Immpact Toolkit: Module 4
Version 2
Productivity Costs Survey
The economic evaluation of health interventions is an important means to support policy-makers in decision-making. Immpact aims to promote evidence-based safe motherhood strategies, and economic evaluation plays an important part in the establishment of the cost effectiveness of such strategies. The costs of interventions not only include direct costs - such as the costs of medical treatment and transport to health facilities - but also the 'productivity costs' of lost, or less productive, working time of the patient due to illness (Mukuria and Newlands, 2004; Russell, 2004). In the case of maternal health, the illness may not only be of the woman herself but also of her baby.
There is little evidence on how best to measure and value production time lost due to ill health (Pritchard and Sculpher, 2000). Although existing methods have been tested in developed countries with some success, these are not directly transferable to maternal health or to developing country contexts. Study design issues are also important. The developed country studies that have collected information on productivity have often relied on self-reported data that is verified against employer records. The prevalence of informal and household work makes verification difficult in a developing country context. There have been a handful of studies that attempt to measure productivity costs in developing countries, but they have focused on endemic diseases - mainly malaria and schistosomiasis, and more recently HIV/AIDS.
Households employ 'coping strategies' to manage both direct and productivity costs, by altering roles within the household and by drawing upon the support of other households such as relatives and friends (Sauerborn et al, 1996). Health expenditure and productivity losses arising from illness may both be significantly reduced by such inter-household income transfers, and inter- and intra-household labour re-allocations.
However, while coping strategies may allow production to be maintained, this may be at the expense of the future welfare of the household and community. Among the more important longer-term impacts is the withdrawal of children from school, either because their labour is required or because the family cannot afford school fees. The effect is a reduced investment in the human capital of the children concerned which is likely to result in lower productivity over their entire lifetime. Other long-term effects arise when coping strategies lead to reduced food security in the form of lower food consumption or a switch to cheaper but less nutritious foods. The consequences include the stunted growth of children, the greater vulnerability of all family members to illness, and the reduced inability to perform physically demanding activities.Coping strategies also mean that there is a difference between the immediate and the broader economic impacts of illness. The immediate effects in terms of lost production are reduced - or may occasionally be almost cancelled out - by coping strategies. While the Productivity Costs tool is a freestanding survey, it could also be conducted alongside the Household Costs Survey tool (see Tool 7 in this module). If this is the case, certain sections of the two surveys could be combined: the household roster; housing and asset ownership; and household expenditure.