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ABSTRACTThe aim of the United Nations’ Sustainable Development Goal (SDG)3 is to ensure healthy lives and promote well-being for all, at all ages; including reducing maternal and child mortality, combating communicable and non-communicable diseases, and achieving Universal Health Coverage (UHC). UHC aims to provide everyone with equal access to quality essential and comprehensive healthcare services including preventions, interventions, and treatments, without exposing them to financial hardship. Making progress toward UHC requires significant investment in technical and financial resources and countries are pursuing the implementation of cost-saving measures within health systems to help them achieve UHC. Whilst many countries are far from attaining UHC, all countries, particularly low- and middle-income countries, can take steps toward achieving UHC. This paper discusses key data showing how immunization is a fundamental, cost-effective tool for reducing morbidity and mortality associated with infectious disease in all populations, creating more productive communities, reducing treatment costs, and consequently, facilitating social and economic advancement. Immunization is key to advancing toward UHC by relieving the burden that diseases place on the healthcare services, freeing essential resources to use elsewhere within the healthcare system. Immunization is an essential, readily available strategy that countries can deploy to achieve UHC and the SDG3 agenda.

In May 2006, the Ministers of Health of all the countries on the African continent, at a special session of the African Union, undertook to institutionalise efficiency monitoring within their respective national health information management systems. The specific objectives of this study were: (i) to assess the technical efficiency of National Health Systems (NHSs) of African countries for measuring male and female life expectancies, and (ii) to assess changes in health productivity over time with a view to analysing changes in efficiency and changes in technology.The analysis was based on a five-year panel data (1999-2003) from all the 53 countries of continental Africa. Data Envelopment Analysis (DEA) − a non-parametric linear programming approach − was employed to assess the technical efficiency. Malmquist Total Factor Productivity (MTFP) was used to analyse efficiency and productivity change over time among the 53 countries' national health systems. The data consisted of two outputs (male and female life expectancies) and two inputs (per capital total health expenditure and adult literacy).The DEA revealed that 49 (92.5%) countries' NHSs were run inefficiently in 1999 and 2000; 50 (94.3%), 48 (90.6%) and 47 (88.7%) operated inefficiently in 2001, 2002, and 2003 respectively. All the 53 countries' national health systems registered improvements in total factor productivity attributable mainly to technical progress. Fifty-two countries did not experience any change in scale efficiency, while thirty (56.6%) countries' national health systems had a Pure Efficiency Change (PEFFCH) index of less than one, signifying that those countries' NHSs pure efficiency contributed negatively to productivity change.All the 53 countries' national health systems registered improvements in total factor productivity, attributable mainly to technical progress. Over half of the countries' national health systems had a pure efficiency index of less than one, signifying that those countries' NHSs pure efficiency contributed negatively to productivity change. African countries may need to critically evaluate the utility of institutionalising Malmquist TFP type of analyses to monitor changes in health systems economic efficiency and productivity over time.

While several studies of developed countries have attempted to understand individual smoking using economic models, no such studies have been conducted in South Africa. The purpose of this paper is to identify which factors influence individual South African women's choice to smoke cigarettes and their knowledge of the health risks of smoking. To allow for the implied correlation between the unobservable components of the reduced form equations for these health inputs the model is estimated as a bivariate probit. In order to identify those women who are most at risk of becoming smokers and those who are most likely to benefit from health education, the results show how the probability of being an uninformed non‐smoker or an uninformed smoker vary across different socio‐economic groups. Copyright © 1999 John Wiley & Sons, Ltd.

While several studies of developed countries have attempted to understand individual smoking using economic models, no such studies have been conducted in South Africa. The purpose of this paper is to identify which factors influence individual South African women's choice to smoke cigarettes and their knowledge of the health risks of smoking. To allow for the implied correlation between the unobservable components of the reduced form equations for these health inputs the model is estimated as a bivariate probit. In order to identify those women who are most at risk of becoming smokers and those who are most likely to benefit from health education, the results show how the probability of being an uninformed non-smoker or an uninformed smoker vary across different socio-economic groups. Copyright © 1999 John Wiley & Sons, Ltd.

When decisions to intervene in different schistosomiasis severity states are taken in isolation, inefficiencies are unavoidable due to failure to take account of the synergy between community and facility level options. To date no studies have been conducted of the sequential nature of decision-making processes in schistosomiasis. The main aim of this study is to develop a methodology that could be used to compute the costs and health benefits of alternative strategies for ameliorating the burden of illness from schistosomiasis, with a view to determine that strategy which would produce the greatest excess of benefits over cost. In other words, the goal is to develop a conceptual framework that could be used to map out the most efficient path of options for intervention across a spectrum of schistosomiasis states - asymptomatic, mild, moderate, severe, and very severe.A cost-utility decision analysis (CUDA) model was developed and applied to the population living within the schistosomiasis endemic region of Kenya covered by the Mwea Irrigation Scheme. Both primary and secondary level options were included in the analysis.The main findings are as follows. Strategies involving treatment at the community level were generally superior to non-treatment community strategies. The selective population praziquantel chemotherapy (SPCPS) was found to be the optimal strategy. Mollusciciding strategies are the most cost-effective among the non-treatment strategies. The results of the sensitivity analyses were, however, mixed. The inconclusive nature of the results indicates that firm policy conclusions cannot be made on the basis of current epidemiological information, and more research is urgently required to establish both the validity and reliability of the health-related quality of life (HRQoL), and the Delphi technique (DT) measurements used in the study.

When decisions to intervene in different schistosomiasis severity states are taken in isolation, inefficiencies are unavoidable due to failure to take account of the synergy between community and facility level options. To date no studies have been conducted of the sequential nature of decision-making processes in schistosomiasis. The main aim of this study is to develop a methodology that could be used to compute the costs and health benefits of alternative strategies for ameliorating the burden of illness from schistosomiasis, with a view to determine that strategy which would produce the greatest excess of benefits over cost. In other words, the goal is to develop a conceptual framework that could be used to map out the most efficient path of options for intervention across a spectrum of schistosomiasis states - asymptomatic, mild, moderate, severe, and very severe.A cost-utility decision analysis (CUDA) model was developed and applied to the population living within the schistosomiasis endemic region of Kenya covered by the Mwea Irrigation Scheme. Both primary and secondary level options were included in the analysis.The main findings are as follows. Strategies involving treatment at the community level were generally superior to non-treatment community strategies. The selective population praziquantel chemotherapy (SPCPS) was found to be the optimal strategy. Mollusciciding strategies are the most cost-effective among the non-treatment strategies. The results of the sensitivity analyses were, however, mixed. The inconclusive nature of the results indicates that firm policy conclusions cannot be made on the basis of current epidemiological information, and more research is urgently required to establish both the validity and reliability of the health-related quality of life (HRQoL), and the Delphi technique (DT) measurements used in the study.