All Working Papers

The costs of diagnosing breast-related conditions at a large, public hospital in Johannesburg, South Africa

Breast cancer is the most common cancer among women in South Africa. Offering comprehensive breast care services requires careful planning; yet, there is limited literature on the costs of providing services in low-resource settings. We aimed to estimate the average costs per procedure and patient for the diagnosis of breast conditions in South Africa, including the impact of shifting to lower-cost imaging 

Keeping track of HIV and TB spending in South Africa: 2013/14 to 2020/21 Expenditure and Budget Review: Occasional Paper 2018-1. CEGAA.

This paper provides an analysis of the health HIV and TB budget and spending in South Africa over an eight-year period (2013/14 - 2020/21), with a special focus on the 2015/16 and 2016/17 provincial programme spending and the 2018/19 to 2020/21 budget. The analysis indicates government’s increasing financial commitment to HIV and TB against the backdrop of declining economic conditions. The problem of over- or under-spending by provinces has been partially attributed to poor estimation of 

Voices from the front lines: A qualitative exploration of integration of HIV, tuberculosis, and primary healthcare services in Johannesburg, South Africa –Manuscript Draft-

In South Africa, in 2013-2014, provision of antiretroviral treatment (ART) shifted in some areas from NGOs to public facilities. Tuberculosis (TB) management has also been integrated into public services. We aimed to explore the opinions and experiences of service managers and healthcare providers regarding integration of HIV and TB services into primary healthcare 

The availability of breast cancer screening, diagnostic and treatment services and integration with HIV-related care in Sub-Saharan Africa: Results from an electronic survey –Working paper–

Breast cancer and breast disease are often excluded from sexual reproductive health advocacy resulting in missed opportunities for advancing breast care services and engaging patients holistically. We aimed to determine the availability of diagnostic and treatment services for breast disease and integration with HIV-related care in Sub-Saharan Africa with a special focus on South 

Costs and cost-effectiveness of LEEP versus cryotherapy for treating cervical dysplasia among HIV-positive women in Johannesburg, South Africa –Manuscript Draft–

Cervical cancer incidence is significant in countries, such as South Africa, with high burdens of both HIV and human papillomavirus (HPV). Cervical cancer is largely preventable if dysplasia is diagnosed and treated early, but there is debate regarding the best approaches for screening and treatment, especially for low-resource settings. Currently South Africa provides Pap smears followed by colposcopic biopsy and LEEP if needed in its public health facilities. We estimated the costs and 

THE HEALTH SERVICE COSTS OF OFFERING FEMALE CONDOMS IN SOUTH AFRICA’S NATIONAL FEMALE CONDOM PROGRAMME 2015/16

The female condom (FC) was identified by the Reproductive Health Supplies Coalition in 2011 as one of several under-used reproductive health technologies having the potential to expand choice in reproductive health and family planning programs, add value to the method mix, and respond to the needs of diverse types of clients (1). The FC also is key to increasing HIV protection options for women and men, and is the only female-initiated HIV prevention barrier method. Although FC distribution 

SA HIV TB Investment Case Summary Report

On Mar 22, 2016 the reports for Phase 1 of the South African HIV and TB Investment Case were launched by the Deputy President during the World TB Day celebrations. HE2RO staff were heavily involved in all aspects of the development of the Investment Case, from devising the analytical framework to reviewing evidence for interventions and enablers to developing the novel optimisation method driving the model analysis to writing the 

SA HIV TB Investment Case Full Report

On Mar 22, 2016 the reports for Phase 1 of the South African HIV and TB Investment Case were launched by the Deputy President during the World TB Day celebrations. HE2RO staff were heavily involved in all aspects of the development of the Investment Case, from devising the analytical framework to reviewing evidence for interventions and enablers to developing the novel optimisation method driving the model analysis to writing the 

NATIONAL DEPARTMENT OF HEALTH STEPWISE GUIDE TO IMPROVE ADHERENCE TO CHRONIC DISEASE MEDICATION: ESTIMATE OF IMPLEMENTATION COSTS FOR THE MINIMUM PACKAGE LIMITED TO THE HIV POPULATION

In 2014, the National Department of Health (NDOH) drafted a strategy to improve adherence to chronic disease medication in South Africa. The strategy includes adherence to HIV, TB, non-communicable disease, and mental health medications. Before the strategy can be adopted, estimates of its overall resource requirements and cost to the national budget are needed. It is also important to estimate the cost of each intervention included in the strategy, so that interventions can be prioritized if 

In 2014, the National Department of Health (NDOH) drafted a strategy to improve adherence to chronic disease medication in South Africa. The strategy includes adherence to HIV, TB, non-communicable disease, and mental health medications. Before the strategy can be adopted, estimates of its overall resource requirements and cost to the national budget are needed. It is also important to estimate the cost of each intervention included in the strategy, so that interventions can be prioritized if insufficient resources are available to implement the entire strategy. In October 2014, the Health Economics and Epidemiology Research Office (HE2RO) was asked to make these cost estimates. This report contains the preliminary results of our cost analysis, for review and comment by NDOH and other stakeholders. It will be finalized once feedback has been received and incorporated into the analysis and report. This report is based on the 1 December 2014 draft of the adherence guide. The adherence guide contains a stepwise approach to supporting linkage to care, retention in care and adherence to treatment through the continuum of care based on a detailed outline of evidence based models and interventions that support linkage to care, adherence and retention in care. In the implementation plan facilities are provided with a minimum package of interventions to support linkage to care, adherence and retention in care with further optional interventions. The cost estimates provided in this document focus on the minimum package of interventions.

South Africa is at the centre of the global HIV epidemic. The public health burden created by HIV/AIDS has the potential to compound existing challenges in the country’s public healthcare system. Addressing these challenges will involve a significant overhaul of existing service delivery structures (South African National Department of Health, 2013) and innovative 

Meeting Report: The Contraceptive Implant in South Africa

South Africa’s new Contraceptive and Fertility Planning Policy and Service Delivery Guidelines were launched in early 2014. These include a focus on expanding access to and uptake of long-acting and reversible methods, through repositioning of existing methods (such as the IUD) as well as introduction of a new method, the subdermal implant. Roll out of the new implant is underway, and recently an article in the Mail and Guardian2,3 highlighted that there are challenges with the service,