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.

Behavioural sciences

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, costing and economics

Sustainable financing and the achievement of value for money in health interventions are increasingly recognised as key pillars in achieving the sustainable development goals for health and universal healthcare. At a time when many countries face large cuts to donor funding and competing demands for domestic resources, we provide technical support to decision makers in navigating this new reality.

Our team draws on multi-disciplinary skills in public financial management, health finance, costing, efficiency studies and other economic analyses, to inform health-financing policies, help build resilient health systems and public financial-management capacities, leading to improved healthcare in the region.

Health systems strengthening

Through user-centred design and collaborative approaches, our team works to build capacity and empower system users to carry out their work.

We consider the principles of organisational and behaviour change to institutionalise desired behaviours among users – from clients to healthcare professionals to the broader public.

Our technical support is tailored to meet the local needs of users thereby addressing critical gaps in capacity.

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

Evaluating NHI Phase 1 implementation for National Department of Health

Project name:
Evaluation of Phase 1 implementation of National Health Insurance (NHI) interventions in the NHI pilot districts in South Africa

Service:
Research, evaluation and design
Health systems strengthening

Sector:
Health
Public and Social

Client:
South African National Department of Health

Date:
2017 - 2019

Country:
South Africa


South Africa faces numerous challenges in delivering high quality health services to the majority of its population.

The National Development Plan (NDP) 2030 indicates that the country should deal with the expensive cost of private healthcare and address the problems of quality of public healthcare to ensure Universal Health Care (UHC). UHC is being pursued in South Africa through the government’s policy of National Health Insurance (NHI).

According to the NHI policy, the implementation of NHI would happen in three phases. Phase 1 primarily focused on preparing primary health care (PHC) for NHI through the introduction of health system strengthening (HSS) interventions in 10 NHI pilot districts across the country. Implementation of Phase 1 began in 2012 and came to an end in 2017.

We undertook the evaluation of the NHI Phase 1 implementation in South Africa. The main aim was to assess whether the NHI Phase 1 interventions had achieved their objective of HSS in PHC facilities. Furthermore, the evaluation aimed to identify lessons learnt from Phase 1 in an attempt to sustain and scale up interventions in the future.

We completed secondary data analysis in the form of two literature reviews. The first assessed the implementation of NHI in other low-to-middle income countries to identify lessons that can be learnt by South Africa. The second review summarised previous NHI annual assessments. This review was used to identify gaps in implementation to date and to develop tools for primary data collection.

Primary data collection was completed at national, provincial, district and facility levels. We visited the 10 NHI pilot districts and key stakeholders were interviewed to gain insight to the successes, challenges and lessons learnt from Phase1 implementation.

In parallel, we analysed the quantitative data from the District Health Information System (DHIS) to assess the performance of the NHI indicators in PHC in the last five years. We compiled an in-depth evaluation report which highlighted both the successes and challenges of NHI phase 1 implementation and made recommendations for future planning and implementation, to support the National Department of Health (NDOH) as it transitioned into phase 2 implementation.

The evaluation findings and recommendations were presented in Cape Town, in November 2018, to the then Minister of Health, Dr Aaron Motsoaledi.

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:
Behavioural Science

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 

Genesis counts cost of lifestyle diseases for Gauteng government

Project name:
Burden of lifestyle diseases on the public health sector in Gauteng

Service:
Behavioural Science

Sector:
Health
Public and Social

Client:
Gauteng Office of the Premier, Planning Division

Date:
2018

Country:
South Africa


Non-communicable diseases (NCDs) of lifestyle are becoming the leading cause of death in most regions of the world.

South Africa faces a quadruple burden of disease: the HIV/AIDS epidemic paired with a high burden of TB, high rates of maternal and child mortality, high levels of violence and injuries, and a growing burden of NCDs. NCDs are disproportionately affecting poor people living in urban settings. The NCDs drive a rising demand for chronic-disease care and pose an increasing burden on the health system.

The Gauteng Office of the Premier’s Planning Division contracted Genesis Analytics to determine the health and financial effects of NCDs on Gauteng’s health system for 2017-2030 and to recommend policies and best practices to address the growing burden in Gauteng.

Genesis developed a model to project the size and profile of the Gauteng population, prevalence of the selected risk factors and NCDs, and costs borne by the Gauteng public health system.

Our projections show that by 2030 the number of NCD cases in Gauteng will increase by 42% to 4.5 million. There will be high levels of morbidity (2.1 million disability-adjusted life years) and mortality (65 700 deaths) because of NCDs.

