Commentary: The Ideal Community of Practice—Engaging Local Stakeholders in Uganda to Develop Cost of Illness Estimates and Beyond

This article was originally posted on immunizationeconomics.org on March 30, 2018

Local engagement and empowerment is essential to develop cost of illness estimates and apply them to policymaking and program planning in Uganda.

DOVE IV: Measuring the cost of illness

As part of the Decade of Vaccine Economics (DOVE) project’s phase IV, researchers from the International Vaccine Access Center at Johns Hopkins University (IVAC) and Makerere University School of Public Health (MAKSPH) have teamed up to measure cost of illness estimates for pneumonia, diarrhea and measles in children under-five in Uganda and Bangladesh. The study has been implemented in four districts in Uganda (Gulu, Jinja, Mbarara and Wakiso districts) and two divisions in Bangladesh (Sylhet and Rajshahi divisions), from July 2017 to August 2018.

The study collects utilization, cost, and expenditure data for the 2017-18 fiscal year, using a micro-costing approach. Six different surveys were developed to capture these data from the perspective of both the patients’ caretakers and the healthcare system. The latter perspective includes costs collected in facilities from the public and private (for-profit and not-) sectors, from rural and urban settings, and at every level of care.

In Uganda, an additional survey was added to collect information from the district health office unique to the setting. It captures the cost of medication provided to public healthcare facilities through the National Medical Stores and the costs related to district-wide healthcare staff training and supervision and outreach activities related to the diseases under study. In Bangladesh, this information was captured at the facility level.

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Source: DOVE learning module #1 (January 2018).

From engagement to partnership with local stakeholders

Beyond national institutions, the Ugandan health system’s strength relies on the hard work and intimate knowledge of district-level stakeholders: the district health officers and their staff who manage public healthcare facilities and the provision of medication, the directors and nurses in charge of managing the healthcare facilities and pediatric wards, the medical personnel providing care to the ill, and the members of the community participating in outreach activities.

These local stakeholders were integral to data collection – from choosing facilities and pharmacies that represent the district’s response to infectious diseases, accessing facility accountancy, to requesting time to interview healthcare staff. In addition, we obtained their permission to access their health and financial records.

Along with data collection, district health officers and private healthcare facility managers also helped define the best protocol to recruit and interview patients’ caretakers and healthcare facility staff to avoid burdening the continuum of care and to protect their rights.

Study team from MAKSPH and IVAC meeting with Dr. Nantamu, the district health officer in Jinja.

These engagements led to partnerships with local stakeholders, who were not only essential to collecting data accurately, but also to appropriately interpret the results for policymaking and program planning. However, it became clear over time that these partnerships required stronger communication efforts to build research skills and provide regular monitoring and evaluation updates. Thus, the study team developed a monthly newsletter to send to all stakeholders with progress updates, current activities and challenges, and preliminary results.

The newsletter serves as a platform to understand in depth the rationale and outputs of DOVE. Sign up for the newsletter and access past editions here.

Enabling the use of economic estimates beyond DOVE

The DOVE project is not only about collecting data, but also prioritizing capacity building. The study provides all partners with the tools and skills to use these data for program planning, research and evaluation. Healthcare facility managers (public and private), government agents at the district level, and other local stakeholders look forward to having the opportunity to use this data in further economic evaluations. Online open access courses and learning modules in plain-language are key to our partnership.

The study team has produced two learning modules so far. The first learning module covers the concept of “cost of illness”. From the various costs found in using and providing healthcare, to the differing economic perspectives synthesized to capture a holistic picture of these costs, this module introduces the audience to the technical approaches used to measure the economic burden of disease.

second learning module explains collection and use of economic and expenditure data and information and the importance of data confidentiality. The team developed this module in response to ongoing concerns that collecting financial data from facilities is equivalent to an audit. The module details how data pooling and confidentiality are used to protect the sensitive information caretakers and facilities share with us.

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Source: DOVE learning module #2 (February 2018)

For audiences seeking more specialized technical information on vaccine economics, DOVE will partner with Teaching Vaccine Economics Everywhere (TVEE) project. TVEE focus on capacity building in applied vaccine economics, cost-effectiveness and finance, using open access courses. The results and lessons learned from DOVE will inform these courses and provide examples of practice in local settings for the upcoming TVEE workshop on economic evaluation. More details to come later.

About DOVE

DOVE in Uganda is a partnership between the International Vaccine Access Center at Johns Hopkins University (IVAC) and Makerere University School of Public Health (MAKSPH). Team members focused on this effort include Dagna Constenla, Gatien de Broucker and Jorge Martin del Campo of IVAC, as well as Elizabeth Ekirapa Kiracho, Aloysius Mutebi, Rebecca Racheal Apolot and Anthony Ssebagereka of MAKSPH. This project is supported by the Bill & Melinda Gates Foundation.

For more information, contact:

Dagna ConstenlaElizabeth Ekirapa Kiracho or Gatien de Broucker