Lindelow, Magnus

Person:
Lindelow, Magnus

Health, Nutrition and Population

Fields of Specialization

health; social protection; public sector

Departments

Health, Nutrition and Population

Last updated: January 31, 2023

Biography

Magnus Lindelow is the Practice Manager for Health, Nutrition and Population for Eastern and Southern Africa at the World Bank. Magnus has worked extensively in East Asia, Latin America and Africa, and most recently held the position of Program Leader for Human Development in the World Bank’s Country Office in Brazil. He has published books and research articles on impact evaluation of health sector programs, distributional issues in the health sector, public finance, service delivery, poverty and other topics. Prior to joining the World Bank, Magnus Lindelow worked as an economist in the Ministry of Planning and Finance in the Mozambique and as a consultant on public finance and health sector issues. Magnus received an undergraduate degree in economics from University College London, and earned M.Phil and D.Phil degrees in Economics from Oxford University.

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Now showing 1 - 10 of 32

An Analysis of Clinical Knowledge, Absenteeism, and Availability of Resources for Maternal and Child Health: A Cross-Sectional Quality of Care Study in 10 African Countries
(World Bank, Washington, DC, 2020-10) Di Giorgio, Laura; Evans, David K.; Lindelow, Magnus; Nguyen, Son Nam; Svensson, Jakob; Wane, Waly; Tarneberg, Anna Welander
This paper assesses the quality of health care across African countries based on health providers' clinical knowledge, their clinic attendance, and drug availability, with a focus on seven conditions accounting for a large share of child and maternal mortality: malaria, tuberculosis, diarrhea, pneumonia, diabetes, neonatal asphyxia, and postpartum hemorrhage. With nationally representative, cross-sectional data from 10 countries in Sub-Saharan Africa, collected using clinical vignettes, unannounced visits, and visual inspections of facilities, this study assesses whether health providers are available and have sufficient knowledge and means to diagnose and treat patients suffering from common conditions amenable to primary health care. The study draws on data from 8,061 primary and secondary care facilities in Kenya, Madagascar, Mozambique, Nigeria, Niger, Senegal, Sierra Leone, Tanzania, Togo, and Uganda, and 22,746 health workers. These data were gathered under the Service Delivery Indicators program. Across all conditions and countries, health care providers were able to correctly diagnose 64 percent of the clinical vignette cases, and in 45 percent of the cases, the treatment plan was aligned with the correct diagnosis. For diarrhea and pneumonia, two common causes of under-five deaths, 27 percent of the providers correctly diagnosed and prescribed the appropriate treatment for both conditions. On average, 70 percent of health workers were present in the facilities to provide care during facility hours when those workers were scheduled to be on duty. Taken together, the estimated likelihood that a facility has at least one staff present with competency and the key inputs required to provide child, neonatal, and maternity care that meets minimum quality standards is 14 percent. Poor clinical knowledge is a greater constraint in care readiness than drug availability or health workers' absenteeism in the 10 countries. However, the paper documents substantial heterogeneity across countries.
Introduction to Special Issue on Health Financing in East and Southern Africa
(Taylor and Francis, 2018-09-24) Schneider, Pia; Yazbeck, Abdo S.; Lindelow, Magnus
This special issue on health financing in East and Sothern Africa comes at an opportune time. Economic growth in the region is contributing to a changing lifestyle and an increasing burden of noncommunicable diseases, such as diabetes, which are costlier to treat. Coupled with the unfinished health agenda of communicable diseases and maternal and child health, demand for health care is increasing rapidly and putting financial pressure on governments. A risky response in a resource-constrained setting is governments reallocating funds away from the poor to more expensive specialist and tertiary care. Another risky response relates to ways of raising additional revenues, especially in countries where health facilities already charge user fees in the absence of prepayment. Relatively poor patients who pay fees when seeking care may have to sell assets and incur debts, which may push them into poverty or deeper into poverty. Protecting households against falling into poverty and ensuring access to essential health services are thus top priorities for governments committed to universal health coverage (UHC) in the region. Achieving this objective requires solving several pertinent problems.
What Are Governments Spending on Health in East and Southern Africa?
(Taylor and Francis, 2018-10-30) Piatti-Funfkirchen, Moritz; Lindelow, Magnus; Yoo, Katelyn
Progress toward universal health care (UHC) in Africa will require sustained increases in public spending on health and reduced reliance on out-of-pocket financing. This article reviews trends and patterns of government spending in the East and Southern Africa regions and points out methodological challenges with interpreting data from the World Health Organization’s (WHO) Global Health Expenditure Database (GHED) and other sources.
