06. Journals
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These are journal articles published in World Bank journals as well as externally by World Bank authors.
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Publication Invitations, Incentives, and Conditions: A Randomized Evaluation of Demand-Side Interventions for Health Screenings(Elsevier, 2022-03) de Walque, Damien; Chukwuma, AdannaThis randomized controlled trial investigates the impact of four demand-side interventions on health screening for diabetes and hypertension among Armenian adults. The interventions are 1) personalized invitations from a physician, 2) personalized invitations with information about peer screening behavior, 3) personalized invitations with a labeled but unconditional financial incentive, and 4) personal invitations with a conditional financial incentive. Compared with the control group, interventions 1 to 3 led to a significant increase in the screening rate of about 15 percentage points for diabetes and hypertension. The highest impact was measured for intervention 4 leading to a 31.2 percentage point increase in both screenings.Publication Generating Political Priority for Primary Health Care Reform in Romania(Taylor and Francis, 2021-08-17) Comsa, Radu; Wang, Huihui; Chukwuma, Adanna; Gong, Estelle; Onofrei, Lidia; Dmytraczenko, TaniaThis paper examines how political priority was generated for comprehensive reforms to address inequitable access to high-quality primary health care (PHC) in Romania. We apply John Kingdon’s model of political agenda setting to explore how the convergence of problems, solutions, and political developments culminated in the adoption of a government program that included critical PHC reforms and approval of a results-based funding instrument for implementation. We draw on a review of the gray and peer-reviewed literature and stakeholder consultations, and use content analysis to identify themes organized in line with the dimensions of Kingdon’s model. We conclude this paper with three lessons that may be relevant for generating political priority for PHC reforms in other contexts. First, national PHC reforms are likely to be prioritized when there is political alignment of health reforms with the broader political agenda. Second, the availability of technically sound and feasible policy proposals makes it possible to seize the political opportunity when the window opens. Third, partners’ coordinated technical and financial support for neglected issues can serve to raise their priority on the political agenda.Publication Improving Services for Chronic Non-communicable Diseases in Samoa: An Implementation Research Study Using the Care Cascade Framework(John Wiley and Sons, Inc., 2021-07-26) Fraser-Hurt, Nicole; Naseri, Leausa Take; Thomsen, Robert; Matalavea, Athena; Ieremia-Faasili, Victoria; Reupena, Muagatutia Sefuiva; Hawley, Nicola L.; Pomer, Alysa; Rivara, Anna C.; Obure, Dayo Carol; Zhang, ZhangSamoa needs to intensify the response to the growing non-communicable disease burden. This study aimed to assess bottlenecks in the care continuum and identify possible solutions. The mixed-methods study used the cascade framework as an analysis tool and hypertension as a tracer condition for chronic non-communicable diseases. Household survey data were integrated with medical record data of hypertension patients and results from focus group discussions with patients and healthcare providers. Hypertension prevalence was 38.1% but only 4.7% of hypertensive individuals had controlled blood pressure. There were large gaps in the care continuum especially at screening and referral due to multiple socio-cultural, economic and service delivery constraints. In Samoa, care for chronic non-communicable diseases is not effectively addressing patient needs. This calls for better health communication, demand creation, treatment support, nutritional interventions and health service redesign, with a focus on primary healthcare and effective patient and community engagement.Publication Challenges and Opportunities for Purchasing High-Quality Health Care: Lessons from Armenia(Taylor and Francis, 2021-04-29) Lylozian, Hratchia; Chukwuma, Adanna; Gong, EstelleThis paper examines how purchasing decisions in Armenia may contribute to barriers in using high-quality health care, particularly for non-communicable diseases, drawing on a review of the literature and key informant interviews. The paper adapts the strategic health purchasing progress framework, to examine how characteristics of purchasing, the health system, and the political, administrative, and macro-fiscal environment may have facilitated or hindered the attainment of service delivery goals. We conclude with six lessons for reforms aimed at improving the coverage and quality of health care in Armenia. First, increasing the political priority of access to quality of health care is a pre-requisite to advancing reforms to address these issues. Second, improved purchasing governance in Armenia will require a purchaser that can make decisions without political interference, with appropriate accountability mechanisms, improvements in technical capacity, and the routine use of data systems. Third, there is a need for the regulatory