R4D Health

Outreach strategies for expanding health insurance coverage in children (Protocol)

Wed, 16 May 2012 08:28 GMT

Document Type: Journal Article
Creator: Meng, Q.; Yuan, B.; Jia, L.; Wang, J.; Garner, P.

Production Year: 2010

Citation: Meng, Q.; Yuan, B.; Jia, L.; Wang, J.; Garner, P. Outreach strategies for expanding health insurance coverage in children (Protocol). Cochrane Database of Systematic Reviews (2010) (1) [DOI: 10.1002/14651858.CD008194]

Summary: This is the protocol for a review which had the following objectives: to assess the effectiveness of outreach strategies for expanding insurance coverage of children who are eligible for health insurance schemes.

Health workforce responses to global health initiatives funding: a comparison of Malawi and Zambia

Wed, 16 May 2012 07:22 GMT

Document Type: Journal Article
Creator: Brugha, R.; Kadzndira, J.; Simbaya, J.; Dicker, P.; Mwapasa, V.; Walsh, A.

Production Year: 2010

Citation: Brugha, R.; Kadzndira, J.; Simbaya, J.; Dicker, P.; Mwapasa, V.; Walsh, A. Health workforce responses to global health initiatives funding: a comparison of Malawi and Zambia. Human Resources for Health (2010) 8 (1) 19. [DOI: 10.1186/1478-4491-8-19]

Summary: Background
Shortages of health workers are obstacles to utilising global health initiative (GHI) funds effectively in Africa. This paper reports and analyses two countries' health workforce responses during a period of large increases in GHI funds.
Methods
Health facility record reviews were conducted in 52 facilities in Malawi and 39 facilities in Zambia in 2006/07 and 2008; quarterly totals from the last quarter of 2005 to the first quarter of 2008 inclusive in Malawi; and annual totals for 2004 to 2007 inclusive in Zambia. Topic-guided interviews were conducted with facility and district managers in both countries, and with health workers in Malawi.
Results
Facility data confirm significant scale-up in HIV/AIDS service delivery in both countries. In Malawi, this was supported by a large increase in lower trained cadres and only a modest increase in clinical staff numbers. Routine outpatient workload fell in urban facilities, in rural health centres and in facilities not providing antiretroviral treatment (ART), while it increased at district hospitals and in facilities providing ART. In Zambia, total staff and clinical staff numbers stagnated between 2004 and 2007. In rural areas, outpatient workload, which was higher than at urban facilities, increased further. Key informants described the effects of increased workloads in both countries and attributed staff migration from public health facilities to non-government facilities in Zambia to PEPFAR.
Conclusions
Malawi, which received large levels of GHI funding from only the Global Fund, managed to increase facility staff across all levels of the health system: urban, district and rural health facilities, supported by task-shifting to lower trained staff. The more complex GHI arena in Zambia, where both Global Fund and PEPFAR provided large levels of support, may have undermined a coordinated national workforce response to addressing health worker shortages, leading to a less effective response in rural areas.

A checklist for health research priority setting: nine common themes of good practice

Wed, 16 May 2012 07:02 GMT

Document Type: Journal Article
Creator: Viergever, R.F.; Olifson, S.; Ghaffar, A.; Terry, R.F.

Production Year: 2010

Citation: Viergever, R.F.; Olifson, S.; Ghaffar, A.; Terry, R.F. A checklist for health research priority setting: nine common themes of good practice. Health Research Policy and Systems (2010) 8: 36. [DOI: 10.1186/1478-4505-8-36]

Summary: Health research priority setting processes assist researchers and policymakers in effectively targeting research that has the greatest potential public health benefit. Many different approaches to health research prioritization exist, but there is no agreement on what might constitute best practice. Moreover, because of the many different contexts for which priorities can be set, attempting to produce one best practice is in fact not appropriate, as the optimal approach varies per exercise. Therefore, following a literature review and an analysis of health research priority setting exercises that were organized or coordinated by the World Health Organization since 2005, we propose a checklist for health research priority setting that allows for informed choices on different approaches and outlines nine common themes of good practice. It is intended to provide generic assistance for planning health research prioritization processes. The checklist explains what needs to be clarified in order to establish the context for which priorities are set; it reviews available approaches to health research priority setting; it offers discussions on stakeholder participation and information gathering; it sets out options for use of criteria and different methods for deciding upon priorities; and it emphasizes the importance of well-planned implementation, evaluation and transparency.

ELLA Policy Brief: Improving Health and Education Through CCTs.

Wed, 16 May 2012 05:02 GMT

Document Type: Briefing
Creator: Jaramillo, M.

Production Year: 2011

Citation: Jaramillo, M. ELLA Policy Brief: Improving Health and Education Through CCTs. ELLA, Practical Action Consulting, Lima, Peru (2011) 5 pp.

