injury
epidemiology and costing
considerations and limitations to the development of a global
injury costing model: conference report
The
1st Safe Community-Conference on Cost Calculations
and Safety Promotion was recently (30 September to 3 October
2001) held in Viborg, Denmark. The aims of this conference were,
to determine primarily, the methodological state of costing
within the field of injury and injury prevention; to present
costing models that have been applied in diverse settings; and
to bring together policy planners, decision makers, administrators
and researchers for debate, discussion and exchange. A further
aim was the improvement of a draft manual for cost calculations
in safe community practice, developed by Swedish collaborators.
Interested communities as well as expert groups did field tests
with the manual, and presented their feedback during the conference.
The conference was highly successful in bringing both the important
issues and the major stumbling blocks to the forefront of inter-sectoral
debate.
Two
important topics stood out in particular: Firstly, finding a
balance between a scientifically rigorous application of health
economics on the one hand, and costing models useful to the
health practitioner and public health researcher without a background
in health economics on the other. A second issue that was repeatedly
discussed during the conference was the impossibility of developing
a globally practicable costing manual, or even model, within
the diversities of safe community practice. It became clear
from numerous presentations and debates, that costing is a far
more complex and problematic task in the developing countries
of the world, than it is in developed ones. Without understating
the complexity of costing within a quasi-experimental research
arena of any kind, developing countries face particularly
high hurdles. Problems range from poverty in relevant communities,
and among paraprofessionals and volunteer fieldworkers, to what
some would call “the myth of influencing policy makers with
costing figures ”. The first gathering of the full range of
socio-economic contexts, from the so called developing health
information systems of South Africa and Bangladesh to the highly
proficient and timeous information databases of the Netherlands
and the USA provided concrete examples of the very real methodological
and context limitations of the global costing of injury.
From
a South African point of view, the cost calculations of injury
and injury prevention is necessarily a long-term objective.
Before a proper costing system can be put in place, baseline
injury measurement systems, still in their infancy must be must
be consolidated and regarded as sustainable. Additionally, very
specific descriptions of the local economies of the community
must be developed to some point of methodological influence.
The double burden of high unemployment and high injury prevalence
in many rural South African communities must be successfully
captured in any schematic for the development of an information
base that attempts to quantify the economic burden of injury
in low-income settings.
In
this regard, South Africa appears to have a comparable low-income
injury context in Bangladesh. Although the forms of injury differ
markedly, these countries seem to have comparable national health
information problems. The expenditure differential between the
public and private health care sectors in Bangladesh seemingly
mirrors the same divide in South Africa. The costs of injury
representatives of both these developing countries agreed that
research collaboration between these countries was plausible.
The loose objective of such collaboration would be to carefully
examine the possibilities for injury costing in low-income settings
whilst formulating the greatest ethical and informatics obstacles
to such an endevour. The outcome of such a project would be
a supplementary chapter or section in a final costing manual.
The
representative editors of the Swedish costing manual welcomed
such proposed collaborations and provisional arrangements for
a visit to South Africa were made. November 7 will see a Swedish
costing team attend a costing workshop to be held in Cape Town.
The aim of this meeting will be to address the developing countries’
concerns as articulated at the Viborg conference.
The
developed countries readily debated the use of advanced costing
techniques, indicating that a cost of injury measure was both
easily accesses and regarded as accurate. South Africa has not
yet the capacity to enter into such debate while its baseline
injury costs cannot be easily ascertained. The Cape Town meeting
will attempt to investigate the possibility of developing income-based
suggestions together with state of developing health systems
prerequisites for final inclusion into a global manual. This
step would go some way to infusing and highlighting the methodological
challenges if injury costing in developing countries to the
costing debates that seem to preoccupy higher income contexts
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