Prioritising within limited health budgets

Amani Thomas has proved that a new and more effective antimalarial medicine can save 360,000 more children from malaria each year in his home country Tanzania.

PhD graduate Amani Thomas Mori from the Centre for International Health at the University of Bergen.
AIMING TO REDUCE THE BURDEN OF DISEASES: “When the resources are limited it is important to ensure that only those interventions with the greatest potential to reduce the burden of diseases are funded,” says Amani Thomas Mori, who recently got his PhD degree at the University of Bergen.
Walter Wehus

After your basic pharmacy studies in Tanzania you wanted to study health policies issues. How come?

 “Because pharmacy is not only about knowing the properties of drugs, but also about how health policies affect access to drugs and resource allocation to drug therapies. Not many people have specialised in pharmacy and health policies, so I had a great interest in these issues. I am very lucky and grateful that the University of Bergen (UiB) shared my views. I came to UiB as a part of a capacity building initiative for developing countries.” 

How did you end up writing about pharmacoeconomics (see FACTS) and formulary decision-making in Tanzania?

“I chose this topic because in Tanzania it is not well known to what extent economic evaluation is used to inform priority-setting decisions involving drug therapies. In Tanzania and other low-income countries, healthcare resources are scarce, and pharmacoeconomic analysis is used precisely to increase efficiency in the use of limited resources to drug therapies. But, unfortunately, we know very little about how and to what extent pharmacoeconomics is used in these countries.”

What did you want to achieve with your PhD?

“My aim was to understand the role of pharmacoeconomics in formulary decision-making and in addition, to generate economic evidence for use of the new antimalarial drug, dihydroartemisinin-piperaquine. For the latter, I showed that this medicine gives more health for each health penny. It will cost the Tanzanian health department an additional 7,4 million US dollars, for drugs and diagnostics budget than the medicine used today, while reducing malaria cases among children by 360,000. However, if you include hospitalisation costs, this new drug saves about half a million US dollars per year compared to the current drug.”

What, in your opinion, is most important in your research?

“When the resources are limited it is important to ensure that only those interventions with the greatest potential to reduce the burden of diseases are funded. This is especially important when you want to reduce the burden of infectious diseases such as HIV/AIDS and malaria which claim millions of lives in developing countries. You will realise that we chose malaria because it is the leading cause of outpatient visits and inpatient admission especially for children under the age of five. So my research among other things has shown that there is a better way to use the limited health resources and that is through the application of pharmacoeconomics, as I showed with the new antimalarial drug.”

How did you work?

“In order to improve the use of economic evidence, I had to identify how many economic evaluation studies about drugs and vaccines that have been conducted in Tanzania. I found 12 studies, but only one of these studies was used to inform decision making in the country. Therefore, I became interested in finding out why the majority of these studies were not used to inform decision-making, and more importantly, to understand how medicines are selected. I decided to interview the decision makers and studied the documents around medicine selection processes.”

What did you find out?

“I found that the decision makers did not have sufficient knowledge to understand, translate and apply economic evaluation evidence in decision-making. My study built an argument that it is important to train more people in health economics in Tanzania if the country wants to improve efficiency in the use of its scarce health resources. I want to continue to work hard in this area in order to make this a reality.”

What are you doing now?

“Now it is time to go home and use the knowledge and skills I gained at UiB to help improve things in Tanzania. I am thinking of more collaboration in research with the professors at UiB to try to address health challenges facing my country. So finishing the PhD marks the beginning of another cycle.”

Where do you see yourself in ten years?

“God willing, if am healthy and alive, I will be one of the leading professors in the field of pharmacoeconomics in Tanzania. My focus is to see economic evaluation being used consistently to inform priority-setting decisions as this will speed up the reduction of the existing burden of disease.”

How are you going to do that?

“I want to make sure that health economics is included in training curricula of higher learning institutions, especially the medical schools, and that short courses are conducted to target decision-makers at the Ministry of Health and other key institutions. More importantly I want to push for the establishment of a Health Technology Assessment (HTA) agency in Tanzania, which will deal specifically with evaluation of all new drugs, vaccines and diagnostic equipment aimed for Tanzania to ensure they give value for money. This is a key strategy used in most high income countries, and I do not see why we cannot do the same in Tanzania, now that I have sufficient expertise in the area.”