1. Interview guide: High level policy makers in the health sector

This guide was prepared to collect evidences on the comprehensive economic evaluation perception, practice and barriers in the Ethiopian health sector. The target group for this interview will be high level policy makers working at the Federal Ministry of Health (FMoH), Federal HIV/AIDS Prevention and Control Office (FHAPCO), Pharmaceutical Fund and Supply Agency (PFSA) and Ethiopian Public Health Institute (EPHI), regional health bureaus, zonal and district level decision making.

2.1Economic Evaluation and its relevance for health care policy making

Q01. What is your view and perception regarding economic evaluation?

Q02. What is your thought on the utilization/use of economic evaluation for the health care decision making?

  1. Never use
  2. Almost never
  3. Occasionally/ sometimes
  4. Almost every time
  5. Frequently use

Q03. Please explain in detail for justifying your response for Q02?

Q04. What are the conditions/opportunities that seem to foster the use of economic evaluation (at the local and national level) in the Ethiopia healthcare delivery system?

Q05. Did you have any experience where the HIV/AIDS programs decision making (in particular the PMTCT program) have ever used economic evaluation evidences? If yes, please explain in-depth?

Q06. What do you think in general the most important barriers to the use of economic evaluation in health care decision-making? Tell usyour response from the following perspectives:

  1. Lack of awareness on the economic evaluation
  2. The decision making takes short time
  3. Lack of expertise and skill,
  4. Lack of credibility on the economic evaluation techniques,
  5. Issue of communication/ jargon(e.g QALY)
  6. Took long time for doing economic evaluation
  7. Cost of doing an economic evaluation
  8. Political imposition/traditional decision making culture
  9. Other (specify)______

Q07. What do you think the most important barriers to the use of economic evaluation in health care decision-making, in the context of PMTCT/HIV/AIDS interventions? Tell us your response from the following perspectives:

  1. Lack of awareness on the economic evaluation
  2. The decision making takes short time,
  3. Lack of expertise and skill,
  4. Lack of credibility on the economic evaluation techniques,
  5. Issue of communication/ jargon/(e.g. DALY, QALY etc.)
  6. Took long time for doing economic evaluation
  7. Cost of doing an economic evaluation
  8. Political imposition/traditional decision making culture
  9. Other (specify)______

Q08.What factors do you take in to account for making decisions in the health care sector, including for the PMTCT program?

Q09. Did you consider economic evaluation/efficiency/economic appraisal evidences for making healthcare decision, including for the PMTCT interventions?

  1. Yes
  2. No

Q10. Would you please list /categorize the different factors which influence health care resource allocation decision?

Possible factors which influence resource allocation in health care.
(adopted from Sax) / Tick (√) the right answer
  1. Political factors, including the philosophy of the Government;

  1. The nature and history of existing policies

  1. Administrative feasibility, timing and implementation;

  1. Equity considerations;

  1. Economic appraisal/efficiency concerns/economic evaluation

  1. The availability of relevant information and expert advice;

  1. The availability of resources;

  1. The climate of opinion in society and pressure groups;

  1. Constitutional factors.

  1. Other (specify)______

Q11. Fill the following table regarding the knowledge, awareness and actual practice or use on the different economic evaluation techniques.

Different economic evaluation techniques / Are you knowledgeable / Are you aware of this technique / Did you use/actual practice
Yes / No / Yes / No / Yes / No
1 / Cost analysis
2 / Cost of illness/burden of disease
3 / Cost consequence analysis
4 / Cost effectiveness analysis
5 / Cost utility analysis
6 / Cost benefit analysis
7 / Discrete choice experiment
8 / Health Technology Assessment (HTA) techniques
9 / Budget Impact analysis
10 / Other specify ______
11 / Other specify______
12 / Other specify______

Q12. What do you recommend for improving the use of economic evaluation for the priority health sector or programs decision making?

  1. What decision makers can do?
  1. What health economists can do?
  1. Shared responsibility

Thank you for your cooperation! Is there anything you would like to ask or say?

Comments by Interviewer:
Date & time ______/ Signature by Interviewer: ______
Comments by Supervisor:
Date & time ______/ Signature by Supervisor: ______
  1. Interview guide: MCH/PMTCT program coordinators

This guide was prepared to retrieve evidences on the comprehensive economic evaluation and utilization related evidences associated with the prevention of mother-to-child transmission of HIV/AIDS intervention in Ethiopia. The target group for this interview guide will be PMTCT program coordinators working at the different health tier system, such as: Federal Ministry of Health (FMoH) and agencies, Regional health bureau, Zonal health departments and district health office setting.

The interview guide consists of three subsections:

  1. Economic Evaluation perception, practices and barriers in the PMTCT program
  2. Discrete choice experiment attributes and values
  3. Cost analysis for program management, monitoring and evaluation activities

2.1Economic Evaluation Perception, Practices and Barriers in the PMTCT program

A21. What is your view and perception regarding economic evaluation, with particular to the PMTCT program intervention implementation?

A22. Did you have any experience where the HIV/AIDS programs decision making (in particular the PMTCT program) have ever used economic evaluation evidences? If yes, please explain in-depth?

