scholarly journals Equity lessons from a large scale private-sector healthcare intervention in Ghana and Kenya: Results for a multi-year qualitative study

2020 ◽  
Vol 4 ◽  
pp. 129
Author(s):  
Dominic Montagu ◽  
Lauren Suchman ◽  
Charlotte Avery Seefeld
Keyword(s):  
Large Scale ◽  
Qualitative Evaluation ◽  
Wealth Quintile ◽  
Healthcare Intervention ◽  
Health Coverage ◽  
Outpatient Services ◽  
Middle Income ◽  
Policy Makers ◽  
Private Providers ◽  
The Poor

Background: The poor fall sick more frequently than the wealthy, and are less likely to seek care when they do.  Private provision in many Low- and Middle-Income Countries makes up half or more of all outpatient care, including among poor paitents.  Understanding the preferences of poor patients which impel them to choose private providers, and how 3rd party payment influences these preferences, is important for policy makers considering expansion of national health insurance financing to advance Universal Health Coverage. This paper reports on the results of a qualitative evaluation of the African Health Markets for Equity intiative (AHME), a multi-year initiative in Ghana and Kenya to increase options and improve quality for outpatient services, especially for the poor. Methods: Interviews with patients from private clinics were conducted annually between 2013 and 2018.  Field staff recruited women for exit interviews as they were leaving these clinics. In the final round of data collection (2018), interviewers screened patients for wealth quintile and selected one third of the sample (approximately 10 patients per country) that fell into the two lowest wealth quintiles (Q1 and Q2).  Transcripts were coded using Atlas.ti and coded for analysis using an inductive, thematic approach. Results: We found four primary drivers of patient preferences for private clinics:  convenience; efficiency and predictability, perceived higher quality, and empowerment which was derived from greater choice in where to go.  Conclusions: Our findings indicate that more options will lead to more opportunities for treatment, and decrease the percentage of those, mostly poor, who become ill and go without care of any kind.  This should be considered as a priority  by policy makers seeking to make the best use of existing national infrastructure and expertise to assure equal health for all.  In this way, private providers offer an opportunity to advance national goals.

scholarly journals Standard Survey Data: Insights Into Private Sector Utilization

2021 ◽  
Vol 8 ◽  
Author(s):  
Dominic Montagu ◽  
Nirali Chakraborty
Keyword(s):  
Private Sector ◽  
Inpatient Care ◽  
Healthcare Services ◽  
Health Coverage ◽  
Outpatient Services ◽  
Health Seeking ◽  
Data Set ◽  
Middle Income ◽  
Global Trends ◽  
Private Care

Universal Health Coverage in Low- and Middle-Income Countries is increasingly expanding through incorporation of private clinics, pharmacies, and hospitals into an overall health system funded in whole or part through government-managed health insurance. This underscores the importance of policies on health provision which apply across the whole delivery system regardless of ownership status. To advance understanding of private-sector policies, and to facilitate sharing of lessons across countries with similar public-private distributions, we have analyzed data on the source of inpatient and outpatient care from 65 countries. While past studies have conducted similar analysis, ours advances the field in two ways. First, we limit our analysis to data sets from 2010 through 2019, making our study more up-to-date than past studies, while changing health seeking patterns for maternal health since 2010 means that our data set is more representative of overall inpatient care. Second, while past multi-country analysis of public-private ownership have been based on the Demographic Health Surveys, we have added to this data from the Multiple Indicator Cluster Surveys, significantly increasing the countries in our analysis. We have aggregated our analysis by WHO's regions. Outside of the EURO region, where the private sector delivers just 4% of all healthcare services, the private sector remains significant, and in many countries represents more than half of all care. The private sector provides nearly 40% of all healthcare in PAHO, AFRO, and WPRO regions, 57% in SEARO, and 62% in EMRO. While specific countries with two recent surveys show variation in the scale of both inpatient and outpatient private provision, we did not find regional or global trends toward or away from private care within LMICs. Private inpatient care is most important for the wealthy in many countries; public vs. private care varies less, by wealth, for outpatient services.

scholarly journals Addressing Data and Methodological Limitations in Estimating Catastrophic Health Spending and Impoverishment in India, 2004-18

2021 ◽  
Author(s):  
Sanjay Mohanty ◽  
Laxmikant Dwivedi
Keyword(s):  
Health Spending ◽  
National Sample ◽  
Catastrophic Health Expenditure ◽  
Outpatient Services ◽  
Middle Income ◽  
Policy Makers ◽  
Middle Income Countries ◽  
Catastrophic Health Spending ◽  
Food Expenditure ◽  
Using Data

