scholarly journals Systematic Review on the Impact of Conditional Cash Transfers on Child Health Service Utilisation and Child Health in Sub-Saharan Africa

2021 ◽  
Vol 9 ◽  
Author(s):  
Chukwuemeka Onwuchekwa ◽  
Kristien Verdonck ◽  
Bruno Marchal
Keyword(s):  
Child Health ◽  
Health Service ◽  
Cash Transfers ◽  
Conditional Cash Transfers ◽  
Health Service Utilisation ◽  
Sub Saharan Africa ◽  
Service Utilisation ◽  
Sub Saharan ◽  
The Impact ◽  
And Child Health

Background: Conditional cash transfers (CCTs) are interventions which provide assistance in the form of cash to specific vulnerable groups on the condition that they meet pre-defined requirements. The impact of conditional cash transfers on children's access to health services and on their overall health has not been established in sub-Saharan Africa.Method: We conducted a systematic review aimed at summarising the available information on the impact of conditional cash transfers on health service utilisation and child health in sub-Saharan Africa. We searched databases for peer-reviewed articles, websites of organisations involved in implementing conditional cash transfer programmes, and Google scholar to identify grey literature. Records were selected based on predefined eligibility criteria which were drawn from a programme impact framework. Records were eligible if one of the following outcomes was evaluated: health services utilisation, immunisation coverage, growth monitoring, anthropometry, illness reported, and mortality. Other records which reported on important intermediate outcomes or described mechanisms significantly contributing to impact were also included in the review. Data items were extracted from eligible records into an extraction form based on predefined data items. Study quality indicators were also extracted into a quality assessment form.Results: Thematic narrative synthesis was conducted using data from nine included records. The review included five cluster randomised evaluations, one quasi-experimental clustered study, one randomised trial at the individual level, one mixed-method study and one purely qualitative study. There was insufficient evidence of an impact of conditional cash transfers on health service utilisation. There was also not enough evidence of an impact on nutritional status. No impact was observed on health status based on illness reports, nor on immunisation rates. None of the included records evaluated the impact on childhood mortality.Conclusions: The findings of this review suggest that a positive impact may be observed in health service utilisation and nutrition, however, this may not translate into improved child health. Further research is needed to understand the mechanisms and pathways by which these interventions work, explore the effect of contextual factors on their impact, and assess their cost implication especially within resource-constrained settings.

scholarly journals The impact of the COVID-19 pandemic on health service utilisation in Sierra Leone

2021 ◽  
Author(s):  
Stephen Sevalie ◽  
Daniel Youkee ◽  
Alex J van Duinen ◽  
Emma Bailey ◽  
Thaimu Bangura ◽  
...  
Keyword(s):  
Health Service ◽  
Sierra Leone ◽  
Health Systems ◽  
Hospital Admissions ◽  
Health Service Utilisation ◽  
Sub Saharan Africa ◽  
Service Utilisation ◽  
Hospital Data ◽  
Sub Saharan ◽  
The Impact

Introduction: The COVID-19 pandemic has adversely affected health systems in many countries, but little is known about effects on health systems in sub-Saharan Africa. This study examines the effects of COVID-19 on health service utilisation in a sub-Saharan country, Sierra Leone. Methods: Mixed-methods study using longitudinal nationwide hospital data (admissions, operations, deliveries and referrals), and qualitative interviews with healthcare workers and patients. Hospital data were compared across Quarters (Q) in 2020, with day 1 of Q2 representing the start of the pandemic in Sierra Leone. Admissions are reported in total and disaggregated by sex, service (surgical, medical, maternity, paediatric), and hospital type (government or private not for profit). Referrals in 2020 were compared with 2019, to assess whether any changes were the result of seasonality. Comparisons were performed using students t test. Qualitative data were analysed using thematic analysis. Results: From Q1-Q2, weekly mean hospital admissions decreased by 14.7% (p=0.005). Larger decreases were seen in male 18.8%, than female 12.5% admissions. The largest decreases were in surgical admissions, a 49.8 % decrease (p<0.001) and medical admissions, a 28.7% decrease (p=0.002). Paediatric and maternity admissions did not significantly change. Total operations decreased by 13.9% (p<0.001), whilst caesarean sections and facility-based deliveries showed significant increases, 12.7 % (p=0.014) and 7.5% (p=0.03) respectively. In Q3 total admissions remained 13.2% lower (p<0.001) than Q1. Mean weekly referrals were lower in Q2 and Q3 of 2020 compared to 2019, suggesting findings were unlikely to be seasonal. Qualitative analysis identified both supply-side factors, prioritisation of essential services, introduction of COVID-19 services and pausing elective care, and demand-side factors, fear of nosocomial infection and financial hardship. Conclusion: The study demonstrated a decrease in health service utilisation during Covid-19, the decrease is less than in other countries during COVID-19 and less than reported during the Ebola epidemic.

