved quality of health services; equitable service utilisation; social sustainability through active community participation; and gains in efficiency were not always realised. CONCLUSIONS: Given that the aspects of the analysis framework described in this paper are interrelated, reviewing one without another provides an answer to a specific question but is insufficient for a comprehensive assessment.

A Review of National Health Policies in Seven Countries in the WHO African Region

Objectives: This paper proposes an analytical framework for assessing compliance of national health policies with WHO/AFRO guidelines. Data sources: Data for this study was obtained from the national health policies of Botswana; Eritrea; Liberia; Namibia; Swaziland; Gambia; and Uganda. Study selections: National health policies of seven of the 19 Anglophone countries of the WHO African region were selected for review using simple random sampling method. These include: Botswana; Eritrea; Liberia; Namibia; Swaziland; Gambia; and Uganda. Data extraction: An analytical framework derived from WHO/AFRO guidelines for developing national health policies and plans was used in the review. It identifies components which are pertinent for appropriate national health policy formulation. Data synthesis: It appears that aspects related to policy content are well addressed. In relation to the process; there is need for improving the mapping of stakeholders and specifying their roles and aspects of collaboration; and the implications for meeting broad service and impact targets. Conclusion: Development of health policies needs to focus on all aspects of the analytical framework with emphasis on improving the articulation for mapping out stakeholders and specifying their roles and aspects of collaboration; and the implications for meeting broad service and impact targets

Status of Health Sector Strategic Plans in Five Countries of the WHO African Region

Objectives: To assess the adequacy of the existing strategic plans and compare the format and content of health sector strategic plans with the guidelines in selected countries of the African region. Data source: The health strategic plans for Gambia; Liberia; Malawi; Tanzania and Uganda; which are kept at the WHO/AFRO; were reviewed. Data extraction: All health strategic plans among the Anglophone countries (Gambia; Ghana; Kenya; Liberia; Malawi; Mauritius; Tanzania; Uganda; Zambia and Zimbabwe) that were developed after the year 2000 were eligible for inclusion. Fifty percent of these countries that fitted this criterion were randomly selected. They included Gambia; Liberia; Malawi; Tanzania and Uganda. The analysis framework used in the review included situation analysis; an assessment of appropriateness of strategies that are selected; well developed indicators for each strategy; the match between the service and outcomes targets with available resources; and existence of a clear framework for partnership engagement for implementation. Data synthesis: Most of the strategic plans identify key ill health conditions and their contributing factors. Health service and resource gaps are described but not quantified in the Botswana; Gambia; Malawi; Tanzania strategic documents. Most of the plans selected strategies that related to the situational analysis. Generally; countries' plans had clear indicators. Matching service and outcome targets to available resources was the least addressed area in majority of the plans. Most of the strategic plans identified stakeholders and acknowledged their participation in the implementation; providing different levels of comprehensiveness. Conclusion: Some of the areas that are well addressed according to the analysis framework included: addressing the strategic concerns of the health policies; identifying key partners for implementation; and selection of appropriate strategies. The following areas needed more emphasis: quantification of health system gaps; setting targets that are cognisant of the local resource base; and being more explicit in what stakeholders' roles are during the implementation period

A Rapid Assessment of District Health Systems in Six Countries of the WHO African Regions

Objectives: This paper reviews the adequacy of inputs and processes at district level to support outputs and outcomes of service delivery at district level using a rapid assessment. The outputs included in this study are those considered essential for the attainment of the Health related Millennium Development Goals(MDGs). Data sources: A questionnaire based rapid District Health Systems assessment was conducted among six African countries during the year 2007. Study selections: The study took place in a random sample of six out of 19 eng speaking countries of the WHO African region. These countries are Ghana; Liberia; Namibia; Nigeria; Sierra Leone and Uganda. Data extraction: The data was extracted from the questionnaires; entered and analysed in Excel spreadsheet. Data synthesis: In spite of the variability in quality and completeness of reporting on the selected parameters; this paper does indicate that according to country norms and standards; the inputs and processes are insufficient to lead to acceptable outputs and outcomes; especially those related to the MDGs. An important point to note is that comparability across countries is made on the basis of individual country norms and standards. Implicit in this assessment is that country norms and standards are reasonable and are appropriate for the attainment of the MDGs. However reasonable the country norms and standard are; it is unlikely that the low resource base as well as weak organisational and managerial capacities in most countries will support effectively the attainment of the MDGs. Conclusion: Most countries manage to offer the essential health services at all levels of care despite the relatively low level of inputs. However; their level of quality and equity is debatable. The general trend is that provision of the essential health services is more at the higher levels of care prompting concerns for the populations served at lower levels of care. There is also a tendency to have wide variations in the performance of service delivery geographically as well as at the different levels of the health systems. This paper recommends further exploration of the impact of focusing on improving quality of existing health services while increasing quantity of service delivery points to achieve higher coverage of essential health services

