World Bank Health, Nutrition, and Population Global Practice
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HEALTH SYSTEM, HEALTH FINANCING, SERVICE DELIVERY, POLITICAL ECONOMY, ARMENIA, RUSSIA
World Bank Health, Nutrition, and Population Global Practice
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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 - 6 of 6
'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) Chukwuma, Adanna ; Mbachu, Chinyere ; Cohen, Jessica ; Bossert, Thomas ; McConnell, MargaretWhile 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.
The Impact of Monetary Incentives on Referrals by Traditional Birth Attendants for Postnatal Care in Nigeria(World Bank, Washington, DC, 2019-05-20) Chukwuma, Adanna ; Mbachu, Chinyere ; McConnell, Margaret ; Bossert, Thomas J. ; Cohen, JessicaGaps 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.
Publication(Elsevier, 2019-04) Chukwuma, Adanna ; Bossert, Thomas J. ; Croke, KevinDo 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.
Publication(Sage Publications, 2020-12-01) Chukwuma, Adanna ; Obi, Uche ; Agu, Ifunanya ; Mbachu, ChinyereClinical performance varies due to academic, clinical, and behavioral factors. However, in many countries, selection of medical professionals tends to focus on exclusively academic ability and clinical acumen. Appropriate selection processes for medical professionals should consider behavioral factors, which may vary across contexts. This study was conducted to identify behavioral competencies considered relevant for effective medical practice in Nigeria, by medical students and doctors, and compared with other contexts. This study is one of the few to examine the perspectives of medical students and physicians on behavioral competencies for effective medical practice in an African country. We found differences in the perspectives of medical physicians and students, and in the prioritized competencies across countries. Our study illustrates the need for careful consideration in identifying subject matter experts and in generalizing competencies across contexts. Future research in this field in Nigeria should examine effective ways of testing for key behavioral competencies among medical students and for residency programs. Also, investigating the perspectives of medical faculty and administrators on important competencies, and exploring the generalizability of these competencies across cultures in Nigeria should be considered.
Armed Conflict and Maternal Health Care Utilization: Evidence from the Boko Haram Insurgency in Nigeria(Elsevier, 2019-04) Chukwuma, Adanna ; Ekhator-Mobayode, Uche EseosaRetention in maternal health care is essential to decreasing preventable mortality. By reducing access to care, armed conflicts such as the Boko Haram Insurgency (BHI), contribute to the high maternal mortality rates in Nigeria. While there is a rich literature describing the mechanisms through which conflict affects health care access, studies that estimate the impact of conflict on maternal health care use are sparse and report mixed findings. In this study, we examine the impact of the BHI on maternal care access in Nigeria. We spatially match 52,675 birth records from the Nigeria Demographic and Health Survey (NDHS) with attack locations in the Armed Conflict Location and Event Dataset (ACLED). We define BH conflict area as NDHS clusters with at least five attacks within 3000, 5000 and 10,000 m of BH activity during the study period and employ difference-in-differences methods to examine the effect of the BHI on antenatal care visits, delivery at the health center and delivery by a skilled professional. We find that the BHI reduced the probability of any antenatal care visits, delivery at a health center, and delivery by a skilled health professional. The negative effects of the BHI on maternal health care access extended beyond the Northeastern region, that is the current focus of humanitarian programs. Systematic efforts to identify and address the mechanisms underlying reductions in maternal health care use due to the BHI, and to target the affected populations, are essential to improving maternal health in Nigeria.
Estimating the impact of trained midwives and upgraded health facilities on institutional delivery rates in Nigeria using a quasi-experimental study design(BMJ Publishing Group Ltd, 2022-05-24) Grépin, Karen Ann ; Chukwuma, Adanna ; Holmlund, Marcus ; Vera-Hernandez, Marcos ; Wang, Qiao ; Rosa-Dias, PedroStudies have shown that demand-side interventions, such as conditional cash transfers and vouchers, can increase the proportion of women giving birth in a health facility in low-income and middle-income countries, but there is limited evidence of the effectiveness of supply-side interventions. We evaluated the impact of the Subsidy Reinvestment and Empowerment Program Maternal and Child Health Project (SURE-PMCH) on rates of institutional delivery and antenatal care. The authors used a differences-in-differences study design that compared changes in rates of institutional delivery and antenatal care in areas that had received additional support through the SURE-PMCH program relative to areas that did not. Data on outcomes were obtained from the 2013 Nigerian Demographic and Health Survey. The authors found that the program significantly increased the proportion of women giving birth in a health facility by approximately 7 percentage points (p=0.069) or approximately 10 percent relative to the baseline after 9 months of implementation. The program, however, did not significantly increase the use of antenatal care. The findings of this study suggest there could be important improvements in institutional delivery rates through greater investment in supply-side interventions.