Person:
Chukwuma, Adanna
Author Name Variants
Fields of Specialization
HEALTH SYSTEM,
HEALTH FINANCING,
SERVICE DELIVERY,
POLITICAL ECONOMY,
ARMENIA,
RUSSIA
Degrees
ORCID
External Links
Departments
World Bank Health, Nutrition, and Population Global Practice
Externally Hosted Work
Contact Information
Last updated
September 14, 2023
Biography
Adanna is a Senior Health Specialist in the Health, Nutrition, and Population Global Practice, where she leads the design, implementation, and evaluation of investment operations. She has over ten years of experience advising national reforms to improve access to high-quality health care, through service delivery organization, strategic purchasing, revenue mobilization, and demand generation, including in Sri Lanka, Sierra Leone, India, Moldova, Tajikistan, the South Caucasus Countries, and Romania. She has published on health care financing, access, and quality in peer-reviewed journals, including the Bulletin of the World Health Organization and Social Science and Medicine. Adanna obtained a medical degree from the University of Nigeria, a Master of Science in Global Health from the University of Oxford, and a Doctor of Science in Health Systems from Harvard University.
Publication Search Results
1 - 10 of 25
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Publication
FinHealth Armenia: Reforming Public Financial Management to Improve Health Service Delivery
(World Bank, Washington, DC, 2020-11-02)This report aims to assess public financial management (PFM) bottlenecks in health service delivery and identify recommendations for the Ministry of Health (MOH) and its partners in Armenia. This PFM assessment identifies health sector–specific bottlenecks and recommends actions that the MOH and regional (Marz) health authorities can take. Governments have a central role to play in moving countries toward universal health coverage. In low- and middle-income countries, making progress toward universal health coverage involves financing mechanisms that allow for coverage for the formal sector, the poor and the informal sector, to improve the coverage of quality health services. PFM systems, the way public budgets are formed, executed, and monitored interact with health system functions to influence service delivery outcomes. This study builds on a body of research that links improved service delivery outcomes in the health sector to systems for fiscal sustainability, operational efficiency, fiscal transparency, and accountability. The evidence supports the proposition that governance matters for the effective use of public resources in health service delivery. -
Publication
Stakeholder Perspectives on e-Health Implementation in Armenia
(World Bank, Washington, DC, 2018-06)There is general recognition across stakeholders in Armenia that the e-health system can facilitate exchange of clinical and non-clinical information, transparency and accountability in service provision, and support for monitoring and evaluation. By tracking patient movement across health facilities, the e-health system links budgetary allocations to service use, enabling efficiency and supporting performance-based financing. However, scale-up of the e-health system has presented financial, technical, and organizational challenges that have negative implications for the sustainability of the system, efficient health care delivery, and the system’s ability to meet informational requirements for health decision-making. There are opportunities to iteratively adapt the e-health system in Armenia through a systematic assessment of the e-health system scale-up experience and through regular and structured interactions between the private operator of the e-health system, key stakeholders involved in the implementation of the e-health system, and policy makers that can facilitate the adoption of needed changes. The Armenian experience of implementing an integrated health information system provides useful lessons for improving the functionality of the current system and for adopting technologies to improve health systems more generally. To encourage facilities to continue to use the e-health system, there is an immediate need for financial support for the associated recurrent costs for maintaining the e-health system and technical assistance, including training and user manuals, to guide everyday use by medical practitioners. -
Publication
Estimating the impact of trained midwives and upgraded health facilities on institutional delivery rates in Nigeria using a quasi-experimental study design
(BMJ Publishing Group Ltd, 2022-05-24)Studies have shown that demand-side interventions, such as conditional cash transfers and vouchers, can increase the proportion of women giving birth in a health facility in low-income and middle-income countries, but there is limited evidence of the effectiveness of supply-side interventions. We evaluated the impact of the Subsidy Reinvestment and Empowerment Program Maternal and Child Health Project (SURE-PMCH) on rates of institutional delivery and antenatal care. The authors used a differences-in-differences study design that compared changes in rates of institutional delivery and antenatal care in areas that had received additional support through the SURE-PMCH program relative to areas that did not. Data on outcomes were obtained from the 2013 Nigerian Demographic and Health Survey. The authors found that the program significantly increased the proportion of women giving birth in a health facility by approximately 7 percentage points (p=0.069) or approximately 10 percent relative to the baseline after 9 months of implementation. The program, however, did not significantly increase the use of antenatal care. The findings of this study suggest there could be important improvements in institutional delivery rates through greater investment in supply-side interventions. -
Publication
Provider Payment Reforms for Improved Primary Health Care in Romania
(World Bank, Washington, DC, 2021-08)Romania faces high levels of amenable mortality reflecting, in part, the relatively low utilization rates of high-quality primary health care (PHC), particularly for non-communicable disease (NCD) prevention and treatment. Provider payment mechanisms do not reward the high-quality care provision and may incentivize bypassing of PHC for hospitals, exacerbating challenges presented by physical, financial, and social barriers to accessing essential care. This paper assesses provider payment mechanisms at the PHC level, by examining their design features and implementation arrangements, and exploring their implications for PHC performance in terms of access and quality of care. The authors conclude with policy recommendations to address the constraints identified. To increase the supply of preventative care and case management, the authors recommend that volume thresholds for fee-for-service payments reflect both the number of enrollees and physicians in a practice; laboratory tests required for case management be reduced in scope and their costs be reimbursed; and the law on health care reform be amended to enable the introduction of new payment mechanisms, such as performance-based payments. To expand the scope of PHC and strengthen care coordination with hospitals, periodic reviews by physician commissions should aim to expand the scope of PHC care in line with provisions in other European Union (EU) countries for ambulatory-care sensitive conditions; capitation payments should be adjusted for gender and historical service use to reduce incentive for over-referrals; and payment mechanisms that reward coordination of care, including bundled payments, should be introduced. To establish an enabling environment for provider payment reforms, health information systems should be strengthened by unifying diagnosis coding, establishing quality standards, and ensuring referral module functionality; payment reforms should be informed by extensive consultations with providers at all service delivery levels; and PHC spending should be increased to support higher reimbursement levels for providers and match expenditure levels in high-performing EU health systems. -
