The cost of a school based mass treatment of schistosomiasis in Ugu District, KwaZulu Natal, South Africa in 2012.

INTRODUCTION: The Neglected Tropical Diseases Roadmap of the WHO set targets for potential elimination as a "public health problem" for the period 2012-2020 in multiple countries in Africa, with the aim of global elimination of schistosomiasis as a "public health problem" by 2025. AIM: The purpose of the study was to estimate the cost from a provider's perspective of the Department of Health's Schistosomiasis Mass Drug Administration (MDA) in Ugu District, KwaZulu-Natal in 2012, with a view to project the costs for the entire KwaZulu Natal Province. METHODS: A total of 491 public schools and 16 independent schools in Ugu District, a predominantly rural district in KwaZulu-Natal with a total of 218 242 learners, were included in the schistosomiasis control programme. They were randomly selected from schools situated below an altitude of 300 meters, where schistosomiasis is endemic. A retrospective costing study was conducted using the provider's perspective to cost. Cost data were collected by reviewing existing records including financial statements, invoices, receipts, transport log books, equipment inventories, and information from personnel payroll, existing budget, and the staff diaries. RESULTS: A total of 15571 children were treated in 2012, resulting in a total cost of the MDA programme of ZAR 2 137 143 and a unit cost of ZAR 137. The three main cost components were Medication Costs (37%), Human Resources Cost (36%) and Capital items (16%). The total cost for treating all eligible pupils in KwaZulu-Natal will be ZAR 149 031 888. However, should the capital cost be excluded, then the unit cost will be ZAR 112 per patient and this will translate to a total cost of ZAR 121 836 288. CONCLUSIONS: Low coverage exacerbates the cost of the programme and makes a decision to support such a programme difficult. However, a normative costing study based on the integration of the programme within the Department of Health should be conducted.

"A tale of two cities." A snapshot survey of neurosurgical procedures performed in public and private sectors in eThekwini.

SUMMARY: Access to neurosurgical care in South Africa is influenced by prevailing inequities in healthcare. It is generally perceived that the public sector performs mainly emergencies relating to trauma, and the private sector performs mainly elective spinal surgery. In March 2015, emergencies constituted 51% of cases in the public sector compared to 8% in the private sector. Trauma, paediatric hydrocephalus and intracranial sepsis constituted nearly 75% of the operative workload in the public sector. Cranial surgery accounted for the majority (95%) of operations in the public sector, whereas the majority in the private sector was spinal (75%). There is considerable disparity in the type of neurosurgery being performed in the public and private sectors in KwaZulu-Natal and with the current financial constraints, there is a potential unmet need for elective spinal surgery in the public sector.

Prevalence and determinants of self-directed referrals amongst patients at hospitals in eThekwini District, KwaZulu-Natal 2015

Background: Non-compliance with designated referral pathways has ramifications such as increased patient waiting time,overburdening of higher levels of care and increasing healthcare costs on patients and the healthcare system. The purposeof this study was to assess the determinants of self-directed referrals amongst patients attending hospitals in the eThekwini district of KwaZulu-Natal.Methods: An analytic, cross-sectional study was conducted at the Medical Outpatient Departments across five district hospitals in eThekwini using interviewer-administered questionnaires. Descriptive statistics were used to determine the proportion and the most frequent factors contributing towards patient self-referral. The likelihood of patients to self-refer was tested using chisquare (X2) and a multivariate regression model.Results: There were 315 patients interviewed with 35% (n = 109/315) having self-referred. The majority (51%; 55/107) of selfreferrals were male and were of African race (74%; n = 80/107). Five institutional factors, namely:availability of medication at the pharmacy (98%); quality of care at the facility (93%); waiting time at facility (92%); services provided (90%); and attitude of healthcare workers (87%), were ranked as the main drivers of self-referral. Multivariate logistic regression established a significant positive association between patient self-referral and male gender (OR 1.73; CI 1.04­2.87, p < 0.05). Age < 39 years (OR 0.96; CI 0.94­0.99, p < 0.05); and patient awareness of a referral letter (OR 0.28; CI 0.09­0.86, p < 0.05) emerged as protective factor against self-referrals.Conclusion: Males patients tend to bypass the referral pathway whilst younger patients and patients who were aware of a referral letter were less likely to bypass the referral system. In addition to addressing the systemic challenges of waiting times, quality of care and availability of medication, a patient-oriented approach that comprises education, encouragement and increased patient awareness is an important strategy to improve referral pathway compliance

Cost of intensive care services at a central hospital in South Africa.

BACKGROUND: Intensive care services are one of the largest cost drivers in a hospital. Increasing life expectancy and comorbidities have resulted in an increased need for intensive care beds. OBJECTIVES: To conduct a cost analysis of intensive care services at a central hospital in the public sector in South Africa (SA). METHODS: A retrospective cost analysis for the 2015/16 financial year was conducted across two intensive care units (ICUs), a trauma ICU (10 beds) and a combined ICU for neurosurgery, medicine and surgery (18 beds). A mixed-methods costing approach was used based on the availability of data. The bottom-up approach was used to calculate the cost of clinical support, pharmaceuticals, consumables and human resources. The top-down approach was used to allocate the cost of equipment and goods and services. RESULTS: There were 544 admissions resulting in 4 987 inpatient days during the study period. The total estimated inpatient cost across the two ICUs was ZAR114 055 104, with a cost per patient day of ZAR22 870. The combined ICU cost per patient day was 58% higher than the cost per patient day in the trauma ICU (ZAR26 954 v. ZAR17 021). The mean cost per admission was ZAR157 883 in the trauma ICU and ZAR245 087 in the combined ICU. Human resources costs were the highest ICU cost driver (55%), followed by direct patient activity costs (medical consumables, pharmaceuticals, laboratory tests, radiology and blood products), which contributed 24%. CONCLUSIONS: This is the first reported cost analysis of intensive care services in SA. Our cost per patient day was higher than that reported in other lower-income countries, but lower than that in high-income countries. These costs vary owing to the different types of ICUs, wide spectrum of disease presentation and availability of diagnostic and treatment options. This study provides useful data that could assist in the planning and provision of intensive care services.