framework to ensure that revisions of the benefits package contribute to reducing the disease burden and improving access to care. Fourth, regulations governing quality-related criteria for provider selection should be enforced and include considerations for process quality. Fifth, payment incentives should be revised to encourage an increase in the supply of primary health care, reduce bypassing for hospital care, and improve the quality of services. Sixth, the potential of purchasing to improve service delivery will be dependent on increased pre-paid and pooled funds and better governance of the quality of care.Publication Invitations and Incentives: A Qualitative Study of Behavioral Nudges for Primary Care Screenings in Armenia(Springer Nature, 2020-12) Gong, Estelle; Chukwuma, Adanna; Ghazaryan, Emma; de Walque, DamienNon-communicable diseases account for a growing proportion of deaths in Armenia, which require early detection to achieve disease control and prevent complications. To increase rates of screening, demand-side interventions of personalized invitations, descriptive social norms, labeled cash transfers, and conditional cash transfers were tested in a field experiment. Our complementary qualitative study explores factors leading to the decision to attend screening and following through with that decision, and experiences with different intervention components. An individual’s decision to screen depends on 1) the perceived need for screening based on how they value their own health and perceive hypertension and diabetes as a harmful but manageable condition, and 2) the perceived utility of a facility-based screening, and whether screening will provide useful information on disease status or care management and is socially acceptable. Following through with the decision to screen depends on their knowledge of and ability to attend screenings, as well as any external motivators such as an invitation or financial incentive. Personalized invitations from physicians can prompt individuals to reconsider their need for screening and can, along with financial incentives, motivate individuals to follow through with the decision to screen. The effect of descriptive social norms in invitations should be further studied. Efforts to increase preventive screenings as an entry point into primary care in Armenia may benefit from implementation of tailored messages and financial incentives.Publication Responding to Aid Volatility: Government Spending on District Health Care in Zambia 2006-2017(Taylor and Francis, 2020-02) Jackson, Amy; Forsberg, Birger; Chansa, Collins; Sundewall, Jesper; Chansa, CollinsA corruption event in 2009 led to changes in how donors supported the Zambian health system. Donor funding was withdrawn from the district basket mechanism, originally designed to pool donor and government financing for primary care. The withdrawal of these funds from the pooled financing mechanism raised questions from Government and donors regarding the impact on primary care financing during this period of aid volatility. Financial data were extracted from Government documents and adjusted for inflation. Budget and expenditure for the district level over the period 2006 to 2017 were disaggregated by programmatic area for analysis. Despite the withdrawal of donor funding from the district basket after 2009, funding for primary care allocated to the district level more than doubled from 2006 to 2017. However, human resources accounted for this increase. The operational grant, on the other hand, declined.Publication Who Needs Big Health Sector Reforms Anyway?: Seychelles' Road to UHC Provides Lessons for Sub-Saharan Africa and Island Nations(Taylor and Francis, 2018-11-06) Workie, Netsanet Walelign; Shroff, Emelyn; Yazbeck, Abdo S.; Nguyen, Son Nam; Karamagi, HumphreyThe road to universal health coverage (UHC) needs not be driven by big reforms that include the initiation of health insurance, provider–funder separation, results-based financing, or other large health sector reforms advocated in many countries in sub-Saharan Africa and elsewhere. The Seychelles experience, documented through a series of analytical products like public expenditure reviews and supporting surveys with assistance from the World Bank and World Health Organization (WHO), shows an alternative, more incremental reform road to UHC, with important lessons to the region and other small-population or island nations. Done well, in some countries, a basic supply-side funded, publicly owned and operated, and integrated health system can produce excellent health outcomes in a cost-effective and sustainable way. The article traces some of the factors that facilitated this success in the Seychelles, including high political commitment, strong voice and a downward accountability culture, strong public health functions, and an impressive investment in primary health care. These factors help explain past successes and also provide a good basis for adaptation of health systems to dramatic shifts in the epidemiological and demographic transitions, disease outbreaks, and rising public expectation and demand for high quality of care. Once again, how the Seychelles responds can show the way for other countries in the region and