scholarly journals Out-of-Pocket Expenditures on Health: A Global Stocktake

2020 ◽  
Vol 35 (2) ◽  
pp. 123-157 ◽  
Author(s):  
Adam Wagstaff ◽  
Patrick Eozenou ◽  
Marc Smitz
Keyword(s):  
Health System ◽  
Low Income ◽  
Poverty Line ◽  
Low Income Countries ◽  
Two Measures ◽  
Per Capita ◽  
Summary Measures ◽  
The Rich ◽  
Catastrophic Expenditures ◽  
Highly Correlated

Abstract This paper provides an overview of research on out-of-pocket health expenditures by reviewing the various summary measures and the results of multi-country studies using these measures. The paper presents estimates for 146 countries from all World Bank income groups for all summary measures, along with correlations between the summary measures and macroeconomic and health system indicators. Large differences emerge across countries in per capita out-of-pocket expenditures in 2011 international dollars, driven in large part by differences in per capita income and the share of GDP spent on health. The two measures of dispersion or risk—the coefficient of variation and Q90/Q50—are only weakly correlated across countries and not explained by our macroeconomic and health system indicators. Considerable variation emerges in the out-of-pocket health expenditure budget share, which is highly correlated with the incidence of “catastrophic expenditures”. Out-of-pocket expenditures tend to be regressive and catastrophic expenditures tend to be concentrated among the poor when expenditures are assessed relative to income, while expenditures tend to be progressive and catastrophic expenditures tend to be concentrated among the rich when expenditures are assessed relative to consumption. At the extreme poverty line of $1.90-a-day, most impoverishment due to out-of-pocket expenditures occurs among low-income countries.

scholarly journals Immigration and economic mobility

2021 ◽  
Author(s):  
Maria F. Hoen ◽  
Simen Markussen ◽  
Knut Røed
Keyword(s):  
Labor Market ◽  
Low Income ◽  
Labor Market Outcomes ◽  
Lower Class ◽  
Low Income Countries ◽  
Market Outcomes ◽  
Wide Range ◽  
Class Background ◽  
The Rich ◽  
Relative Prime

AbstractWe examine how immigration affects natives’ relative prime-age labor market outcomes by economic class background, with class background established on the basis of parents’ earnings rank. Exploiting alternative sources of variation in immigration patterns across time and space, we find that immigration from low-income countries reduces intergenerational mobility and thus steepens the social gradient in natives’ labor market outcomes, whereas immigration from high-income countries levels it. These findings are robust with respect to a wide range of identifying assumptions. The analysis is based on high-quality population-wide administrative data from Norway, which is one of the rich-world countries with the most rapid rise in the immigrant population share over the past two decades. Our findings suggest that immigration can explain a considerable part of the observed relative decline in economic performance among natives with a lower-class background.

scholarly journals Using Facebook Ad Data to Track the Global Digital Gender Gap

2018 ◽  
Author(s):  
Masoomali Fatehkia ◽  
Ridhi Kashyap ◽  
Ingmar Weber
Keyword(s):  
Mobile Phone ◽  
Gender Gap ◽  
Low Income ◽  
Low Income Countries ◽  
Gender Gaps ◽  
Mobile Access ◽  
Country Level ◽  
Highly Correlated ◽  
And Gender ◽  
Official Data

Gender equality in access to the internet and mobile phones has become increasingly recognised as a development goal. Monitoring progress towards this goal however is challenging due to the limited availability of gender-disaggregated data, particularly in low-income countries. In this data sparse context, we examine the potential of a source of digital trace `big data' -- Facebook's advertisement audience estimates -- that provides aggregate data on Facebook users by demographic characteristics covering the platform's over 2 billion users to measure and `nowcast' digital gender gaps. We generate a unique country-level dataset combining `online' indicators of Facebook users by gender, age and device type, `offline' indicators related to a country's overall development and gender gaps, and official data on gender gaps in internet and mobile access where available. Using this dataset, we predict internet and mobile phone gender gaps from official data using online indicators, as well as online and offline indicators. We find that the online Facebook gender gap indicators are highly correlated with official statistics on internet and mobile phone gender gaps. For internet gender gaps, models using Facebook data do better than those using offline indicators alone. Models combining online and offline variables however have the highest predictive power. Our approach demonstrates the feasibility of using Facebook data for real-time tracking of digital gender gaps. It enables us to improve geographical coverage for an important development indicator, with the biggest gains made for low-income countries for which existing data are most limited.