scholarly journals Conditional cash transfers, uptake of maternal and child health services, and health outcomes in western rural China

2020 ◽  
Author(s):  
Huan Zhou ◽  
Yuju Wu ◽  
Chengfang Liu ◽  
Chang Sun ◽  
Yaojiang Shi ◽  
...  
Keyword(s):  
Child Health ◽  
Health Outcomes ◽  
Breast Feeding ◽  
Maternal And Child Health ◽  
Rural Areas ◽  
Cash Transfers ◽  
Conditional Cash Transfers ◽  
Child Health Outcomes ◽  
The Impact ◽  
And Child Health

Abstract Background: Empirical evidence suggests that the uptake of maternal and child health (MCH) services is still low in poor rural areas of China. There is concern that the low uptake of MCH services may detrimentally affect child health outcomes. Previous studies have not yet identified the exact nature of the impact that conditional cash transfers (CCT) have on the uptake of MCH services and ultimately, on child health outcomes. The objective of this study is to examine the relationship between CCT, uptake of MCH services, and health outcomes among children in poor rural areas of western China.Methods: We designated two different sets of comparison villages and households that were used as comparison against which outcomes of the treated households could be assessed. In 2014 we conducted a large-scale survey of 1,522 households at 75 villages (including 25 treatment and 50 comparison) from nine nationally-designated poverty counties in two provinces of China. In each village, 21 households were selected based on their eligibility status for the CCT program. Difference-in-difference analyses were used to assess the impact of CCT on outcomes in terms of both Intention-to-treat (ITT) and average-treatment-effects-on-the-treated (ATT). Results: Overall, the uptake of MCH services in the sample households were low, especially in terms of post-partum care visits, early breast feeding, exclusive breast feeding, and physical examination of the baby. The uptake of the seven types of MCH services in the CCT treatment villages were significantly higher than that in the comparison villages. Results from both the ITT and ATT analyses showed the CCT program had a positive, although small, impact on the uptake of MCH services and the knowledge of mothers about MCH health issues. Nonetheless, the CCT program had no noticeable effect on child health outcomes.Conclusions: The CCT program generated modest improvements in the uptake of MCH services and mothers' knowledge of MCH services in poor rural areas of Western China. These improvements, however, did not translate into substantial improvements in child health outcomes for two possible reasons: poor CCT implementation and the low quality of rural health facilities.

scholarly journals Association of frailty with health service utilisation and health care expenditure in sub-Saharan Africa: evidence from Côte d’Ivoire

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rachel C. Ambagtsheer ◽  
Richard K. Moussa
Keyword(s):  
Health Service ◽  
Cote D'ivoire ◽  
Côte D’Ivoire ◽  
Health Service Utilisation ◽  
Sub Saharan Africa ◽  
Service Utilisation ◽  
Self Medication ◽  
Cote D’Ivoire ◽  
Sub Saharan ◽  
Traditional Practitioners

Abstract Background Frailty, a syndrome resulting in heightened risk of negative outcomes for older adults, is increasing across the globe. However, little is known about the health service impacts of frailty in low-income countries (LICs), and in particular, sub-Saharan Africa (SSA). This study explores the relationship between frailty and health service 1) utilisation and 2) expenditure within Côte d’Ivoire. Methods Participants aged 50 years and over participated in the Living Condition, Health and Resilience among the Elderly study. Frailty was assessed using a 30-item Frailty Index (FI). The association between frailty and self-reported health service utilisation was analysed for general practitioners (GPs), specialists, overnight hospitalisations, traditional practitioners and self-medication. Expenditure over the previous month included consulting, medications, hospitalisations and total expenditure. Results Among participants [n = 860, mean age (SD) = 61.8 (9.7) years, 42.9% female], 60.0% were frail, 22.8% pre-frail and 17.2% robust. The mean (SD) FI was 0.28 (0.17). Increased health service utilisation was associated with frailty for GP attendance, traditional practitioners and self-medication but not specialists or overnight hospitalisation. Pre-frailty and frailty were associated with increased total health service expenditure, with frailty also associated with aggregate consulting costs and medications. Conclusions Although frailty is associated with health service utilisation and expenditure in a variety of contexts, the study results suggest that such impacts may vary across the globe. The experience of frailty in LICs is likely to differ from that experienced elsewhere due to cultural traditions, attitudes to the health system, and accessibility, with more research needed.

