Browsing by Author "Ogbuoji, Osondu"

Young people living with HIV (YPLWH) constitute a growing proportion of the global population of people living with HIV but have less access to HIV testing, diagnosis, treatment, and face heightened mental health challenges. To address these challenges, targeted mental health and medication adherence interventions have been developed, including in Tanzania, which is home to 6% of the world's YPLWH. This study proposes a mathematical model to estimate the health and economic outcomes of mental health HIV adherence interventions targeting YPLWH in Tanzania.We developed a Markov model to predict the long-term health (Disability-Adjusted Life Years (DALY)) and economic outcomes (Value of a Statistical Life Year (VLSY)) of mental health HIV adherence interventions targeting YPLWH. We parameterized the model using outcomes data from the 2016-2020 Sauti ya Vijana randomized control trial (RCT) conducted in Moshi, Tanzania. Cost data were retrieved from a cost analysis of the same RCT and supplemented with data from published literature. The study is conducted from a health payer’s perspective, and the Willingness-To-Pay (WTP) per DALY averted was set to the 2021 Tanzanian GDP per capita (USD 1099.3). Costs and outcomes were modeled for ten years and discounted at an annual rate of 3%. The findings suggest that the Sauti ya Vijana intervention modeled in this study is cost-effective at a WTP of USD 1099.3. The Incremental cost-effectiveness ratio for the intervention compared to the standard of care was USD 637.06 per DALY averted at a 3% discount rate. The benefit-to-cost ratio of the intervention was USD 26.54 in economic productivity for the intervention arm for every dollar spent on the intervention, and the net economic productivity benefit was USD 17,174.74 over a decade. Mental health adherence interventions hold the promise of improving health outcomes amongst YPLWH. The mathematical model developed in this study is a valuable decision-making tool for policymakers regarding mental health adherence interventions targeting YPLWH in Tanzania. The model contributes to the global goal of achieving the UNAIDS 95-95-95 targets for YPLWH.

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Background: Globally, about five million children under the age of five years old die each year, of which Nigeria accounts for roughly eight hundred and fifty thousand. Despite the alarming number of deaths, persistent financial barriers hinder immunization efforts, with a central focus on the low budgetary allocation for routine immunization, which fosters a dependence on external funding and a lack of attention to developing sustainable domestic financing strategies. Methods: I conducted a problem-driven political economy analysis to explore the interplay between political dynamics, economic considerations, and internal and external contextual factors that impact Nigeria's ability to sustainably finance vaccines beyond its partnership with Gavi. This PEA involved 14 key informant interviews across actors from national government organizations, developmental partners, and civil society organizations. Results: I found that a significant challenge in the vaccine payment pathway arose from delayed approval and release of funds. Furthermore, participants identified other central challenges to vaccine financing including the lack of prioritization by the government, limited fiscal space, and Nigeria’s adverse macroeconomic conditions such as currency devaluation and high debt financing. To tackle some of the challenges, participants reported that exhaustive stakeholder engagement, enhanced state government involvement in decision-making, excise taxes, private sector involvement via local vaccine manufacturing, and internal accountability by CSOs and private entities were some opportunities for change. Conclusions: These findings underscore the need for robust institutional processes to streamline and optimize vaccine financing mechanisms. Furthermore, comprehensive engagement and representation across all stakeholder groups are imperative to foster ownership and commitment to immunization initiatives. Addressing the identified challenges in the vaccine financing landscape would ensure the sustainability of the National Program on Immunization and drive improvements in public health outcomes.

