Person:
Chukwuma, Adanna

World Bank Health, Nutrition, and Population Global Practice
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HEALTH SYSTEM, HEALTH FINANCING, SERVICE DELIVERY, POLITICAL ECONOMY, ARMENIA, RUSSIA
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0000-0001-7873-7633
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World Bank Health, Nutrition, and Population Global Practice
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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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Sub-Saharan Africa: Western Africa × Author: Bossert, Thomas J. ×

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    Health Service Delivery and Political Trust in Nigeria
    (Elsevier, 2019-04) Bossert, Thomas J.; Chukwuma, Adanna; Croke, Kevin
    Do improvements in health service delivery affect trust in political leaders in Africa? Citizens expect their government to provide social services. Intuitively, improvements in service delivery should lead to higher levels of trust in and support for political leaders. However, in contexts where inadequate services are the norm, and where political support is linked to ethnic or religious affiliation, there may be weak linkages between improvements in service delivery and changes in trust in political leaders. To examine this question empirically, we take advantage of a national intervention that improved health service delivery in 500 primary health care facilities in Nigeria, to estimate the impact of residence within 10 km of one or more of the intervention facilities on trust in the president, local councils, the ruling party, and opposition parties. Using difference-in-difference models, we show that proximity to the intervention led to increases in trust in the president and the ruling party. By contrast, we find no evidence of increased trust in the local council or opposition parties. Our study also examines the role of ethnicity and religious affiliation in mediating the observed increases in trust in the president. While there is a large literature suggesting that both the targeting of interventions, and the response of citizens to interventions is often mediated by ethnic, geographic or religious identity, by contrast, we find no evidence that the intervention was targeted at the president's ethnic group, zone, or state of origin. Moreover, there is suggestive evidence that the intervention increased trust in the president more among those who did not share these markers of identity with the president. This highlights the possibility that broad-based efforts to improve health services can increase trust in political leaders even in settings where political attitudes are often thought to be mediated by group identity.
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    The Impact of Monetary Incentives on Referrals by Traditional Birth Attendants for Postnatal Care in Nigeria
    (World Bank, Washington, DC, 2019-05-20) Mbachu, Chinyere; Chukwuma, Adanna; McConnell, Margaret; Bossert, Thomas J.; Cohen, Jessica
    Gaps in postnatal care use represent missed opportunities to prevent maternal and neonatal death in sub-Saharan Africa. As one in every three non-facility deliveries in Nigeria is assisted by a traditional birth attendant (TBA), and the TBA’s advice is often adhered to by their clients, engaging TBAs in advocacy among their clients may increase maternal and neonatal postnatal care use. This study estimates the impact of monetary incentives for maternal referrals by TBAs on early maternal and neonatal postnatal care use (within 48 h of delivery) in Nigeria. Overall, 207 TBAs participated in this study: 103 in the treatment group and 104 in the control group. The intervention increased the proportion of maternal clients of TBAs that reported attending postnatal care within 48 h of delivery by 15.4 percentage points [95% confidence interval (CI): 7.9–22.9]. The proportion of neonatal clients of TBAs that reportedly attended postnatal care within 48 h of delivery also increased by 12.6 percentage points [95% CI: 5.9–19.3]. However, providers often did not address the issues that may have led to maternal and newborn postnatal complications during these visits. We show that motivating TBAs using monetary incentives for maternal postnatal care use can increase skilled care use after delivery among their maternal and neonatal clients, who have a higher risk of mortality because of their exposure to unskilled birth attendance. However, improving the quality of care is key to ensuring maternal and neonatal health gains from postnatal care attendance.