‘It makes you someone who changes with the times’: health worker and client perspectives on a smartphone-based counselling application deployed in rural Tanzania

2019 ◽  
Vol 34 (4) ◽  
pp. 307-315 ◽  
Author(s):  
Kristy Hackett ◽  
Mina Kazemi ◽  
Curtis Lafleur ◽  
Peter Nyella ◽  
Lawelu Godfrey ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Health System ◽  
Data Management ◽  
Low Income ◽  
Community Intervention ◽  
Health Workers ◽  
Low Income Countries ◽  
Maternal And Newborn Health ◽  
Pregnancy And Childbirth

AbstractMobile health (mHealth) applications have been developed for community health workers (CHW) to help simplify tasks, enhance service delivery and promote healthy behaviours. These strategies hold promise, particularly for support of pregnancy and childbirth in low-income countries (LIC), but their design and implementation must incorporate CHW clients’ perspectives to be effective and sustainable. Few studies examine how mHealth influences client and supervisor perceptions of CHW performance and quality of care in LIC. This study was embedded within a larger cluster-randomized, community intervention trial in Singida, Tanzania. CHW in intervention areas were trained to use a smartphone application designed to improve data management, patient tracking and delivery of health messages during prenatal counselling visits with women clients. Qualitative data collected through focus groups and in-depth interviews illustrated mostly positive perceptions of smartphone-assisted counselling among clients and supervisors including: increased quality of care; and improved communication, efficiency and data management. Clients also associated smartphone-assisted counselling with overall health system improvements even though the functions of the smartphones were not well understood. Smartphones were thought to signify modern, up-to-date biomedical information deemed highly desirable during pregnancy and childbirth in this context. In this rural Tanzanian setting, mHealth tools positively influenced community perceptions of health system services and client expectations of health workers; policymakers and implementers must ensure these expectations are met. Such interventions must be deeply embedded into health systems to have long-term impacts on maternal and newborn health outcomes.

scholarly journals Estimated number of ophthalmologists worldwide (International Council of Ophthalmology update): will we meet the needs?

2019 ◽  
Vol 104 (4) ◽  
pp. 588-592 ◽  
Author(s):  
Serge Resnikoff ◽  
Van Charles Lansingh ◽  
Lindsey Washburn ◽  
William Felch ◽  
Tina-Marie Gauthier ◽  
...  
Keyword(s):  
Cataract Surgery ◽  
Visual Impairment ◽  
Low Income ◽  
Care Delivery ◽  
Low Income Countries ◽  
Gdp Per Capita ◽  
Prevalence Rates ◽  
Eye Care ◽  
Care Needs ◽  
Per Capita

Background/aimsTo estimate 2015 global ophthalmologist data and analyse their relationship to income groups, prevalence rates of blindness and visual impairment and gross domestic product (GDP) per capita.MethodsOnline surveys were emailed to presidents/chairpersons of national societies of ophthalmology and Ministry of Health representatives from all 194 countries to capture the number and density (per million population) of ophthalmologists, the number/density performing cataract surgery and refraction, and annual ophthalmologist population growth trends. Correlations between these data and income group, GDP per capita and prevalence rates of blindness and visual impairment were analysed.ResultsIn 2015, there were an estimated 232 866 ophthalmologists in 194 countries. Income was positively associated with ophthalmologist density (a mean 3.7 per million population in low-income countries vs a mean 76.2 in high-income countries). Most countries reported positive growth (94/156; 60.3%). There was a weak, inverse correlation between the prevalence of blindness and the ophthalmologist density. There were weak, positive correlations between the density of ophthalmologists performing cataract surgery and GDP per capita and the prevalence of blindness, as well as between GDP per capita and the density of ophthalmologists doing refractions.ConclusionsAlthough the estimated global ophthalmologist workforce appears to be growing, the appropriate distribution of the eye care workforce and the development of comprehensive eye care delivery systems are needed to ensure that eye care needs are universally met.

