Measurement and Mapping of Maternal Health Service Coverage Through a Novel Composite Index: A Sub-National Level Analysis in India

Background: Expansion of maternal health service coverage is crucial for the survival and wellbeing of both mother and child. To date, limited literature exists on the measurement of maternal health service coverage at the sub-national level in India. The prime objectives of the study were to comprehensively measure the maternal health service coverage by generating a composite index; map India by categorizing it into low, medium and high zones and examine its incremental changes over time. Methods: Utilising a nationally representative time series data of 15 key indicators spread across three domains of antenatal care, intranatal care and postnatal care, we constructed a novel ‘Maternal Health Service Coverage Index’ (MHSI) for 29 states and 5 union territories of India for the base (2017-18) and reference (2019-20) years. Following a rigorous procedure, MHSI scores were generated using both arithmetic mean and geometric mean approach. We categorized India into low, medium and high maternal health coverage zones and further generated geospatial maps to examine the extent and transition of maternal health service coverage from base to reference year.Results: India registered the highest mean percentage coverage (93.66%) for ‘institutional delivery’ and lowest for ‘treatment for obstetric complications’ (9.25%) among all the indicators. Depending on the usage of arithmetic mean and geometric mean approach, the maternal health service coverage index score for India exhibited marginal incremental change (between 0.015- 0.02 index points) in the reference year. West zone exhibited an upward transition in the coverage of maternal health service indicators, while none of the zones recorded a downward movement. States of Mizoram (east zone), Puducherry (south zone) showed a downward transition. Union territories of Dadra & Nagar Haveli (west zone) and Chandigarh (north zone) along with the states of Maharashtra (west zone), Assam, as well as Jharkhand (both from the east & north east zone), showed upward transition.Conclusion: Overall, maternal health service coverage is increasing across India. Our study offers a novel summary measure to comprehensively quantify the coverage of maternal health service, which can momentously help India to identify lagged indicators and low performing regions, thereby warranting the targeted interventions and concentrated programmatic efforts to bolster the maternal health service coverage at the sub-national level.

Market structure and horizontal growth strategies – A case study of the container shipping industry

This article aims to review the structural transformation in the container shipping industry from 1995 to 2020 and identify the growth strategies of global carriers to enhance their market presence. Along with large investments in mega vessels, the growing deployment of charter capacity in all ship sectors has been a prominent trend in fleet expansion. The waves of mergers/acquisitions and bankruptcies have narrowed the group of global carriers. In addition to internal and external growth, they have been increasingly involved in strategic alliances to expand service coverage and compete well with powerful rivals. A few mega carriers have progressively captured the industry. In 2020, the Top 12 controlled 88 % of the global supply, and nearly 56 % was in the hands of the Top 4. Besides the substantial expansion of the four biggest carriers, we can identify the de-concentration within this gigantic group through the less inequality between their market shares.

Research on the Driving Factors for the Development of Inclusive Finance in Rural Commercial Banks: Market Competition or Government Intervention?

Based on the survey data of 43 rural commercial banks in Jiangsu Province, China, from 2015 to 2018, 14 indicators among 3 dimensions—coverage, business implementation and service quality—were selected to establish the inclusive finance index of rural commercial banks. The impact of market competition and government intervention on the development of the inclusive finance of rural commercial banks and the mechanism were empirically tested. The heterogeneous performance of market competition and government intervention in different market conditions were also thoroughly discussed. The results show that both market competition and government intervention can help reduce the pricing level and broaden the service coverage of rural commercial banks, which can promote the development of inclusive finance. But the role of market competition has a stronger impact than that of government intervention. The heterogeneity test shows that market competition plays a more significant role in the regions with higher levels of market competition and financial development, and in the southern and central Jiangsu Province, where the economy is relatively more developed. However, in the regions with lower levels of market competition and financial development, as well as in the northern Jiangsu Province, with a relatively backward economy, government intervention significantly improves the degree of inclusive finance of rural commercial banks. Finally, we advocate that the roles of market and government should be applied according to local conditions, and the development of the inclusive finance in rural commercial banks needs to be continuously promoted.

Commercial real estate finance and the lending cap rate

PurposeThe aim of this study is to report on a simple derivation that results in what the authors refer to as the lending cap rate. The lending cap rate is a unique cap rate resulting in a property valuation that perfectly aligns the maximum loan amount for the financing of commercial real estate.Design/methodology/approachThe derivation is the result of simple algebra relating the two most common underwriting ratios: debt service coverage and loan-to-value with the formula for the present value of an annuity. Numerical examples are presented to demonstrate the calculation of the lending cap rate, property valuation and maximum loan amount. The authors also present comparative statics results.FindingsThe main finding of this research is that once a lender knows the debt service coverage ratio, loan-to-value ratio and lending terms for a specific property financing request, a simple calculation reveals the lending cap rate and the property valuation that aligns the maximum loan amount implied by the two underwriting ratios.Practical implicationsOne practical implication of the research is that a simple calculation reveals the lending cap rate which facilitates timely property evaluations for lending purposes. The methods demonstrated also offer real estate finance educators a practical means of connecting the loan underwriting process with property appraisal thereby facilitating conceptual understanding.Originality/valueThe key finding is original, and the importance of the finding is that the determination of the lending cap rate is simple and has the ability to make commercial real estate lending faster and cheaper, especially in lending situations where an evaluation rather than an appraisal is appropriate.

