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 - 8 of 8
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.
Invitations, Incentives, and Conditions: A Randomized Evaluation of Demand-Side Interventions for Health Screenings(Elsevier, 2022-03) de Walque, Damien ; Chukwuma, Adanna ; Ayivi-Guedehoussou, Nono ; Koshkakaryan, MariannaThis randomized controlled trial investigates the impact of four demand-side interventions on health screening for diabetes and hypertension among Armenian adults. The interventions are 1) personalized invitations from a physician, 2) personalized invitations with information about peer screening behavior, 3) personalized invitations with a labeled but unconditional financial incentive, and 4) personal invitations with a conditional financial incentive. Compared with the control group, interventions 1 to 3 led to a significant increase in the screening rate of about 15 percentage points for diabetes and hypertension. The highest impact was measured for intervention 4 leading to a 31.2 percentage point increase in both screenings.
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(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.
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) Kruk, Margaret E. ; Chukwuma, Adanna ; Mbaruku, Godfrey ; Leslie, Hannah H.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(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.
Publication(FXB Harvard School of Public Health, 2018-06) Iyer, Hari S. ; Chukwuma, Adanna ; Mugunga, Jean Claude ; Manzi, Anatole ; Ndayizigiye, Melino ; Anand, SudhirStrong 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.
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.