Michael Otim

How much does intellectual disability really cost? First estimates for Australia

Abstract Background Given the paucity of relevant data, this study estimates the cost of intellectual disability (ID) to families and the government in Australia. Method Family costs were collected via the Client Service Receipt Inventory, recording information relating to service use and personal expense as a consequence of ID. Government expenditure on the provision of support and services was estimated using top-down costing. Results A total of 109 parents participated. The cost of ID in Australia is high, especially for families. Total economic costs of ID are close to

The effect of payment and incentives on motivation and focus of community health workers: five case studies from low- and middle-income countries

14,720 billion annually. Opportunity cost of lost time provided 85% of family expense. A comparison of family expense and social welfare benefits received suggests that families suffer considerable loss. This may impact on families’ physical and emotional wellbeing. Conclusions Monitoring of changes in expenditure is required. Policies should ensure that money devoted to ID is allocated in a rational, equitable, and cost-effective manner.

Retaining doctors in rural Timor-Leste: a critical appraisal of the opportunities and challenges

IntroductionCommunity health workers (CHWs) have been proposed as a means for bridging gaps in healthcare delivery in rural communities. Recent CHW programmes have been shown to improve child and neonatal health outcomes, and it is increasingly being suggested that paid CHWs become an integral part of health systems. Remuneration of CHWs can potentially effect their motivation and focus. Broadly, programmes follow a social, monetary or mixed market approach to remuneration. Conscious understanding of the differences, and of what each has to offer, is important in selecting the most appropriate approach according to the context.Case descriptionsThe objective of this review is to identify and examine different remuneration models of CHWs that have been utilized in large-scale sustained programmes to gain insight into the effect that remuneration has on the motivation and focus of CHWs. A MEDLINE search using Ovid SP was undertaken and data collected from secondary sources about CHW programmes in Iran, Ethiopia, India, Bangladesh and Nepal. Five main approaches were identified: part-time volunteer CHWs without regular financial incentives, volunteers that sell health-related merchandise, volunteers with financial incentives, paid full-time CHWs and a mixed model of paid and volunteer CHWs.Discussion and evaluationBoth volunteer and remunerated CHWs are potentially effective and can bring something to the health arena that the other may not. For example, well-trained, supervised volunteers and full-time CHWs who receive regular payment, or a combination of both, are more likely to engage the community in grass-roots health-related empowerment. Programmes that utilize minimal economic incentives to part-time CHWs tend to limit their focus, with financially incentivized activities becoming central. They can, however, improve outcomes in well-circumscribed areas. In order to maintain benefits from different approaches, there is a need to distinguish between CHWs that are trained and remunerated to be a part of an existing health system and those who, with little training, take on roles and are motivated by a range of contextual factors. Governments and planners can benefit from understanding the programme that can best be supported in their communities, thereby maximizing motivation and effectiveness.

Priority setting in Indigenous health: assessing priority setting process and criteria that should guide the health system to improve Indigenous Australian health.

Timor-Leste is in the process of addressing a key issue for the countrys health sector: a medical workforce that is too small to provide adequate care. In theory, a bilateral programme of medical cooperation with Cuba created in 2003 could solve this problem. By the end of 2013, nearly 700 new doctors trained in Cuba had been added to Timor-Lestes medical workforce and by 2017 a further 328 doctors should have been trained in the country by Cuban and local health professionals. A few more doctors who have been trained in Indonesia and elsewhere will also soon enter the workforce. It is expected that the number of physicians in Timor-Leste in 2017 will be more than three times the number present in the country in 2003. Most of the new physicians are expected to work in rural communities and support the national governments goal of improving health outcomes for the rural majority. Although the massive growth in the medical workforce could change the way health care is delivered and substantially improve health outcomes throughout the country, there are challenges that must be overcome if Timor-Leste is to derive the maximum benefit from such growth. It appears crucial that most of the new doctors be deployed in rural communities and managed carefully to optimize their rural retention.

Towards best practice in acute stroke care in Ghana: A survey of hospital services

IntroductionThe health of Indigenous Australians is worse than that of other Australians. Most of the determinants of health are preventable and the poor health outcomes are inequitable. The Australian Government recently pledged to close that health gap. One possible way is to improve the priority setting process to ensure transparency and the use of evidence such as epidemiology, equity and economic evaluation.The purpose of this research was to elicit the perceptions of Indigenous and non-Indigenous decision-makers on several issues related to priority setting in Indigenous-specific health care services. Specifically, we aimed to:1.identify the criteria used to set priorities in Indigenous-specific health care services;2.determine the level of uptake of economic evaluation evidence by decision-makers and how to improve its uptake; and3.identify how the priority setting process can be improved from the perspective of decision-makers.MethodsWe used a paper survey instrument, adapted from Mitton and colleagues’ work, and a face-to-face interview approach to elicit decision-makers’ perceptions in Indigenous-specific health care in Victoria, Australia. We used mixed methods to analyse data from the survey. Responses were summarised using descriptive statistics and content analysis. Results were reported as numbers and percentages.ResultsThe size of the health burden; sustainability and acceptability of interventions; historical trends/patterns; and efficiency are key criteria for making choices in Indigenous health in Victoria. There is a need for an explicit priority setting approach, which is systematic, and is able to use available data/evidence, such as economic evaluation evidence. The involvement of Indigenous Australians in the process would potentially make the process acceptable.ConclusionsAn economic approach to priority setting is a potentially acceptable and useful tool for Aboriginal Community Controlled Health Services (ACCHS). It has the ability to use evidence and ensure due process at the same time. The use of evidence can ensure that health outcomes for Indigenous peoples can be maximised – hence, increase the potential for ‘closing the gap’ between Indigenous and other Australians.

