Removing user fees to improve access to caesarean delivery: a quasi-experimental evaluation in western Africa

IntroductionMali and Benin introduced a user fee exemption policy focused on caesarean sections in 2005 and 2009, respectively. The objective of this study is to assess the impact of this policy on service utilisation and neonatal outcomes. We focus specifically on whether the policy differentially impacts women by education level, zone of residence and wealth quintile of the household.MethodsWe use a difference-in-differences approach using two other western African countries with no fee exemption policies as the comparison group (Cameroon and Nigeria). Data were extracted from Demographic and Health Surveys over four periods between the early 1990s and the early 2000s. We assess the impact of the policy on three outcomes: caesarean delivery, facility-based delivery and neonatal mortality.ResultsWe analyse 99 800 childbirths. The free caesarean policy had a positive impact on caesarean section rates (adjusted OR=1.36 (95% CI 1.11 to 1.66; P≤0.01), particularly in non-educated women (adjusted OR=2.71; 95% CI 1.70 to 4.32; P≤0.001), those living in rural areas (adjusted OR=2.02; 95% CI 1.48 to 2.76; P≤0.001) and women in the middle-class wealth index (adjusted OR=3.88; 95% CI 1.77 to 4.72; P≤0.001). The policy contributes to the increase in the proportion of facility-based delivery (adjusted OR=1.68; 95% CI 1.48 to 1.89; P≤0.001) and may also contribute to the decrease of neonatal mortality (adjusted OR=0.70; 95% CI 0.58 to 0.85; P≤0.001).ConclusionThis study is the first to evaluate the impact of a user fee exemption policy focused on caesarean sections on maternal and child health outcomes with robust methods. It provides evidence that eliminating fees for caesareans benefits both women and neonates in sub-Saharan countries.

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The impact and cost-effectiveness of user fee exemption by contracting out essential health package services in Malawi

BMJ Global Health ◽

10.1136/bmjgh-2018-001286 ◽

2019 ◽

Vol 4 (2) ◽

pp. e001286 ◽

Cited By ~ 1

Author(s):

Wu Zeng ◽

Daxin Sun ◽

Henry Mphwanthe ◽

Tianwen Huan ◽

Jae Eun Nam ◽

...

Keyword(s):

Cost Effectiveness ◽

Service Utilisation ◽

Contracting Out ◽

Life Years ◽

Fee Exemption ◽

User Fee ◽

Per Capita ◽

The Government ◽

Utilisation Data ◽

The Impact

ObjectivesTo examine the impact and cost-effectiveness of user fee exemption by contracting out essential health package services to Christian Health Association of Malawi (CHAM) facilities through service-level agreements (SLAs) to inform policy-making in Malawi.MethodsThe analysis was conducted from the government perspective. Financial and service utilisation data were collected for January 2015 through December 2016. The impact of SLAs on utilisation of maternal and child health (MCH) services was examined using propensity score matching and random-effects models. Subsequently, the improved services were converted to quality-adjusted life years (QALYs) gained, using the Lives Saved Tool (LiST), and incremental cost-effectiveness ratios (ICERs) were generated.FindingsOver the 2 years, a total of $1.5 million was disbursed to CHAM facilities through SLAs, equivalent to $1.24 per capita. SLAs were associated with a 13.8%, 13.1%, 19.2% and 9.6% increase in coverage of antenatal visits, postnatal visits, delivery by skilled birth attendants and BCG vaccinations, respectively. This was translated into 434 lives saved (95% CI 355 to 512) or 11 161 QALYs gained (95% CI 9125 to 13 174). The ICER of SLAs was estimated at $134.7/QALYs gained (95% CI $114.1 to $164.7).ConclusionsThe cost per QALY gained for SLAs was estimated at $134.7, representing 0.37 of Malawi’s per capita gross domestic product ($363). Thus, MCH services provided with Malawi’s SLAs proved cost-effective. Future refinements of SLAs could introduce pay for performance, revising the price list, streamlining the reporting system and strengthening CHAM facilities’ financial and monitoring management capacity.

