Calculating the cost of health
NSTF-TW Kambule Award for an emerging researcher: post-doc in a period of up to six years after award of a PhD or equivalent
South Africa is one of the most unequal societies in the world. Access to, and quality of, healthcare is an area in which the chasm between rich and poor is most starkly evident. Professor John Ele-Ojo Ataguba’s passion is to understand this reality, and the actions that could change it.
“The debates around how the country’s healthcare system can be transformed aroused my interest in the link between poverty, inequality and ill health in South Africa,” says the public health researcher. He is an associate professor in the Health Economics Unit of the school of public health and family medicine, faculty of health sciences at the University of Cape Town.
Interested not only in particular disease conditions but in a comprehensive analysis of overall health inequalities and how they relate to poverty, Ataguba spent the last nine years influencing public health economic research in the country. He has developed, among other outputs, novel methodologies for assessing health financing systems that focus on the poor and marginalised.
“The novelty of my research was adapting methodologies to investigate the health system as a whole, and not just the public sector or individual diseases,” he explains.
Most of the methods traditionally used in health economic research were developed in the context of developed countries. One model, for instance, describes out-of-pocket payments for health services as “catastrophic” when they exceed a fixed percentage of any household’s income. In the work he did to adapt such methodologies to developing countries, Ataguba has shown that a small fraction of income spent on health services can be substantial and hurtful for a very poor household — long before the catastrophic threshold percentage is reached. “We have to recognise that R1 is more valuable to the poorest individual than to the richest individual,” he says.
Ataguba’s work has contributed greatly to our understanding of health inequalities, social determinants of health, and health system equity in South Africa and the rest of Africa. He has, for instance, published the first comprehensive analysis of health inequalities in South Africa, showing that the poor suffers a disproportionately higher burden of ill health.
On a practical impact level, Ataguba’s research outputs have significantly added to the health policy debate in South Africa, particularly in terms of government’s proposed National Health Insurance.
Ataguba’s work is invaluable because health and healthcare impacts are not confined to people’s physical wellbeing. The truth is that the growth of an economy depends largely on the health of the population. When health inequalities are reduced, illness and death in a society decrease. The substantial gains in lives saved result in long-term savings for the economy. Furthermore, the impacts of good health sector reforms extend into substantial reductions in inequalities in income and access to other social services.
In terms of future research, Ataguba wants to focus more on the social determinants of health. “We already know that factors outside the health sector contribute to health inequalities in South Africa,” he says. For example bad roads lead to accidents, and poor sanitation causes communicable diseases.
“I want to do more public advocacy and get the general population involved in reducing health inequalities. This will be an exciting time, as it will bring together skills and knowledge from diverse disciplines,” says Ataguba.