Health

We work with our clients to develop solutions aimed at improving the health of populations throughout sub-Saharan Africa. Our region is beset by a range of diseases, both communicable and non-communicable, and has relatively weak health services. Within this context, we provide experts with decades of experience in the design, implementation and evaluation of health programmes.

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Expertise Areas

Research, evaluation and design

We design and implement a variety of research projects -  from national household surveys to discrete and focused programme reviews or process evaluations. Our researchers have decades of experience in quantitative and qualitative research methodologies, and of applying these in a practical way, which ensures that our findings can be confidently used by the commissioning companies and organisations.

We like to work with clients on the design of an appropriate evaluation for their programmes, using robust methods and a cost-effective approach.

Prevention

A significant challenge in healthcare is persuading people to embrace a healthy lifestyle. Our team works on social and behaviour change communication programmes that are evidence-informed and designed for maximum impact.

We keep an eye firmly on the views and lives of target populations in order to design interventions that resonate with them, and not necessarily with public-health experts.

Our team has worked on addressing the HIV epidemic in sub-Saharan Africa for the past 20 years. This work has included finding ways to prevent HIV in adults and children, as well as ways to mitigate the impact of the epidemic, especially in the era before HIV treatment became widely available.

Our behavioural economists have also studied why people struggle with these lifestyle decisions, and have delivered a set of tools that are often cheaper to use, more effective in changing health behaviour and, ultimately, more effective at achieving better health outcomes.

Health financing and health economics

We focus on understanding the economic and epidemiological outcomes of disease and the effectiveness, benefits, and costs of interventions in order to improve the health care in the region. 

Our team provides technical assistance across the health financing functions, answering questions like: What services should people be paying for? What interventions are cost-effective? What financing mechanisms should be used? What reimbursement mechanisms work?

Regulatory economics

Genesis is also a leading provider of regulatory economics advice, offering the full spectrum of expert economic and regulatory accounting services to governments, regulators and private firms. We have played a central role in critical policy and regulatory debates across numerous sectors.  

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Competition economics

As the leading provider of competition economics services in Africa, Genesis Analytics has an unmatched breadth and depth of skills and experience. Blue-chip companies across Africa routinely rely on us for expert advice and support when they interact with competition authorities. We also work extensively with regulators and competition authorities, giving us a position of trust based on a strong reputation for providing robust and independent expert economic views.

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Projects

Positve impact of Soul Buddyz Clubs on young women

Project name:
Evaluation of the Soul Buddyz Clubs

Service:
Monitoring and evaluation
Prevention

Sector:
Public and social
Health

Area of Expertise:
Research, evaluation and design

Client:
Soul City Institute for Health and Development Communication

Date:
2015 - 2017

Country:
South Africa


The Soul City Institute for Health and Development Communication (SCIHDC) has been running Soul Buddyz Clubs (SBC) in primary schools in South Africa since 2004. SCIHDC wanted to determine the long-term impact of participation in SBC on previous members’ overall health, community participation and level of education attainment. 

We undertook this evaluation together with fieldwork partner, Social Surveys Africa (SSA). The proposed sample comprised people who were SBC members between 2004 and 2008. 

The challenges included having to find and recruit members retrospectively without a sample frame, establishing an appropriate control group, getting participants to come to a central venue for interviews and asking participants to get an HIV test.

Winner in Joburg receiving his camera from Mpho Molebatsi from SSA

Winner in Joburg receiving his camera from Mpho Molebatsi from SSA

Our approach was to first conduct a feasibility study to determine the likelihood of being able to locate previous SBC members and to determine the preferred control group. We used these findings to develop an innovative retrospective cohort study design to meet the study objectives. 

We then used a multi-pronged recruitment approach to recruit the ex-SBC members. Methods included radio adverts, a Facebook group, WhatsApp and telephone calls to those identified through snowballing. We incentivised referrals of previous SBCs to improve snowballing. We established where the majority of the ex-SBC members attended primary school and together with SSA we identified appropriate community controls using random sampling. SAA staff were at the fieldwork sites and ensured participants were given transport money and thank-you gifts. We ran competitions at the fieldwork sites to improve the response rate.

We were able to combine epidemiological expertise, in-depth sector knowledge and real world experience to solve a difficult evaluation problem for our client using an innovative study design. The results of the study will be used to determine whether school-based programmes have any lasting impact on HIV – an area where there is not much evidence. In addition, SCIHDC now has a list of previous members as well as an activate platform (Facebook group) through which it can communicate with them. 

