Opportunities to Catalyze Improved Healthcare Access in Pluralistic Systems: A Cross-Sectional Study in Haiti

Klarman, Molly B.; Schon, Justin; Cajusma, Youseline; Maples, Stace; Rochars, Valery Madsen Beau De; Baril, Chantale; Nelson, Eric J.

doi:10.2139/ssrn.3702940

Cited by 1 publication

(3 citation statements)

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“…INACT-1 found that families sought care for 32% of pediatric health events. 23 The 2016 DHS in Haiti found that children under 5 sought care for 40.4% of acute respiratory infections and 32.9% of diarrheal cases. 33 These figures were averaged to estimate 35.1% of families with a sick child seek care.…”

Section: Ethicsmentioning

confidence: 99%

“…During INACT-2, 30% of families paid in full and 25% paid in part (250 gourdes, 2.89). 23 We conservatively assumed the same ratio for these analyses. Daily wages were estimated from the mean per capita gross national income.…”

Section: Ethicsmentioning

confidence: 99%

“…1 Respiratory infection and diarrheal disease are major contributors to this burden, accounting for over half of hospitalizations and over a third of deaths of hospitalized children. 22 To better understand barriers to pediatric healthcare in Haiti, we conducted a needs assessment to identify differences in household healthcare seeking intention ('would do') and behavior ('did do'); 23 this initiative was part of the Improving Nighttime Access to Care and Treatment Study (INACT-1). In this needs assessment, households expressed an intention to seek care from a provider within conventional networks, but because of cost, distance, and nighttime hours, in practice sought care from disconnected providers near to the household.…”

Section: Introductionmentioning

confidence: 99%

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A nighttime telemedicine and medication delivery service to avert pediatric emergencies: An exploratory cost-effectiveness analysis

Flaherty

Klarman

Cajusma

et al. 2021

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Objective: We sought to compare the costs of a nighttime pre-emergency pediatric telemedicine and medication delivery service (TMDS) per disability-adjusted life year (DALY) averted to the costs of hospital emergency medicine (HEM) per DALY averted from a societal perspective. Methods: We studied a nighttime pediatric TMDS and HEM in a semi-urban and rural region of Haiti. Costs of the 2 services were enumerated to represent the financial investments of both providers and patients. DALYs averted were calculated to represent the years lives lost (YLL) and years lost to disability (YLD) from diarrheal, respiratory, and skin (bacterial and scabies etiologies) disease among children from zero to 9 years old. The incremental cost-effectiveness ratio (ICER) was estimated and compared to the per-capita gross domestic product (GDP) of Haiti ($1,177). Cost-effectiveness was defined as an ICER less than 3 times the per-capita GDP of Haiti ($3,531). Univariate sensitivity analysis was performed to evaluate how uncertainty of individual parameter estimates (utilization rates, costs, lost wages, discounting factor) affected the ICER. Results: The total costs of the nighttime TMDS and HEM to society were $285,931.72 per year and $89,335.41 per year, respectively. The DALYs averted by the TMDS and HEM were 199.76 and 22.37, respectively. Through sensitivity analyses, the ICER of the TMDS ranged from $791.43 to $1,593.35. Conclusion: A nighttime pediatric TMDS is a cost-effective alternative to HEM for pre-emergency pediatric care in semi-urban and rural regions in Haiti, and possibly in similar lower-middle income countries.

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Section: Ethicsmentioning

confidence: 99%

Section: Ethicsmentioning

confidence: 99%