Analyzing Health Equity Using Household Survey Data : A Guide to Techniques and Their Implementation
(Washington, DC: World Bank, 2008) O'Donnell, Owen; van Doorslaer, Eddy; Wagstaff, Adam; Lindelow, Magnus
This book shows how to implement a variety of analytic tools that allow health equity - along different dimensions and in different spheres - to be quantified. Questions that the techniques can help provide answers for include the following: Have gaps in health outcomes between the poor and the better-off grown in specific countries or in the developing world as a whole? Are they larger in one country than in another? Are health sector subsidies more equally distributed in some countries than in others? Is health care utilization equitably distributed in the sense that people in equal need receive similar amounts of health care irrespective of their income? Are health care payments more progressive in one health care financing system than in another? What are catastrophic payments? How can they be measured? How far do health care payments impoverish households? This volume has a simple aim: to provide researchers and analysts with a step-by-step practical guide to the measurement of a variety of aspects of health equity. Each chapter includes worked examples and computer code. The authors hope that these guides, and the easy-to-implement computer routines contained in them, will stimulate yet more analysis in the field of health equity, especially in developing countries. They hope this, in turn, will lead to more comprehensive monitoring of trends in health equity, a better understanding of the causes of these inequities, more extensive evaluation of the impacts of development programs on health equity, and more effective policies and programs to reduce inequities in the health sector.
Contracting for Primary Health Care in Brazil : The Cases of Bahia and Rio de Janeiro
(World Bank Group, Washington, DC, 2014-09) Araujo, Edson; Cavalini, Luciana; Girardi, Sabado; Ireland, Megan; Lindelow, Magnus
This study presents two case studies, each on a current initiative of contracting for primary health services in Brazil, one for the state of Bahia, the other for the city of Rio de Janeiro. The two initiatives are not linked and their implementation has independently sprung from a search for more effective ways of delivering public primary health care. The two models differ considerably in context, needs, modalities, and outcomes. This paper identifies their strengths and weaknesses, initially by providing a background to universal primary health care in Brazil, paying particular attention to the family health strategy, the driver of the basic health care model. It then outlines the history of contracting for health care within Brazil, before analyzing the two studies. The state of Bahia sought to expand coverage of the family health strategy and increase the quality of services, but had difficulty in attracting and retaining qualified health professionals. Rigidities in the process of public hiring led to a number of isolated contracting initiatives at the municipal level and diverse, often unstable employment contracts. The state and municipalities decided to centralize the hiring of health professionals in order to offer stable positions with career plans and mobility within the state, and chose to create a state foundation, acting under private law to manage and oversee this process. Results have been mixed as lower than expected municipal involvement resulted in relatively high administrative costs and consequent default on municipal financial contributions. The state foundation is undergoing a governance reform and has now diversified beyond hiring for primary care. The municipality of Rio de Janeiro, which until recently relied on an expansive hospital network for health care delivery, sought in particular to expand primary health services. The public health networks suffered from inefficiency and poor quality, and it was therefore decided to contract privately owned and managed, not-for-profit, social organizations to provide primary care services. The move has succeeded in attracting considerable increases in funding for primary health and coverage has increased significantly. Performance initiatives, however, still need fine-tuning and reliable information systems must be implanted in order to evaluate the system.
Universal Health Coverage for Inclusive and Sustainable Development : Country Summary Report for Brazil
(World Bank Group, Washington, DC, 2014-09) Araujo, Edson C.; Lindelow, Magnus
Over the last 20 years, Brazil has seen profound economic, political, and demographic changes. After a period of military dictatorship (from 1964 to 1985), political and economic stability was achieved in the mid-1990s. The country has urbanized, improved access to water and sanitation, achieved solid economic growth, and reduced income inequality. It was one of the first Latin American countries to establish universal health coverage (UHC) as a fundamental right, based on the principles that health care is a duty of the state and should be free at the point of use. The reform in the late 1980s created the Unified Health System (Sistema Único de Saúde, or SUS) and was based on the principle that health care should be free at the point of use to all Brazilian citizens.
Twenty Years of Health System Reform in Brazil : An Assessment of the Sistema Único de Saúde
(Washington, DC: World Bank, 2013-06-13) Couttolenc, Bernard; Gragnolati, Michele; Lindelow, Magnus
