MRC PhD students

An economic assessment of HIV/AIDS interventions in South Africa

Lungiswa Nkonki is a PHD intern from the Health Systems Research Unit.

South Africa is a middle income country faced with many challenges to combat. The health care is one of government primary focus.

The country has experienced consistent   economic growth reflected by a rise in GDP at market prices from 3.2 in 1994 to 4.9 in 2005 (Statistics South Africa, 2006). However, vital health indicators do not reflect the status of South Africa as a middle country.

Despite the vast gap between private and public sectors, a number of health systems ills could explain the poor health indicators.

Amongst those factors, human resource shortages, organizational and logistical challenges, health systems issues, poor implementation of programmes and vast inequities in access to economic and social resources healthcare outcomes and healthcare access (McIntyre and Gilson, 2002).

The interplay of these various factors reflects in many health interventions. For instance the PMTCT programmes in South Africa characterize health systems problems.

Given the national issues outlined above, the research will involve a detailed assessment of four areas which affect the impact of health interventions, with particular focus on the PMTCT programme:

• Measuring health inequality amongst a cohort of HIV positive mother-to-child pairs in South Africa with a focus on the relationship between socio-economic status and child health outcomes.
• Identifying missed opportunities by the health service and by mothers for participation in a prevention of mother-to-child transmission (PMTCT) programme in three sites in South Africa.
• Conduct a cost-effectiveness analysis of an intervention aimed at addressing the promotion of exclusive feeding. The intervention aims at assessing whether community level workers improve infant feeding and child health outcomes.
• An assessment of the resources (financial and HR resources) required for scaling up the intervention. This exercise will include considering appropriateness of the current cluster sizes, the time allocation of peer supporters and peer supporter supervisor.

Her course supervisor is Emmanuelle Daviaud of the MRC. Principal supervisor is Bjarne Robberstad, Centre for International Health, Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway.