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Improving WASH Facili3es: the case for Return on Investment (RoI) analysis
Prof Ric Fordham FFPH Health Economics Group University of East Anglia
WHO Burden of Disease Workshop London March 24th 2016
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Health Economics
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Economic benefits Scoping necessary..
• BeDer paEent care/outcomes inc. lives saved/DALYs • Improve effecEveness of care eg. reduce infecEons, outbreaks • Improve efficiency: lowers excessive LOS, reduces staffing, less medicines use (frees up already scarce hospital resources) • Improves producEvity, earnings & informal economy • Educates the community on good sanitaEon pracEces; protects staff • Prevents wider contaminaEon.. • More ????+++
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Health Economics
• An aid to decision-‐making • Based on costs and outcomes • PerspecEve is important (on whom the costs and benefits are expected to fall?) • Audience influences methods
• Cost-‐effecEveness (cost per change in actual outcome) • Cost-‐uElity (cost per QALY) • Cost-‐benefit (monetary benefits – monetary costs)
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Key informa3on
• Toilets per health facility (if any!) • RaEo of toilets to paEents/staff • % down-‐Eme (blockages, malfuncEons, repair etc) • Cleanliness/infecEvity (cleaned per day) • Provision of proximal alternaEve toilet arrangements (% usage) • Clean running water (for hands and sewage disposal) & essenEal infrastructure • Other sanitaEon measures
= DAYS OF EXPOSURE x NO. OF PATIENTS
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Epidemiological data
• Background risks/rates of local disease • Exposure (dose x Eme) • RR in acquiring disease with compromised toilet/sanitaEon faciliEes • ImplicaEons of hospital acquired infecEons (impacts)
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Economic model
• Costs of care with improved sanitaEon/addiEonal resources needed • Costs of care without (projecEon) • Compares the alternaEve scenarios • Capital investment ($) in service improvement required (Eme-‐period) • AddiEonal maintenance p.a. required ($) • AddiEonal educaEonal, training investments ($) Calculates expected RoI/QALYS/DALYS/Disease avoided
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An Economic Tool
• Capable of producing economic arguments for different situaEons • Takes account of risk and uncertainty among key parameters • Evidence-‐based and flexible to local/country condiEons (data, epidemiology etc) • Adaptable to local costs and outcomes • Choice of Eme-‐horizon • InteracEve and user-‐friendly (e-‐tool ?)
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Key research issues
• Data-‐set regarding the faciliEes, uElisaEon and infrastructure • Costs of provision and maintenance • An agreed scope of measurable benefits to define the returns • Reliable epidemiological data by locality/region/country • Understanding the effecEveness of intervenEons