Abstract Background Estimates of catastrophic health expenditure (CHE) are counterintuitive to researchers, policy makers, and developmental partners due to data and methodological limitation. While inferences drawn from use of capacity-to-pay (CTP) and budget share (BS) approaches are inconsistent, the non-availability of data on food expenditure in the health survey in India is an added limitation. Methods Using data from the health and consumption surveys of National Sample Surveys over 14 years, we have overcome these limitations and estimated the incidence and intensity of CHE and impoverishment using the CTP approach. Results The incidence of CHE for health services in India was 12.5% in 2004, 13.4% in 2014 and 9.1% by 2018. Among those households incurring CHE, they spent 1.25 times of their capacity to pay in 2004 (intensity of CHE), 1.71 times in 2014 and 1.31 times by 2018. The impoverishment due to health spending was 4.8% in 2004, 5.1% in 2014 and 3.3% in 2018. The state variations in incidence and intensity of CHE and incidence of impoverishment is large. The concentration index (CI) of CHE was -0.16 in 2004, -0.18 in 2014 and -0.22 in 2018 suggesting increasing inequality over time. The concentration curves based on CTP approach suggests that the CHE was concentrated among poor. The odds of incurring CHE were lowest among the richest households [OR 0.22; 95% CI: 0.21, 0.24], households with elderly members [OR 1.20; 95% CI:1.12, 1.18] and households using both inpatient and outpatient services [OR 2.80, 95% CI 2.66, 2.95]. Access to health insurance reduced the chance of CHE and impoverishment among the richest households. The pattern of impoverishment was similar to that of CHE. Conclusion In the last 14 years, the CHE and impoverishment in India has declined while inequality in CHE has increased. We recommend the CTP approach when estimating CHE and impoverishment in low and middle-income countries.

Setting Up Community Health Programmes in Low and Middle Income Countries, Fourth Edition, by Ted Lankester and Nathan Grills, Oxford University Press, May 2019

2020 ◽  
Vol 7 (2) ◽  
pp. 155-158
Author(s):  
Sundeep Manoth ◽  
Bethany Carr
Keyword(s):  
Global Health ◽  
Community Health ◽  
Rural Areas ◽  
Health Coverage ◽  
Middle Income ◽  
Policy Makers ◽  
Rural And Urban ◽  
Wide Range ◽  
Health And Development ◽  
Low And Middle Income

Universal health coverage is still out of reach for many people in the world and not surprisingly, it is those in rural areas made up of largely poor communities who are the most deprived. Setting Up Community Health and Development Programmes in Low and Middle-Income Settings is a practical tool to guide the process of starting, developing and maintaining a healthcare programme in these areas. Its purpose is to help stakeholders to empower communities to identify and solve their own problems so as to decrease inequality and inequity which remain serious issues in global health. This book also aims to assist academics, policy makers and planners to understand the realities of field-based development and progress. The book has a wide range of contributors with expertise in different areas and they address two main audiences. The first is those working in the field: programme managers, and practitioners from government and civil society involved in setting up or developing community health and development programmes, rural and urban. This book is also written for global health and other health care students, academics, policy makers and planners who wish to anchor their work in field-based situations.

scholarly journals How is implementation research applied to advance health in low-income and middle-income countries?

2019 ◽  
Vol 4 (2) ◽  
pp. e001257 ◽  
Author(s):  
Olakunle Alonge ◽  
Daniela Cristina Rodriguez ◽  
Neal Brandes ◽  
Elvin Geng ◽  
Ludovic Reveiz ◽  
...  
Keyword(s):  
Low Income ◽  
Implementation Research ◽  
Large Scale ◽  
Scale Up ◽  
Middle Income ◽  
Policy Makers ◽  
Is Implementation ◽  
Middle Income Countries ◽  
Ir Studies ◽  
Learning And Change