Summary:

One of the worst characteristics of poverty is its tendency to self-perpetuate, with poor families often being forced to under-invest in their children's health and education. In Latin America, Conditional Cash Transfer (CCT) programmes have been effective in ensuring higher school attendance and greater health services use, both of which are valuable inputs for human capital development and future productivity. However, CCT evaluations have had a harder time identifying effects on health and education impacts. This brief describes how Latin American countries have used CCTs to improve health and education, the results achieved, and lessons learned for improving health and education in other settings.

Key Lessons:

CCTs have proven to be effective in increasing school attendance and access to health services.
However, it has been more difficult to identify improvements in education and health outcomes and long-term impacts.
Supply side interventions are important to assure that increasing service use has an impact on education and health outcomes.

Use of the Environmental Impact Quotient to Estimate Health and Environmental Impacts of Pesticide Usage in Peruvian and Ecuadorian Potato Production

Wed, 16 May 2012 04:56 GMT

Document Type: Journal Article
Creator: Kromann, P.; Pradel, W.; Cole, D.; Taipe, A.; Forbes, G.A.

Production Year: 2011

Citation: Kromann, P.; Pradel, W.; Cole, D.; Taipe, A.; Forbes, G.A. Use of the Environmental Impact Quotient to Estimate Health and Environmental Impacts of Pesticide Usage in Peruvian and Ecuadorian Potato Production. Journal of Environmental Protection (2011) 02 (05) 581-591. [DOI: 10.4236/jep.2011.25067]

Summary: Currently there is no effective mechanism for measuring the potential benefits of integrated pest and disease interventions in terms of reducing pesticide risks in potato production in developing countries. The environmental impact quotient (EIQ), a composite hazard indicator, was applied to data from potato field trials implemented in Ecuador to evaluate the practical boundaries of this metric related to potato production practices in the Andes. The EIQ was also applied to data from two independent farmer surveys, one from Peru and one from Ecuador to compare potato farming practices and the utility of the EIQ when applied to existing survey data. In the Ecuadorian field trials, the EIQ values, i.e., environmental impact (EI) per ha, varied greatly among the different potato systems tested and ranged from 40 for an integrated pest management system (resistant cultivar plus less hazardous pesticides) to 1235 for a high-input conventional system (susceptible cultivar plus frequent use of hazardous pesticides). Thus, this parameter demonstrates substantial variation under different conditions and different crop management approaches. EI per ha values from the two surveys fell within the range found in the field trial, but in the survey values were toward the lower end, ranging from 64 to 213. Methodical and biophysical factors are discussed that may account for the relatively low EI per ha found in the field survey data. Our study demonstrates the utility of the EIQ for assessing health and environmental hazards of potato production in the Andes and potentially other areas in the developing world. Nonetheless, there are limitations to the EIQ as presently used and care is needed in the interpretation of results. We see our work as an initial step in the development of an integrated metric to estimate environmental and human health hazards related to pesticide use in potato production in the diverse conditions of developing countries.

Climate change and plant health.

Wed, 16 May 2012 02:40 GMT

Document Type: Journal Article
Creator: Hoeschle-Zeledon, I.

Production Year: 2011

Citation: Hoeschle-Zeledon, I. Climate change and plant health. R4D Review (2011) 6: 6-11.

Summary: CGIAR research on climate change and crop health is outlined.

Making health markets work better for poor people: the case of informal providers

Tue, 15 May 2012 03:46 GMT

Document Type: Journal Article
Creator: Bloom, G.; Standing, H.; Lucas, H.; Bhuiya, A.; Oladepo, O.; Peters, D.H.

Production Year: 2011

Citation: Bloom, G.; Standing, H.; Lucas, H.; Bhuiya, A.; Oladepo, O.; Peters, D.H. Making health markets work better for poor people: the case of informal providers. Health Policy and Planning (2011) 26 (Suppl. 1) i45-i52. [DOI: 10.1093/heapol/czr025]

Summary: There has been a dramatic spread of market relationships in many low- and middle-income countries. This spread has been much faster than the development of the institutional arrangements to influence the performance of health service providers. In many countries poor people obtain a large proportion of their outpatient medical care and drugs from informal providers working outside a regulatory framework, with deleterious consequences in terms of the safety and efficacy of treatment and its cost. Interventions that focus only on improving the knowledge of these providers have had limited impact. There is a considerable amount of experience in other sectors with interventions for improving the performance of markets that poor people use. This paper applies lessons from this experience to the issue of informal providers, drawing on the findings of studies in Bangladesh and Nigeria. These studies analyse the markets for informal health care services in terms of the sources of health-related knowledge for the providers, the livelihood strategies of these providers and the institutional arrangements within which they build and maintain their reputation. The paper concludes that there is a need to build a systematic understanding of these markets to support collaboration between key actors in building institutional arrangements that provide incentives for better performance.

