Hou, Xiaohui

Health, Nutrition and Population, East Asia and Pacific Region, World Bank
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health economics; social safety nets; poverty
Health, Nutrition and Population, East Asia and Pacific Region, World Bank
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Last updated: January 31, 2023
Hou, Xiaohui is a Senior Economist in the World Bank.  Joined as a Young Professional, she has since worked in Human Development department and Poverty Reduction and Economic Management department across the East Europe and Central Asia region, the South Asia region, and most recently the East Asia and Pacific region.  She also spent a number of years in the World Bank Institute, the capacity building arm of the World Bank, focusing on face to face training and network development.  Her fields include health economics, social safety net, labor economics and impact evaluation. She has published a dozen of papers in both economics and medical peer reviewed journals. She also teaches as a visiting scholar. A Peking University graduate, she obtained her Ph.D. in the Health Services and Policy Analysis and a Master’s degree in Economics from the University of California, Berkeley, and a Master’s degree in Health Policy and Administration from the Washington State University. 
Citations 44 Scopus

Publication Search Results

Now showing 1 - 9 of 9
  • Publication
    Stagnant Stunting Rate Despite Rapid Economic Growth in Papua New Guinea: Factors Correlated with Malnutrition among Children under Five
    (World Bank, Washington, DC, 2015-06) Hou, Xiaohui
    Maternal and child undernutrition is a pervasive and detrimental condition in Papua New Guinea. Despite rapid economic growth during the past decade, the stunting rate for children under 5, one of the primary indicators for child undernutrition, was estimated at 46 percent in Papua New Guinea in 2010, stagnant from 44 percent in 2005. This paper analyzes the association between the demographic, socioeconomic, environmental, and health-related factors on nutritional status for children under age 5 years, using the 2009–10 Papua New Guinea Household Income and Expenditure Survey. Stunting and underweight rates sharply rise in the first 24 months. Even in the better-off quintiles, children suffer from suboptimal breastfeeding and complementary food in the first 24 months. In general, the regression results showed that household wealth and geographic location are crucial factors that contribute to children’s malnutrition. More importantly, food quality, measured by protein intake, has significant predicting power on child malnutrition. Broadly increasing socioeconomic status and improving the quantity and quality of caloric intake are general steps to improving health outcomes in Papua New Guinea. In addition, three key areas were identified as critical to alleviating the persistent and detrimental stunting rate in the country: (1) exclusive breastfeeding and complementary food; (2) interventions by health workers; and (3) nutrition education.
  • Publication
    A Snapshot of Health Equity in Papua New Guinea: An Analysis of the 2010 Household Income and Expenditure Survey
    (World Bank, Washington, DC, 2015-06) Irava, Wayne; Barker, Katie; Somanathan, Aparnaa; Hou, Xiaohui
    This paper highlights challenges that the government of Papua New Guinea faces in delivering equitable health care. It analyses findings from the 2010 household survey, including sickness reporting, health service utilization and out of pocket expenditure, concluding that the poorest quintile is most vulnerable to illness, yet has the lowest utilization rates of healthcare facilities. The lack of healthcare workers and the distance to facilities are among the most dominant reasons cited for not utilizing healthcare facilities in the poorest quintile while out-of-pocket payments have minimal catastrophic impact, yet have still been found to be a barrier to utilization. The paper also sets out policy implications of these findings, including the need for the government to focus on, and prioritize, strengthening the health services delivery to achieve universal health coverage.
  • Publication
    Determinants of Tobacco Consumption in Papua New Guinea: Challenges in Changing Behaviors
    (World Bank, Washington, DC, 2015-06) Hou, Xiaohui; Anderson, Ian
    This paper analyzes smoking prevalence and smoking behaviors in Papua New Guinea. Using the 2009–10 Papua New Guinea Household Income and Expenditure Survey, the paper analyzes the determinants of tobacco use and tobacco choices in Papua New Guinea. The results show that adults (18 years and above) in the poorest quartile are more likely to smoke. Tobacco consumption imposes a large financial burden to poor households. Tobacco consumption accounts for about 23 percent of total household food expenditure for households in the poorest quartile, compared with 15 percent for the entire sample. However, most of these households consume non-processed tobacco. The study reveals the urgency to control tobacco consumption in Papua New Guinea and considers some practical challenges that the country may face.
  • Publication
    Financing the Frontline in Papua New Guinea: An Analytical Review of Provincial Administrations' Rural Health Expenditure 2006-2012
    (World Bank, Washington, DC, 2015-09) Cairns, Alan; Hou, Xiaohui
    Financing the Frontline updates the expenditure analysis carried out in Below the Glass Floor (2013) and tests whether the spending patterns emerging in 2009 and 2010 in Papua New Guinea have been sustained or improved in 2011 and 2012. The review also supports a better understanding of the issues that confront frontline service delivery — such as the ambiguity of roles and responsibilities in some rural health functions — and proposes next steps. Concurrently, the National Department of Health performance information on facilities (from the National Health Information System) has been reviewed. The integration of the expenditure analysis, the NHIS performance information and the findings from the Promoting Effective Public Expenditure facility surveys will provide a rich source of information to help sharpen understanding and shape solutions.
  • Publication
    Understanding Health Workers' Job Preferences to Improve Rural Retention in Timor-Leste: Findings from a Discrete Choice Experiment
    (PLoS, 2016-11-15) Smitz, Marc-Francois; Witter, Sophie; Lemiere, Christophe; Eozenou, Patrick Hoang-Vu; Lievens, Tomas; Zaman, Rashid U.; Engelhardt, Kay; Hou, Xiaohui
    Timor-Leste built its health workforce up from extremely low levels after its war of independence, with the assistance of Cuban training, but faces challenges as the first cohorts of doctors will shortly be freed from their contracts with government. Retaining doctors, nurses and midwives in remote areas requires a good understanding of health worker preferences. The article reports on a discrete choice experiment (DCE) carried out amongst 441 health workers, including 173 doctors, 150 nurses and 118 midwives. Qualitative methods were conducted during the design phase. The attributes which emerged were wages, skills upgrading/specialisation, location, working conditions, transportation and housing.
