Global Health Priorities
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Access to surgical services in rural Ethiopia - balancing health, finance and equity

Surgical disease cause a high disease burden and there is limited access to surgical services in low- and middle-income countries. In a new article published in Health Policy and Planning , a DCP-Ethiopia and Priorities2020 team examined how policies to expand access to surgery in rural Ethiopia would impact health, impoverishment and equity.

picture of operation theatre

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In the article, an extended cost-effectiveness analysis was performed, and number of deaths averted, the number of cases of poverty averted and the number of cases of catastrophic expenditure averted for each policy were estimated for different wealth quintiles. Health benefits, financial risk protection and equity appear to be in tension in the expansion of access to surgical care in rural Ethiopia.

Health benefits from each of the examined policies accrued primarily to the poor. However, without travel vouchers, many policies also induced impoverishment in the poor while providing financial risk protection to the rich, calling into question the equitable distribution of benefits by these policies. Adding travel vouchers removed the impoverishing effects of a policy but decreased the health benefit that could be bought per dollar spent. These results were robust to sensitivity analyses. 

In addition to death and disability, falling ill can push persons and families into poverty. In many countries large parts of the medical bill must be covered by the patient. Every year hundreds of millions experience financial hardship because they get ill. Protection not only for a disease, but also for the economical impact of diagnosis and treatment is concidered a priority. You can read more at WHO.

Extended cost-effectiveness analysis exploring non-health outcomes and benefits are a priority in our research group. Associate professor Kjell Arne Johansson have an extended cooperation with University of Washington professor Dean Jamison and Harvard Assistant professor Stéphane Verguet through the DCP3-project. Disease Control Priorities Network is a large project financed by the Gates foundation to promote and support the use of economic evaluation for priority setting at both global and national levels. In this paper, the DCP3-researchers have collaborated with Harvard researchers Mark Shrime and Margaret Kruk and also Master Student at Centre for International Health at Uni of Bergen Dawit Desalegn.