elsewhere regardless of the types of reforms countries engage in.Publication A Comparison of Health Achievements in Rwanda and Burundi(FXB Harvard School of Public Health, 2018-06) Iyer, Hari S.; Chukwuma, Adanna; Mugunga, Jean Claude; Manzi, Anatole; Ndayizigiye, Melino; Anand, SudhirStrong primary health care systems are essential for implementing universal health coverage and fulfilling health rights entitlements, but disagreement exists over how best to create them. Comparing countries with similar histories, lifestyle practices, and geography but divergent health outcomes can yield insights into possible mechanisms for improvement. Rwanda and Burundi are two such countries. Both faced protracted periods of violence in the 1990s, leading to significant societal upheaval. In subsequent years, Rwanda’s improvement in health has been far greater than Burundi’s. To understand how this divergence occurred, we studied trends in life expectancy following the periods of instability in both countries, as well as the health policies implemented after these conflicts. We used the World Bank’s World Development Indicators to assess trends in life expectancy in the two countries and then evaluated health policy reforms using Walt and Gilson’s framework. Following both countries’ implementation of health sector policies in 2005, we found a statistically significant increase in life expectancy in Rwanda after adjusting for GDP per capita (14.7 years, 95% CI: 11.4–18.0), relative to Burundi (4.6 years, 95% CI: 1.8–7.5). Strong public sector leadership, investments in health information systems, equity-driven policies, and the use of foreign aid to invest in local capacity helped Rwanda achieve greater health gains compared to Burundi.Publication Pathways to High and Low Performance: Factors Differentiating Primary Care Facilities under Performance-Based Financing in Nigeria(Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine, 2018-01) Mabuchi, Shunsuke; Sesan, Temilade; Bennett, Sara C.The determinants of primary health facility performance in developing countries have not been well studied. One of the most under-researched areas is health facility management. This study investigated health facilities under the pilot performance-based financing (PBF) scheme in Nigeria, and aimed to understand which factors differentiated primary health care centers (PHCCs) which had performed well, vs those which had not, with a focus on health facility management practices. We used a multiple case study where we compared two high-performing PHCCs and two low-performing PHCCs for each of the two PBF target states. Two teams of two trained local researchers spent 1 week at each PHCC and collected semi-structured interview, observation and documentary data. Data from interviews were transcribed, translated and coded using a framework approach. The data for each PHCC were synthesized to understand dynamic interactions of different elements in each case. We then compared the characteristics of high and low performers. The areas in which critical differences between high and low-performers emerged were: community engagement and support; and performance and staff management. We also found that (i) contextual and health system factors particularly staffing, access and competition with other providers; (ii) health center management including community engagement, performance management and staff management; and (iii) community leader support interacted and drove performance improvement among the PHCCs. Among them, we found that good health center management can overcome some contextual and health system barriers and enhance community leader support. This study findings suggest a strong need to select capable and motivated health center managers, provide long-term coaching in managerial skills, and motivate them to improve their practices. The study also highlights the need to position engagement with community leaders as a key management practice and a central element of interventions to improve PHCC performance.Publication Variation in Quality of Primary-Care Services in Kenya, Malawi, Namibia, Rwanda, Senegal, Uganda and the United Republic of Tanzania(World Health Organization, 2017-06) Kruk, Margaret E.; Chukwuma, Adanna; Mbaruku, Godfrey; Leslie, Hannah H.Although substantial progress has been made in reducing child and maternal deaths in the past 15 years, many women and children in low- and middle-income countries continue to die of avertable causes. To stimulate a concerted effort to narrow the gap between rich and poor countries, the United Nation’s sustainable development goals (SDGs) include new targets to reduce maternal mortality to less than 70 per 100 000 live births and to reduce deaths of children younger than five years to 25 per 1000 live births by 2030. In this paper, we analyse the variation in the quality of processes of care in health facilities in seven countries in subSaharan Africa for two primary-care services: (i) antenatal care and (ii) care of sick children, using observations of clinical care, a gold standard measure of process quality. The results will inform policy-makers about current performance and provide a starting point for a broader discussion of quality measurement in the SDG era.