  • Publication
    Vulnerability Map for Response to the COVID-19 Epidemic: A Case Study on Indonesia
    (Washington, DC: World Bank, 2022-02-01) Hou, Xiaohui; Tariverdi, Mersedeh; Pambudi, Eko Setyo; Harimurti, Pandu; Nagpal, Somil; Vicencio, Jasmine Marie; Görgens, Marelize; Garrett, Keith Patrick
    The COVID-19 pandemic has emerged as a threat to global health security. This paper uses geospatial analyses to create a COVID Vulnerability Mapping Dashboard that examines and displays social vulnerability indices at the national and subnational levels in Indonesia. The dashboard answers three main questions: 1. Where are the vulnerable populations 2. What is the capacity of local health systems and 3. What is the local trend in COVID cases The dashboard prototype presented herein was developed and used to direct attention to geographic areas where risks are expected to be greatest.
  • Publication
    A Snapshot of Health Equity in Papua New Guinea: An Analysis of the 2010 Household Income and Expenditure Survey
    (World Bank, Washington, DC, 2015-05) Irava, Wayne; Barker, Katie; Somanathan, Aparnaa; Hou, Xiaohui
    In Papua New Guinea the poorest quintile is most vulnerable to illness, yet has the lowest utilization rates of healthcare facilities. When looking at age groups the elderly ( 55) are the most vulnerable to illness and the least likely to seek treatment. The lack of healthcare workers and the distance to facilities are among the most dominant reasons cited for not utilizing heath care in the poorest quintile. The perceived quality of services is a barrier to health care utilization across all quintiles. Out-of-pocket (OOP) payments have minimal catastrophic impact, yet have been found to still be a barrier to utilization - especially amongst the poorest quintile. The government should focus on and prioritize strengthening the health services delivery to achieve universal health coverage.
  • Publication
    Turning Challenges into Opportunities: The Medium Term Health Expenditure Pressure Study in Timor-Leste
    (World Bank, Washington, DC, 2016) Hou, Xiaohui
    Timor-Leste has achieved significant improvements in the health sector since becoming independent a little over a decade ago. Timor-Leste is undergoing an epidemiology transition as the non-communicable disease burden increases, while infectious disease prevalence remains high. The report aims to: (i) analyze trends in health sector public expenditures (budgets and realized expenditures); (ii) document trends in staffing and training, including their costs; (iii) understand the likely resource envelope available to the health sector over the next five years (from all sources); and (iv) provide options to adjust expenditures, to support key priorities, and improve the efficiency of existing expenditures to create space for key priorities. This report reviews the critical fiscal issues facing the health sector in the medium term, including the key areas demanding fiscal space, and the likely resource envelope from government and donors. The report analyzes past trends in health expenditures (by the government and donors), forecasts future resource availability, and examines implications for the Ministry of Health (MOH) to sustain delivery of quality health services. The report is organized as follows: chapter one gives introduction. Chapter two analyzes human resource development in health by discussing three scenarios for medium term health staff planning. Chapter three examines trends in government health spending by key expenditure areas and discusses the increasingly important role that government spending will play in the health sector. Chapter four analyzes the past trends in donor health financing in Timor-Leste. Chapter five concludes by reviewing four key areas (rising wage bill, pharmaceutical spending, overseas medical transfers, and declining donor spending) that are exerting pressure on health sector financing, and suggests policy recommendations based on the analysis detailed in this report.
  • Publication
    Exploring Factors Driving the Performance of Rural Health Care in Papua New Guinea
    (World Bank, Washington, DC, 2018-06-06) Cairns, Alan; Witter, Sophie; Hou, Xiaohui
    Examining performance patterns of sub-national units, such as provinces and districts, within a health system is important to understand their drivers and what might be needed to improve outputs. Such literature is relatively rare in low and middle-income countries. It is particularly relevant for Papua New Guinea, which is underperforming in relation to its neighbours and targets for core health indicators and faces particular geographical challenges, with a dispersed and diverse population. In this analysis, we undertake simple correlation analysis between remoteness of populations, expenditure on frontline services and core outputs by provinces and regions, such as antenatal care, outpatient visits, outreach clinics, referrals of patients and facility supervision in 2012. In the context of the challenging geography of Papua New Guinea, these are expected to be important factors. Some expected patterns were found – for example, between remoteness and higher service costs, as well as between remoteness and higher outreach services. Outpatient visits, however, increased with remoteness, which was surprising. Our correlation analyses suggest a virtuous circle operating in some areas (even in the most geographically challenged) between outreach clinics, immunisation coverage, supervision, frontline spending and overall health system performance, which merits further investigation into the factors supporting these and how they can be reinforced elsewhere. Whilst expenditure did not correlate closely with provincial performance, it was evident that the provinces with higher performance across the selection of metrics typically were also the higher spenders on frontline services. There was some correlation of higher performance with density of public provision. More fine-grained assessment, including at the district level, will be needed to understand the low levels of outreach clinics, transfers and supervision, all of which are critical for quality health care in these kinds of contexts. The analysis illustrates what can be learned from combining routine data sources, as well as the limits and the need to complement such analysis with more detailed local qualitative investigations. It also reinforces the message that local leadership, supportive supervision and resources directed to frontline services can be effective in raising health system performance, even in challenging settings.