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Makerere University Research Repository >
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Please use this identifier to cite or link to this item:
http://hdl.handle.net/123456789/1802
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| Title: | Potential impact of task-shifting on costs of antiretroviral therapy and physician supply in Uganda |
| Authors: | Babigumira, Joseph B
Castelnuovo, Barbara
Lamorde, Mohammed
Kambugu, Andrew
Stergachis, Andy
Easterbrook, Philippa
Garisson, Louis P |
| Keywords: | Antiretroviral therapy
Physician
Infectious Diseases
HIV/AIDS
Uganda |
| Issue Date: | 2009 |
| Publisher: | BMC Health Services Research |
| Citation: | Babigumira, J.,Castelnuovo, B.,Lamorde, M., Kambugu, A., Stergachis, A., Easterbrook, P., Garisson, L.P. (2009). Potential impact of task-shifting on costs of antiretroviral therapy and physician supply in Uganda.BMC Health Services Research, 9(192) |
| Abstract: | Background
Lower-income countries face severe health worker shortages. Recent evidence suggests that this
problem can be mitigated by task-shifting—delegation of aspects of health care to less
specialized health workers. We estimated the potential impact of task-shifting on costs of
antiretroviral therapy (ART) and physician supply in Uganda. The study was performed at the
Infectious Diseases Institute (IDI) clinic, a large urban HIV clinic.
Methods
We built an aggregate cost-minimization model from societal and Ministry of Health (MOH)
perspectives. We compared physician-intensive follow-up (PF), the standard of care, with two
methods of task-shifting: nurse-intensive follow-up (NF) and pharmacy-worker intensive followup
(PWF). We estimated personnel and patient time use using a time-motion survey. We
obtained unit costs from IDI and the literature. We estimated physician personnel impact by
calculating full time equivalent (FTE) physicians saved. We made national projections for
Uganda.
Results
Annual mean costs of follow-up per patient were $59.88 (societal) and $31.68 (medical) for PF,
$44.58 (societal) and $24.58 (medical) for NF and $18.66 (societal) and $10.5 (medical) for
PWF. Annual national societal ART follow-up expenditure was $5.92 million using PF, $4.41
million using NF and $1.85 million using PWF, potentially saving $1.51 million annually by
using NF and $4.07 million annually by using PWF instead of PF. Annual national MOH
expenditure was $3.14 million for PF, $2.43 million for NF and $1.04 for PWF, potentially
saving $0.70 million by using NF and $2.10 million by using PWF instead of PF. Projected national physician personnel needs were 108 FTE doctors to implement PF and 18 FTE doctors
to implement NF or PWF. Task-shifting from PF to NF or PWF would potentially save 90 FTE
physicians, 4.1% of the national physician workforce or 0.3 FTE physicians per 100,000
population.
Conclusion
Task-shifting results in substantial cost and physician personnel savings in ART follow-up in
Uganda and can contribute to mitigating the heath worker crisis. |
| URI: | http://www.biomedcentral.com/1472-6963/9/192
doi:10.1186/1472-6963-9-192
http://hdl.handle.net/123456789/1802 |
| ISSN: | 1472-6963 |
| Appears in Collections: | Research Articles (IDI)
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Files in This Item:
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| Babigumira-J-idi-res1.pdf | | 135Kb | Adobe PDF | View/Open |
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