Monitoring and Evaluation of Health Sector Reforms in the WHO African Region

Objectives: To describe a comprehensive analytical framework for assessing health sector reforms and demonstrates use of the analysis framework using cost-recovery mechanisms as a case study in the WHO African Region. Data sources: Health sector reforms published literature review. Study selection: No selection involved. Data extraction: This paper draws from previous published literature to describe a comprehensive framework to assess the performance of health sector reforms in the African region. Using this framework; it goes on to illustrate how it may be used to analyze cost recovery reforms as a case study. The major elements for the analysis include a description of the context; design; process and intended results. Data synthesis: In terms of context and design of the cost recovery reform; there were gaps in the stewardship role of governments as evidenced by the lack of appropriate policies and information to monitor and/or influence the process. Regarding the cost recovery implementation; it is not clear from the literature reviewed in this paper that there was a comprehensive stakeholder coordination mechanism that catered for all who were involved. Concerning results of the expected results of implementing cost recovery reforms such as improved quality of health services; equitable service utilisation; social sustainability through active community participation; and gains in efficiency were not always realised. Conclusions: Given that the aspects of the analysis framework described in this paper are interrelated; reviewing one without another provides an answer to a specific question but is insufficient for a comprehensive assessment

Health-related biotechnology transfer to Africa: principal-agency relationship issues.

The aim of this paper is to stimulate debate on the agency (principal-agent) in health-related biotechnology research. It attempts to answer the following questions: What is health-related biotechnology and biotechnology research? What is an agency? What factors are likely to undermine the principal's capacity to exercise informed consent? When might the principal-agency problem arise? How could the agency in biotechnology transfer be strengthened in Sub-Saharan Africa (SSA)? The transfer of health-related biotechnology to SSA ought to be preceded by research to ascertain the effectiveness of such technologies on population health. In that process, the national ethical review committee (REC), as an agent of every human research subject (principal), ought to ensure that international principles (e.g. beneficence, non-malfeasance, autonomy, justice, dignity, truthfulness and honesty) for human experimentation are observed by biotechnology researchers in order to satisfy moral, ethical and legal requirements. The key factors that undermine principals' sovereignty in exercising their right to informed consent to participate in biotechnology trials are discussed. The paper ends with a list of activities that can strengthen the agency, e.g. legislative requirement that all health-related biotechnology transfer should be preceded by rigorous evaluation; continuous update of the agents knowledge of the contents of the international ethical guidelines; and education of potential and actual principals on their human rights; among others.

Inequalities in Selected Health-Related Millennium Development Goals Indicators in all WHO Member States

The objective of this study was to quantify inequalities in selected Millennium Development Goal (MDG) indicators in all the 192 WHO Member States using descriptive statistics; the Gini coefficient and the Theil coefficient. The data on all the indicators were obtained from The World Health Report 2004. The main findings were as follows: (i) generally; all the MDG indicators are significantly worse in low-income countries than in the other three income groupings; (ii) for all the MDG indicators; there are inequalities within individual countries; within the four income groups; and across income groups of countries; (iii) the inequalities in the MDG indicators are higher among the low-income countries than in high-income countries; and (iv) the ranking of income groups; by various indicators; is fairly stable whether one employs the Gini coefficient or Theil coefficient. As Member States strive to expand the effective coverage of strategies and interventions (including health promotion; primary and secondary prevention; treatment; and care) geared at reducing child mortality; improving maternal health; combating HIV/AIDS; malaria and TB; and ensuring environmental sustainability (through reduction in the use of solid fuels and expansion in access to improved water and sanitation); it is vitally important to ensure that they are implemented in a manner that redresses the inequalities in various MDG indicators. Thus; it is vital for countries to systematically monitor not only the changes in various MDG indicators but also the inequalities across the various income quintiles. In addition; at the regional and global levels; it is necessary to set up mechanisms for rigorous monitoring of the inequalities in the MDG indicators across the income groups of countries. The lessons learnt from the monitoring processes should inform the design and targeting of the various MDG-related policies; strategies and interventions with a view to eradicating the inequalities

An overview of health financing patterns and the way forward in the WHO African Region.

