Person:
Chukwuma, Adanna

World Bank Health, Nutrition, and Population Global Practice

Fields of Specialization

HEALTH SYSTEM, HEALTH FINANCING, SERVICE DELIVERY, POLITICAL ECONOMY, ARMENIA, RUSSIA

ORCID

0000-0001-7873-7633

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Departments

World Bank Health, Nutrition, and Population Global Practice

Last updated: January 5, 2024

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.

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Publication Search Results

Now showing 1 - 10 of 10

Macroeconomic Effects of Financing Universal Health Coverage in Armenia
(World Bank, Washington, DC, 2021-06-08) Dudu, Hasan; Chukwuma, Adanna; Manookian, Armineh; Aghazaryan, Anastas; Zeshan, Muhammad
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.
FinHealth Armenia: Reforming Public Financial Management to Improve Health Service Delivery
(World Bank, Washington, DC, 2020-11-02) Gurazada, Srinivas; Chukwuma, Adanna; Jain, Manoj; Tsaturyan, Saro; Khcheyan, Makich
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.
Using Allocative Efficiency Analysis to Inform Health Benefits Package Design for Progressing towards Universal Health Coverage: Proof-of-Concept Studies in Countries Seeking Decision Support
(PLoS, 2021-11-29) Fraser-Hurt, Nicole; Hou, Xiaohui; Wilkinson, Thomas; Duran, Denizhan; Abou Jaoude, Gerard J.; Skordis, Jolene; Chukwuma, Adanna; Lao Pena, Christine; Tshivuila Matala, Opope O.; Gorgens, Marelize; Wilson, David P.
Countries are increasingly defining health benefits packages (HBPs) as a way of progressing towards Universal Health Coverage (UHC). Resources for health are commonly constrained, so it is imperative to allocate funds as efficiently as possible. We conducted allocative efficiency analyses using the Health Interventions Prioritization tool (HIPtool) to estimate the cost and impact of potential HBPs in three countries. These analyses explore the usefulness of allocative efficiency analysis and HIPtool in particular, in contributing to priority setting discussions.
Invitations, Incentives, and Conditions: A Randomized Evaluation of Demand-Side Interventions for Health Screenings in Armenia
(World Bank, Washington, DC, 2020-07) De Walque, Damien; Chukwuma, Adanna; Ayivi-Guedehoussou, Nono; Koshkakaryan, Marianna
The study is a randomized controlled trial that investigates the impact of four demand-side interventions on health screening for diabetes and hypertension among Armenian adults ages 35-68 who had not been tested in the last 12 months. The interventions are personal invitations from a physician (intervention group 1), personal invitations with information about peer screening behavior (intervention group 2), a labeled but unconditional cash transfer in the form of a pharmacy voucher (intervention group 3), and a conditional cash transfer in the form of a pharmacy voucher (intervention group 4). Compared with the control group in which only 3.5 percent of participants went for both screenings during the study period, interventions 1 to 3 led to a significant increase in the screening rate of about 15 percentage points among participants. The highest intervention impact was measured among recipients in intervention group 4, whose uptake of screening on both tests increased by 31.2 percentage points. The levels of cost-effectiveness of intervention groups 1, 2, and 4 are similar while for intervention group 3 it is about twice more expensive per additional person screened.
Challenges and Opportunities for Purchasing High-Quality Health Care: Lessons from Armenia
(Taylor and Francis, 2021-04-29) Lylozian, Hratchia; Chukwuma, Adanna; Gong, Estelle
This 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.
Strategic Purchasing for Better Health in Armenia
(World Bank, Washington, DC, 2020-09) Chukwuma, Adanna; Lylozian, Hratchia; Gong, Estelle; Ghazaryan, Emma
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.
Reforming the Basic Benefits Package in Armenia: Modeling Insights from the Health Interventions Prioritization Tool
(World Bank, Washington, DC, 2021-03-26) Fraser, Nicole; Chukwuma, Adanna; Koshkakaryan, Marianna; Yengibaryan, Lusine; Hou, Xiaohui; Wilkinson, Tommy
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.
More Money for Health: Resource Mobilization for Universal Health Coverage in Armenia
(World Bank, Washington, DC, 2021-12-20) Maduko, Franklin; Chukwuma, Adanna; Minasyan, Gevorg; Manookian, Armineh; Saldarriaga Noel, Miguel Angel; Tandon, Ajay
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.
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, Damien
Non-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.
Stakeholder Perspectives on e-Health Implementation in Armenia
(World Bank, Washington, DC, 2018-06) Koshkakaryan, Marianna; Chukwuma, Adanna
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.