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

Campaign does improve men's perceptions on HIV testing

Project name:
Impact evaluation of the Testa Boy campaign and baseline assessment on the knowledge of HIV testing and treatment among men and women in South Africa

Service:
Prevention

Sector:
Health

Area of Expertise:
Evaluation & impact assessment

Client:
Centre for Communication Impact

Date:
2017

Country:
South Africa


Genesis Analytics was contracted by the Centre for Communication Impact  to evaluate the impact of CCI’s Testa Boy campaign. The campaign aims to address the slow uptake of HIV testing among men. It promotes the benefits of testing under the slogan: “Negative or positive, you are the same person, Testa Boy.”

The campaign was announced nation-wide on TV, radio, outdoor media, film and internet-based media.  Reports of campaign ambassadors were written and posted through videos on YouTube, and promoted on social media. Billboards featuring the campaign ambassadors were placed in 61 locations. 

Genesis, in partnership with Freshly Ground Insights (FGI), conducted face-to-face interviews with 3 000 South Africans aged 18-34.

Our evaluation showed that the Testa Boy campaign improved perceptions among men who tested for HIV, as well as actual testing behaviour. Those who were exposed were 50% more likely to agree that men who tested for HIV were regarded as strong and responsible. Those exposed were also 40% more likely to have had HIV testing in the past 12 months. The study found that men were 60% more likely to be tested if five or more of their friends had also tested for HIV.

These findings highlight the value of campaigns to improve perceptions about HIV testing and promote behaviour change. 

The advert that has been used in the campaign 

South Africans more aware of risks of sugary drinks

Project name:
Baseline and follow-up evaluation of the “Are you drinking yourself sick?” campaign in South Africa

Service:
Prevention

Sector:
Health

Area of Expertise:
Research, evaluation and design

Client:
Vital Strategies

Date:
2017

Country:
South Africa


South Africa has the highest obesity rate in Sub-Saharan Africa, with 39% of men and 69% of women classified as obese or overweight. Sugary-drink consumption is high and growing in South Africa; we are among the top ten global consumers of soft drinks, and about a third of our added dietary sugars are from sugar-sweetened beverages.

Vital Strategies and Healthy Living Alliance (HEALA) identified a need to educate South Africans on the sugar content in sugar-sweetened beverages and the harm of excessive sugar consumption. They launched a campaign, “Are you drinking yourself sick?”, to reduce sugary-drinks consumption and promote support for the sugar tax. 

Genesis Analytics was contracted to do a baseline and follow-up evaluation of the HEALA campaign. The baseline evaluation was conducted in October 2016, before the campaign launch, while the evaluation was conducted in July 2017 after the campaign had been running for almost 10 months. 

Both evaluations comprised samples of 1 000 people aged 18-55 years. Representative household surveys were conducted in the metros and cities of Gauteng, KwaZulu-Natal and Western Cape. 

Preliminary report: Public attitudes towards sugary drinks and support for government action

Public support for sugary drinks tax is growing

Sugary drinks tax gets green light for National Assembly

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 2003. SCIHDC wanted to determine the long-term impact of participation in SBC on previous members’ overall health, community participation and level of education attainment. 

The clubs, whose members are between 8 - 14 years, focused on promoting positive attitudes and behaviours that related to HIV, such as self-efficacy for safer sexual behaviour, condom use, community activity, gender based violence and alcohol or drug use.

The sample comprised people who were SBC members between 2004 and 2008. We designed a retrospective cohort study design in order to determine the impact of being an SBC member. Cases comprised individuals aged 18-24 years who attended SBC's approximately 6-10 years ago (2004-2008). Controls were individuals aged 18-24 years who never attended SBC but grew up and attended in schools in the same communities. Our fieldwork partner, Social Surveys Africa, were able to interview 800 respondents (300 cases and 500 controls) between Gauteng and KwaZulu-Natal.

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. We found that ex-buddyz were more likely to have completed Grade 12, be involved in community activities and to have used condom at first sex. They were less likely to have sex before 15 years, to have had more than one partner in the past 12 months and have had multiple sexual partners in the past month. 

Female ex-Buddyz were less likely to be HIV positive than controls. There was no effect on male ex-Buddyz, possibly because the sample size of HIV positive men in this age group was too small.