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Geospatial analysis of determinants of neonatal mortality in Ghana

BMC Public Health ◽

10.1186/s12889-021-10473-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Duah Dwomoh

Keyword(s):

Risk Factors ◽

Birth Weight ◽

Low Birth Weight ◽

Neonatal Mortality ◽

Neonatal Death ◽

Reproductive Age ◽

Multiple Births ◽

Demographic And Health Surveys ◽

Neonatal Deaths ◽

The Impact

Abstract Background Ghana did not meet the Millennium Development Goal 4 of reducing child mortality by two-thirds and may not meet SDG (2030). There is a need to direct scarce resources to mitigate the impact of the most important risk factors influencing high neonatal deaths. This study applied both spatial and non-spatial regression models to explore the differential impact of environmental, maternal, and child associated risk factors on neonatal deaths in Ghana. Methods The study relied on data from the Ghana Demographic and Health Surveys (GDHS) and the Ghana Maternal Health Survey (GMHS) conducted between 1998 and 2017 among 49,908 women of reproductive age and 31,367 children under five (GDHS-1998 = 3298, GDHS-2003 = 3844, GDHS-2008 = 2992, GDHS-2014 = 5884, GMHS-2017 = 15,349). Spatial Autoregressive Models that account for spatial autocorrelation in the data at the cluster-level and non-spatial statistical models with appropriate sampling weight adjustment were used to study factors associated with neonatal deaths, and a p-value less than 0.05 was considered statistically significant. Results Population density, multiple births, smaller household sizes, high parity, and low birth weight significantly increased the risk of neonatal deaths over the years. Among mothers who had multiple births, the risk of having neonatal deaths was approximately four times as high as the risk of neonatal deaths among mothers who had only single birth [aRR = 3.42, 95% CI: 1.63–7.17, p < 0.05]. Neonates who were perceived by their mothers to be small were at a higher risk of neonatal death compared to very large neonates [aRR = 2.08, 95% CI: 1.19–3.63, p < 0.05]. A unit increase in the number of children born to a woman of reproductive age was associated with a 49% increased risk in neonatal deaths [aRR = 1.49, 95% CI: 1.30–1.69, p < 0.05]. Conclusion Neonatal mortality in Ghana remains relatively high, and the factors that predisposed children to neonatal death were birth size that were perceived to be small, low birth weight, higher parity, and multiple births. Improving pregnant women’s nutritional patterns and providing special support to women who have multiple deliveries will reduce neonatal mortality in Ghana.

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Mediating Role of Interpersonal Interactions Between Chinese Farmers' Social Networks and their Subjective Well-Being

Social Behavior and Personality An International Journal ◽

10.2224/sbp.6730 ◽

2018 ◽

Vol 46 (5) ◽

pp. 721-732 ◽

Cited By ~ 1

Author(s):

Jianjun Zhang ◽

Yang Xu ◽

Yu Hou

Keyword(s):

Social Networks ◽

Rural Areas ◽

Positive Impact ◽

General Social Survey ◽

Well Being ◽

Psychological Needs ◽

Mediating Effect ◽

Subjective Well Being ◽

Interpersonal Interactions ◽

The Impact

As more than half the population of China lives in rural areas, farmers' subjective well-being is important to the maintenance of socialism in the countryside and the Chinese people's target of comprehensively building a prosperous society. Using data collected in the 2012 Chinese General Social Survey, we built a regression model to examine the impact of farmers' social networks on their subjective well-being, and the mediating effect of their interpersonal interactions on this relationship. Results showed that farmers' social networks had a positive impact on their overall subjective well-being, which was, in turn, mediated by their interpersonal interactions. Farmers with well-developed social networks tended to have effective interpersonal interactions that satisfied their social psychological needs and enhanced their subjective well-being. Our findings provide a valuable reference for enhancing the subjective well-being of farmers in China.

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The Impact of the Comprehensive Rural Village Development Program on Rural Sustainability in Korea

Sustainability ◽

10.3390/su10072436 ◽

2018 ◽

Vol 10 (7) ◽

pp. 2436 ◽

Cited By ~ 4

Author(s):

Jaehee Hwang ◽

Jonghoon Park ◽

Seongwoo Lee

Keyword(s):

Rural Areas ◽

Central Government ◽

Positive Impact ◽

Evaluation Studies ◽

Development Program ◽

Policy Implications ◽

Rural Village ◽

Rural Sustainability ◽

Ex Post ◽

The Impact

An imperative challenge emerges from the demand to apply the scientific method in the assessment of recent agricultural and rural policies throughout the world. The objective of the present study was to conduct an ex-post quantitative evaluation of the Comprehensive Rural Village Development Program (CRVDP), a representative rural development policy operated by the Ministry of Agriculture, Food and Rural Affairs, a central government agency in South Korea. The primary purpose of this program is to ensure sustainable rural society. This study found a moderate but significant positive impact of the policy in enhancing the standard of living in rural areas. The present paper concludes with suggesting some policy implications, limitations and future directions of policy evaluation studies.

