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Open Access Publications from the University of California

Recent Work

The Bay Area International Group focuses on the quantitative aspects of family planning and reproductive health. Our overall goal is to expand family planning and improve reproductive health in developing countries by using limited resources as effectively as possible. Our group draws on the cross-disciplinary skills of a number of academic institutions in the San Francisco Bay Area, and includes economists, public health professionals, epidemiologists, as well as international experts in business, reproductive health and AIDS prevention.

Cover page of Cost-Effectiveness of HIV Interventions for Resource Scarce Countries: Setting Priorities for HIV/AIDS

Cost-Effectiveness of HIV Interventions for Resource Scarce Countries: Setting Priorities for HIV/AIDS


Objectives: Despite recent foundation donations and bilateral commitments there are insufficient funds to implement all of the desired interventions for AIDS prevention and treatment. This paper explores one methodto analyze the allocation of limited budgets. Methods: Based on existing data from African countries, we compare the cost-effectiveness of both HIV prevention and treatment interventions using cost per life-year saved as the outcome measure. We examined five prevention interventions: (1) voluntary counseling and testing; (2) prevention of mother-to-child transmission; (3) STD mass treatment for general population; (4) STD management for sex workers; and (5) blood screening – and four drug price scenarios for antiretroviral treatment for HIV+ patients. In a hypothetical country of one million people and a generalized epidemic, we performed a static budgetary simulation with constrained resources to estimate total life-years gained and number of HIV cases prevented/treated with only prevention or treatment interventions. Results: Both the cost-effectiveness analysis and the budgetary analysis suggest that HIV prevention interventions are much more cost-effective than ARV treatment. Both blood screening and STD control among sex workers are the most cost-effective preventative interventions at the costs of $3.35 and $3.95 per life-year saved (LYS), respectively. ARV treatment is the least cost-effective, costing $1,317.20 per life-year saved at generic drug prices. In the budgetary simulation scenario with donated drugs, ARV treatment consumes the entire budget saving up to 2,974 life years annually. A portfolio of prevention interventions does not require the entire budget and results in 135,030 life years saved. Conclusions: Both the cost-effectiveness analysis and the budgetary analysis suggest that HIV prevention interventions should be prioritized if poor countries hope to maximize the scarce resources available for reducing the impact of the AIDS epidemic.

Cover page of Whither India?  Ten Lessons Learned from the HIV Epidemic in Africa

Whither India? Ten Lessons Learned from the HIV Epidemic in Africa


Recent reports show that the HIV epidemic is rapidly spreading in parts of the largest Asian countries, namely India and China. Despite its strong foothold, there are still opportunities to minimize the problems if we apply these ten lessons learned from the HIV epidemic in Africa 1) The needed decisions will be controversial and require involvement of the beneficiaries in all aspects; 2) Focus on cost-effective programs especially those that affect the core transmission groups such as participants in transactional sex, intravenous drug use, and men who have sex with men; 3) Secure the commodities pipeline - adequate supplies of condoms and antibiotics are essential; 4) Invest only in projects that can be brought to scale; 5) Ensure appropriate delegation of needed tasks to optimize the effectiveness of health workers; 6) Reexamine the structure and work of international donors to exploit faster and more efficient ways to channel funds into the most effective programs; 7) Reduce the number of large international meetings. They waste resources; 8) Confront the “shell game” trade-off in the allocation of competing resources for prevention and highly-active antiretroviral therapy; 9) Update evidence-based policies and program efficiently; and finally, 10) Increase national and global budgets now. Large investments at the outset of the epidemic have a greater impact on slowing its progress than at a later stage. By applying these lessons, more effective policies and strategies may be able to stem the tide of this deadly epidemic.

Cover page of Franchising of Health Services in Developing Countries

Franchising of Health Services in Developing Countries


Grouping existing providers under a franchised brand, supported by training, advertising and supplies, is a potentially important way of improving access to and assuring quality of some types of clinical medical services. While franchising has great potential to increase service delivery points and method acceptability, a number of challenges are inherent to the delivery model: controlling the quality of services provided by independent practitioners is difficult, positioning branded services to compete on either price or quality requires trade-offs between social goals and provider satisfaction, and understanding the motivations of clients may lead to organizational choices which do not maximize quality or minimize costs. This paper describes the structure and operation of existing franchises and presents a model of social franchise activities that will afford a context for analyzing choices in the design and implementation of health-related social franchises in developing countries.

Cover page of Costing Cairo: An Annotated Bibiliography of the Cost Literature on ICPD Programme of Action Components in Sub-Saharan Africa

Costing Cairo: An Annotated Bibiliography of the Cost Literature on ICPD Programme of Action Components in Sub-Saharan Africa


The 1994 International Conference on Population and Development (ICPD), held in Cairo, produced a Programme of Action accepted and signed by over 180 governments. The Programme of Action marked an important shift in the ideological framework of population programs. By stating such programs should ensure that “a full-range of reproductive health care services, including family planning, are accessible, affordable, acceptable and convenient to all users” (ICPD Programme of Action, 1994, 7.5.a), Cairo identified the crux of population programs to be the reproductive health of women, and expanded the notion of family planning accordingly. This bibliography was initiated as part of an effort to revise the original UNFPA estimates of the cost of implementing the Cairo agenda. It is focused on sub-Saharan Africa for two reasons. First, sub-Saharan Africa, by almost any measure, is most in need of improved provision of health services. Second, accuracy and completeness was a high priority, requiring that the scope be narrowed. Every effort was made to include all relevant literature published in developing countries or unpublished sources. It is primarily focused on recent literature, as the objective is to facilitate estimation of current and future implementation costs. When little or no cost estimates in sub-Saharan Africa are available, such as for breast cancer screening and treatment, we include cost estimates from outside the region. Within each topic references are organized in order (subjectively) of usefulness and quality. Each reference gives a description of points of the study relevant to the cost figures to the extent that the study presents itself. We briefly describe the methodology, including any information provided on which costs were included or not included. The costs presented are typically unit costs, where the units are most often per CYP, per capita, per illness and per affected individual. When additional calculations were necessary to produce unit costs, the additional figures used in the calculations are also presented. We provide the year-basis for the cost figures where possible and the exchange rate used where necessary. When the precise year-basis information was not available or was ambiguous in the source material we attempted provide the dates for the period of the intervention as available to offer some context for the cost data. We occasionally included dates in other references as well to offer addition context as necessary.

Cover page of War and Reproduction: Angola’s Fertility in Comparative Perspective

War and Reproduction: Angola’s Fertility in Comparative Perspective


For four decades, Angola has experienced war, which has inevitably inè uenced the country’s social development. The intensity and geographical spread of the war has è uctuated over that period. This paper examines fertility and other relevant socio-demographic characteristics in Angola and attempts to relate them to its protracted civil conè ict. To situate Angola’s fertility in the sub-Saharan context, comparisons are made with a selection of other African countries. The analysis paints a picture of a generally pre-transitional society characterised by an early start of childbearing, high fertility and a contraceptive prevalence that is among the lowest in Africa. Angola also trails behind most of the sub-continent in childhood mortality and maternal care indicators. The available data suggest that Angola’s fertility drops when hostilities peak and rebounds in the periods of relative peacefulness, and that these è uctuations are stronger in regions more affected by the é ghting than in less affected ones. However, there is no indication that the war has exerted any enduring and direct impact on trends in Angola’s fertility beyond its generally inhibiting effect on any improvements in social welfare that might otherwise have encouraged some fertility decline.