This high burden has significant associated costs. NCDs account for nearly 40% of healthcare spending in Gauteng. This spending will lead to a 39% increase over 13 years to R19.2 billion in 2030, without adjusting for inflation. The projected NCD costs are expected to outpace Gauteng Department of Health budget increases.

Genesis prioritised a number of “best buys” (according to the World Health Organisation) to address the health and financial burden in Gauteng, which would bolster the efforts of the National Department of Health. Specifically the province should invest in mass-media campaigns to promote behaviour change and awareness of a healthy diet and physical activity.

This is a cost-effective intervention and the upfront investment will ultimately result in long-term savings and benefits for the province. For NCDs Gauteng needs to develop well-prioritised, efficient and effective treatment and rehabilitation services for chronic-disease care.

Sexual and reproductive services will improve health of SA's youth

Project name:
The Understandibility, Accessibility and Acceptability of the Provisions of Sexual and Reproductive Health Services in Schools in South Africa

Sector:
Health
Education
Public and Social
Africa’s youth wave

Area of Expertise:
Behavioural sciences

Client:
Department of Basic Education (funded by Bill & Melinda Gates Foundation (BMGF) United Nations Population Fund (UNFPA))

Date:
2018 - 2019

Country:
South Africa


Access to sexual and reproductive (SRH) services, including contraceptives, HIV testing and counselling, pregnancy testing and family planning are desirable in schools as youth have limited information and access to these services and products.

Genesis Analytics supported the Department of Basic Education (DBE) to investigate the understanding, accessibility and acceptability of providing sexual and reproductive health (SRH) services to boys and girls attending school in South Africa.

Our team undertook discussions with school leaners to understand what their SRH needs were and how best to deliver these services and products that would encourage their appropriate use among learners.

We also conducted interviews with teachers and discussions with parents to understand what was acceptable and feasible in terms of making these services and products available at schools.

The research findings were presented at multiple platforms to the DBE, donor groups such as the Gates Foundation and UNFPA, as well as to life orientation officials.

We used the results to workshop models of service delivery with NGOs, donor groups, broader government departments and academic institutions. The models consider the realities of learners in both rural and urban areas, and the roles that both government and NGOs play in making vital SRH services and products available to the South African youth.

A rapid decline in fertility, investment in family planning, improved child survival and educating girls allows young people to contribute meaningfully to South Africa’s economy. By improving the sexual and reproductive health outcomes of our youth, South Africa can take full advantage of its demographic dividend.

Raising the drinking age to 21: Pros and cons

Project name:
Evaluating the economic, health and social impacts of the proposed Liquor Amendment Bill, 2017

Service:
Economic impact assessment
Shared value and corporate impact
Regulatory economics and accounting

Sector:
Health
Manufacturing
Public and Social

Area of Expertise:
Socio-economic and regulatory impact assessment
Corporate impact
Financial modelling
Impact of regulatory decisions

Client:
National Economic Development and Labour Council (NEDLAC)

Date:
2017

Country:
South Africa


Most South Africans do not drink alcohol yet the consumption per capita is extremely high by international standards. In other words, those who do drink, drink to excess. Binge drinking is typical and levels of youth drinking are also high.

Based on this, government (led by the Department of Trade and Industry and supported by the Department of Health) proposed amendments to the national Liquor Act, 2003, including:

  • Raising the legal drinking age from 18 to 21;
  • Banning alcohol advertising;
  • Introducing vicarious liability for manufacturers, distributors and retailers of alcohol.

Genesis was asked by the National Economic and Development Labour Council (NEDLAC) to conduct an independent study on the likely economic, health and social impacts of proposals.

The team produced the most comprehensive review to date of the alcohol industry and of alcoholic consumption patterns. It found that South Africa faced four main challenges.

First, while most South Africans do not drink those who do, drink to excess - thus heavy binge drinking is a big challenge.

Second, there is a worryingly early uptake of alcohol by children and high levels of binge drinking by teens and young people. This is particularly dangerous for the cognitive development of the brain, which is only complete at 24.

Third, much hazardous drinking occurs in the large unlicensed sector.

Finally, we found evidence that existing liquor laws are poorly enforced.

Using seven approaches to estimate impact, we found that the proposals would reduce consumption of between 3.2% and 7.4%. This was also in line with the views of the major alcohol companies.

The proposals will help to bring down levels of hazardous drinking over time, slow the uptake of drinking by young people and create public health savings of up to R1.9 billion a year. We also estimated that about 185 lives a year would be saved from alcohol-related traffic fatalities.

