The costs of changing national policy: lessons from malaria treatment policy guidelines in Tanzania
The costs of changing national policy: lessons from malaria treatment policy guidelines in Tanzania
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DOI：
10.1111/j.1365-3156.2006.01590.x
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发表时间：
2006-04-01
影响因子：
3.3
通讯作者：
Mills, A
中科院分区：
文献类型：
--
作者：
Mulligan, JA;Mandike, R;Mills, A
目的记录坦桑尼亚政府因改变疟疾一线治疗政策（从氯喹改为磺胺多辛-乙胺嘧啶）而产生的费用。方法从卫生部的角度分析费用，包括所有资金来源。公共卫生部门外部的成本（例如私人和社区成本）不包括在内。假设组织基础设施已经就位，基本案例分析采用增量而非全部成本方法。然而，特别关注了国家疟疾控制规划工作人员的负担。我们还计算了已计划但未实施的活动的成本，以估算“理想”流程的总费用。结果 总成本为 7.95 亿先令（813 743 美元），其中培训所占比例最大。政策改变过程的成本相当于政府和捐助者每年用于疟疾的支出的约 4%，以及公共卫生总支出的约 1%。一些计划的活动没有实施；包括这些在内，总成本将达到 8.8 亿新台币（896 130 美元）。 结论 除了药物本身的额外成本之外，治疗政策的改变还需要国家和地方层面的时间、资源和强大的管理能力。更好地了解这些问题和所涉及的成本有利于各国规划和实施政策变革。
OBJECTIVE To document the cost incurred by the Tanzanian government by changing the policy on first-line treatment of malaria, from chloroquine to sulfadoxine-pyrimethamine.METHODS Costs were analysed from the perspective of the Ministry of Health and included all sources of funding. Costs external to the public health sector (e.g. private and community costs) were not included. The base case analysis adopted an incremental rather than a full cost approach, assuming that an organizational infrastructure was already in place. However, specific attention was paid to the burden placed on National Malaria Control Program staff. We also costed activities planned but not implemented to estimate the total expense for an 'ideal' process.RESULTS Total costs were Tsh 795 million (USD 813 743), with the largest proportion accounted for by training. Costs of the policy change process were equivalent to about 4% of annual government and donor expenditure on malaria and to about 1% of overall public expenditure on health. A number of planned activities were not implemented; including these would bring the total cost to Ts 880 million (USD 896 130).CONCLUSION On top of extra costs for the drugs themselves, a change in treatment policy requires time, resources and substantial management capacity at national and local level. A better understanding of these issues and the costs involved benefits countries planning and implementing policy change.