Home and Community-Based Services Between the USA and Taiwan

Home and community-based services (HCBS) are critical to support our rapidly growing and aging population around the world. This paper takes initial steps to compare HCBS between the USA and Taiwan from four perspectives: funding sources, service types, challenges, and recommendations. Peer-reviewed articles and governmental reports (both English and Chinese) in the U.S.A. and Taiwan were reviewed. Analyses showed both countries mainly use tax dollars to fund HCBS. Although both countries have similar service categories, USA lack a clear organization scheme whereas Taiwan has detailed and clear services provisions. Workforce quality and shortage were common challenges for both countries, especially from culture perceptive. Recommendations for USA include expanded funding pool, better coordination between agencies, and rebalancing HCBS and institutional care with limited budget. Recommendations for Taiwan include expanded service coverage and quality to reduce disparity in rural areas, and providing more support for informal caregivers.

Evaluation and development planning for clean water supply system of Sanih Fountain in Buleleng regency

The rising population and economic activity have induced an increase in the demand for clean water in Buleleng Regency, especially in Sawan, Kubutambahan, and Tejakula District, respectively. The distribution of clean water supply is carried out through house connections and public hydrant by the Water Supply Company of Buleleng Regency with service coverage only reaching 40.09% in 2018. So it is necessary to evaluate and develop plans for the existing clean water supply system to increase service coverage. The evaluation of the water supply system includes an analysis of the availability and demand of clean water based on the population, with a projection for the next 25 years. Analysis of the clean water supply system development plan considers the availability of water resources potential. The evaluation results show that the existing system has not met the water demands in the service area. The development plan carried out to fulfill the demand for clean water is by optimizing the discharge of the Sanih Fountain by 125 liters/second and the construction of the Bungkulan 2 well.

Improving equity in the distribution and financing of health services in Mauritius, a small island state with deeply rooted welfare state standards

BackgroundEnsuring benefits of free healthcare services are accessible to those in need is essential to achieve universal health coverage (UHC). Mauritius has sustained a welfare state over four decades with free health services in all public facilities. However, paradoxically, the national UHC service coverage index stood at only 63 in 2017. An assessment of who benefits from health interventions is, therefore, vital to shape future health financing strategies.MethodsThe study applied benefit incidence analysis (BIA) to understand the distribution of healthcare utilisation and spending in comparison to income distribution. Also, a financial incidence analysis (FIA) was conducted to assess the progressivity of the health financing systems. Data from the national survey on household out-of-pocket (OOP) expenditure for health were used for the purpose of BIA and FIA. Concentration curves and concentration indices (CI) were nationally estimated and disaggregated to rural/urban levels. Kakwani index (KI) was calculated to assess the progressivity of private healthcare financing.ResultsThe CI for outpatient, inpatient and day care within the public health sector is estimated at −0.33, –0.14 and −0.14, respectively. Overall, CI in the public sector is −0.26. Benefit distribution in the private sector is pro-rich with CI of 0.27. Healthcare financing is regressive as demonstrated by a KI of −0.004, with the poorest population groups contributing a large share, in terms of taxes and OOP, to finance the health system.ConclusionThe BIA posits that government spending on public healthcare has resulted in significant pro-poor services distribution. This is largely offset by pro-rich distribution in the private sector. Thus, implying health financing strategies must be reviewed to promote financial protection against catastrophic health payments and bolster efforts to improve UHC service coverage index and achieve UHC Target 3.8 under Sustainable Development Goal 3.

Assessing the effects of disease-specific programs on health systems: An analysis of the Bangladesh Lymphatic Filariasis Elimination Program’s impacts on health service coverage and catastrophic health expenditure

This study presents a methodology for using tracer indicators to measure the effects of disease-specific programs on national health systems. The methodology is then used to analyze the effects of Bangladesh’s Lymphatic Filariasis Elimination Program, a disease-specific program, on the health system. Using difference-in-differences models and secondary data from population-based household surveys, this study compares changes over time in the utilization rates of eight essential health services and incidences of catastrophic health expenditures between individuals and households, respectively, of lymphatic filariasis hyper-endemic districts (treatment districts) and of hypo- and non-endemic districts (control districts). Utilization of all health services increased from year 2000 to year 2014 for the entire population but more so for the population living in treatment districts. However, when the services were analyzed individually, the difference-in-differences between the two populations was insignificant. Disadvantaged populations (i.e., populations that lived in rural areas, belonged to lower wealth quintiles, or did not attend school) were less likely to access essential health services. After five years of program interventions, households in control districts had a lower incidence of catastrophic health expenditures at several thresholds measured using total household expenditures and total non-food expenditures as denominators. Using essential health service coverage rates as outcome measures, the Lymphatic Filariasis Elimination Program cannot be said to have strengthened or weakened the health system. We can also say that there is a positive association between the Lymphatic Filariasis Elimination Program’s interventions and lowered incidence of catastrophic health expenditures.