scholarly journals Maternal health service utilisation of adolescent women in sub-Saharan Africa: a systematic scoping review

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Tensae Mekonnen ◽  
Tinashe Dune ◽  
Janette Perz
Keyword(s):  
Maternal Health ◽  
Health Service ◽  
Adolescent Mothers ◽  
Maternity Care ◽  
Post Partum ◽  
Health Service Utilisation ◽  
Sub Saharan Africa ◽  
Maternal Health Service ◽  
Service Utilisation ◽  
Sub Saharan

Abstract Introduction Sub-Saharan Africa has the highest rate of adolescent pregnancy in the world. While pregnancy during adolescence poses higher risks for the mother and the baby, the utilisation of maternity care to mitigate the effects is low. This review aimed to synthesise evidence on adolescent mothers’ utilisation of maternity care in Sub-Saharan Africa and identify the key determinant factors that influence adolescent mothers’ engagement with maternity care. Method A systematic review of scholarly literature involving seven databases: ProQuest, PubMed, EMBASE/Elsevier, SCOPUS, PsycINFO, CINAHL and Infomit was conducted. Studies published in English between 1990 and 2017 that examined Sub-Saharan adolescent mothers’ experiences of utilising biomedical maternity care during pregnancy, delivery and the post-partum period were included. Results From 296 relevant articles 27 were identified that represent the experience of adolescent mothers’ maternal health service utilisation in Sub-Saharan Africa. The review indicates that maternal health service utilisation in the majority of Sub-Saharan African countries is still low. There is also a wide discrepancy in the use of maternity care services by adolescent mothers across countries in Sub-Saharan Africa. Conclusions The review reveals that a significant number of adolescents in Sub-Saharan Africa do not access and use maternity services during pregnancy. Several factors from individual to systemic levels contributed to low access and utilisation. This implies that interventions targeting the women, their partners, healthcare professionals, communities and the organisations (local to national) are necessary to improve adolescent mother’s engagement with maternity care in Sub-Saharan Africa.

scholarly journals Armed conflicts and national trends in reproductive, maternal, newborn and child health in sub-Saharan Africa: what can national health surveys tell us?

2019 ◽  
Vol 4 (Suppl 4) ◽  
pp. e001300 ◽  
Author(s):  
Ties Boerma ◽  
Hannah Tappis ◽  
Ghada Saad-Haddad ◽  
Jai Das ◽  
Dessalegn Y Melesse ◽  
...  
Keyword(s):  
Child Health ◽  
Child Growth ◽  
Armed Conflicts ◽  
Sub Saharan Africa ◽  
Newborn And Child Health ◽  
National Surveys ◽  
Sub Saharan ◽  
National Trends ◽  
The Impact ◽  
And Child Health

Armed conflicts are widespread in sub-Saharan Africa and considered to be an important factor in slowing down national progress in reproductive, maternal, newborn and child health (RMNCH). The measurement of the impact of conflicts on national levels and trends in RMNCH is difficult. National surveys conducted before and sometimes during and after conflicts are a major source of information on the national and local effects of conflicts on RMNCH. We examined data from national surveys in 13 countries in sub-Saharan Africa with major conflicts during 1990–2016 to assess the levels and trends in RMNCH intervention coverage, nutritional status and mortality in children under 5 years in comparison with subregional trends. The surveys provide substantive evidence of a negative association between levels and trends in national indicators of RMNCH service coverage, child growth and under-5 mortality with armed conflict, with some notable exceptions. National surveys are an important source of data to assess the longer term national consequences of conflicts for RMNCH in most countries, despite limitations due to sampling and timing of the surveys.

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