Health system reconstitution syndrome: an often misunderstood phenomenon in global health practice

2019 ◽  
Vol 34 (8) ◽  
pp. 618-624
Author(s):  
Anatole Manzi ◽  
Alyssa Ierardo ◽  
Jean Claude Mugunga ◽  
Cate Oswald ◽  
Patrick Ulysse ◽  
...  
Keyword(s):  
Global Health ◽  
Health System ◽  
Low Income ◽  
Program Implementation ◽  
Quality Care ◽  
Building Blocks ◽  
Health Systems Strengthening ◽  
Low Income Countries ◽  
Global Movement ◽  
Active Implementation

Abstract The beginning of the 21st century was marked by the new definition and framework of health systems strengthening (HSS). The global movement to improve access to high-quality care garnered new resources to design and implement comprehensive HSS programs. In this effort, billions of dollars flowed from novel mechanisms such as The Global Fund to Fight AIDS, Tuberculosis and Malaria; Gavi, the Vaccine Alliance; and several bilateral funders. However, poor health outcomes, particularly in low-income countries, raise questions about the effectiveness of HSS program implementation. While several evaluation projects focus on the ultimate impact of HSS programs, little is known about the short- and mid-term reactions occurring throughout the active implementation of HSS interventions. Using the well-documented WHO framework of six HSS building blocks, we describe the evolution and phases of health system reconstitution syndrome (HSRS), including: (1) quiescent phase, (2) reactive phase, (3) restorative phase and (4) stability phase. We also discuss the implications of HSRS on global health funding, implementation, policy and research. Recognizing signs of HSRS could improve the rigour of HSS program design and minimize premature decisions regarding the progress of HSS interventions.

Sustaining Long-Run Growth and Macroeconomic Stability in Low-Income Countries—The Role of Structural Transformation and Diversification

Policy Papers ◽  
2014 ◽  
Vol 2014 (38) ◽  
Author(s):  
Keyword(s):  
Structural Transformation ◽  
Low Income ◽  
Low Income Countries ◽  
Macroeconomic Performance ◽  
Export Structure ◽  
Long Run ◽  
Trading Partners ◽  
Per Capita

Diversification and structural transformation play important roles in influencing the macroeconomic performance of low-income countries (LICs). Increases in income per capita at early stages of development are typically accompanied by a transformation in a country’s production and export structure. This can include diversification into new products and trading partners as well as increases in the quality of existing products.

Are Low Income Countries Catching up or Falling Further Behind? Evidence from Income and Demographic Indicators

1993 ◽  
Vol 4 (1) ◽  
pp. 98-119
Author(s):  
N. Kakwani ◽  
K. Subbarao
Keyword(s):  
Low Income ◽  
Living Standards ◽  
Infant Mortality Rate ◽  
Standard Of Living ◽  
Low Income Countries ◽  
Demographic Indicators ◽  
Life Expectancy At Birth ◽  
Catching Up ◽  
The World ◽  
Per Capita

The main objective of this paper is to measure changes in living conditions in one hundred and ten countries of the World during the period 1961 to 1990. Our concern is whether the economic and social gap is narrowing or widening. We also examine in which countries has there been a consistent improvement in average living standards. The standard of living is measured in terms of (a) per capita income, (b) life expectancy at birth and (c) infant mortality rate. The justification of these indicators is provided in terms of functionings and capabilities.

scholarly journals Counseling at all contacts for postpartum contraceptive use: can paper-based tools help community health workers improve continuity of care? A qualitative study from Ethiopia

