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 19
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Publication
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)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. -
Publication
Invitations, Incentives, and Conditions: A Randomized Evaluation of Demand-Side Interventions for Health Screenings in Armenia
(World Bank, Washington, DC, 2020-07)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. -
Publication
Challenges and Opportunities for Purchasing High-Quality Health Care: Lessons from Armenia
(Taylor and Francis, 2021-04-29)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. -
Publication
Invitations and Incentives: A Qualitative Study of Behavioral Nudges for Primary Care Screenings in Armenia
(Springer Nature, 2020-12)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. -
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. -
Publication
A Comparison of Health Achievements in Rwanda and Burundi
(FXB Harvard School of Public Health, 2018-06)Strong 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
'Once the delivery is done, they have finished': A Qualitative Study of Perspectives on Postnatal Care Referrals by Traditional Birth Attendants in Ebonyi State, Nigeria
(Springer Nature, 2017-12-19)While 79% of Nigerian mothers who deliver in facilities receive postnatal care within 48 h of delivery, this is only true for 16% of mothers who deliver outside facilities. Most maternal deaths can be prevented with access to timely and competent health care. Thus, the World Health Organization, International Confederation of Midwives, and International Federation of Gynecology and Obstetrics recommend that unskilled birth attendants be involved in advocacy for skilled care use among mothers. This study explores postnatal care referral behavior by TBAs in Nigeria, including the perceived factors that may deter or promote referrals to skilled health workers. Differences in TBA referral before, during, and after delivery appear to reflect the TBAs understanding of the added value of skilled care for the client and the TBA, as well as the TBA’s perception of the implications of referral for her credibility as a maternal care provider among her clients. We also found that there are opportunities to engage TBAs in routine postnatal care referrals to facilities in Nigeria by using incentives and promoting a cordial relationship between TBAs and skilled health workers. Thus, despite the potential negative consequences TBAs may face with postnatal care referrals, there are opportunities to promote these referrals using incentives and promoting a cordial relationship between TBAs and skilled health workers. Further research is needed on the interactions between postnatal maternal complications, TBA referral behavior, and maternal perception of TBA competence. -
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)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. -
Publication
Quality of Antenatal Care Predicts Retention in Skilled Birth Attendance: A Multilevel Analysis of 28 African Countries
(Springer Nature, 2017-05-17)An effective continuum of maternal care ensures that mothers receive essential health packages from pre-pregnancy to delivery, and postnatally, reducing the risk of maternal death. However, across Africa, coverage of skilled birth attendance is lower than coverage for antenatal care, indicating mothers are not retained in the continuum between antenatal care and delivery. This paper explores predictors of retention of antenatal care clients in skilled birth attendance across Africa, including sociodemographic factors and quality of antenatal care received. Among ANC clients in the study sample, 66% received SBA. Adjusting for all demographic covariates and country indicators, the odds of retention in SBA were higher among ANC clients that had their blood pressure checked, received information about pregnancy complications, had blood tests conducted, received at least one tetanus injection, and had urine tests conducted. Higher quality of ANC predicts retention in SBA in Africa. Improving quality of skilled care received prenatally may increase client retention during delivery, reducing maternal mortality. -
Publication
Challenges and Opportunities in the Continuity of Care for Hypertension: A Mixed-Methods Study Embedded in a Primary Health Care Intervention in Tajikistan
(Springer Nature, 2019-12-03)Hypertension, a significant risk factor for ischemic heart disease and other chronic conditions, is the third-highest cause of death and disability in Tajikistan. Thus, ensuring the early detection and appropriate management of hypertension is a core element of strategies to improve population health in Tajikistan. For a strategy to be successful, it should be informed by the causes of gaps in service delivery and feasible solutions to these challenges. The objective of this study was to undertake a systematic assessment of hypertension case detection and retention in care within Tajikistan’s primary health care system, and to identify challenges and appropriate solutions. We review the results for the case detection stage of the cascade of care, which had the most significant gaps. Of the half a million people with hypertension in Khatlon and Sogd Oblasts (administrative regions), about 10% have been diagnosed in Khatlon and only 5% in Sogd. Barriers to case detection include misinformation about hypertension, ambiguous protocols, and limited delivery capacity. Solutions identified to these challenges were mobilizing faith-based organizations, scaling up screening through health caravans, task-shifting to increase provider supply, and introducing job aids for providers. Translating findings on discontinuities in care for hypertension and other chronic diseases to actionable policy insights can be facilitated by collaboration with local stakeholders, triangulation of data sources, and identifying the intersection between the feasible and the effective in defining solutions to service delivery challenges.