Guy Hutton

Human health benefits from livestock vaccination for brucellosis: case study

OBJECTIVE To estimate the economic benefit, cost-effectiveness, and distribution of benefit of improving human health in Mongolia through the control of brucellosis by mass vaccination of livestock. METHODS Cost-effectiveness and economic benefit for human society and the agricultural sector of mass vaccination against brucellosis was modelled. The intervention consisted of a planned 10-year livestock mass vaccination campaign using Rev-1 livestock vaccine for small ruminants and S19 livestock vaccine for cattle. Cost-effectiveness, expressed as cost per disability-adjusted life year (DALY) averted, was the primary outcome. FINDINGS In a scenario of 52% reduction of brucellosis transmission between animals achieved by mass vaccination, a total of 49,027 DALYs could be averted. Estimated intervention costs were US

Human resources for health care delivery in Tanzania: a multifaceted problem

8.3 million, and the overall benefit was US

Evaluation of the costs and benefits of interventions to reduce indoor air pollution

26.6 million. This results in a net present value of US

The sector-wide approach: a blessing for public health?

18.3 million and an average benefit-cost ratio for society of 3.2 (2.27-4.37). If the costs of the intervention were shared between the sectors in proportion to the benefit to each, the public health sector would contribute 11%, which gives a cost-effectiveness of US

The cost-effectiveness of intermittent preventive treatment for malaria in infants in Sub-Saharan Africa

19.1 per DALY averted (95% confidence interval 5.3-486.8). If private economic gain because of improved human health was included, the health sector should contribute 42% to the intervention costs and the cost-effectiveness would decrease to US

Cost-effectiveness of malaria intermittent preventive treatment in infants (IPTi) in Mozambique and the United Republic of Tanzania

71.4 per DALY averted. CONCLUSION If the costs of vaccination of livestock against brucellosis were allocated to all sectors in proportion to the benefits, the intervention might be profitable and cost effective for the agricultural and health sectors.

Global costs and benefits of reaching universal coverage of sanitation and drinking-water supply

BackgroundRecent years have seen an unprecedented increase in funds for procurement of health commodities in developing countries. A major challenge now is the efficient delivery of commodities and services to improve population health. With this in mind, we documented staffing levels and productivity in peripheral health facilities in southern Tanzania.MethodA health facility survey was conducted to collect data on staff employed, their main tasks, availability on the day of the survey, reasons for absenteeism, and experience of supervisory visits from District Health Teams. In-depth interview with health workers was done to explore their perception of work load. A time and motion study of nurses in the Reproductive and Child Health (RCH) clinics documented their time use by task.ResultsWe found that only 14% (122/854) of the recommended number of nurses and 20% (90/441) of the clinical staff had been employed at the facilities. Furthermore, 44% of clinical staff was not available on the day of the survey. Various reasons were given for this. Amongst the clinical staff, 38% were absent because of attendance to seminar sessions, 8% because of long-training, 25% were on official travel and 20% were on leave. RCH clinic nurses were present for 7 hours a day, but only worked productively for 57% of time present at facility. Almost two-third of facilities had received less than 3 visits from district health teams during the 6 months preceding the survey.ConclusionThis study documented inadequate staffing of health facilities, a high degree of absenteeism, low productivity of the staff who were present and inadequate supervision in peripheral Tanzanian health facilities. The implications of these findings are discussed in the context of decentralized health care in Tanzania.

The Costs of Meeting the 2030 Sustainable Development Goal Targets on Drinking Water, Sanitation, and Hygiene

Worldwide, more than three billion people cook with wood, coal and other solid fuels on open fires or traditional stoves, contributing to more than 1.5 million deaths annually and a multitude of negative economic and environmental impacts. The aim of this article is to present the costs and benefits of interventions to reduce indoor air pollution by halving the global population currently lacking access to (1) cleaner fuels (liquefied petroleum gas (LPG)) and (2) cleaner-burning and more efficient stoves. Results are presented for 11 world subregions. Annual costs and benefits of the two interventions are modelled from 2005 until 2015. Intervention costs include fuel, stove, and programme costs, from which monetary fuel cost savings are subtracted to estimate net costs. Economic benefits include less expenditure on health care, health-related productivity gains, fuel collection and cooking time savings, and environmental impacts. Globally, annual economic benefits of halving the population without access to LPG amount to (US)

The Knowledge Base for Achieving the Sustainable Development Goal Targets on Water Supply, Sanitation and Hygiene.

91 billion at a net cost of

Economic Evidence on the Health Impacts of Climate Change in Europe

13 billion. The improved stove intervention generates