This paper examines the characteristics of implementation research (IR) efforts in low-income and middle-income countries (LMICs) by describing how key IR principles and concepts have been used in published health research in LMICs between 1998 and 2016, with focus on how to better apply these principles and concepts to support large-scale impact of health interventions in LMICs. There is a stark discrepancy between principles of IR and what has been published. Most IR studies have been conducted under conditions where the researchers have considerable influence over implementation and with extra resources, rather than in ‘real world’ conditions. IR researchers tend to focus on research questions that test a proof of concept, such as whether a new intervention is feasible or can improve implementation. They also tend to use traditional fixed research designs, yet the usual conditions for managing programmes demand continuous learning and change. More IR in LMICs should be conducted under usual management conditions, employ pragmatic research paradigm and address critical implementation issues such as scale-up and sustainability of evidence-informed interventions. This paper describes some positive examples that address these concerns and identifies how better reporting of IR studies in LMICs would include more complete descriptions of strategies, contexts, concepts, methods and outcomes of IR activities. This will help practitioners, policy-makers and other researchers to better learn how to implement large-scale change in their own settings.

scholarly journals An Overview of Insurance Services in Nepal

2017 ◽  
Vol 2 ◽  
pp. 12-20
Author(s):  
Puspa Raj Sharma
Keyword(s):  
Health Care Providers ◽  
Large Scale ◽  
Insurance Companies ◽  
Care Providers ◽  
Multiple Sources ◽  
Policy Makers ◽  
Life Insurers ◽  
The Poor ◽  
Poor Households ◽  
Wage Loss

The present scenario of micro (finance and insurance) seems a lot of uncertainty. Naturally uncertainty gives birth to risk. Therefore, the need for risk-management solutions is undisputed by policy makers, who are aware that poor families can lose - in a matter of hours - assets that took years to accumulate, due to a sudden sickness or accident. The policy to provide free primary care and to a certain degree secondary care is positive step and could effectively help to reduce financial exposure of Nepal’s poor when the policy is implemented and functional on large scale. But even if this would succeed, only a part of the vulnerability is reduced: the poor still have to pay for services not covered under this policy, such as certain hospitalization cases, the transportation to health care providers, wage-loss – to name a few. The poor households currently need to finance huge amounts of health expenses (out of pocket expenditure) which are over and above their current income(s) and savings. They therefore need to resort to multiple sources of financing, of which a major source is borrowing.At present, there are 25 registered insurance companies in Nepal. Of these, 8 are private commercial life insurers, 16 are private commercial non-life insurers and 1 is composite insurer, i.e., Rastriya Beema Sansthan owned by the government.Janapriya Journal of Interdisciplinary StudiesVol. 2, No.1 (December 2013), page: 12-20

scholarly journals Addressing Data and Methodological Limitations in Estimating Catastrophic Health Spending and Impoverishment in India, 2004-18

2020 ◽  
Author(s):  
Sanjay Mohanty ◽  
Laxmikant Dwivedi
Keyword(s):  
Health Spending ◽  
National Sample ◽  
Catastrophic Health Expenditure ◽  
Outpatient Services ◽  
Middle Income ◽  
Policy Makers ◽  
Middle Income Countries ◽  
Catastrophic Health Spending ◽  
Food Expenditure ◽  
Using Data

Abstract BackgroundEstimates of catastrophic health expenditure (CHE) are counterintuitive to researchers, policy makers, and developmental partners due to data and methodological limitation. While inferences drawn from use of capacity-to-pay (CTP) and budget share (BS) approaches are inconsistent, the non-availability of data on food expenditure in the health survey in India is an added limitation. MethodsUsing data from the health and consumption surveys of National Sample Surveys over 15 years, we have overcome these limitations and estimated the incidence and intensity of CHE and impoverishment using the CTP approach. ResultsThe incidence of CHE for health services in India has declined from 12.5% in 2004 to 9.1% by 2018 and that of intensity of CHE has increased from 1.25 to 1.31 during the same period. The impoverishment due to health spending was 4.8% in 2004, 5.1% in 2014 and 3.3% in 2018. The state variations in incidence and intensity of CHE and incidence of impoverishment is large. The odds of incurring CHE were lowest among the richest households [OR 0.22; 95% CI: 0.21,0.24], households with elderly members [OR 1.20; 95% CI :1.12,1.18] and households using both inpatient and outpatient services [OR 2.80, 95% CI 2.66, 2.95]. Access to health insurance reduced the chance of CHE and impoverishment among the richest households. The pattern of impoverishment was similar to that of CHE. ConclusionWe recommend the CTP approach when estimating CHE and impoverishment in low and middle-income countries.

scholarly journals What next after GDP-based cost-effectiveness thresholds?