BACKGROUND: The way a health system is financed affects the performance of its other functions of stewardship, input (or resource) creation and services provision, and ultimately, the achievement of health system goals of health improvement (or maintenance), responsiveness to people's non-medical expectations and fair financial contributions. OBJECTIVES: To analyse the changes between 1998 and 2002,in health financing from various sources; and to propose ways of improving the performance of health financing function in the WHO African Region. DESIGN: A retrospective analysis of data obtained from the World Health Report, 2005. METHODS: The analysis reported in this paper is based on the National Health Accounts (NHA) data for the 46 WHO Member States in the African Region. The data were obtained from the World Health Report 2005. It consisted of information on: levels of per capita expenditure on health; total expenditure on health as a percentage of gross domestic product (GDP); general government expenditure on health as a percentage of total expenditure on health; private expenditure on health as a percentage of total expenditure on health; general government expenditure on health as a percentage of total government expenditure; external expenditure as a percentage of total expenditure on health; social security expenditure on health as a percentage of general government expenditure on health; out-of-pocket expenditure as a percentage of private expenditure on health; and private prepaid plans as a percentage of private expenditure on health. The analysis was done using Lotus SmartSuite software. RESULTS: The analysis revealed that: fifteen countries spent less than 4.5% of their GDP on health; forty four countries spent less than 15% of their national annual budget on health; sixty three percent of the governments in the Region spent less than US$10 per person per year; fifty per cent of the total expenditure on health in 24 countries came from government sources; prepaid health financing mechanisms cover only a small proportion of populations in the Region; private spending constituted over 40% of the total expenditure on health in 31; direct out-of-pocket expenditures constituted over 50% of the private health expenditure in 38 countries. CONCLUSION: Every country needs to develop clear pro-poor health financing policy and a comprehensive health financing strategic plan with a clear roadmap of how it plans to transit from the current health financing state dominated by inequitable, catastrophic and impoverishing direct out-of-pocket payments to a visionary scenario of universal coverage. The strategic plan should strengthening of health sector advocacy and health financing capacities, health economics evidence generation and utilisation in decision-making, making better use of available and expected resources, monitoring of equity in financing, strengthening of the exemption mechanisms, managed removal of direct out-of-pocket payments (for countries that choose to), and improving country-led sectoral coordination mechanisms (e.g. Sector Wide Approaches).

An Overview of Health Financing Patterns and the Way Forward in the WHO African Region

The way a health system is financed affects the performance of its other functions of stewardship; input (or resource) creation and services provision; and ultimately; the achievement of health system goals of health improvement (or maintenance); responsiveness to people's non-medical expectations and fair financial contributions. To analyse the changes between 1998 and 2002;in health financing from various sources; and to propose ways of improving the performance of health financing function in the WHO African Region. A retrospective analysis of data obtained from the World Health Report; 2005. The analysis reported in this paper is based on the National Health Accounts (NHA) data for the 46 WHO Member States in the African Region. The data were obtained from the World Health Report 2005. It consisted of information on: levels of per capita expenditure on health; total expenditure on health as a percentage of gross domestic product (GDP); general government expenditure on health as a percentage of total expenditure on health; private expenditure on health as a percentage of total expenditure on health; general government expenditure on health as a percentage of total government expenditure; external expenditure as a percentage of total expenditure on health; social security expenditure on health as a percentage of general government expenditure on health; out-of-pocket expenditure as a percentage of private expenditure on health; and private prepaid plans as a percentage of private expenditure on health. The analysis was done using Lotus SmartSuite software. Results: The analysis revealed that: fifteen countries spent less than 4.5of their GDP on health; forty four countries spent less than 15 of their national annual budget on health; sixty three percent of the governments in the Region spent less than US$10 per person per year; fifty per cent of the total expenditure on health in 24 countries came from government sources; prepaid health financing mechanisms cover only a small proportion of populations in the Region; private spending constituted over 40 of the total expenditure on health in 31; direct out-of-pocket expenditures constituted over 50of the private health expenditure in 38 countries. Every country needs to develop clear pro-poor health financing policy and a comprehensive health financing strategic plan with a clear roadmap of how it plans to transit from the current health financing state dominated by inequitable; catastrophic and impoverishing direct out-of-pocket payments to a visionary scenario of universal coverage. The strategic plan should strengthening of health sector advocacy and health financing capacities; health economics evidence generation and utilisation in decision-making; making better use of available and expected resources; monitoring of equity in financing; strengthening of the exemption mechanisms; managed removal of direct out-of-pocket payments (for countries that choose to); and improving country-led sectoral coordination mechanisms (e.g. Sector Wide Approaches)