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

Pricing study for private eye care practice

Project name:
Costing model for private healthcare group

Service:
Health financing and health economics

Sector:
Health

Client:
Ophthalmology group

Date:
2017

Country:
South Africa


Genesis was contracted to evaluate the baseline cost structures and practice operations for a private healthcare group, determine whether global fees for disease management appropriately recover their costs, and to assist with pricing strategy and evaluation.

The client is a private healthcare group based in Gauteng that strives to provide high quality, cost effective eye care using a suite of cutting edge technology. 

Genesis started by conducting a full baseline audit of the practice, including assessment of services offered, patient profiles, staff time, consumables, equipment and overheads. The data were used to develop a model which evaluates potential growth strategies for the company by projecting capacity utilization, costs, revenue and profitability for different input scenarios. 

As part of their continued growth, the practice is meeting with major medical schemes to negotiate global fees for selected patient diagnoses. 

Genesis quantified potential fees, based on modelling to optimize cost savings for the medical schemes, growth for the practice, and most importantly to provide quality services and outcomes to patients.

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


Globally, there are 36.7 million people living with HIV/AIDS. Cities and urban areas are particularly affected by HIV, with the 200 cities most affected by the epidemic estimated to account for a third of the global HIV/AIDS burden. Fast-tracking HIV responses in cities is therefore crucial to ending the AIDS epidemic.

The Paris Declaration was signed by 27 cities on World AIDS Day 2014. These cities committed to prioritising their response to HIV with the goal of attaining the ambitious UNAIDS 90-90-90 targets (that is 90% of people living with HIV aware of their status, 90% of diagnosed PLHIV on ART, and 90% of PLHIV on ART with viral suppression) as well as zero discrimination and stigma targets. 

The mayor of eThekwini, who was among the signatories in Paris, committed to organising a follow-up Fast-Track Cities meeting in South Africa to support cities in formulating their own plans to meet the 90-90-90 targets. Genesis was contracted by UNAIDS to support the planning and facilitation of this meeting. UNAIDS contracted Genesis Analytics to support this meeting, through providing background support and facilitation at the meeting.

Mayors and councillors from 19 municipalities were invited to the meeting, which cover almost 50% of the people living with HIV in South Africa. Approximately 52% of new HIV infections among young women aged 15-24 years occur in these municipalities and 78% of South Africans living with HIV who are still in need of ART reside in these municipalities. In addition, 55% of AIDS related deaths in the country occur in these municipalities. Therefore, addressing the epidemic in these high-burden cities is of high priority.

The municipalities 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.

In preparation for the meeting, Genesis conducted rigorous analysis and research on the 19 municipalities to characterise each of their health profiles and better understand their different responses to the HIV epidemic. We used the data to develop informative municipal fact sheets, in partnership with each district. This collaborative approach ensured agreement on the data prior to the meeting such that discussions were evidence-informed and strategic. The fact sheets were printed as large banners at the meeting to facilitate exchange and learning. 

The meeting, attended by 80 representatives, was facilitated by Dr Saul Johnson, who balanced the competing priorities and voices of multiple stakeholders. Participants were guided in reviewing the municipal fact sheets, discussing best practices, and agreeing on indicators and targets to track progress. 

The meeting successfully built stakeholder consensus and drove the development of fast-track action plans for each municipality. The Mayors all personally committed their support and leadership to achieving these plans, eleven of whom signed the Paris Declaration to pledge this commitment. Genesis therefore effectively facilitated the alignment of municipal responses for achieving the UNAIDS 90-90-90 targets.

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

Our expertise in research, evaluation and design

Our expertise in prevention

Our expertise in health economics and financing

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

Campaign does improve men's perceptions on HIV testing

South Africans (18-34 years) who are exposed to the Testa Boy campaign are 50% more likely to agree that men who test for HIV are strong and responsible, according to a study done by Genesis Analytics for the Centre for Communication Impact.

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Project

South Africans more aware of risks of sugary drinks

Genesis was contracted to do a baseline and follow-up evaluation of the Healthy Living Alliance (HEALA) campaign “Are you drinking yourself sick?”, which was aimed at reducing sugary-drinks consumption and promoting support for the sugar tax. 

View Project

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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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