Task-Sharing or Public Finance for Expanding Surgical Access in Rural Ethiopia: An Extended Cost-Effectiveness Analysis

Authors: Mark Shrime, Stéphane Verguet, Kjell Arne Johansson, Dawit Desalegn, Dean Jamison, Margaret Kruk

Ethiopia is used as a case study of policies of universal public financing (UPF) and travel vouchers and policies of task-sharing with nonsurgeon providers. For purposes of the study in rural Ethiopia, the authors defined a basic package of surgery comprising nine surgical procedures treating 13 conditions. Task-sharing was predicted to avert 250 deaths per 1 million population per year in rural Ethiopia. Combining task-sharing with UPF is predicted to avert 291 deaths per year per I$100,000 spent. Task-sharing has been promoted, with nonspecialist doctors and nonphysicians increasingly filling a deficit in medical services and emergency obstetric care. Using the median age in Ethiopia of 16.8 and average life expectancy of 52.1 additional years predicts that task-sharing will cost I$7,200 per life year gained; UPF + task-sharing + vouchers, the most expensive policy, will cost I$184,000 per life year gained.