Effects of Maternal Mortality on Gross Domestic Product (GDP) in the WHO African Region

WHO African region has got the highest maternal mortality rate compared to the other five regions. Maternal mortality is hypothesized to have significantly negative effect on the gross domestic product (GDP). The objective of the current study was to estimate the loss in GDP attributable to maternal mortality in the WHO African Region. The burden of maternal mortality on GDP was estimated using a doublelog econometric model. The analysis is based on cross-sectional data for 45 of the 46 Member States in the WHO African Region. Data were obtained from UNDP and the World Bank publications. All the explanatory variables included in the doublelog model were found to have statistically significant effect on per capita gross domestic product (GDP) at 5level in a t-distribution test. The coefficients for land (D); capital (K); educational enrolment (EN) and exports (X) had a positive sign; while labor (L); imports (M) and maternal mortality rate (MMR) were found to impact negatively on GDP. Maternal mortality of a single person was found to reduce per capita GDP by US$ 0.36 per year. The study has demonstrated that maternal mortality has a statistically significant negative effect on GDP. Thus; as policy-makers strive to increase GDP through land reform programs; capital investments; export promotion and increase in educational enrolment; they should always remember that investments in maternal mortalityreducing interventions promises significant economic returns

Health Economics: Potential Applications in HIV/AIDS Control in Africa

There is growing evidence that HIV/AIDS has enormous negative impact on health status and economic development of individuals; households; communities and nations in the African region [33]. Thus; there is urgent need for various disciplines to demonstrate how they can contribute in curbing the spread of this deadly disease in the African region. This paper; using an extended version of Professor Alan Williams [32] schema as the conceptual framework; attempts to demonstrate how health economics can be used to inform policy and managerial choices related to HIV/AIDS advocacy; prevention; treatment and management. It argues that the discipline of health economics (and economics generally) is extremely valuable in: measuring health impacts of the disease and interventions; evaluating the relationships between health care-seeking behaviour of individuals and health system specific attributes; the estimation of determinants of compliance of HIV/AIDS patients with treatment regimen; establishing of health institutions efficiency in combating AIDS; guiding choices of HIV/AIDS interventions; assessing the relationships between HIV/AIDS; development; poverty; and trade; programme planning; monitoring and evaluation; and assessing health system's overall performance. The paper is a modest attempt to show how the discipline of health economics can elucidate; and help in resolving practical and conceptual issues in HIV/AIDS control in Africa

Technical efficiency of public clinics in Kwazulu-Natal Province of South Africa.

BACKGROUND: In sub-Saharan Africa (SSA) much of the attention of policy makers, health care managers, health systems researchers and donors is focussed almost solely on mobilising additional resources and not on efficiency in their use. OBJECTIVE(S): To investigate the technical inefficiencies among 155 primary health care clinics in Kwazulu-Natal Province of South Africa; and to draw policy implications. DESIGN: Cross-sectional provincial health clinic survey. SELLING: Kwazulu-Natal Provincial Department of Health Clinics survey, 1996. SUBJECTS: The analysis is based on 155 public clinics. INTERVENTIONS: Non-intervention Data Envelopment Analysis (DEA) study. MAIN OUTCOME MEASURES: Technical and scale efficiency scores. RESULTS: Forty seven (30%) were found to be technically efficient. Among the 108 (70%) technically inefficient facilities, 16% had an efficiency score of 50% or less. The presence of inefficiencies indicates that a clinic has excess inputs or insufficient outputs compared to those clinics on the efficiency frontier. To achieve technical efficiency, Kwazulu-Natal clinics would, in total have to decrease inputs by 417 nurses and 457 general staff. Alternatively, outputs would have to be increased by 115,534 antenatal visits, 1,010 births (deliveries), 179,075 child care visits, 5,702 dental visits, 121,658 family planning visits, 36,032 psychiatric visits, 56,068 sexually transmitted disease visits and 34,270 tuberculosis visits. CONCLUSION: There is need for more detailed studies in a number of the relativdy efficient clinics to determine why they are efficient with a view of documenting attributes of 'best practise' that other clinics can emulate. The potential benefit of replicating this kind of study in other provinces, and indeed, other SSA countries cannot be overemphasised.