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Background: Prematurity is the leading cause of child deaths, accounting for >30% of neonatal (first 28 days) deaths globally. Social determinants, defined as the social, economic, geographic, and environmental conditions of individuals, play an important role in shaping a preterm infant’s health outcome and their likelihood of survival. However, there remains a gap in understanding the extent to which these determinants impact a preterm infant’s survival. There is also a dearth of evidence to evaluate the effectiveness of the current policies and programs that determine the kind of care provided to newborns, particularly preterm babies. This study aimed to identify determinants (infant, social and demographic, and mother's reproductive and behavioral, country-level factors) of mortality in preterm infants. Methods: This was a mixed-methods study with two parts: 1) Quantitative and 2) Qualitative. The quantitative part consisted of analyzing data from the Demographic Health Survey (DHS) to identify main determinants of survival of preterm babies born in low- and -middle income countries (LMICs). A multilevel mixed-effects survival analysis was performed to find the association of these determinants with mortality in preterm infants within the first 7, 30, 365 days of life. To delve deeper into the country-level factors, qualitative interviews were conducted with policymakers to understand their perspective on the issue of newborn and preterm infant health in one of the selected LMICs, Ethiopia. Interviews were analyzed using thematic analysis. All analysis was performed using Stata version 17 and NVivo version 14. Results: A total of 16,539 preterm births were recorded, within which 1,742 deaths occurred in the first 7 days, 2,036 deaths occurred in the first 30 days, and 2,367 occurred in the first year of life. Being born female (7 days HR: 0.672, CI: 0.602 - 0.750), urban residence (7 days HR = 0.754, CI: 0.627 - 0.907), birth interval of between 24- and 60-months (7 days HR = 0.508, CI: 0.419 - 0.617), breastfeeding (7 days HR: 0.008, CI: 0.005 - 0.011), and higher pregnancy duration (gestational age) of the mother (HR: 0.457, CI: 0.424 - 0.493) were associated with a lower risk of death. Small birthweight babies had a higher risk of death (7 days HR: 1.484, CI: 1.893 - 3.322). The HR for all determinants remained similar for death at 7 days, 30 days, and 365 days. Evidence for within and across country variation was also found, indicating unobserved factors at the country and primary sampling unit level that contribute to differences in mortality among preterm children. Qualitative findings showed that despite a strong national policy for preterm care, critical gaps persist – regional disparities, rural-urban divides, inadequate health infrastructure, budget constraints, limited access to care, low community awareness, and a shortage of skilled professionals hinder effective policy implementation in Ethiopia. International collaboration, increased financial investment, human resource development, and enhanced healthcare infrastructure is required to bolster preterm infant survival outcomes in Ethiopia. Conclusions: This study’s findings highlight the significance of factors such as infant characteristics, social and demographic determinants, and maternal behaviors in influencing survival outcomes and emphasize the need for targeted interventions to address gender disparities, promote breastfeeding practices, and improve access to healthcare services. An alignment between policy development and execution is required to see the effectiveness of efforts done to improve preterm infant health in LMIC settings.

Background:In their pursuit of Universal Health Coverage (UHC), a challenge African countries face is extending health coverage to the poor and informal sector. This group accounts for a significant proportion of the population in most African countries, yet there is a wealth of evidence documenting their low health coverage and a contrasting paucity of data available to inform financing policy reform. This thesis intends to collect and apply data to this challenge, redressing this paucity and generating evidence on policies that support a fair, progressive realization of UHC.

Methods:I used a policy surveillance methodology to transform the text of health financing laws and policies into quantitative and qualitative data for analysis. I surveyed the 47 countries of the World Health Organization AFRO region with a codebook consisting of 28 questions relating to the coverage of the poor and informal sector. I answered questions using publicly available, country level documents. I used the data to (i) identify prevailing financing policies that provide health coverage to the poor and informal sector and (ii) present a comparative case analysis examining associations between health financing policies and essential health service coverage.

Results:Health insurance and user fees are predominant UHC financing approaches in Africa. 45 of 47 countries (96%) have health insurance policy and 34 countries (72%) have policy enforcing user fees. To help the poor and informal sector overcome these financial access barriers, countries use exemptions and subsidies. Of the 45 countries with health insurance, 18 (40%) exempt or subsidise premiums for the poor. Of the 34 countries with user fees, 18 (53%) exempt and/or subsidise user fees for the poor. Of the 41 countries with health service packages, 19 countries (46%) provide the health services for free. In general, there is a lack of targeted financing mechanisms for the informal sector.

Conclusions:Extending coverage to the poor and informal sector is a challenge within the broader context of expanding UHC in Africa. This study provides a comprehensive overview of financing policy solutions from within the continent and lays the foundation for further analyses to clarify what reforms work best.