Top picture: Sarah Magni, the manager of the Health practice, addresses a briefing on the study that was presented at the 8th SA AIDS Conference in Durban in June 2017

Positive impact of health club on young women's HIV status

SA cities sign up to meet 90-90-90 targets

Project name:
Fast Track Cities South Africa

Service:
Prevention

Sector:
Health
Public and social

Client:
UNAIDS

Date:
2015 - 2016

Country:
South Africa


The 90-90-90 targets assist countries to control the HIV epidemic by setting ambitious targets to get people on antiretroviral (ARV) treatment and ensure they are virally suppressed. Since cities around the world contain a high percentage of people living with HIV, an initiative was launched in Paris in 2015 to fast track cities’ response to HIV. 

South Africa decided, as a response to this initiative, to host a country meeting, with the aim of supporting South African municipalities to formulate their own plans to meet the 90:90:90 targets. UNAIDS contracted Genesis Analytics to support this meeting, through providing background support and facilitation at the meeting.

Nineteen municipalities were invited to the meeting, which cover almost 50% of the people living with HIV in South Africa.  These included Buffalo city, Cape Town, Ekurhuleni, Ethekwini, Johannesburg, Mangaung, Nelson Mandela Bay, Tshwane, Emalahleni, Emfuleni, Kimberley, Mafikeng, Mbombela, Mogale, Msundunzi, Polokwane, Rustenburg, Ulundi and Umhlathuze.

Genesis used its expertise to create informative and useful municipal data sheets and a subsequent meeting report. This was done through rigorous research into each city, providing an overview of the HIV epidemic, with a focus on the response taken by the city and what the city has done to fast track the 90-90-90 targets.

Genesis was also responsible for planning and facilitating the technical meeting with officials from the municipalities, as well as supporting high-level meeting of the city mayors. The meetings produced municipal plans to address HIV and its underlying causes in all of the municipalities.

The work done at the meeting will ensure that all the major South African cities in South Africa will have a plan for dealing with HIV, for meeting the 90:90:90 targets, with support from their mayors and assisted by UNAIDS and SALGA.

TOP: Thabo Manyoni, mayor of Mangaung and chairperson of SALGA, signs the Paris declaration to end the AIDS epidemic in Mangaung.

HIV prevention strategy for the Gates Foundation

Project name:
A new HIV prevention strategy for the Gates Foundation

Service:
Prevention

Sector:
Health

Area of Expertise:
Prevention

Client:
The Bill and Melinda Gates Foundation (BMGF)

Date:
2015 – ongoing

Country:
Global


The HIV prevention field is changing rapidly as treatment becomes widely available and as new prevention technologies reach the market. The BMGF commits significant funding to healthcare and HIV, and needs to decide whether its strategic focus areas are appropriate in this changing landscape.

We are supporting the BMGF by contracting experts worldwide to answer these questions. The Imperial College, London is modelling the impact of various HIV prevention interventions and determining which combinations would have the most impact. The London School of Hygiene and Tropical Medicine has also prepared various reviews and thought pieces to assist the foundation

The Health team has ensured that the approaches and recommendations used in these projects are grounded in the reality of the Southern African HIV epidemic, which is the most severe in the world. Once completed, this work will guide the investments the foundation will make. The resulting papers will also be published and made available to a wide audience of opinion leaders and policy-makers.

Genesis tests names for new HIV prevention ring

Project name:
Dapivirine ring branding study

Service:
Prevention

Sector:
Health

Area of Expertise:
Research, evaluation and design

Client:
International Partnership for Microbicides

Date:
2017

Country:
Malawi
South Africa
Uganda
Zimbabwe


In Sub-Saharan Africa, far more women are infected with HIV than men. There are no female-controlled HIV prevention methods currently available other than the female condom and, more recently, pre-exposure prophylaxis (PreP). 

The International Partnership for Microbicides (IPM) has pioneered various initiatives that aim to provide women with affordable, self-initiated methods to protect themselves against HIV, including the dapivirine vaginal ring (DVR). 

The DVR is a monthly vaginal ring containing the antiretroviral drug, dapivirine, which new research has shown helps to prevent new HIV infections in women. IPM is seeking to register the DVR with various regulatory agencies and to do so they need a name for the DVR. This name needs to be applicable across the countries where it will be used. IPM had developed eight potential names and required support in testing these. 

