Browsing by Author "Boniface Mutatina"

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Economic Analysis of a New Four-Panel Rapid Screening Test in Antenatal Care in Kenya, Rwanda, and Uganda
(BMC Health Services Research, 2023) Donald S Shepard; Yara A Halasa-Rappel; Katharine R Rowlands; Maria Kulchyckyj; Robert K Basaza; Emmanuel D Otieno; Boniface Mutatina; Simon Kariuki; Sabine Musange
Background We performed an economic analysis of a new technology used in antenatal care (ANC) clinics, the ANC panel. Introduced in 2019–2020 in five Rwandan districts, the ANC panel screens for four infections [hepatitis B virus (HBV), human immunodeficiency virus (HIV), malaria, and syphilis] using blood from a single fingerstick. It increases the scope and sensitivity of screening over conventional testing. Methods We developed and applied an Excel-based economic and epidemiologic model to perform cost-effectiveness and cost-benefit analyses of this technology in Kenya, Rwanda, and Uganda. Costs include the ANC panel itself, its administration, and follow-up treatment. Effectiveness models predicted impacts on maternal and infant mortality and other outcomes. Key parameters are the baseline prevalence of each infection and the effectiveness of early treatment using observations from the Rwanda pilot, national and international literature, and expert opinion. For each parameter, we found the best estimate (with 95% confidence bound). Results The ANC panel averted 92 (69–115) disability-adjusted life years (DALYs) per 1,000 pregnant women in ANC in Kenya, 54 (52–57) in Rwanda, and 258 (156–360) in Uganda. Net healthcare costs per woman ranged from $0.53 ($0.02-$4.21) in Kenya, $1.77 ($1.23-$5.60) in Rwanda, and negative $5.01 (-$6.45 to $0.48) in Uganda. Incremental cost-effectiveness ratios (ICERs) in dollars per DALY averted were $5.76 (-$3.50-$11.13) in Kenya, $32.62 ($17.54-$46.70) in Rwanda, and negative $19.40 (-$24.18 to -$15.42) in Uganda. Benefit-cost ratios were $17.48 ($15.90-$23.71) in Kenya, $6.20 ($5.91-$6.45) in Rwanda, and $25.36 ($16.88-$33.14) in Uganda. All results appear very favorable and cost-saving in Uganda. Conclusion Though subject to uncertainty, even our lowest estimates were still favorable. By combining field data and literature, the ANC model could be applied to other countries.
Identifying and Characterising Health Policy and System-Relevant Documents in Uganda: A Scoping Review to Develop a Framework for the Development of a One-Stop Shop
(Healthy Research Policy and Systems, 2017) Boniface Mutatina; Robert Basaza; Ekwaro Obuku; John N. Lavis; Nelson Sewankambo
Background: Health policymakers in low- and middle-income countries continue to face difficulties in accessing and using research evidence for decision-making. This study aimed to identify and provide a refined categorisation of the policy documents necessary for building the content of a one-stop shop for documents relevant to health policy and systems in Uganda. The on-line resource is to facilitate timely access to well-packaged evidence for decision-making. Methods: We conducted a scoping review of Uganda-specific, health policy, and systems-relevant documents produced between 2000 and 2014. Our methods borrowed heavily from the 2005 Arksey and O’Malley approach for scoping reviews and involved five steps, which that include identification of the research question; identification of relevant documents; screening and selection of the documents; charting of the data; and collating, summarising and reporting results. We searched for the documents from websites of relevant government institutions, non-governmental organisations, health professional councils and associations, religious medical bureaus and research networks. We presented the review findings as numerical analyses of the volume and nature of documents and trends over time in the form of tables and charts. Results: We identified a total of 265 documents including policies, strategies, plans, guidelines, rapid response summaries, evidence briefs for policy, and dialogue reports. The top three clusters of national priority areas addressed in the documents were governance, coordination, monitoring and evaluation (28%); disease prevention, mitigation, and control (23%); and health education, promotion, environmental health and nutrition (15%). The least addressed were curative, palliative care, rehabilitative services and health infrastructure, each addressed in three documents (1%), and early childhood development in one document. The volume of documents increased over the past 15 years; however, the distribution of the different document types over time has not been uniform. Conclusion: The review findings are necessary for mobilising and packaging the local policy-relevant documents in Uganda in a one-stop shop; where policymakers could easily access them to address pressing questions about the health system and interventions. The different types of available documents and the national priority areas covered provide a good basis for building and organising the content in a meaningful way for the resource.
