Santé (Montrouge, France)
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Santé (Montrouge, France) · Oct 2003
Review[Evolution and new perspectives of health care financing in developing countries].
Over the last twenty five years, the perspective of health care financing has dramatically changed in developing countries. In this context, it is worth reviewing the literature and the experiences in order to understand the major shifts on this topic. During the sixties, health care policies focused on fighting major epidemics. ⋯ In this early millenium, there is a general agreement on some major aspects of health care financing such as: Lack of resources for financing health care; cost recovery as a part of any sustainable health care system; health as a public good needing some extended subsidies; protecting people from the burden of disease as a part of financing schemes; equity in relation with the public private mix at the center of many debates; financing as a key mechanism for the regulation of the whole health care system and not only as a resource mobilization; HIV in bringing up new problems clearly shows how all these matters are related. Health care financing is at the heart of ongoing questions on health care reforms. Although developing countries have low insurance coverage and weak modern medical care, they share the same questions as developed countries: How to promote technical and allocative efficiency? What place for incentives? What role for the public sector? How can market and contracting bring results? What progress through stewardship and better governance?
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Santé (Montrouge, France) · Oct 2003
[Microeconomic evaluation of a mass preventive immunisation campaign against meningococcal meningitis and yellow fever in Senegal in 1997].
Large epidemics of group A meningococcal meningitis occurred in 1995 and 1996 in several countries of the Sub-Saharan Africa zone known as the "meningitis belt", and more particularly in West Africa. Most of these countries affected by the epidemics met difficulties to set up the strategy recommended by the World Health Organization and which includes: Epidemiological surveillance and epidemic incidence threshold calculation to detect early meningitis epidemics and emergency vaccination campaigns with meningococcal A + C polysaccharide vaccine, if possible within the 4-to-6 weeks following the moment the threshold is reached. In this context of epidemics, notably in Mali, and in front of the risk of resurgence of yellow fever, the Ministry of Health of Senegal decided to conduct mass preventive immunization campaigns in 1997 against meningo- coccal meningitis and yellow fever in the districts located in the eastern part of the country and where emergency vaccination would have been difficult in case of epidemic because these area are difficult to reach. ⋯ Direct unit costs increased when the size of target communities decreased (in communities with less than 100 people to vaccinate versus 0.38 euro in communities with more than 2,000 people to vaccinate). This study allowed us to set up a method to measure, describe and analyze the costs of a mass preventive campaign. It demonstrated the economic impact of using multiple antigens during a single preventive campaign.