South Asia Health, Nutrition, and Population Global Practice
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Health Service Delivery, Nutrition, Child Development
South Asia Health, Nutrition, and Population Global Practice
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Last updated January 31, 2023
Kathryn Andrews is a health economist in the South Asia Health, Nutrition, and Population Global Practice, leading analytical work related to health service delivery measurement and supporting operational work on health systems strengthening. She was previously a Young Professional in the Human Development Chief Economist’s Office, where she supported the design and implementation of Service Delivery Indicators (SDI) surveys. She previously worked at the World Health Organization and Institute for Health Metrics and Evaluation.
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Now showing 1 - 4 of 4
The Quality of Health and Education Systems Across Africa: Evidence from a Decade of Service Delivery Indicators Surveys(Washington, DC: World Bank, 2021-11-18) Gatti, Roberta ; Andrews, Kathryn ; Avitabile, Ciro ; Conner, Ruben ; Sharma, Jigyasa ; Yi Chang, AndresHave teachers mastered the subject matter they are teaching? Can doctors accurately diagnose and treat critical health conditions? Are schools and health facilities sufficiently stocked with needed equipment and supplies? Are they sufficiently supported and staffed to optimize learning and health care outcomes? For the past decade, the World Bank’s Service Delivery Indicators (SDI) surveys have collected nationally representative data in countries across Africa to answer these questions. The surveys aim to measure the quality of services where they meet citizens: in schools and health facilities. The Quality of Health and Education Systems Across Africa: Evidence from a Decade of Service Delivery Indicators Surveys identifies areas of achievement and constraint in service delivery, shedding light on how service delivery may foster or stunt human capital accumulation. SDI surveys show that schools and health clinics across Africa are still falling short in some critical areas. The delivery of primary care services is very heterogenous between and within countries. Many health facilities lack the basic necessities to provide proper care, such as essential medicines, basic diagnostic equipment, and adequate water and sanitation. Moreover, health care providers’ ability to diagnose and treat common health conditions correctly is low and distributed unevenly. Health personnel’s absence from health facilities remains a concern across the surveyed countries. Learning is low, and, not unlike health care, levels of student learning vary significantly across countries: less than half of grade 4 students can recite a simple sentence or perform basic mathematical operations. This deficient learning is correlated with teachers’ low levels of content knowledge and sub-par pedagogy skills. Some schools are also missing crucial inputs, such as blackboards or private and gendered toilets, and struggle with high pupil-teacher ratios. Despite these challenges, success stories in both sectors illustrate the quality of service delivery that could be achieved and showcase the dedication of teachers and medical staff across Africa. By studying data from thousands of facilities, considering the local context, and drawing insights from the literature, this book offers important insights for how countries can strengthen health and education systems and build back better in the wake of the massive disruptions brought about by the COVID-19 pandemic.
What Can the Service Delivery Indicator Surveys Tell Us about COVID-19 Preparedness?(World Bank, Washington, DC, 2020-07) Sharma, Jigyasa ; Andrews, Kathryn ; Conner, Ruben ; Gatti, RobertaTo aid national and international efforts to support countries in enhancing their pandemic preparedness in the face of COVID-19, this paper draws from the World Bank's Service Delivery Indicator surveys to highlight key aspects of health service preparedness in Kenya, Sierra Leone, and Tanzania. The results of this analysis paint a highly variable picture. At least 10 percent of lower-level facilities in all three countries have inpatient care capacity, suggesting that these lower-level facilities could help absorb surges in patient flow. Less than half of the facilities in the three countries have a fixed or mobile phone and less than a third have internet access, suggesting a likely challenge in communication and timely sharing of essential information. Concerningly, less than half of the facilities have appropriate handwashing facilities for patients, with even lower rates in rural areas. Between 80 and 95 percent of the facilities have a thermometer to diagnose fever, but availability of a thermometer, stethoscope, and blood pressure cuff together is variable (ranging from almost 90 percent of the facilities in Tanzania to less than 65 percent in Sierra Leone). The paper concludes by highlighting key innovations for future surveys to improve measurement of pandemic preparedness.
The Realities of Primary Care: Variation in Quality of Care Across Nine Countries in Sub-Saharan Africa(World Bank, Washington, DC, 2021-04) Andrews, Kathryn ; Conner, Ruben ; Gatti, Roberta ; Sharma, JigyasaThe COVID-19 pandemic has highlighted the centrality of primary care in protecting people’s health and well-being during and beyond crises. It has also provided an opportunity to strengthen and redesign primary care so that it will better serve its purpose. However, to-date there is limited evidence on the quality of service delivery in primary care. Service Delivery Indicators surveys have attempted to fill this gap. Using Service Delivery Indicators surveys of 7,810 health facilities and 66,151 health care providers in nine Sub-Saharan African countries, this paper investigates the quality of care across five domains to understand a citizen’s experience of primary care in his/her country. The results indicate substantial heterogeneity in the quality of primary care service delivery between and within countries. The availability of basic equipment, infrastructure, and essential medicines varies—public facilities, facilities in rural areas, and non-hospitals are more lacking compared with private facilities, urban facilities, and hospitals. In terms of patient care, health care providers’ ability to correctly diagnose and treat common health conditions is low and variably distributed. COVID-19 has catalyzed a long overdue health system redesign effort, and the Service Delivery Indicators surveys offer an opportunity to examine carefully the quality of service delivery, with an eye toward health system reform.
Domestic Government Spending on Human Capital: A Cross-Country Analysis of Recent Trends(World Bank, Washington, DC, 2019-10) Andrews, Kathryn ; Avitabile, Ciro ; Gatti, RobertaUsing a new data set comprised of publicly available information, this paper provides cross-country evidence on domestic government spending for human capital in recent years. Creating a measure of social spending that covers the three sectors of health, education, and social protection has proven to be a challenging task. Only for health spending is there high data coverage over time and across countries. Education and, especially, social protection display large gaps. Increases in social sector spending have generally been slow and unsteady. Although education spending in low-income countries has seen a stable and steady increase, spending on health has been remarkably flat. Human capital outcomes are only weakly correlated with spending in the three sectors. Finally, this paper discusses future research required to provide guidance on how much and what type of investment is needed to achieve high levels of human capital.