Papers by Joses Muthuri Kirigia
BMC Medical Ethics, 2015
The increasing emphasis on research, development and innovation for health in providing solutions... more The increasing emphasis on research, development and innovation for health in providing solutions to the high burden of diseases in the African Region has warranted a proliferation of studies including clinical trials. This changing public health landscape requires that countries develop adequate ethics review capacities to protect and minimize risks to study participants. Therefore, this study assessed the readiness of national ethics committees to respond to challenges posed by a globalized biomedical research system which is constantly challenged by new public health threats, rapid scientific and technological advancements affecting biomedical research and development, delivery and manufacture of vaccines and therapies, and health technology transfer. This is a descriptive study, which used a questionnaire structured to elicit information on the existence of relevant national legal frameworks, mechanisms for ethical review; as well as capacity requirements for national ethics committees. The questionnaire was available in English and French and was sent to 41 of the then 46 Member States of the WHO African Region, excluding the five Lusophone Member States. Information was gathered from senior officials in ministries of health, who by virtue of their offices were considered to have expert knowledge of research ethics review systems in their respective countries. Thirty three of the 41 countries (80.5 %) responded. Thirty (90.9 %) of respondent countries had a national ethics review committee (NEC); 79 % of which were established by law. Twenty-five (83.3 %) NECs had secretarial and administrative support. Over 50 % of countries with NECs indicated a need for capacity strengthening through periodic training on international guidelines for health research (including clinical trials) ethics; and allocation of funds for administrative and secretariat support. Despite the existing training initiatives, the Region still experiences a shortage of professionals trained in health research ethics/ethicists. Committees continue to face various capacity needs especially for evaluating clinical trials, for monitoring ongoing research, database management and for accrediting institutional ethics committees. Given the growing number of clinical trials involving human participants in the African Region, there is urgent need for supporting countries without NECs to establish them; capacity strengthening where they exist; and creation of a regional network and joint ethical review mechanisms, whose membership would be open to all NECs of the Region.
Health research policy and systems / BioMed Central, 2015
A number of resolutions of the World Health Assembly and the WHO Regional Committee for Africa ca... more A number of resolutions of the World Health Assembly and the WHO Regional Committee for Africa call upon African countries and their development partners to make the required investments in national health research systems (NHRS) to generate knowledge and promote its use in tackling priority public health challenges. Implementation of these resolutions is critical for Africa to progress with the rest of the world in achieving the post-2015 health sustainable development goal. This study assesses the current status of some NHRS components in the 47 countries of the WHO African Region, identifies the factors that enable and constrain NHRS, and proposes the way forward. To track progress in NHRS components and for comparison, a questionnaire that was used in NHRS surveys in 2003 and 2009 was administered in all 47 countries in the African Region. The national health research focal persons were responsible for completing the questionnaire, which had been hand-delivered to them by the WH...
Infectious Diseases of Poverty, 2015
By 28 June 2015, there were a total of 11,234 deaths from the Ebola virus disease (EVD) in five W... more By 28 June 2015, there were a total of 11,234 deaths from the Ebola virus disease (EVD) in five West African countries (Guinea, Liberia, Mali, Nigeria and Sierra Leone). The objective of this study was to estimate the future productivity losses associated with EVD deaths in these West African countries, in order to encourage increased investments in national health systems. A cost-of-illness method was employed to calculate future non-health (NH) gross domestic product (GDP) (NHGDP) losses associated with EVD deaths. The future non-health GDP loss (NHGDPLoss) was discounted at 3 %. Separate analyses were done for three different age groups (< =14 years, 15-44 years and = >45 years) for the five countries (Guinea, Liberia, Mali, Nigeria, and Sierra Leone) affected by EVD. We also conducted a one-way sensitivity analysis at 5 and 10 % discount rates to gauge their impacts on expected NHGDPLoss. The discounted value of future NHGDPLoss due to the 11,234 deaths associated with EVD was estimated to be Int$ (international dollars) 155,663,244. About 27.86 % of the loss would be borne by Guinea, 34.84 % by Liberia, 0.10 % by Mali, 0.24 % by Nigeria and 36.96 % by Sierra Leone. About 27.27 % of the loss is attributed to those aged under 14 years, 66.27 % to those aged 15-44 years and 6.46 % to those aged over 45 years. The average NHGDPLoss per EVD death was estimated to be Int$ 17,473 for Guinea, Int$ 11,283 for Liberia, Int$ 25,126 for Mali, Int$ 47,364 for Nigeria and Int$ 14,633 for Sierra Leone. In spite of alluded limitations, the estimates of human and economic losses reported in this paper, in addition to those projected by the World Bank, show that EVD imposes a significant economic burden on the affected West African countries. That heavy burden, coupled with human rights and global security concerns, underscores the urgent need for increased domestic and external investments to enable Guinea, Liberia and Sierra Leone (and other vulnerable African countries) to develop resilient health systems, including core capacities to detect, assess, notify, verify and report events, and to respond to public health risks and emergencies.