Identifying Key Steps in Developing a One-stop Shop for Health Policy and System Information in a Limited-resource Setting: A Case Study
(Journal of Research and Health, 2022-11-01) Boniface Mutatina; Robert Kanyarutokye Basaza; Nelson Kawulukusi Sewankambo; John Norman Lavis
Background: Limited understanding exists about the development of online one-stop shops for evidence in a limited-resource setting, such as Uganda. This study aimed to provide a comprehensive account of the development process of the online resource for local policy and systems-relevant information in this setting. Methods: We utilized a case study design to address our objective where the case (i.e., unit of analysis) was defined as “the Uganda clearinghouse for health policy and system (UCHPS) the development process”. We collected data from multiple sources, including key informant interviews, participant observations, and archival records to develop a comprehensive account of the case under investigation. Results: We found out that the development of Uganda clearinghouse for health policy and system (UCHPS) followed a seven-step process, characterized by iterations that occurred within and between the steps. The essential components of the process included concept development, prototyping the key structure, engaging with policymakers, researchers, and other stakeholders, mobilizing and indexing the content, disseminating the resource, user-testing, and updating the system. Conclusion: Our study provides key steps for developing a one-stop shop for local evidence to inform health policy and system decisions. Researchers and institutions, especially those in low and middle income countries (LMICs) may apply this step-by-step inventory to develop similar resources. The inventory is based on knowledge translation (KT) evidence and product design principles along with insights drawn from the practical experience of developing an online KT platform in a limited-resource setting.
The Feasibility Analysis of Integrating Community-Based Health Insurance Schemes Into the National Health Insurance Scheme in Uganda
(PloS one, 2024-04-14) Prossy Kiddu Namyalo; Boniface Mutatina; Sarah Byakika; Aliyi Walimbwa; Rose Kato; Robert K. Basaza
Background Uganda has a draft National Health Insurance Bill for the establishment of a National Health Insurance Scheme (NHIS). The proposed health insurance scheme is to pool resources, where the rich will subsidize the treatment of the poor, the healthy will subsidize the treat- ment of the sick, and the young will subsidize the treatment of the elderly. However, there is still a lack of evidence on how the existing community-based health insurance schemes (CBHIS) can fit within the proposed national scheme. Thus, this study aimed at determining the feasibility of integrating the existing community-based health financing schemes into the proposed National Health Insurance Scheme. Methods In this study, we utilized a multiple–case study design involving mixed methods. The cases (i.e., units of analysis) were defined as the operations, functionality, and sustainability of the three typologies of community-based insurance schemes: provider-managed, community-managed, and third party-managed. The study combined various data collection methods, including interviews, survey desk review of documents, observation, and archives. Findings The CBHIS in Uganda are fragmented with limited coverage. Only 28 schemes existed, which covered a total of 155,057 beneficiaries with an average of 5,538 per scheme. The CBHIS existed in 33 out of 146 districts in Uganda. The average contribution per capita was estimated at Uganda Shillings (UGX) 75,215 = equivalent to United States Dollar (USD) 20.3, accounting for 37% of the national total health expenditure per capita UGX 51.00 = at 2016 prices. Membership was open to everyone irrespective of socio-demographic status. The schemes had inadequate capacity for management, strategic planning, and finances and lacked reserves and reinsurance. The CBHIS structures included promoters, the scheme core, and the community grass-root structures. Conclusion The results demonstrate the possibility and provide a pathway to integrating CBHIS into the proposed NHIS. We however recommend implementation in a phased manner including first providing technical assistance to the existing CBHIS at the district level to address the critical capacity gaps. This would be followed by integrating all three elements of CBHIS structures. The last phase would then involve establishing a single fund for both the formal and informal sectors managed at the national level.