Publication
Reforming the Basic Benefits Package in Armenia: Modeling Insights from the Health Interventions Prioritization Tool
(World Bank, Washington, DC, 2021-03-26)Armenia is an upper-middle-income (UMI) country in the South Caucasus region. The Coronavirus (COVID-19) pandemic and a regional crisis have resulted in the real economy's contraction following rapid growth in the past five years. Improving access to high-quality health care is essential for responding to non-communicable diseases (NCDs) and preventing mortality from infectious diseases in Armenia. Armenia is faced with the challenge of achieving Universal Health Coverage (UHC) when funding for health services faces downward pressures due to a donor funding transition, the Coronavirus (COVID-19) pandemic, and regional conflict. This report is part of the World Bank’s technical support toward universal health coverage in Armenia, which includes advisory services and analytics aimed at supporting the government’s efforts to expand access to high-quality health care. The report draws on the Health Interventions prioritization tool to optimize allocations across essential health services in the basic benefits package and estimate the potential impact of these allocations on population health. -
Publication
Macroeconomic Effects of Financing Universal Health Coverage in Armenia
(World Bank, Washington, DC, 2021-06-08)Armenia has made significant progress in improving population health outcomes over the past two decades. However, essential health care for non-communicable diseases (NCDs) is underutilized in part due to the cost of access. Armenia has also committed as a signatory to the Sustainable Development Goals, to making progress towards Universal Health Coverage (UHC). This commitment involves guaranteeing access to essential health care for all its citizens. The Ministry of Health (MoH) has developed a concept note for the introduction for Universal Health Insurance that proposes to mobilize additional revenue through payroll taxes or higher budgetary allocations to the sector. However, the Ministry of Finance (MoF) has noted that revenue mobilization options should ideally demonstrate positive returns in terms of economic growth and employment. Therefore, at the request of the MoH, the World Bank has modeled the macroeconomic impacts of options to increase domestic resource mobilization to finance universal access to essential health services in the basic benefits package. The analysis assumes that through UHC reforms that mobilize additional public spending, the government would cover the cost of ninety-five percent of household needs for health care from 2021 to 2050, and that the increase in the demand for care will be supported by improvements in supply-side efficiency. The results suggest that increasing direct taxes is better than increasing indirect taxes as the former are less distortionary and cause smaller allocative inefficiencies. -
Publication
More Money for Health: Resource Mobilization for Universal Health Coverage in Armenia
(World Bank, Washington, DC, 2021-12-20)Armenia has made significant gains in population health, but faces challenges in ensuring health care access, due to financial barriers. As mortality caused by infectious diseases has fallen over the past two decades, the prevalence of noncommunicable diseases (NCDs) has increased. The NCD burden can be reduced via public health measures, such as tobacco control exposure, and access to high-quality health care. However, financial barriers to access are a significant challenge. -
Publication
The Impact of Health Taxes in Armenia
(Washington, DC: World Bank, 2023-09-14)This report has been prepared by the World Bank, at the request of the MoH, to support ongoing efforts to improve population health and revenue mobilization in the sector. The study estimates the health impacts of increasing taxation on SSBs, alcohol, and tobacco across gender and income-quintiles. The revenue potential of these taxes is also explored. The target audience for these findings includes senior policymakers and technical advisers in the MoH, Ministry of Economy, and Ministry of Finance (MoF).The remainder of this report is organized as follows. In Chapter 2, the authors reviewthe current state of health and consumption taxes in Armenia. Chapter 3 outlines themethods used to estimate the change in tax revenue and consumption of alcohol,tobacco, and SSBs. Chapter 4 reports the analysis results, including the potentialadditional fiscal space and health gains. Finally, chapter 5 presents the conclusionsbased on the findings. -
Publication
Strategic Purchasing for Better Health in Armenia
(World Bank, Washington, DC, 2020-09)This report is an activity under the technical support towards universal health coverage in Armenia, which includes advisory services and analytics aimed at supporting the government’s efforts to expand access to high-quality health care. The report, Strategic Purchasing for Better Health in Armenia, draws on an adaptation of the strategic purchasing progress framework to examine the country’s experience in purchasing healthcare, identify contextual factors that limit the potential of purchasing to reform healthcare, and integrate these findings with relevant global examples of strategic purchasing reforms. The authors conclude the report with tailored recommendations for strategic purchasing that can improve population health. -
Publication
Disrupted Service Delivery? The Impact of Conflict on Antenatal Care Quality in Kenya
(Frontiers Media, 2021-02-28)African countries facing conflict have higher levels of maternal mortality. Understanding the gaps in the utilization of high-quality maternal health care is essential to improving maternal survival in these states. Few studies have estimated the impact of conflict on the quality of health care. In this study, we estimated the impact of conflict on the quality of health care in Kenya, a country with multiple overlapping conflicts and significant disparities in maternal survival. Our study demonstrates the importance of designing maternal health policy based on the context-specific evidence on the mechanisms through which conflict affects health care. In Kenya, deterioration of equipment and infrastructure does not appear to be the main mechanism through which conflict has affected ANC quality. Further research should focus on better understanding the determinants of the gaps in process quality in conflict-affected settings, including provider motivation, competence, and incentives.