Bulletin of the World Health Organization, 2008
More than 20% of total health expenditure in 48% of the 46 countries in the WHO African Region is... more More than 20% of total health expenditure in 48% of the 46 countries in the WHO African Region is provided by external sources. Issues surrounding aid effectiveness suggest that these countries ought to implement strategies for weaning off aid dependency. This paper broaches the following question: what are some of the strategies that countries of the region can employ to wean off donor funding for health? Five strategies are discussed: reduction in economic inefficiencies; reprioritizing public expenditures; raising additional tax revenues; increased private sector involvement in health development; and fighting corruption.
Journal of Biology Agriculture and Healthcare, Jan 25, 2012
The specific objectives of this paper were: (i) to estimate the effects of life expectancy and mo... more The specific objectives of this paper were: (i) to estimate the effects of life expectancy and mortality rates on the per capita gross national income; and (ii) to propose to countries in the African region a set of generic steps for implementing the action agenda recommended by WHO Commission for Macroeconomics and Health (CMH), within the context of national development plans and poverty reduction strategies. Four simple double-log (log-linear or constant elasticity) regression equations were estimated with data from the World Health Statistics 2011. The dependent variable in all equations was the logarithm of per capita gross national income.
African journal of health sciences
Information on hospital costs is urgently needed in planning, budgeting, and hospital-based effic... more Information on hospital costs is urgently needed in planning, budgeting, and hospital-based efficiency evaluations. The aim of this study was to estimate and compare the total and unit costs of providing care in Kilifi District hospital (KDH) and Malindi Sub-district Hospital (MSH). However, the specific objectives were: calculate the annual total cost of providing care in KDH and MSH; compare the unit costs for KDH with those of MSH; and demonstrate hospital costing methodology. The step-down procedure was used to apportion general costs to departments that provided direct patient care, i.e the wards and outpatient department. Results indicated that the Kenyan Government spent about Ksh 49.4 million and Kshs.22.7 million during the financial year 1993/94 on eh KDH and MSH, respectively. In KDH, the paediatrics ward absorbs the greatest proportion of inpatient department's share of the total cost; whereas, in MSH it is the maternity ward that consumes the greatest proportion. The KDH is more expensive than MSH even in terms of unit costs. For example, the cost per admission was Kshs.5,055 in KDH an dKshs.2,088 in MSH; cost per inpatient day was Kshs.445 in KDH and Kshs.365 in MSH; cost per bed was Kshs.119,590 in KDH and Kshs.112.064 in MSH; and cost per visit was Ksh.206 in KDH and kshs.118 in MSH. However it is likely that the level and quality of service provided between the two hospitals also differ. The public hospitals absorb a substantial proportion of the recurrent budget, so it is imperative that resource use and the role of the role (as district referral facility) in the district health system should be monitored and evaluated regularly.
African journal of health sciences
The objectives of this paper are fourfold: first, to develop a model for a cost benefit analysis ... more The objectives of this paper are fourfold: first, to develop a model for a cost benefit analysis (CBA) to appraise various preventive schistosomiasis interventions; second, to identify the relevant types of data needed for such a model; third, to use the model to inform choices about optimal prevention strategies; and fourthly, to discuss the utility of this form of decision analysis to policy-makers. The following data were used: expected costs of each option over the 15 year project life; willingness-to-pay value for health states (outcomes); probabilities of health states with and without various interventions; 15 year population forecasts; discount factors for each year; and a standard conversion factor. All the interventions examined had a positive net present value, with the drip mollusciciding option dominating the other options. The study also highlighted the fact that there is as need for collaboration between tropical disease epidemiologists and health economists in the design and execution of randomized controlled trails to obtain the probabilistic effectiveness data needed in such decision analyzes.