We further estimated that the alcohol industry would create fewer jobs (between 645 and 1 500 fewer jobs in the next 10 years). The advertising industry would lose about R400 million (about 1% of its current revenue), and the media would lose about R800 million in revenue. Hardest hit would be SABC, e.tv and Multichoice.

Moreover, advertising spending by the bigger liquor companies will move from above-the-line to below-the-line marketing like store promotions, events, and competitions. This would crowd out smaller firms that tend to use below-the-line marketing, which would negatively affect competition in the alcohol industry.

Genesis’s technical inputs across three practices produced a rigorous, independent and objective study that provided the social partners and the government with facts and evidence to further debate the merits of the amendments.

Genesis’s report provides a full and balanced view of the pros and cons, in line with our company purpose to help leaders make better decisions, fairly and fully informed.

Why Nedlac wants a new study to quantify cost of liquor

Government wants to ban liquor ads

Full report

GENESIS CO-MANAGES UNAIDS TECHNICAL SUPPORT MECHANISM

Project name:
Technical Support Mechanism

Service:
Health systems strengthening

Sector:
Health
Public and Social

Area of Expertise:
HIV prevention
Project management
Monitoring and evaluation

Client:
UNAIDS

Date:
2018 - ongoing

Country:
Angola
Botswana
Burundi
Kenya
Lesotho
Malawi
Mozambique
Namibia
Rwanda
South Africa
Swaziland
Tanzania
Uganda
Zambia
Zimbabwe


The Joint United Nations Programme on HIV and AIDS (UNAIDS) has established the Technical Support Mechanism (TSM), a project meant to support the provision of high-quality technical assistance in three regions, namely the East and Southern Africa (ESA), Asia-Pacific (AP), and West and Central Africa (WCA). The TSM is set up to be adaptable and responsive to country needs to accelerate progress toward achieving the Fast-Track targets and the goals of the 2016 Political Declaration on HIV and AIDS.

Genesis Analytics, as part of the Oxford Policy Management-led consortium, is tasked with managing all TSM operations in the East and Southern Africa region. Through the use of quality assured regional and national consultants, countries are assisted with developing evidence-informed HIV national strategic plans and HIV prevention plans aligned with UNAIDS 90-90-90 targets. They develop funding requests to the Global Fund, streamline the grant-making process, and improve Global Fund grant implementation as well as ensure the sustainability of interventions and programmes.

HIV prevention has been noted by UNAIDS as a priority because the HIV incidence, particularly in Sub-Saharan Africa, has been difficult to reduce. Genesis Analytics has been tasked to lead the HIV prevention thematic area and work closely with the UNAIDS secretariat to devise strategies that are country adaptable, efficient, impactful and sustainable.

Showing value for money and impact is key for UNAIDS, making the TSM project’s monitoring and evaluation a crucial aspect. Genesis Analytics developed the TSM’s results framework and a related theory of change (ToC) through to the impact result level. The Genesis Analytics team continues to implement the monitoring and evaluation plan by undertaking data reviews monthly to check quality and completeness, and to flag any problems with implementing the project.

Estimating cost of expanding community-based malaria control

Project name:
Estimating the cost of expanding community-based case management for malaria control

Service:
Health financing, costing and economics

Sector:
Health

Client:
Elimination 8

Date:
2018 - 2019

Country:
Angola


Genesis calculated the incremental cost of implementing and scaling-up community-based interventions in southern Angola to reduce the spread of malaria to neighbouring countries.

This donor-supported initiative aims to reduce the transmission of malaria across borders. It plans to do so through intensive community-based case management and the wide distribution of long-lasting insecticidal nets.

Elimination Eight, representing eight neighbouring countries, coordinates interventions that are being implemented by PSI and World Vision in Angola.

As part of a bigger study, Genesis was responsible for estimating the incremental cost of expanding case-management activities to other districts. This costing exercise required the re-coding and analysis of the implementing agent’s general ledger to facilitate an allocation of incremental expenditure to both cost categories and pre-defined activities. In-kind contributions were also analysed.

Stakeholders and implementers were interviewed with a customised interview tool translated into the local language. The analysis provided valuable insights into the key cost drivers and identified the significant loss of time recorded by community activists travelling between villages and the potential for significantly increased supervision costs in deep rural settings.

These findings will inform the planning for the expansion of interventions to other districts.

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:
Behavioural Science

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. 