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Does Farmland Size Affect the Collective Action in Rural Areas? An Empirical Study on the Public Irrigation System in China

E3S Web of Conferences ◽

10.1051/e3sconf/202129201028 ◽

2021 ◽

Vol 292 ◽

pp. 01028

Author(s):

Liangzhen Zang ◽

Yiqing Su

Keyword(s):

Public Sector ◽

Collective Action ◽

Rural Areas ◽

Positive Impact ◽

Irrigation System ◽

The Public ◽

Land Circulation ◽

Per Capita ◽

Agricultural Business ◽

The Impact

Since smallholders accounted for a high proportion of 98.1% among the 207 million agricultural business households across China, it is particularly important to study the impact of farmland size on the provision of public goods attached to the public sector industries from the perspective of the irrigation collective action in rural areas. Based on the survey data of 283 villages in China, this paper finds that the farmland size has a positive impact on irrigation collective action, although the average of per capita farmland area is only 0.214 hectares in each household of China. Therefore, it is necessary to promote the farmland scale operation by land circulation, so as to improve the ability of collective action and the development of public sector industries in rural areas of China.

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Impact of Educational Qualification on Social Support, Social Isolation and Social and Emotional Loneliness: A Study of Senior Citizens

Peshawar Journal of Psychology and Behavioral Sciences (PJPBS) ◽

10.32879/picp.2018.4.2.153 ◽

2019 ◽

Vol 4 (2) ◽

pp. 153-170

Author(s):

Salma Naz Gul ◽

Rabia Chishti ◽

Maher Bano

Keyword(s):

Social Support ◽

Social Isolation ◽

Rural Areas ◽

Positive Impact ◽

Senior Citizens ◽

Sampling Technique ◽

Educational Qualification ◽

Social And Emotional ◽

Emotional Loneliness ◽

The Impact

The present study aims to investigate the impact of educational qualification on social support, social isolation, and loneliness (social and emotional) among Senior Citizens. De Jong Gierveld Loneliness Scale (1985),Social Support Scale developed by Malik (2002), and Friendship Scale developed by Hawthorne (2006) were used to measure the pertinent constructs of present study. Purposive convenient sampling technique was used to draw the sample of older adults (N = 500) aged 60 to 90 years (M = 67.59, SD = 7.54) from both urban and rural areas of various districts of Khyber Pakhtunkhwa province of Pakistan. Alpha coefficients, for all the variables were computed, which ranged between .60 for social loneliness to .96 for social support total scale. Study found significant differences among the variables. Findings revealed that educational qualification of the sample had a positive impact on their social support and they were less socially isolated as compared to uneducated senior citizens.

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Urgensi Omnibus Law (Undang-Undang Cipta Kerja) Terhadap Hak Masyarakat Adat di Wilayah Pesisir

Balobe Law Journal ◽

10.47268/balobe.v1i2.653 ◽

2021 ◽

Vol 1 (2) ◽

pp. 119

Author(s):

Dolfries J Neununy

Keyword(s):

Indigenous Peoples ◽

Rural Areas ◽

Scientific Community ◽

Positive Impact ◽

The Other ◽

Ordinary People ◽

Legal Research ◽

Political Approach ◽

The Government ◽

The Impact

Introductioan: Substantial application of the Omnibus Law (Cipta Kerja) for the rights of indigenous peoples in coastal areas.Purposes of the Research: Reviewing and analyzing the impact of the Copyright Act on indigenous peoples in coastal areas.Methods of the Research: The research was conducted through normative legal research with a political approach to review and analyze legislation or other legal materials related to the Urgency of Omnibus Law on the Rights of Indigenous Peoples in coastal areas.Results of the Research: The presence of the Omnisbus Law will have a positive impact on the community from the aspect of legal knowledge that people belonging to the scientific community can understand the purpose of the government to implement the Omnisbus Law but from the other side the ordinary people who are in coastal areas and remote rural areas do not understand well the application of the Omnisbus Law so that protection is important.

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Impact of Microcredit on Living Standard of Dairy Entrepreneurs: Special Focus on Oddusuddan DS Division in Mullaitivu District

Indian Journal of Finance and Banking ◽

10.46281/ijfb.v3i2.456 ◽

2019 ◽

Vol 3 (2) ◽

pp. 43-48

Author(s):

Saseela Balagobei ◽

Sankeetha Aravinthakumar

Keyword(s):

