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Tropical Medicine and International Health. 2008 Oct; 13(10):1245-56.OBJECTIVE: To estimate recurrent costs per patient and costs for a national HIV/AIDS treatment programme model in Rwanda. METHODS: A national HIV/AIDS treatment programme model was developed. Unit costs were estimated so as to reflect necessary service consumption of people living with HIV/AIDS (PLWHA). Two scenarios were calculated: (1) for patients/clients in the year 2006 and (2) for potential increases of patients/clients. A sensitivity analysis was conducted to test the robustness of results. RESULTS: Average yearly treatment costs were estimated to amount to 504 US$ per patient on antiretroviral therapy (ART) and to 91 US$ for non-ART patients. Costs for the Rwandan HIV/AIDS treatment programme were estimated to lie between 20.9 and 27.1 million US$ depending on the scenario. ART required 9.6 to 11.1 million US$ or 41-46% of national programme costs. Treatment for opportunistic infections and other pathologies consumed 7.1 to 9.3 million US$ or 34% of total costs. CONCLUSION: Health Care in general and ART more specifically is unaffordable for the vast majority of Rwandan PLWHA. Adequate resources need to be provided not only for ART but also to assure treatment of opportunistic infections and other pathologies. While risk-pooling may play a limited role in the national response to HIV/AIDS, considering the general level of poverty of the Rwandan population, no appreciable alternative to continued donor funding exists for the foreseeable future.
[Review of methods of dietary assessment during pregnant] Metodos de avaliacao do consumo alimentar de gestantes: uma revisao.
Revista Brasileira de Saude Materno Infantil. 2006 Oct-Dec; 6(4):383-390.Physiological pregnancy changes impact nutritional needs and food intake. The adequate use of tools providing knowledge of food consumption during this life cycle is relevant because it enables the diagnosis for possible nutrition deficits and excesses. The objective of the survey was to perform a bibliographic review on food intake assessment methods during pregnancy. The literature reviewed was selected from an electronic database published between 1994 and September 2004 in Brazil and abroad. This article aims at describing and assessing the different methods and main results of studies determining food intake during pregnancy, among them, the following are highlighted: 24 hour recall, food registration, questionnaire on food intake consumption and food history. The results determine that the 24 hour recall method was the one more frequently used, nevertheless, for many times it was not applied beyond a two day investigation period and it did not take weekends into account. The choice for this method is related to pragmatism and a favorable cost benefit ratio. The conclusion is that to obtain reliable results, the choice of method and study design should always be related to the objectives of the enquiry. (author's)
Bethesda, Maryland, Abt Associates, Health Financing and Sustainability Project, 1995 Aug. , xvii, 69 p. (USAID Contract No. DPE-5974-Z-00-9026-00)This technical report, prepared by USAID's Health Financing and Sustainability (HFS) project, reviews policy issues and constraints in developing countries. This report summarizes the nature and extent of HFS applied research activities in over 40 countries, synthesizes findings, and draws some conclusions and implications for policy and applied research. The following topics were the focus of HFS research: 1) quality of care and cost recovery, 2) protection of the poor under cost recovery, 3) mechanisms to promote demand, 4) provider incentives, 5) feasibility of social financing and insurance for low income populations, 6) public-private differences in efficiency, 7) private sector development, 8) private-public collaboration, and 9) reallocation of public sector spending. Over 40 applied research projects were conducted in mostly low income countries. Each project included a literature review of health service provision and costs, lessons learned, and field work. This report refers extensively to HFS research activities in Niger, Senegal, and the Central African Republic because of the large size and scope of research activities in these locations. Major findings are presented on the following topics: quality of care and its role in cost recovery and in government health services, protection of the poor under cost recovery, public sector reform, efficiency in service provision and differences between the public and private sectors, reallocation of public sectoring spending, expanding social financing, private sector potential for health care delivery in Africa, and the economic impact of malaria in Africa. It is concluded that the main quality of care problems were lack of drugs, medical supplies, and equipment and inappropriate medical practices. It is concluded that cost recovery may be able to cover the cost of essential drugs for treatment of ambulatory patients. Factors relating to the high rates of cost recovery are identified. Use of a fee or insurance system is considered to be dependent on the population's willingness to purchase premiums, managerial capability, and the means to invest insurance revenues. Willingness to pay appeared to be high among most population and income groups.