African journal of health sciences
On May,24 1994, the then South African president, Mr. Nelson Mandela, declared that all health ca... more On May,24 1994, the then South African president, Mr. Nelson Mandela, declared that all health care for children under the age of 6 years, and pregnant women would be free. Unfortunately, there has been no significant decrease in maternal, perinatal and infant mortality. Thus, there is a need of research into the factors that influence the demand for antenatal services. The objectives of this paper are to (a) establish the determinants of individual pregnant women's choice to seek antenatal care; and (b) deal with potential endogeneity bias in the relationship between the decision to seek pre-natal care and perceived health status. The joint determination of consumption of antenatal care and pregnant woman's health status requires estimation of a simultaneous system. To help mitigate the simultaneity bias and avoid the inconsistency inherent in the application of Ordinary least Squares (OLS) method to simultaneous equations systems, we used Two-Stage Probit Maximum Likelihood Estimator Method. In the antenatal structural-form equation, the coefficients for TOILET, AGE, OCCUPATION, EMPLOYMENT, SMOKER, METHODS and QUALITY were statistically significant at P </= 0.05. There are three main implications for policy. (1) Those women who are either risk-lovers or risk-neutral are unlikely to consume preventive and promotive health care, including antenatal care. Thus, there is need to put in place incentives that would convert seemingly risk-lovers to risk-averters. (2) Programmes aimed at reducing women unemployment and general working conditions would improve use of pre-natal care. (3) Improvements in perceived quality of care at the health facilities that offer antenatal care is needed to boost the consumption of antenatal care and probably other forms of health care.
African journal of health sciences
Cost-benefit analysis (CBA) provides a framework for identifying, quantifying, and valuing in mon... more Cost-benefit analysis (CBA) provides a framework for identifying, quantifying, and valuing in monetary terms all the important costs and consequences to society of competing disease interventions. Thus, CBA requires that impacts of schistosomiasis interventions on beneficiaries'health be valued in monetary terms Economic theory requires the use of the willingness to pay (WTP) approach in valuation of changes in health as a result of intervention. It is the only approach which is consistent with the potential Pareto improvement principle, and hence, consistent with CBA. The present study developed a health outcome measure and tested its operational feasibility. Contingent valuation for certain return to normal health from various health states, and for remaining in one's current health state were elicited through direct interview of randomly selected rice farmers, teachers, and health personnel in Kenya. The WTP to avoid risk of advancing to the next more severe state, seemed to be higher than WTP for a return to normal health. Generally, there was a significant difference between the average WTP values of farmers, teachers and health personnel populations. The gender and occupation variable coefficients were positive and highly significant in all regressions. The coefficients of the other explanatory variables were generally not statistically significant, indicating that medical expenses, anxiety cost, loss of earnings, and loss of work time, implied in various health states descriptions did not have significant effect on respondents expressed WTP values. The latter finding shows that there is need for more research to identify the other (besides gender and occupation) determinants of expressed WTP values in Africa. This study has demonstrated that it is possible to elicit coherent WTP values from economically under-developed countries. Further empirical work is clearly needed to at least address the validity and reliability of the contingent valuation approach and its measurements in Africa.
Efficient utilization of health resources is a critical requirement for attaining health system g... more Efficient utilization of health resources is a critical requirement for attaining health system goals particularly in low income countries. Inefficiency in health resource utilization may imply death for the next child in the queue in a resource constrained environment. This study analyzes the technical and scale efficiencies in hospitals in low income countries using Nigeria as a case study. The study uses primary data sample of 200 hospitals to estimate technical and scale efficiencies using the Data Envelopment Analysis (DEA). The results clearly indicate large variation in the efficiency of hospitals with average efficiency score of about 59% under the constant returns to scale assumption and about 72% under variable returns to scale. This raises some concerns about the level of technical and scale efficiencies in utilization of scarce health resources in the hospital sector particularly in low income countries.
Background: To date no study in Benin has attempted to determine whether there has been productiv... more Background: To date no study in Benin has attempted to determine whether there has been productivity growth in the hospital sector as a result of the various health sector reforms undertaken in the recent past. The objective of this study was to assess the changes in productivity of zone hospitals in Benin over five years (2003)(2004)(2005)(2006)(2007) with a view to analysing source of the change. Methods: Malmquist data envelopment analysis method was used to analyze productivity among a sample of 23 zonal public hospitals in the Republic of Benin over a period of five years, i.e. 2003 to 2007. Health inputs and utilization data was collected from records of sampled hospitals through physical visits by one of the authors. Results: Ten (43.5 per cent) out of 23 hospitals experienced productivity growth given that they had Malmquist Productivity Indexes greater than one. In contrast, the Malmquist Productivity Indices for 13 (56.5 per cent) hospitals were less than one, signifying productivity decline over time. None of the hospitals had Malmquist Productivity Index of exactly one, which would have signified stagnation. The average Malmquist total factor productivity (MTFP) score for the entire sample was 0.951 (STDEV=0.085); which signifies that on average hospitals experienced productivity decline between periods t and 1 t of 4.9 per cent. Whereas the relative efficiency of hospitals being assessed increased 26 per cent, technical change (innovation) regressed by 24.3 per cent. Empirical results show evidence of a decrease in productivity among zonal public hospitals in Benin between 2003 and 2007. The decrease was largely due to technical regress. Such MTFP analyses may be useful for monitoring the effects of health sector reforms on hospital efficiency and productivity in the WHO African Region.