Quantitative Analysis ◽

Low Income ◽

Rural Areas ◽

Positive Impact ◽

Primary Data ◽

Living Standard ◽

Poor People ◽

Special Focus ◽

The Impact ◽

Micro Credit

Microcredit is part of micro finance, which provides a wider range of financial services for low income people. Micro credit serves as a vital role for Living standard of poor people in the developing countries as well as in Sri Lanka. In this Study Oddusuddan DS division in Mullaitivu district was selected as research area. After the 30 years conflict situation most people in the Oddusuddan area in Mullaitivu district are subordinate to the poverty line, because most of the displaced people who are female other than male staying here. Women lost their male relatives in struggle, and forced to take a responsibility of their family in order to look after their children, aged parents and their male relatives. Micro credit helps the poor people particularly women in effective ways in order to create income generating activities. The prime objective of this study is to investigate the impact of Microcredit on living standard of dairy entrepreneurs in Oddusuddan DS division in Mullaitivu District. In the rural areas of Mullaitivu, Oddusuddan Divisional Secretariat Divisions 100 dairy entrepreneurs were selected as the sample size of population. The selected entrepreneurs who have received loan from samurdhi bank for dairy farming activities in Oddusuddan DS Division. Primary data were used for gathering information and quantitative analysis was carried out to find out the results. In the quantitative analysis the correlation and regression methods were employed to examine the hypotheses by using SPSS. The result of this study concluded that there is a positive impact of samurdhi micro credit on living standard of dairy entrepreneurs in Oddusuddan DS Division. In addition to this, using micro credit facilities create more job opportunities and variety of economic activities and improve household education, income, saving and heath condition of the people. The study recommends that micro credit institution should consider improve the living standard of dairy entrepreneurs through increase the loan amount with lower interest rate.

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Vitalizing Rural Communities: China’s Rural Entrepreneurial Activities from Perspective of Mixed Embeddedness

Sustainability ◽

10.3390/su11061609 ◽

2019 ◽

Vol 11 (6) ◽

pp. 1609

Author(s):

Huasheng Zhu ◽

Yawei Chen ◽

Kebi Chen

Keyword(s):

Rural Communities ◽

Environmental Sustainability ◽

Rural Areas ◽

Positive Impact ◽

Binary Logistic Regression ◽

Transitional Period ◽

Population Mobility ◽

Rural Economies ◽

Entrepreneurial Activities ◽

The Impact

Rural entrepreneurial activities play an important role in the development of rural economies and the vitality of rural areas, and they can also contribute to an increase in the employment opportunities of farmers and environmental sustainability during China’s transitional period. As a local organization, the community connects individuals, collective agencies, local authorities, and the market in reforming rural economies in China. Based on the concepts of mixed embeddedness and on the database of the China Family Panel Studies (CFPS), this paper uses a binary logistic regression (BLR) model to analyze the impact of social, institutional, and economic environments of rural communities on entrepreneurship. The finding shows that informal, entrepreneurship-oriented institutions in rural communities have more significantly positive impact on farmer entrepreneurship than formal institutions, as well as economic and social environments. Furthermore, compared with kinship, neighborhood relationships and weak ties based on the population mobility in rural communities are more important for farmer entrepreneurship. Additionally, rural communities are the production places and markets, and their economic levels are positively related to entrepreneurship. Last but not least, compared with urban communities, rural communities play a much more prominent role in local entrepreneurship.

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Entrepreneurs and Territorial Diversity: Success and Failure in Andalusia 2007–2015

Land ◽

10.3390/land9080262 ◽

2020 ◽

Vol 9 (8) ◽

pp. 262

Author(s):

Eugenio Cejudo García ◽

José Antonio Cañete Pérez ◽

Francisco Navarro Valverde ◽

Noelia Ruiz Moya

Keyword(s):

Rural Area ◽

Rural Areas ◽

Project Success ◽

Positive Impact ◽

Primary Source ◽

Rural Development Programme ◽

Application Procedure ◽

Different Types ◽

Europe Today ◽

The Impact

Rural Europe today cannot be understood without considering the impact of the EU’s Liaisons Entre Actions de Developpement de l’Economie Rurale (LEADER) rural development programme. Although in general it has had a positive impact, research has also revealed spatial and social disparities in the distribution of funds. Our primary source was the files for all the LEADER projects processed in Andalusia between 2007 and 2015. In addition to successfully executed projects, we also focused on “unfunded” projects, those in which, although promoters had initiated the application procedure, a grant was never ultimately obtained. Project failure must be studied so as to avoid biased findings. We then classified these projects within the different types of rural area and analysed the behaviour of the different promoters in these areas. Relevant findings include: project success or failure varies according to the different types of rural area, as does the behaviour of the different promoters; the degree of rurality can hinder project success; young and female entrepreneurs were more likely to fail; the type of promoter is strongly influenced by the distance to cities in that companies and Individual Entrepreneurs tend to invest in periurban spaces, while public sector promoters such as Local Councils are more prominent in remote rural areas.

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