Understanding the incremental cost of increasing access to maternal health care services: Perspectives from a Voucher Scheme in Eastern Uganda

Tue, 15 May 2012 03:30 GMT

Document Type: PowerPoint Presentation
Creator: Mayora, C.; Ekirapa-Kiracho, E.; Ssengooba, F.; Baine, S.O.; Okui, O.

Production Year: 2011

Citation: Mayora, C.; Ekirapa-Kiracho, E.; Ssengooba, F.; Baine, S.O.; Okui, O. Understanding the incremental cost of increasing access to maternal health care services: Perspectives from a Voucher Scheme in Eastern Uganda. Presented at iHEA's 8th World Congress on Health Economics, Toronto, Canada, 11 July 2011. (2011) 19 pp.

Summary: Chrispus Mayora of the Makerere University School of Public Health looks at the incremental costs of implementing a voucher scheme for ante-natal, delivery and post-natal care in several districts in Uganda.

Comparison of trust in public vs private health care providers in rural Cambodia

Tue, 15 May 2012 02:16 GMT

Document Type: Journal Article
Creator: Ozawa, S.; Walker, D.G.

Production Year: 2011

Citation: Ozawa, S.; Walker, D.G. Comparison of trust in public vs private health care providers in rural Cambodia. Health Policy and Planning (2011) 26 (Suppl. 1) i20-i29. [DOI: 10.1093/heapol/czr045]

Summary: How trust in providers affects health care-seeking behaviour is not well understood. Focus groups and household surveys were conducted in Cambodia to examine how villagers describe their trust in public and private providers, and to assess whether a difference exists in provider trust levels. Our findings suggest the reasons for trusting public and private providers differ, and that villagers’ trust in and relationship with providers is one of the important considerations affecting where they seek care. People believed that public providers were ‘honest’ and ‘sincere’, did not ‘bad mouth people’ and explained the ‘status of [the] disease’. Villagers trusted public providers for their skills and abilities, and for an effective referral system. In contrast, respondents noted that seeing private providers was ‘comfortable and easy’, that they ‘come to our home’ and patients can ‘owe [them] some money’. Private providers were trusted for being very friendly and approachable, extremely thorough and careful, and easy to contact. Among those who sought care in the past 30 days, trust in the health care provider was listed as the fifth and second most important consideration for choosing public or private providers, respectively. This study illustrates the importance of trust as a unique concept that can affect people’s choice of health care providers in a low-income country.

Exploring new health markets: experiences from informal providers of transport for maternal health services in Eastern Uganda

Tue, 15 May 2012 01:57 GMT

Document Type: Journal Article
Creator: Pariyo, G.W.; Mayora, C.; Okui, O.; Ssengooba, F.; Peters, D.H.; Serwadda, D.; Lucas, H.; Bloom, G.; Rahman, M.H.; Ekirapa-Kiracho, E.

Production Year: 2011

Citation: Pariyo, G.W.; Mayora, C.; Okui, O.; Ssengooba, F.; Peters, D.H.; Serwadda, D.; Lucas, H.; Bloom, G.; Rahman, M.H.; Ekirapa-Kiracho, E. Exploring new health markets: experiences from informal providers of transport for maternal health services in Eastern Uganda. BMC International Health and Human Rights (2011) 11 (Suppl 1) S10. [DOI: 10.1186/1472-698X-11-S1-S10]

Summary: Background Although a number of intermediate transport initiatives have been used in some developing countries, available evidence reveals a dearth of local knowledge on the effect of these rural informal transport mechanisms on access to maternal health care services, the cost of implementing such schemes and their scalability. This paper, attempts to provide insights into the functioning of the informal transport markets in facilitating access to maternal health care. It also demonstrates the role that higher institutions of learning can play in designing projects that can increase the utilization of maternal health services.

Objectives To explore the use of intermediate transport mechanisms to improve access to maternal health services, with emphasis on the benefits and unintended consequences of the transport scheme, as well as challenges in the implementation of the scheme.

Methods This paper is based on the pilot phase to inform a quasi experimental study aimed at increasing access to maternal health services using demand and supply side incentives. The data collection for this paper included qualitative and quantitative methods that included focus group interviews, review of project documents and facility level data.

Results There was a marked increase in attendance of antenatal, and delivery care services, with the contracted transporters playing a leading role in mobilizing mothers to attend services. The project also had economic spill-over effects to the transport providers, their families and community generally. However, some challenges were faced including difficulty in setting prices for paying transporters, and poor enforcement of existing traffic regulations.

Conclusions and implications The findings indicate that locally existing resources such as motorcycle riders, also known as “boda boda” can be used innovatively to reduce challenges caused by geographical inaccessibility and a poor transport network with resultant increases in the utilization of maternal health services. However, care must be taken to mobilize the resources needed and to ensure that there is enforcement of laws that will ensure the safety of clients and the transport providers themselves.