EQUIFINANCE

This project is led by professor Kjell Arne Johansson and is a collaboration between the Bergen Centre for Ethics and Priority Setting (BCEPS), the Centre for Intervention Science in Maternal and Child Health (CISMAC) at the University of Bergen, the Centre for Health Research and Development, Society for Applied Studies (CHRD-SAS) in India, and the Translational Health Science and Technology Institute (THSTI), also in India. 

The main idea behind EQUIFINANCE is to develop and evaluate new methods to assess equity and economic impact (financial risk protection) of healthcare interventions on households. 

Impact on equity and economic return for households of maternal, neonatal and child health interventions will be assessed in five high-quality studies listed as follows: 

Equity and Poverty impact of Community initiated Kangaroo Mother Care (ciKMC) 

This operation intends to assess the equity and poverty impact of training mothers in Kangaroo Mother Care (KMC) initiated in community settings for reducing mortality and morbidity of low-birth-weight babies. KMC comprises skin-to-skin contact (SSC) between mother and baby and exclusive breastfeeding. 

Studies shows that KMC may result in a 340% relative reduction in neonatal mortality, 65% relative reduction in the risk of nosocomial infections or sepsis, shorter hospital stay, and a lower risk of lower respiratory tract infections in babies with birth weight. 

Healthcare Expenditure Survey

Globally, around 13% households face catastrophic healthcare expenditure (CHE) i.e., healthcare expenditure > 10% of their household income, and in India, this proportion is around 17%.

In this study we aim to assess care seeking for preventive, promotive and curative healthcare services and estimate its associated costs. This will provide us high quality evidence on direct medical and non-medical expenses as well as indirect costs due to productivity loss, proportion of households experiencing catastrophic healthcare expenditure and impoverishment due to healthcare seeking. 

Action III 

A multi-country, multi-centre, three-arm, parallel group, double-blind, placebo-controlled, randomized trial of two doses of antenatal corticosteroids for women with a high probability of birth in the late preterm period in hospitals in low-resource countries to improve newborn outcomes: Impact on equity, poverty, and cost-effectiveness analysis. 

This study aims to assess the equity impact of the intervention across levels of household consumption, gender, place of residence and maternal education. 

The poverty and equity impact study embedded in the ACTION 3 trial will: 

• Assess the equity impact of the intervention across levels of household consumption, gender, place of residence, maternal education, and religion.  
• Estimate the OOP expenditures, catastrophic healthcare expenditure and impoverishment due to healthcare seeking for the infant and the mother.  
• Assess the cost-effectiveness of the two regimens of ACS compared to standard treatment from a societal perspective.  
• Asses the extended-cost effectiveness of the two regimens of ACS compared to standard treatment and evaluate cost per distributive impact of financial protection and health benefits across household consumption group.   
   

Group for Advanced Research on Birth outcomes - DBT India Initiative  (GARBH-Ini-Equity) 

This study will specifically focus on equity and financial impact analysis on families with high-risk infants and additional expenditures incurred by the health-care system in the district hospital during follow-up of these children in the GARBH-ini cohort. Information will be collected to get a total household consumption and health care expenditures incurred by the family of the high-risk infant and expenditures incurred by the health-care system in setting up and conducting the high-risk infant follow-up program in the District Hospital at the end of 1 and 2 years of follow-up.

The equity and financial household impact study embedded in GARBHI-Ini phase II aims to: 

• Assess the inequity in growth and development outcomes across levels of household consumption and maternal education.
• Estimate the OOP expenditures, catastrophic healthcare expenditure and impoverishment due to healthcare seeking between high risk and non high risk  group of infants. 
• Estimate the cost of neurodevelopmental follow up regimen from a societal perspective.
   

Equity and Poverty impact of Zinc-sepsis 

This study project intends to examine Zinc as adjunct for treatment of clinical severe infection in infants younger than 2 months. 

Objectives are health gain, financial risk protection, and cost-effectiveness analysis.  

The trial aims to evaluate the health and economic consequences of providing zinc as adjunct to standard treatment to infants (age 3-59 days) hospitalized with “clinical severe infection”.    

A randomised double-blind placebo-controlled trial will measure to what extent 10 mg of elemental zinc orally daily in infants aged 1 day to 2 months hospitalised with very severe disease, will reduce their risk of death. The study has enrolled 2913 infants in India across 5 centres as they have a large burden of young infants with very severe disease and provide care to all sections of society in this region. The data on equity & financial risk protection was collected alongside the trial for 705 families and final data from this trial is now being prepared for analysis.