We analysed the results from the baseline survey using descriptive analysis to quantify the sociodemographic characteristics, sugary drinks consumption patterns, knowledge and attitudes towards sugary drinks, level of support for advocacy to reduce consumption of sugary drinks, health status as well as recall of messages/ads of sugary drinks. At endline, we performed bivariate and multivariate analysis in STATA to analyse the impact of the campaign on intention and actual reduction in consumption of sugary drinks.

Our evaluation at endline showed an increase (90%) in the identification of sugary drinks as one of the biggest contributes to obesity and there was stronger belief that sugary drinks increase the risk of diseases such as diabetes and high blood pressure compared to baseline. 

We also found that there was strong support for the government to be involved in reducing the impact of sugary drinks on health which included implementing the sugar tax. The support for the sugar tax increased by 16% since baseline. 

The increased support for the sugar tax campaign was strongly associated with exposure to the campaign, with those who were exposed to the campaign being 37% more likely to support the idea of a sugar tax. 

The findings from the evaluation have been used to inform the implementation of the sugar tax law in South Africa and has demonstrated the importance for policy makers to adopt policies that encourage healthy lifestyles.

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

Scaling up male circumcision in SA to prevent HIV infections

Project name:
Medical Male Circumcision (MMC) Sustain

Service:
Health systems strengthening

Sector:
Health
Public and Social

Client:
Bill & Melinda Gates Foundation

Date:
2018 - 2021

Country:
South Africa


South Africa has the world’s largest HIV epidemic with an estimated seven million people living with HIV and more than 380,000 new HIV infections each year. Medical male circumcision (MMC) has been identified as a key HIV prevention intervention for South Africa as it reduces the risk of female to male HIV transmission by approximately 60%.

In 2010, the South African National Department of Health (NDOH) began implementing a plan to medically circumcise men between the ages 15-49. By 2019, the national MMC programme has achieved extraordinary scale having circumcised close to 3.8 million men.

MMC SUSTAIN (Medical Male Circumcision Scale Up and Sustainability to Avert New HIV Infections) is a three-year investment from Bill & Melinda Gates Foundation (BMGF). The grant was awarded to MMC SUSTAIN, comprising Genesis Analytics and the Foundation for Professional Development (FPD) in September 2018. The strategic goal is to go beyond scaling up the national MMC programme and transitioning toward sustainability of MMC in South Africa. The MMC SUSTAIN team is providing technical assistance to the South African national MMC programme to build resilient local systems that successfully plan, effectively manage, and efficiently execute the programme at scale.

Our team provides technical assistance to the South African National MMC programme. We design and implement behaviourally informed interventions to understand the causes of, and solutions to, existing low levels of ownership, motivation and capacity across the programme. Interventions will aim to:

  • Improve integration of the MMC programme across public health services;
  • Encourage positive feedback processes;
  • Increase adherence to quality assurance and data reporting processes;
  • Improve planning and management.

By incorporating social/non-financial incentives into the performance management, we can improve motivation of the programme staff.

Our support for the MMC national programme will focus on technical assistance in eight districts across three provinces, namely KwaZulu-Natal (eThekwini, Amajuba, iLembe, uMgungundlovu), Mpumalanga (Gert Sibande), and Gauteng (City of Johannesburg, West Rand and Ekurhuleni).

Behavioural economics is effective at driving behaviour change

We provide support for govt plan of 2,5m male circumcisions by 2022

Pricing study for private eye care practice

Project name:
Costing model for private healthcare group

Service:
Health financing, costing and 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.

Meet the Team

Areas of Service Expertise

  • Research, evaluation and design
  • Health financing, costing and economics
  • Health systems strengthening
  • Competition economics

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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Projects

Project

Evaluating NHI Phase 1 implementation for National Department of Health

Genesis undertook the evaluation of the Phase 1 implementation of the government’s policy of National Health Insurance (NHI) in South Africa. The main aim was to assess whether the NHI Phase 1 interventions had achieved their objective of health system strengthening in primary health care facilities. It also aimed to identify lessons learnt from Phase 1 in an attempt to sustain and scale up interventions in the future.

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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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Leading the team

Saul Johnson

Partner (Health)

Saul Johnson
Partner (Health)
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​Sarah Magni

Principal

​Sarah Magni
Principal
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Steve Cohen

Principal

Steve Cohen
Principal
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Ntabozuko Dwane

Manager

Ntabozuko Dwane
Manager
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Carl Schütte

Associate Principal

Carl Schütte
Associate Principal
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Lisa Mulenga

Programme Director (MMC)

Lisa Mulenga
Programme Director (MMC)
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Neil Lightfoot

Partner (Applied Behavioural Economics)

Neil Lightfoot
Partner (Applied Behavioural Economics)
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