Alphoncina, health economist fighting for equitable care

Dar es Salaam. Who are these women? Why were they treated that way, and why was I treated differently? What shall we do? These are the questions she asked her lecturer on the topic of health insurance a few weeks after she resumed her classes after she was discharged.

“To answer my questions, he advised me to do some research and advise the policymakers. I had to promise myself that I would do a PhD in health economics and look into how those who cannot be covered by national health insurance can also be protected.”

This is an emerging health economist, Alphoncina Kagaigai, who works as an assistant lecturer at Muhimbili University of Health and Allied Sciences (MUHAS).

Her interest in health economics dates back to 2013 and 2014. In 2013, she had a terrible car accident, which kept her in the hospital for two months and later confined her to a wheelchair for some months after she was discharged. In 2014, she lost her unborn child.

She said that while in the maternity ward, patients were divided into two groups. Those with national health insurance had rooms equipped with two beds covered with a mosquito net. Those without insurance were put together in a big area. The common area had few beds, and the beds had no mosquito nets. Some had to share a bed, and some slept on the floor.

“The sad part was that during the night, the women in the common area, especially those who had already given birth, would come with their infants to ask if we could sleep with their newborn babies under the net to protect them from malaria,” said Alphoncina.

The challenges she encountered and observed from other patients during her treatment time made her think about what and how her family would have financed her medical bills if she had no health insurance.

Alphoncina, who holds a master’s degree in economics and a bachelor’s degree in economics and statistics from the University of Dar es Salaam, will soon defend her PhD thesis in health economics at the University of Oslo, Norway, with a project titled “Towards Universal Health Coverage: The Case of the Improved Community Health Fund (iCHF) in Rural Tanzania.”

The thesis aims to assess the effectiveness of the insurance scheme with regard to healthcare accessibility, utilisation, and exposure to catastrophic health expenditure (CHE) among rural households.

She grew up knowing there were a lot of her fellow young girls who were not as fortunate as she was to have the opportunity to pursue their dreams. This pushed her to work hard and accomplish her dreams so that she wouldn’t let down those who sacrificed for her.

As a health economist, her roles typically revolve around analysing healthcare systems, policies, and practices by applying economic principles and methodologies to understand and address the challenges facing healthcare systems, with the ultimate goal of improving health outcomes and maximising the value of healthcare resources.

Her key responsibilities include dealing with healthcare financing, where she researches different healthcare financing mechanisms such as insurance systems, out-of-pocket, public funding, and private financing.

She analyses the implications of financing structures on accessibility, equity, and efficiency. She does analysis of different healthcare interventions and provides economic opinion to the project implementers and policymakers, as well as cost-effectiveness analysis of healthcare treatments and interventions by comparing the costs of different options with their health outcomes to determine the most efficient use of resources.

Alphoncina has experience in various private and public institutions. Before joining MUHAS, she worked as a tax consultant with Ernest &Young (E&Y), as an internal auditor with the Tanzania Revenue Authority (TRA), and as an economist (performance auditor) at the National Audit Office (NAOT).

“The lesson I’ve learned from my moves from various institutions to where I am now is that we shouldn’t be scared of chasing our dreams because we don’t know what is ahead of us. Take courage and move forward, but also be flexible,” she said.

Being adaptable and open to change is crucial when moving to various work environments, whether in private or public institutions. Another important lesson is continuous learning and growth, she added.

Apart from being a lecturer, she is also involved in research and consultancy activities. Her research interests revolve around healthcare financing, economic evaluation of healthcare intervention programmes, health systems, mental health, gender, and behavioural economics research, which uses behavioural nudges to change human behaviour.

She has also developed an interest in conducting impact evaluation research to evaluate the impact of projects related to the Productive Social Safety Net (PSSN) implemented by the Tanzania Social Action Fund (TASAF).

This enables the majority of poor women to learn how to set goals, manage to save the little they receive from TASAF, and establish economic activities of their choice, she said.

When asked how she promotes gender equality using her position at MUHAS, she said she takes different initiatives, including conducting research, incorporating gender perspectives into her teachings, and encouraging discussions on gender issues in classrooms and academic settings. She also mentors and supports students and early-career researchers at my institution, especially in the field of health economics.

Commenting on why we need women’s representation in the health economics industry, she said it will help to promote gender equality and advance the field through diverse perspectives and expertise, leading to better decision-making and more effective policies.

Addressing gender-specific health issues is important as women often face specific health challenges that may not be adequately addressed without representation in the health economics field. Issues such as reproductive health, maternal health, and gender-based disparities in access to healthcare require attention from researchers who understand the nuances of these issues.

For women who wish to be like her, they have to actively seek education and training opportunities in health economics or their fields of interest. Doing the right thing at the right time.

They appreciate the opportunities they get because there are girls and women out there who wish they could have that opportunity. And finally, every minute counts in our lives, so they should not waste time, added Alphoncina.