World Bank Health, Nutrition, and Population Global Practice
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Fields of Specialization
HEALTH SYSTEM, HEALTH FINANCING, SERVICE DELIVERY, POLITICAL ECONOMY, ARMENIA, RUSSIA
World Bank Health, Nutrition, and Population Global Practice
Externally Hosted Work
Last updated September 14, 2023
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
Now showing 1 - 10 of 10
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, MariannaThe 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.
Publication(World Bank, Washington, DC, 2020-11-02) Chukwuma, Adanna ; Gurazada, Srinivas ; Jain, Manoj ; Tsaturyan, Saro ; Khcheyan, MakichThis 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(Taylor and Francis, 2021-04-29) Chukwuma, Adanna ; Lylozian, Hratchia ; 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.
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.
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, TommyArmenia 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(World Bank, Washington, DC, 2021-12-20) Maduko, Franklin ; Chukwuma, Adanna ; Minasyan, Gevorg ; Manookian, Armineh ; Saldarriaga Noel, Miguel Angel ; Tandon, AjayArmenia 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(World Bank, Washington, DC, 2020-09) Chukwuma, Adanna ; Meessen, Bruno ; Lylozian, Hratchia ; Gong, Estelle ; Ghazaryan, EmmaThis 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(World Bank, Washington, DC, 2021-06-08) Dudu, Hasan ; Chukwuma, Adanna ; Manookian, Armineh ; Aghazaryan, Anastas ; Zeshan, MuhammadArmenia 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(Taylor and Francis, 2021-08-17) Wang, Huihui ; Chukwuma, Adanna ; Comsa, Radu ; Dmytraczenko, Tania ; Gong, Estelle ; Onofrei, LidiaThis 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(World Bank, Washington, DC, 2021-08) Chukwuma, Adanna ; Comsa, Radu ; Chen, Dorothee ; Gong, EstelleRomania 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.