A23. Fill the following table regarding the knowledge, awareness and actual practice/use on the different economic evaluation techniques and current contemporary methods

Different economic evaluation techniques / Are you knowledgeable / Are you aware of this technique / Did you use/actual practice
Yes / No / Yes / No / Yes / No
1 / Cost analysis
2 / Cost of illness/burden of disease
3 / Cost consequence analysis
4 / Cost effectiveness analysis
5 / Cost utility analysis
6 / Cost benefit analysis
7 / Discrete choice experiment
8 / Health Technology Assessment techniques
9 / Budget Impact analysis
10 / Other specify

A24. What do you think the most important barriers to the use of economic evaluation in in the context of PMTCT/HIV/AIDS interventionsdecision-making? Tell us your response from the following perspectives:

  1. Lack of awareness on the economic evaluation
  2. The decision making takes short time,
  3. Lack of expertise and skill,
  4. Lack of credibility on the economic evaluation techniques,
  5. Issue of communication/ jargon/(e.g DALY, QALY etc)
  6. Took long time for doing economic evaluation
  7. Cost of doing an economic evaluation
  8. Political imposition/traditional decision making culture
  9. Other (specify)______

B. Discrete Choice Experiment: attributes and values

(This is the qualitative information for identifying relevant attributes and values attributed to the prevention of mother-to-child transmission of HIV/AIDS program utilization)

B25. What is your role on the PMTCT program? Please explain

B26. What are the critical challenges by the health provider for the PMTCT service provision? Explain in the priority order?

B27. Do you think there is a cost increment on the MNCH service, due to the additional PMTCT service/ via integration? Yes No

B28. Please explain why?

B29. In your respective region/zone/district, who provides PMTCT training for health care providers? Who covers these costs?

Q30. What are the critical attributes/factor relevant for PMTCT service program improvement for the pregnant women accessing antenatal care service in the country?

DCE potential attributes / Response / Why
Waiting time / Yes

No
Service Fee/
Money / Yes

No
Location / Yes

No
Service Integration/ward/
unit / Yes

No
Counseling / Yes

No
Other specify / Yes

No
Other specify / Yes

No

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  1. Cost analysis of PMTCT program management, monitoring and evaluation activities

C31. At your office/level, could you please tell us the type of experts involved on the PMTCT related activities, and fill the following two tables?

Unit cost data per working day by staff category – Health care tier (circle the appropriate choice)
1)Federal Ministry of Health 2) Regional Health Bureau/ City Administration 3) Zonal health department/sub city 4) Woreda/District health office
Title / Pay grade/ Scale / Organization that pays / Unit/Ward/Process / Base pay per month, 2014 ETB / Housing allowance per month, 2014 ETB / Night duty allowance per month, 2014 ETB / Other salary or allowance per month, 2014 ETB / Gross salary per year, 2014 ETB / Total working days per year** / Gross salary per working day, 2014 ETB (unit costs for labor inputs)
Title / Pay grade/ Scale / Total Days worked per month on any service / Total days worked per month on HIV services / Total days worked per month on PMTCT services / Hours per day working on PMTCT services / Note

C32. For above indicated health experts; on average, how many working days do you usually spent per a week, for managing PMTCT related activities, such as: program management, PMTCT meeting, report preparation, plan submission.

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C33. What are the other resources used for the PMTCT program management, monitoring and evaluation related activities? Please explain in detail

  • ______
  • ______
  • ______
  • ______
  • ______
  • ______
  • ______
  • ______

C34. What are your partners in your respective/region/zone/district who collaborate and support the prevention of mother-to-child transmission of HIV/AIDS program?

C35. What types of support do they provide? Please explain in-depth?

C36. Documents to be collected by the data collectors/supervisors:

Name of Document / Remark
(x, √)
PMTCT progress report
(Jan 01, 2014 to Dec 31, 2014)/ Tekemet 01, 2006 to Tahesase 30, 2007/
PMTCT progress report
(Jan 01, 2013 to Dec 31, 2013)/ Tekemet 01, 2005 to Tahesase 30, 2006/
PMTCT survey reports (if there are any)
Economic evaluation / costing reports (if there are any)
PMTCT guidelines/ job aids
Supportive supervision reports
JSS checklists
Other related studies on PMTCT
Others (please specify)
Others (please specify)

Thank you for your cooperation! Is there anything you would like to ask or say?

Comments by Interviewer:
Date & time ______/ Signature by Interviewer: ______
  1. Interview guide for the health facility head/ MCH health workers

AGeneral health facility information / economic evaluation perceptions
Data collector: This is an open ended interview guide to ask the health facility head or health care provides regarding the overall PMTCT program implementation at the health facility, economic evaluation perception and practices, facilitating factors, challenges (or bottlenecks), and recommendation.
A1 / Would you please explain how the PMTCT service delivery provided at this facility, including the level of integration with MCH and other services?
A2 / What are the major facilitating factors/opportunities for expanding the PMTCT access and coverage?
A3 / What are the major challenges and bottlenecks for PMTCT service with the current option B+ regimen, task shifting and integration?
A4 / What do you recommend to improve the PMTCT service uptake and recommended treatment options?
A5 / Do you have any knowledge/use/practice associated with economic evaluation evidences for the decision making in your health facility? / Y / N
If ‘YES’, please explain?
A6 / Who provides training on the prevention of mother-to-child transmission of HIV/AIDS? For how long? Do you think the training is adequate?
A7 / Did you do building/facility improvement to start the PMTCT service/option B+ at your facility?
Thank you for your cooperation! Is there anything you would like to ask or say?
Comments by Interviewer:
Date & time ______/ Signature by Interviewer: ______

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