Acceptability of programme budgeting and marginal analysis as a tool for routine priority setting in Indigenous health

BackgroundStroke and other non-communicable diseases are important emerging public health concerns in sub-Saharan Africa where stroke-related mortality and morbidity are higher compared to other parts of the world. Despite the availability of evidence-based acute stroke interventions globally, uptake in low-middle income countries (LMIC) such as Ghana is uncertain. This study aimed to identify and evaluate available acute stroke services in Ghana and the extent to which these services align with global best practice.MethodsA multi-site, hospital-based survey was conducted in 11 major referral hospitals (regional and tertiary - teaching hospitals) in Ghana from November 2015 to April 2016. Respondents included neurologists, physician specialists and medical officers (general physicians). A pre-tested, structured questionnaire was used to gather data on available hospital-based acute stroke services in the study sites, using The World Stroke Organisation Global Stroke Services Guideline as a reference for global standards.ResultsAvailability of evidence-based services for acute stroke care in the study hospitals were varied and limited. The results showed one tertiary-teaching hospital had a stroke unit. However, thrombolytic therapy (thrombolysis) using recombinant tissue plasminogen activator for acute ischemic stroke care was not available in any of the study hospitals. Aspirin therapy was administered in all the 11 study hospitals. Although eight study sites reported having a brain computed tomographic (CT) scan, only 7 (63.6%) were functional at the time of the study. Magnetic resonance imaging (MRI scan) services were also limited to only 4 (36.4%) hospitals (only functional in three). Acute stroke care by specialists, especially neurologists, was found in 36.4% (4) of the study hospitals whilst none of the study hospitals had an occupational or a speech pathologist to support in the provision of acute stroke care.ConclusionThis study confirms previous reports of limited and variable provision of evidence based stroke services and the low priority for stroke care in resource poor settings. Health policy initiatives to enhance uptake of evidence-based acute stroke services is required to reduce stroke-related mortality and morbidity in countries such as Ghana.

Building evidence for peer-led interventions: assessing the cost of the Adolescent Asthma Action program in Australia

OBJECTIVE This study aimed to examine the acceptability of programme budgeting and marginal analysis (PBMA) as a tool for priority setting in the Indigenous health sector. METHODS The study uses a mix of quantitative and qualitative methods. A survey of key decision makers in Indigenous health in Victoria was conducted to assess the acceptability of PBMA as a potential tool for priority setting. Respondents comprised 24 bureaucrats from the Victorian Department of Human Services (DHS) and 26 senior executives from the aboriginal community controlled health sector (ACCHS) in Victoria. The survey instrument included both closed-ended and open-ended questions and was administered face-to-face by a trained researcher in 2007-2008. Closed-ended questions were analysed using descriptive statistics, and content analysis was used for the open-ended ones. RESULTS The PBMA was well received as having the potential to improve priority setting processes in Indigenous health. Sixty-nine percent of the DHS respondents felt that PBMA was acceptable as a routine decision-making tool, and nearly 80% of ACCHS respondents thought that PBMA was intuitively appealing and would most probably be an acceptable priority setting approach in their organisations. The challenges of using PBMA were related to resource constraints and data intensity. CONCLUSION Programme budgeting and marginal analysis is potentially acceptable within the ACCHS and was perceived as useful in terms of assisting the decision maker to maximise health outcomes, but data systems need to be re-oriented to address its significant data needs. IMPLICATION Proper guidelines need to be developed to facilitate PBMA application within the Indigenous-controlled community health sector. Copyright

Health professionals’ views on the barriers and enablers to evidence-based practice for acute stroke care: a systematic review

Asthma is the most common chronic illness among adolescents in Australia. Aboriginal and Torres Strait Islander adolescents, in particular, face substantial inequalities in asthma-related outcomes. Triple A (Adolescent Asthma Action) is a peer-led education intervention, which aims to improve asthma self-management and reduce the uptake of smoking among adolescents. The aim of this study was to determine the cost of implementing the Triple A program in Australia. Standard economic costing methods were used. It involved identifying the resources that were utilised (such as personnel and program materials), measuring them and then valuing them. We later performed sensitivity analysis so as to identify the cost drivers and a stress test to test how the intervention can perform when some inputs are lacking. Results indicate that the estimated cost of implementing the Triple A program in five schools was

Effectiveness of a cough management algorithm at the transitional phase from acute to chronic cough in Australian children aged <15 years: protocol for a randomised controlled trial

41060, assuming that the opportunity cost of all the participants and venues was accounted for. This translated to

The respiratory health of urban indigenous children aged less than 5 years: study protocol for a prospective cohort study

8212 per school or