How to develop an operational plan for health.

BACKGROUND: About 88%, 8%, 36% and 28% of the ministries of health in African countries do not have long-term health plans (LTHPs), health policies (HPs), strategic plans (SPs), and operational plans (OPs), respectively. Eight per cent, 38% and 54% of the countries with OPs rated their formulation as 'excellent', 'satisfactory' and 'needs improvement', respectively. OBJECTIVE(S): To provide a rationale for an OP; to describe its contents; and to explain the process of developing it. DESIGN: Descriptive study. SETTING: Operational plans in the WHO African Region. INTERVENTIONS: Non-intervention descriptive study. MAIN OUTCOME MEASURES: Operational plan (OP) for health. RESULTS: An OP framework and process that could be adapted by countries is proposed. CONCLUSION: An adequately formulated OP will contain objectives, targets, expected results, activities, required resources, and a monitoring and evaluation plan (consisting of responsibilities, monitoring indicators, evaluation indicators, data sources - for verifying indicators, and periodicity). In the next two decades, we envision that all the UN agencies and other health partners working in Africa will cooperate with individual countries to develop (or strengthen) LTHPs, HPs, SPs, and OPs of the Ministries of Health (national, provincial and district level).

Evaluation of health-related programmes in Africa: a vision for 2020.

BACKGROUND: Whereas systematic evaluation practice is over five decades old in economically developed continents (DCs), that culture has not yet taken root in Africa. OBJECTIVE(S): To provide an overview of the current situation of health-related evaluation in the African Region; to envision an appropriate evaluation framework for the next two decades; and to provide overviews of what formative (FE) and summative (SE) evaluations are and how they could be conducted. DESIGN: Descriptive study. SETTING: Health policies and plans evaluation in the WHO African Region. SUBJECTS OR PARTICIPANTS: WHO Country Representatives for 25 African Countries. INTERVENTIONS: Non-intervention descriptive study. MAIN OUTCOME MEASURES: Availability and quality of long-term health plan (LTHP), health policy (HP), strategic plan (SP), operational plan (OP), and an evaluation culture. RESULTS: The study found that: 88%, 8%, 36%, 28% and 48% of the countries in the Region do not have LTHP, HP, SP, OP and evaluation culture. A conceptual evaluation framework, tools for formative and summative evaluations are proposed. CONCLUSION: It is envisioned that all partners for health development in Africa will cooperate with individual countries to develop (or strengthen) LTHPs, HPs, SPs, and Ministries of Health OPs (national, provincial and district level); and to make complementary investments in building technical and administrative capacity for evaluating implementation of District Operational Plans (DOPs).

A cost-benefit analysis of preventive schistosomiasis interventions in Kenya.

The objectives of this paper are fourfold: first, to develop a model for a cost benefit analysis (CBA) to appraise various preventive schistosomiasis interventions; second, to identify the relevant types of data needed for such a model; third, to use the model to inform choices about optimal prevention strategies; and fourthly, to discuss the utility of this form of decision analysis to policy-makers. The following data were used: expected costs of each option over the 15 year project life; willingness-to-pay value for health states (outcomes); probabilities of health states with and without various interventions; 15 year population forecasts; discount factors for each year; and a standard conversion factor. All the interventions examined had a positive net present value, with the drip mollusciciding option dominating the other options. The study also highlighted the fact that there is as need for collaboration between tropical disease epidemiologists and health economists in the design and execution of randomized controlled trails to obtain the probabilistic effectiveness data needed in such decision analyzes.