The efficient performance of hospitals is critical to cost containment and the delivery of effect... more The efficient performance of hospitals is critical to cost containment and the delivery of effective health services. This paper examines the efficiency of hospitals in LIC context using a sample of 200 hospitals generated from a survey of hospitals in southeast Nigeria. The paper uses the translog production function version of the stochastic frontier model (SFA) to estimate the efficiency levels of individual hospitals and the determinants of inefficiency. The results indicate large variations in the efficiency scores of sample healthcare facilities with average efficiency of 71%. Private hospitals show greater level of efficiency than public ones. The average scale elasticity was also found to reflect constant returns to scale. The results suggest that large social welfare gains could be made by improving the efficiency of hospitals in LICs. Suggestions are made on how to achieve greater efficiency in these institutions.
Background: Community-based health insurance (CBHI) schemes should be designed so that they are a... more Background: Community-based health insurance (CBHI) schemes should be designed so that they are affordable, provide financial risk protection against catastrophic costs and harness community solidarity in form of altruism so as to ensure high levels of enrollment and use of the services. This paper presents information about the socio-economic status (SES) and geographic differences in affordability, catastrophic costs and altruism within the context of instituting effective CBHI schemes. Methods: The study took place in a rural, urban and semi-urban community in two states in Nigeria. A questionnaire was used to collect information from 3070 randomly selected householders. Contingent valuation method was used to elicit altruistic willingness to pay. Catastrophic health expenditures were examined at 40%, 10% and 5% thresholds based on household non-food expenditures. Affordability was measured as proportion of total household expenditure that will be consumed by the existing per cap...
Efficient utilization of health resources is a critical requirement for attaining health system g... more Efficient utilization of health resources is a critical requirement for attaining health system goals particularly in low income countries. Inefficiency in health resource utilization may imply death for the next child in the queue in a resource constrained environment. This study analyzes the technical and scale efficiencies in hospitals in low income countries using Nigeria as a case study. The study uses primary data sample of 200 hospitals to estimate technical and scale efficiencies using the Data Envelopment Analysis (DEA). The results clearly indicate large variation in the efficiency of hospitals with average efficiency score of about 59% under the constant returns to scale assumption and about 72% under variable returns to scale. This raises some concerns about the level of technical and scale efficiencies in utilization of scarce health resources in the hospital sector particularly in low income countries.
BMC Health Services Research, 2015
Background: Several instruments at both the global and regional levels to which countries in the ... more Background: Several instruments at both the global and regional levels to which countries in the WHO African Region are party call for action by governments to strengthen national health research systems (NHRS). This paper debates the extent to which Malawi has fulfilled this commitment.
African journal of medicine and medical sciences, 2007
The aim of this paper is to stimulate debate on the agency (principal-agent) in health-related bi... more The aim of this paper is to stimulate debate on the agency (principal-agent) in health-related biotechnology research. It attempts to answer the following questions: What is health-related biotechnology and biotechnology research? What is an agency? What factors are likely to undermine the principal's capacity to exercise informed consent? When might the principal-agency problem arise? How could the agency in biotechnology transfer be strengthened in Sub-Saharan Africa (SSA)? The transfer of health-related biotechnology to SSA ought to be preceded by research to ascertain the effectiveness of such technologies on population health. In that process, the national ethical review committee (REC), as an agent of every human research subject (principal), ought to ensure that international principles (e.g. beneficence, non-malfeasance, autonomy, justice, dignity, truthfulness and honesty) for human experimentation are observed by biotechnology researchers in order to satisfy moral, eth...
African journal of health sciences, 1998
Information on hospital costs is urgently needed in planning, budgeting, and hospital-based effic... more Information on hospital costs is urgently needed in planning, budgeting, and hospital-based efficiency evaluations. The aim of this study was to estimate and compare the total and unit costs of providing care in Kilifi District hospital (KDH) and Malindi Sub-district Hospital (MSH). However, the specific objectives were: calculate the annual total cost of providing care in KDH and MSH; compare the unit costs for KDH with those of MSH; and demonstrate hospital costing methodology. The step-down procedure was used to apportion general costs to departments that provided direct patient care, i.e the wards and outpatient department. Results indicated that the Kenyan Government spent about Ksh 49.4 million and Kshs.22.7 million during the financial year 1993/94 on eh KDH and MSH, respectively. In KDH, the paediatrics ward absorbs the greatest proportion of inpatient department's share of the total cost; whereas, in MSH it is the maternity ward that consumes the greatest proportion. Th...
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Papers by Joses Muthuri Kirigia