Genesis tested eight potential brand names for the DVR in four countries: Uganda, Malawi, South Africa and Zimbabwe. We developed the data collection tools, conducted focus groups with women in those countries, analysed the data and compiled a report for IPM. The report provided recommendations about which names were suitable and which were not and why as well as discussing various factors which may influence DVR’s uptake and use. 

We found that not all tested names were relevant or culturally appropriate for the DVR. Some names were disliked because in the women’s local cultures and languages, the names held negative connotations; were far-fetched from the intentions of the ring or difficult to pronounce. For example, one name was disliked across all countries because it meant ‘death’ in some local languages. Some names had connotations which could influence use. For example, another name sounded Chinese, and was perceived to be associated with something cheap. Women expressed being more likely to use the DVR if the name was relatable either to their language, circumstances or what the ring offered to do. 

This work demonstrated the importance of testing potential names for a medical product with end-users prior to its introduction. In order for health products to be successfully launched, providers need to also understand consumer preferences of product names. As well as gain insight on the cultural connotations of names which hold potential to influence the use or non-use of certain health products.  

IPM will have an appropriate brand name to include in regulatory packages for the Medicines Control Council of South Africa and the US Food and Drug Administration.

The National HIV Communication Survey

Project name:
The National HIV Communication Survey

Sector:
Health

Area of Expertise:
Research, evaluation and design

Client:
Johns Hopkins Health and Education South Africa, the South African Department of Health, among others

Date:
2006 – 2012

Country:
South Africa


There are many HIV communication campaigns running in South Africa and many have overlapping objectives. However, funders need to know whether these campaigns are working, in which areas they are working, and what to continue with and what to stop or change.

Saul Johnson and Sarah Magni have been responsible for three national surveys, which have measured exposure to various communication programmes, as well as knowledge, attitudes and sexual behaviour linked to the HIV epidemic. Each of these surveys has had a sample of around 10 000 adult South Africans.

The surveys have been instrumental in showing how well-considered and constructed communications programmes can have a direct and indirect effect on curbing the HIV epidemic. The results have been widely used by donors and government departments, and were presented by the Minister of Health in Washington DC.

Protecting sex workers in Mpumalanga

Project name:
Protecting sex workers in Mpumalanga

Service:
Prevention
Applied behavioural economics

Sector:
Health

Area of Expertise:
Prevention

Client:
The US Centers for Disease Control

Date:
2011 – 2016

Country:
South Africa


For this project we conducted extensive research in the Gert Sibande District in Mpumalanga, which showed that many young women engaged in commercial sex work and transactional sex. This is as a result of very high unemployment levels among women in the area. It is also probably the reason why HIV infection levels in this area are among the highest in the country.

The team designed a peer-education programme and clinical services to reach sex workers in the district. We focused on taverns, since these seemed to be where sex workers found their clients. The sex workers also went on a course to explain to them how to reduce their risk of contracting HIV.

The programme is considered a best-practice example of working with key and vulnerable populations. A magazine produced for the sex workers as part of the programme has proven so popular that it is now distributed by the Department of Health throughout the country.

We showed that using innovation, combined with a respectful and engaged approach to the target audience, could result in a ground-breaking programme in this very difficult area.

HPCSA vs Buchanan

Project name:
HPCSA vs Buchanan

Service:
Competition economics

Sector:
Health

Area of Expertise:
Expert testimony

Client:
HPCSA

Date:
2014

Country:
South Africa


Whether corporate ownership of healthcare providers can improve efficiency and lower prices is a hotly contested topic in the healthcare sector. In this case an individual who operated a large franchise of optometrists put this topic on trial. The person lodged a competition law complaint that the Health Professions Council of South Africa (HPCSA) was involved in a restrictive horizontal practice by not permitting corporate ownership. Genesis was retained by the HPCSA to provide an expert economic view of whether this was the case.

While there were legal questions as to whether the practice could fall within the ambit of a restrictive trade practice, Genesis focused on the core economic question of whether the complainant was able to demonstrate that competition was indeed lessened by the exclusion of corporate ownership. Genesis first sought to determine, from the international applied economic literature and regulatory reviews, what the specific benefits were alleged to follow corporate ownership. On that basis, Genesis was able to determine that most of these alleged benefits could already be realised through permitting franchise arrangements in optometry, and that the only potential incremental benefit was raising capital. However, the evidence collected by Genesis demonstrated that this was not a barrier to entry in optometry.