It has been more than 20 years since Brazil's 1988 Constitution formally established the Unified Health System (Sistema Unico de Saude, SUS). Building on reforms that started in the 1980s, the SUS represented a significant break with the past, establishing health care as a fundamental right and duty of the state and initiating a process of fundamentally transforming Brazil's health system to achieve this goal. This report aims to answer two main questions. First is have the SUS reforms transformed the health system as envisaged 20 years ago? Second, have the reforms led to improvements with regard to access to services, financial protection, and health outcomes? In addressing these questions, the report revisits ground covered in previous assessments, but also brings to bear additional or more recent data and places Brazil's health system in an international context. The report shows that the health system reforms can be credited with significant achievements. The report points to some promising directions for health system reforms that will allow Brazil to continue building on the achievements made to date. Although it is possible to reach some broad conclusions, there are many gaps and caveats in the story. A secondary aim of the report is to consider how some of these gaps can be filled through improved monitoring of health system performance and future research. The introduction presents a short review of the history of the SUS, describes the core principles that underpinned the reform, and offers a brief description of the evaluation framework used in the report. Chapter two presents findings on the extent to which the SUS reforms have transformed the health system, focusing on delivery, financing, and governance. Chapter three asks whether the reforms have resulted in improved outcomes with regard to access to services, financial protection, quality, health outcomes, and efficiency. The concluding chapter presents the main findings of the study, discusses some policy directions for addressing the current shortcomings, and identifies areas for further research.
Are Health Shocks Different?: Evidence from a Multi-Shock Survey in Laos
(Wiley, 2014-06) Wagstaff, Adam; Lindelow, Magnus
Using primary data from Laos, we compare a broad range of different types of shocks in terms of their incidence, distribution between the poor and the better off, idiosyncrasy, costs, coping responses, and self-reported impacts on well-being. Health shocks are more common than most other shocks, more concentrated among the poor, more idiosyncratic, more costly, trigger more coping strategies, and highly likely to lead to a cut in consumption. Household members experiencing a health shock lost, on average, 0.6 point on a five-point health scale; the wealthier are better able to limit the health impacts of a health shock. For non-commercial use in accordance with Wiley Terms and Conditions at http://olabout.wiley.com/WileyCDA/Section/id-820227.html
Achieving Universal Health Coverage through Voluntary Insurance: What Can We Learn from the Experience of Lao PDR?
(BioMed Central, 2013-12-17) Alkenbrack, Sarah; Jacobs, Bart; Lindelow, Magnus
The Government of Lao Peoples’ Democratic Republic (Lao PDR) has embarked on a path to achieve universal health coverage (UHC) through implementation of four risk-protection schemes. One of these schemes is community-based health insurance (CBHI) – a voluntary scheme that targets roughly half the population. However, after 12 years of implementation, coverage through CBHI remains very low. Increasing coverage of the scheme would require expansion to households in both villages where CBHI is currently operating, and new geographic areas. In this study we explore the prospects of both types of expansion by examining household and district level data.
Assessing the Elimination of User Fees for Delivery Services in Laos
(Public Library of Science, 2014-03-14) Boudreaux, Chantelle; Chanthala, Phetdara; Lindelow, Magnus
A pilot eliminating user fees associated with delivery at the point of services was introduced in two districts of Laos in March 2009. Following two years of implementation, an evaluation was conducted to assess the pilot impact, as well as to document the pilot design and implementation challenges. Study results show that, even in the presence of the substantial access and cultural barriers, user fees associated with delivery at health facilities act as a serious deterrent to care seeking behavior. We find a tripling of facility-based delivery rates in the intervention areas, compared to a 40% increase in the control areas. While findings from the control region suggest that facility-based delivery rates may be on the rise across the country, the substantially higher increase in the pilot areas highlight the impact of financial burden associated with facility-based delivery fees. These fees can play an important role in rapidly increasing the uptake of facility delivery to reach the national targets and, ultimately, to improve maternal and child health outcomes. The pilot achieved important gains while relying heavily on capacity and systems already in place. However, the high cost associated with monitoring and evaluation suggest broad-scale expansion of the pilot activities is likely to necessitate targeted capacity building initiatives, especially in areas with limited district level capacity to manage funds and deliver detailed and timely reports.