2019 ◽  
Vol 3 ◽  
pp. 1652 ◽  
Author(s):  
Muluneh Yigzaw Mossie ◽  
Anne Pfitzer ◽  
Yousra Yusuf ◽  
China Wondimu ◽  
Eva Bazant ◽  
...  
Keyword(s):  
Decision Making ◽  
Health System ◽  
Community Health ◽  
Low Income ◽  
Health Workers ◽  
Continuum Of Care ◽  
Low Income Countries ◽  
Health Extension Workers ◽  
Pregnancy Risk ◽  
The Continuum

Background: Globally, there has been a resurgence of interest in postpartum family planning (PPFP) to advance reproductive health outcomes. Few programs have systematically utilized all contacts a woman and her baby have with the health system, from pregnancy through the first year postpartum, to promote PPFP. Nested into a larger study covering two districts, this study assessed the use, acceptability, and feasibility of tools for tracking women’s decision-making and use of PPFP in the community health system in Oromia region, Ethiopia. Community-level tracking tools included a modified Integrated Maternal and Child Health (IMCH) card with new PPFP content, and a newly developed tool for pregnant and postpartum women for use by Women Development Armies (WDAs). Proper completion of the tools was monitored during supervision visits. Methods: In-depth interviews and focus group discussions were conducted with health officials, health extension workers, and volunteers. A total of 34 audio-files were transcribed and translated into English, double-coded using MAXQDA, and analyzed using a thematic approach. Results: The results describe how HEWs used the modified IMCH card to track women’s decision making through the continuum of care, to assess pregnancy risk and to strengthen client-provider interaction. Supervision data demonstrated how well HEWs completed the modified IMCH card. The WDA tool was intended to promote PPFP and encourage multiple contacts with facilities from pregnancy to extended postpartum period. HEWs have reservations about the engagement of WDAs and their use of the WDA tool. Conclusions: To conclude, the IMCH card improves counseling practices through the continuum of care and is acceptable and feasible to apply. Some elements have been incorporated into a revised national tool and can serve as example for other low-income countries with similar community health systems. Further study is warranted to determine how to engage WDAs in promoting PPFP.

scholarly journals Health spending and vaccination coverage in low-income countries

2020 ◽  
Author(s):  
Francisco Castillo-Zunino ◽  
Pinar Keskinocak ◽  
Dima Nazzal ◽  
Matthew C Freeman
Keyword(s):  
Vaccination Coverage ◽  
Low Income ◽  
National Income ◽  
Health Spending ◽  
Gross National Income ◽  
Low Income Countries ◽  
Childhood Immunization ◽  
Government Health ◽  
Per Capita ◽  
The Impact

SummaryBackgroundRoutine childhood immunization is a cost-effective way to save lives and protect people from disease. Some low-income countries (LIC) have achieved remarkable success in childhood immunization, despite lower levels of gross national income or health spending compared to other countries. We investigated the impact of financing and health spending on vaccination coverage across LIC and lower-middle income countries (LMIC).MethodsAmong LIC, we identified countries with high-performing vaccination coverage (LIC+) and compared their economic and health spending trends with other LIC (LIC-) and LMIC. We used cross-country multi-year linear regressions with mixed-effects to test financial indicators over time. We conducted three different statistical tests to verify if financial trends of LIC+ were significantly different from LIC- and LMIC; p-values were calculated with an asymptotic χ2 test, a Kenward-Roger approximation for F tests, and a parametric bootstrap method.FindingsDuring 2014–18, LIC+ had a mean vaccination coverage between 91–96% in routine vaccines, outperforming LIC- (67–80%) and LMIC (83–89%). During 2000–18, gross national income and development assistance for health (DAH) per capita were not significantly different between LIC+ and LIC- (p > 0·13, p > 0·65) while LIC+ had a significant lower total health spending per capita than LIC- (p < 0·0001). Government health spending per capita per year increased by US$0·42 for LIC+ and decreased by US$0·24 for LIC- (p < 0·0001). LIC+ had a significantly lower private health spending per capita than LIC- (p < 0·012).InterpretationLIC+ had a difference in vaccination coverage compared to LIC- and LMIC that could not be explained by economic development, total health spending, nor aggregated DAH. The vaccination coverage success of LIC+ was associated with higher government health spending and lower private health spending, with the support of DAH on vaccines.

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