The Competition Tribunal concurred with the Genesis opinion and cited the Genesis findings as its primary reasons for dismissing the complaint. This included findings that there was no evidence the optometry market was uncompetitive.

Regulation of medicine dispensing fee in pharmacies

Project name:
Regulation of the dispensing fee for medicines through pharmacies

Service:
Damages, trade and other litigation
Regulatory economics and accounting

Sector:
Health

Client:
Pharmacy Stakeholders Forum of South Africa

Date:
2006 – 2010

Country:


Genesis has worked extensively with the Pharmacy Stakeholders Forum of South Africa (PSF) in its protracted litigation with the Department of Health regarding price regulation of the dispensing fee for medicines sold through pharmacies.  The central question was whether the dispensing fees prescribed by the Department of Health were sufficient to provide a reasonable revenue stream to community pharmacies so as ensure the viability of the businesses.

Price regulation, by its very nature, raises intricate questions that require one to protect the interests of consumers while preserving the impetus for investment and operational sustainability of the regulated firm.  This was particularly complex in the case of community pharmacies, which comprise a large number of widely diverse individual businesses with differing operating models and levels of financial vulnerability.  Against this backdrop, Genesis was able to provide input to the key economic principles that would be important to ensure appropriate forms of price regulation that not only achieved the objectives of the Department of Health, but also safeguarded the sustainability community pharmacies.  Genesis also provided an economic assessment of the impact that the proposed dispensing fees would have on a sample of 142 pharmacies, for which detailed operational and financial information had been collected. 

Based on this analysis, Genesis found that the proposed dispensing fees, in their existing form, threatened to undermine the viability of a large number of community pharmacies.  This economic analysis proved instrumental in a settlement between PSF and the Department of Health which led to the suspension of the proposed dispensing fees in their original form.

Expert advice on private healthcare inquiry

Project name:
Expert advice for a Competition Commission 1nquiry into the healthcare sector

Service:
Competition economics

Sector:
Health

Area of Expertise:
Expert testimony
Health financing and health economics

Client:
Competition Commission of South Africa

Date:
2012

Country:
South Africa


Genesis was commissioned by the Competition Commission of South Africa to provide expert advice on a potential inquiry into the private healthcare industry, which was prompted by a concern over the increases in costs in the private sector.

Based on its investigation of competition issues in healthcare funding, the provision of healthcare services and the provision of consumables and medicines, the project team provided an opinion on what the focus of the inquiry should be. It also provided the research required in order to deal with key issues in the various focus areas. 

Following the advice provided by Genesis, the commission announced in 2013 that inquiry would start in September of that year.

For more information on the inquiry

Meet the Team

More information about our Health practice

Our FOCUS is on public health in Africa.

We develop CUSTOMISED SOLUTIONS to improve
the health of people throughout sub-Saharan Africa.

We deliver ROBUST ANALYSIS for clients across the Health sector.

Our DEEP TECHNICAL EXPERTISE and experience
enable our clients to make better decisions

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Areas of Service Expertise

  • Research, evaluation and design
  • Health financing and health economics
  • Regulatory economics
  • Competition economics

Projects

Project

Positve impact of Soul Buddyz Clubs on young women

Genesis was asked by Soul City to evaluate their Soul Buddyz HIV-prevention campaign in schools from 2004. We used social media, as well as direct approaches, to track down Soul Buddyz members for the study.

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Project

SA cities sign up to meet 90-90-90 targets

UNAIDS contracted us to support the meeting of South African municipalities to implement its 90-90-90 project that assists countries to control the HIV epidemic by setting ambitious targets to get people on antiretroviral (ARV) treatment and ensure they are virally suppressed. We did rigorous research into each city to provide an overview of the HIV epidemic, with a focus on the response taken by the city and what it has done to fast track the 90-90-90 targets.

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Leading the team

Saul Johnson

Partner (Health)

Saul Johnson
Partner (Health)
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​Sarah Magni

Manager

​Sarah Magni
Manager
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​Alyna Wyatt

Partner (Evaluation for Development)

​Alyna Wyatt
Partner (Evaluation for Development)
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James Hodge

Director and Managing Partner (Competition and Regulatory Economics)

James Hodge
Director and Managing Partner (Competition and Regulatory Economics)
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Neil Lightfoot

Partner (Applied Behavioural Economics)

Neil Lightfoot
Partner (Applied Behavioural Economics)
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