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 14

Provider Payment Reforms for Improved Primary Health Care in Romania
(World Bank, Washington, DC, 2021-08) Chukwuma, Adanna; Chen, Dorothee; Gong, Estelle
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.
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.
Payment Incentives for Improved Quality of Health Service Delivery in Republika Srpska and the Federation of Bosnia and Herzegovina
(Washington, DC: World Bank, 2024-01-05) Huseinagic, Senad; Stevic, Sinisa; Birungi, Charles; Chukwuma, Adanna
This report outlines a strategic approach to introduce pay-for-performance (P4P) incentives for improved noncommunicable disease (NCD) care in Republika Srpska (RS) and the Federation of Bosnia and Herzegovina (FBiH). Developed under the context of the Functional Review of Health Systems’ Performance Program financed by the European Union and implemented by the World Bank Group, it intends to provide initial framework for methodological documents to be supported by the Health Systems Improvement Project (HSIP), focusing on evidence-based, technically sound, and politically feasible strategies. Participatorily developed, the report synthesizes global lessons and analyzes the policy environment in RS and FBiH. It proposes key design features, addressing strategic opportunities and operational challenges. Behavioral economics insights and political economy factors inform the approach, identifying key levers, opportunities, and challenges affecting P4P implementation capacity. To enhance NCD care quality, the report recommends changes in the provider payment mix, tailored reforms at entity and cantonal levels, and active service user engagement. Emphasizing the importance of linking payment incentives to performance, the proposed design spans dimensions such as performance measures, basis of payment, payment attributes, recipient of payment, and targeted outcomes. An enabling environment is deemed critical. Relatedly, effective implementation requires robust data systems, stakeholder engagement, adapted legal frameworks, and suitable institutional arrangements. Technical assistance and budgetary support needs are identified. It is expected that P4P implementation will enhance NCD care coverage and quality, thereby improving health outcomes and overall health system performance in RS and FBiH.
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.
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.
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.
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.
The Impact of Health Taxes in Armenia
(Washington, DC: World Bank, 2023-09-14) Saxena, Akshar; Chukwuma, Adanna; Qaiser, Seemi; Manookian, Armineh; Minasyan, Gevorg
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.
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.
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.