2020 ◽  
Vol 4 ◽  
pp. 176
Author(s):  
Y-Ling Chi ◽  
Mark Blecher ◽  
Kalipso Chalkidou ◽  
Anthony Culyer ◽  
Karl Claxton ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Decision Rules ◽  
Cost Effective ◽  
Evidence Base ◽  
Decision Makers ◽  
Health Coverage ◽  
Middle Income ◽  
Policy Makers ◽  
Middle Income Countries ◽  
The World

Public payers around the world are increasingly using cost-effectiveness thresholds (CETs) to assess the value-for-money of an intervention and make coverage decisions. However, there is still much confusion about the meaning and uses of the CET, how it should be calculated, and what constitutes an adequate evidence base for its formulation. One widely referenced and used threshold in the last decade has been the 1-3 GDP per capita, which is often attributed to the Commission on Macroeconomics and  WHO guidelines on Choosing Interventions that are Cost Effective (WHO-CHOICE). For many reasons, however, this threshold has been widely criticised; which has led experts across the world, including the WHO, to discourage its use. This has left a vacuum for policy-makers and technical staff at a time when countries are wanting to move towards Universal Health Coverage. This article seeks to address this gap by offering five practical options for decision-makers in low- and middle-income countries that can be used instead of the 1-3 GDP rule, to combine existing evidence with fair decision-rules or develop locally relevant CETs. It builds on existing literature as well as an engagement with a group of experts and decision-makers working in low, middle and high income countries.

Doctor Retention in Ireland - What it may mean for the Global Health Workforce Reform Agenda Comment on "Doctor Retention: A Cross-sectional Study of How Ireland Has Been Losing the Battle"

2020 ◽  
Author(s):  
Bernard Hope Taderera
Keyword(s):  
Global Health ◽  
Health Workforce ◽  
Cross Sectional Study ◽  
Early Career ◽  
Healthcare Personnel ◽  
Health Coverage ◽  
Cross Sectional ◽  
Middle Income ◽  
Reform Agenda ◽  
Medical Graduates

The study of healthcare personnel migration in Ireland reports that most medical graduates plan to leave the country’s health system. It may be possible to address this challenge by understanding and addressing the reasons why young doctors plan to leave. Future studies should contribute to the retention of early career doctors in highincome countries such as Ireland. This will help reduce the migration of doctors from low- and middle-income countries in order to address the global health workforce crisis and its impact on the attainment of universal health coverage in all health systems.

Private Agricultural R&D: Do the Poor Benefit?

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Jock R. Anderson ◽  
Regina Birner ◽  
Latha Najarajan ◽  
Anwar Naseem ◽  
Carl E. Pray
Keyword(s):  
Poverty Reduction ◽  
Agricultural Research ◽  
Farming Systems ◽  
Agricultural Technologies ◽  
Policy Makers ◽  
The Public ◽  
The Poor ◽  
The World ◽  
Agricultural Research And Development ◽  
The Impact

Abstract Private agricultural research and development can foster the growth of agricultural productivity in the diverse farming systems of the developing world comparable to the public sector. We examine the extent to which technologies developed by private entities reach smallholder and resource-poor farmers, and the impact they have on poverty reduction. We critically review cases of successfully deployed improved agricultural technologies delivered by the private sector in both large and small developing countries for instructive lessons for policy makers around the world.

scholarly journals What We Talk about When We Talk about Poverty: Culture and Welfare State Development in Britain, Denmark and France

2021 ◽  
pp. 1-24
Author(s):  
Cathie Martin ◽  
Tom Chevalier
Keyword(s):  
Economic Growth ◽  
National Level ◽  
Political Stability ◽  
Historical Case ◽  
Policy Makers ◽  
The Poor ◽  
Fiction Writers ◽  
Welfare State Development ◽  
Political Agents ◽  
Cross National

Why did historical anti-poverty programs in Britain, Denmark and France differ so dramatically in their goals, beneficiaries and agents for addressing poverty? Different cultural views of poverty contributed to how policy makers envisioned anti-poverty reforms. Danish elites articulated social investments in peasants as necessary to economic growth, political stability and societal strength. British elites viewed the lower classes as a challenge to these goals. The French perceived the poor as an opportunity for Christian charity. Fiction writers are overlooked political agents who engage in policy struggles. Collectively, writers contribute to a country's distinctive ‘cultural constraint’, or symbols and narratives, which appears in the national-level aggregation of literature. To assess cross-national variations in cultural depictions of poverty, this article uses historical case studies and quantitative textual analyses of 562 British, 521 Danish and 498 French fictional works from 1770 to 1920.

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