| In this proposal a phased comprehensive evaluation is described of an innovative (private sector) health care intervention that is currently carried out by a consortium of partners in Namibia, supported by PharmAccess Foundation. The intervention is in the health insurance market, aiming at providing affordable insurance coverage for the cost of basic health care, including AIDS treatment to Namibians working in the formal and informal sector. The intervention's target groups include AIDS patients in urgent need of HAART, volunteers working for various NGO?s and approximately 15,000 individuals working in the formal and informal sector in greater Windhoek, Namibia. The study will be in the areas of human behavior, economy and bio-medical sciences. The stakeholders are multi-center: the project is a collaboration between the Amsterdam Institute for International Development (AIID) of the University of Amsterdam and the Multi-disciplinary Research and Consultancy Center (MRCC) of the University of Namibia. These organizations are supported by the Center for Poverty-Related Communicable Diseases (CPCD) of the University of Amsterdam and by the Center for International Health and Development (CIHD) of the University of Boston. The AIID will take the administrative lead responsibility. The CV's of the stakeholders are depicted in Annex 1. The research project encompasses a thorough analysis of the effect of the introduction of affordable health care insurance options for Namibians. The research will provide important insights in all four dimensions of health care systems: the funds, the administration systems, the medical service delivery and the patient selection. Results of these studies will be invaluable for the implementation of the Health Care Subsidy Fund that is currently being established through a collaboration of the Netherlands Ministry of Foreign Affairs and PharmAccess (see annex 2 for a brief description). This Subsidy Fund is meant to support private health insurance systems in Africa to provide access to basic medical care including AIDS treatment. Namibia is considered a pilot country for the Subsidy Fund and the first 3 million euro of the Subsidy Fund are realized through a generous donation from Stop AIDS Now / Postcodelottery (see below). The next countries short listed for support by the Subsidy Fund are Kenya and Nigeria. Thus, results from the proposed Namibian studies will be beneficial to the approaches taken elsewhere in Africa. It is not excluded that part of the research that is currently planned in Namibia will be performed in Kenya and/or Nigeria in order to improve the regional applicability of lessons learnt. In the area of human behavior, various topics will be studied, including: health seeking behavior (uptake into the insurance and use of its services), (changes in) knowledge, attitude and practice related to HIV/AIDS, and drug adherence behavior and its most important determinants. Subsequently the socio-economic impact will be studied (with a special emphasis on investment in the human capital of young children), the impact on the private sector employers, and finally the macro-economic impact. In the bio-medical area, the impact of offering primary health care, HIV testing, and highly active antiretroviral treatment (HAART) will be studied. |