In: Environmental management and economic development, edited by Gunter Schramm and Jeremy J. Warford. Baltimore, Maryland, Johns Hopkins University Press, 1989. 117-38.The UN Development Programme/World Bank assessment of the Ethiopian energy sector in 1983 recognized the large gap between supply and demand of firewood and the need for a massive afforestation effort to reduce the imbalance. For the great majority of rural settlements, the use of modern petroleum fuels is fiscally inconceivable. There are 5 stages of ecological transition in Ethiopian smallholder systems until almost all tree cover is removed, and a high proportion of the cow dung produced is sold for cash in urban markets. Soil erosion is dramatic and nutrient-rich topsoil is much depleted. There is a total collapse in the production of organic matter. Peasants abandon their land in search of food, and starvation is prevalent. Evidence in the direction of the terminal state is seen in the fact that firewood in Addis Ababa has increased at the rate of 9%/year during the past decade. The 1981-82 Ethiopian livestock census estimated the total cattle population at 24.6 million. Dung production was estimated at roughly 23.2 million tons. A survey of fuels found that in some towns in Eritrea and Tigrai up to 90% of total household cooking is done with dung transported from the rural hinterland. In the present marketplace, dung returns more money when sold as fuel than it does when used as a fertilizer to produce additional grain. Nevertheless, rural afforestation produces a fuel of higher quality for less than 1/4 of the cost of the dung. In economic terms, in rural areas afforestation is justified in order to replace dung with wood as fuel. Dung could then be used as fertilizer. There is a 35-70% economic rate of return based on the costs of planting trees and the net productive increment in grain production from the retention of dung as a fertilizer. Afforestation programs provide an attractive medium to longterm rural development strategy with important benefits of added energy supplies, increased agricultural output, and environmental protection.
TECHNOLOGY IN SOCIETY. 1987; 9(3-4):261-73.Technology as a factor influencing fertility is discussed. The author argues that "technological change affects the demand for children, and hence for fertility regulation, both by directly altering the expected benefits and costs of children to parents and by influencing the cultural and social structural underpinnings of that economic calculus. Routes of that influence include the demand for education generated by competition for modern sector employment, the consumerist values and lifestyles conveyed by communications media, and the erosion of community and kin pressures on individual behavior in a more mobile and more commercialized society. Such forces for behavioral change, it is argued, are more powerful factors in fertility decline than either the 'social technology' of contraceptive service delivery (family planning programs) or improvements in the technology of contraception itself." (EXCERPT)
Chicago, Illinois, Economics Research Center, 1987. 37 p. (Discussion Paper Series No. 87-14.)Valuation formulas for age-specific mortality risks are derived from life-cycle allocation theory under uncertainty and related to empirical estimates of the value of life. A change in an age-specific mortality risk affects all subsequent survivor functions and reallocates consumption and labor supply over the entire life cycle. The value of eliminating a risk to life at a specific age is the expected present value of consumer surplus from that age forward. Approximate numerical extrapolations from cross-section estimates imply that values decrease rapidly in current age and in the distance between current age and age at risk. (author's)
[Unpublished] 1984. Paper presented at the Population Association of America Annual Meeting, Minneapolis, Minn., May 3-5, 1984. 49 p.Add to my documents.
Baltimore, Md., Johns Hopkins University Press, 1980. xv, 463 p.Add to my documents.
Washington, D.C., Worldwatch Institute, 1980. 48 p. (Worldwatch paper, no. 34)Add to my documents.
[Unpublished] 1980. Paper presented at the Population Association of America Annual Meeting, Denver, Colo., Apr. 10-12, 1980. 39 p.Add to my documents.
Manila, Commission on Population and the University of Philippines Population Institute, August 1973. 65pIn the Philippines, because of differential trends in fertility and mortality, the rate of natural increase--which may be viewed as a measure of population growth rate, since migration is negligible--rose to 32 per 1000 in 1960 from 12 per 1000 in 1903. Today 1/2 of the population is under 18 years of age, the completed family size is around 6 children, and the annual growth rate is 3.01%. The population problem of Filipinos, then, is a pressing one. This chartbook shows the effects of rapid population growth on socioeconomic development, and presents the measures taken to curb the growth rate. In 1973, family planning clinics were functioning in all major provinces. The acceptance rates from December 1969 to July 1973 ranged from nearly 400 per 1000 population in Manila to 140 per 1000 population in Southern Mindanao. During the same period, more than 1/2 of the acceptors chose the pill as their first method. Approximately 1 in 6 accepted the condom, 1 in 7 the IUD and 1 in 10 rhythm. The costs per couple year of protection present a general downward trend. From fiscal year 1960 to 1976, the growth rate is expected to decline from 3% to 2.57%.
Geographical Analysis. 1983 Oct; 15(4):287-304.The independent but linked traditions of stock adjustment models of residential mobility and the hedonic theory of housing demand are brought together. The principal research findings of these traditions are reviewed, an application of the random utility model to housing choice and mobility decisions is proposed, and preliminary empirical results based on retrospective household surveys conducted in South Bend, Indiana, are reported. (author's)