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Published online: 14 September 2016
© Springer International Publishing Switzerland 2016
Abstract
Background Globally, economic evaluation (EE) is increasingly being considered as a critical tool for allocating scarce healthcare resources. However, such considerations are less documented in low-income countries, such as in Ethiopia. In particular, to date there has been no assessment conducted to evaluate the perception and practice of and barriers to health EE.
Objective This paper assesses the use and perceptions of EE in healthcare decision-making processes in Ethiopia.
Methods In-depth interview sessions with decision makers/healthcare managers and program coordinators across six regional health bureaus were conducted. A qualitative analysis approach was conducted on three thematic areas.
Results A total of 57 decision makers/healthcare managers were interviewed from all tiers of the health sector in Ethiopia, ranging from the Federal Ministry of Health down to the lower levels of the health facility pyramid. At the high-level healthcare decision-making tier, only 56 % of those interviewed showed a good understanding of EE when explaining in terms of cost and consequences of alternative courses of action and value for money. From the specific program perspective, 50 % of the prevention of mother-to-child transmission of HIV/AIDS program coordinators indicated the relevance of EE to program planning and decision making. These respondents reported a limited application of costing studies on the HIV/AIDS prevention and control program, which were most commonly used during annual planning and budgeting.
Conclusion The study uncovered three important barriers to growth of EE in Ethiopia: a lack of awareness, a lack of expertise and skill, and the traditional decision-making culture.
1 Introduction
Economic evaluation (EE) generates evidence that informs alternative courses of action and facilitates an optimal utilization of scarce resources [1]. EE has been extensively used in developed countries [2, 3] to inform healthcare policy decisions, to enhance program management, and to assess new health technologies. In particular, EE has been extensively used for decision making in Europe and Australasia [3, 4]. An increasing number of EE assessments have been conducted to explore policy makers' perceptions of EE and its relevance for decision making in the context of developed countries [3, 5-7]. These studies reported challenges encountered in the effective use of EE in health sector decision making and health technology...