Health Policy

China’s role as a global health donor in Africa: what can we learn from studying under reported resource flows?

China’s role as a global health donor in Africa: what can we learn from studying under reported resource flows?
Globalization and Health 2014, 10:84 doi:10.1186/s12992-014-0084-6

Grépin, KA, Fan, VY, Shen, GC, Chen L
12/30/2014

Background

There is a growing recognition of China’s role as a global health donor, in particular in Africa, but there have been few systematic studies of the level, destination, trends, or composition of these development finance flows or a comparison of China’s engagement as a donor with that of more traditional global health donors.

Methods

Using newly released data from AidData on China’s development finance activities in Africa, developed to track under reported resource flows, we identified 255 health, population, water, and sanitation (HPWS) projects from 2000–2012, which we descriptively analyze by activity sector, recipient country, project type, and planned activity. We compare China’s activities to projects from traditional donors using data from the OECD’s Development Assistance Committee (DAC) Creditor Reporting System.

Results

Since 2000, China increased the number of HPWS projects it supported in Africa and health has increased as a development priority for China. China’s contributions are large, ranking it among the top 10 bilateral global health donors to Africa. Over 50% of the HPWS projects target infrastructure, 40% target human resource development, and the provision of equipment and drugs is also common. Malaria is an important disease priority but HIV is not. We find little evidence that China targets health aid preferentially to natural resource rich countries.

Conclusions

China is an important global health donor to Africa but contrasts with traditional DAC donors through China’s focus on health system inputs and on malaria. Although better data are needed, particularly through more transparent aid data reporting across ministries and agencies, China’s approach to South-South cooperation represents an important and distinct source of financial assistance for health in Africa.

Shanghai rising: health improvements as measured by avoidable mortality since 2000

Shanghai rising: health improvements as measured by avoidable mortality since 2000
International Journal of Health Policy Management; 4(1), 1–6.

Gusmano, MK., Rodwin, VG. Wang C., Weisz D., Luo L., and Hua F.
12/27/2014

Over the past two decades, Shanghai, the largest megacity in China, has been coping with unprecedented growth of its economy and population while overcoming previous underinvestment in the health system by the central and local governments. We study the evolution of Shanghai’s healthcare system by analyzing “Avoidable Mortality” (AM) – deaths amenable to public health and healthcare interventions, as previously defined in the literature. Based on analysis of mortality data, by cause of death, from the Shanghai Municipal Center for Disease Control and Prevention, we analyze trends over the period 2000–10 and compare Shanghai’s experience to other mega-city regions – New York, London and Paris. Population health status attributable to public health and healthcare interventions improved dramatically for Shanghai’s population with permanent residency status. The age-adjusted rate of AM, per 1,000 population, dropped from 0.72 to 0.50. The rate of decrease in age-adjusted AM in Shanghai (30%) was comparable to New York City (30%) and Paris (25%), but lower than London (42%). Shanghai’s establishment of the Municipal Center for Disease Control and Prevention and its upgrading of public health and health services are likely to have contributed to the large decrease in the number and rate of avoidable deaths, which suggests that investments in public health infrastructure and increasing access to health services in megacities – both in China and worldwide – can produce significant mortality declines. Future analysis in Shanghai should investigate inequalities in avoidable deaths and the extent to which these gains have benefitted the significant population of urban migrants who do not have permanent residency status.


See five commentaries on the article

The Top Ten Global Health Supply Chain Issues: Perspectives from the Field

The Top Ten Global Health Supply Chain Issues: Perspectives from the Field
Operations Research for Health Care. 3(4) 226-230.

Privett, N. and D. Gonsalves
12/01/2014

In the battle for global health, supply chains are often found wanting. Yet most of what is known about in-country pharmaceutical supply chains resides in the experiences of individual stakeholders, with limited amounts of this knowledge captured in technical reports and papers. This short communication taps into the collective experience and wisdom of global health supply chain professionals through interviews and surveys to identify and prioritize the top 10 global health pharmaceutical supply chain challenges: (1) lack of coordination, (2) inventory management, (3) absent demand information, (4) human resource dependency, (5) order management, (6) shortage avoidance, (7) expiration, (8) warehouse management, (9) temperature control, and (10) shipment visibility. As such, this work contributes to the foundational knowledge of global health pharmaceutical supply chains. These challenges must be addressed by researchers, policy makers, and practitioners alike if global pharmaceutical supply chains are to be developed and improved in emerging regions of the world.

Application of Global Positioning System Methods for the Study of Obesity and Hypertension Risk Among Low-Income Housing Residents in New York City: A Spatial Feasibility Study.

Application of Global Positioning System Methods for the Study of Obesity and Hypertension Risk Among Low-Income Housing Residents in New York City: A Spatial Feasibility Study.
Duncan DT, Regan SD, Shelley D, Day K, Ruff RR, Al-Bayan M, Elbel B. Application of Global Positioning System Methods for the Study of Obesity and Hypertension Risk Among Low-Income Housing Residents in New York City: A Spatial Feasibility Study. Geospatial Health. 2014; 9(1): 57-70.

Duncan DT, Regan SD, Shelley D, Day K, Ruff RR, Al-Bayan M, Elbel B.
11/10/2014

The purpose of this study was to evaluate the feasibility of using global positioning system (GPS) methods to understand the spatial context of obesity and hypertension risk among a sample of low-income housing residents in New York City (n = 120). GPS feasibility among participants was measured with a pre- and post-survey as well as adherence to a protocol which included returning the GPS device as well as objective data analysed from the GPS devices. We also conducted qualitative interviews with 21 of the participants. Most of the sample was overweight (26.7%) or obese (40.0%). Almost one-third (30.8%) was pre-hypertensive and 39.2% was hypertensive. Participants reported high ratings of GPS acceptability, ease of use and low levels of wear-related concerns in addition to few concerns related to safety, loss or appearance, which were maintained after the baseline GPS feasibility data collection. Results show that GPS feasibility increased over time. The overall GPS return rate was 95.6%. Out of the total of 114 participants with GPS, 112 (98.2%) delivered at least one hour of GPS data for one day and 84 (73.7%) delivered at least one hour on 7 or more days. The qualitative interviews indicated that overall, participants enjoyed wearing the GPS devices, that they were easy to use and charge and that they generally forgot about the GPS device when wearing it daily. Findings demonstrate that GPS devices may be used in spatial epidemiology research in low-income and potentially other key vulnerable populations to understand geospatial determinants of obesity, hypertension and other diseases that these populations disproportionately experience.

Syndemic Vulnerability, Sexual and Injection Risk Behaviors, and HIV Continuum of Care Outcomes in HIV-Positive Injection Drug Users

Syndemic Vulnerability, Sexual and Injection Risk Behaviors, and HIV Continuum of Care Outcomes in HIV-Positive Injection Drug Users
AIDS & Behavior, Sep 2014. DOI: 10.1007/s10461-014-0890-0

Mizuno, Y., D.W. Purcell, A.R. Knowlton, J.D. Wilkinson, M.N. Gourevitch, and K.R. Knight
09/24/2014

Limited investigations have been conducted on syndemics and HIV continuum of care outcomes. Using baseline data from a multi-site, randomized controlled study of HIV-positive injection drug users (n = 1,052), we examined whether psychosocial factors co-occurred, and whether these factors were additively associated with behavioral and HIV continuum of care outcomes. Experiencing one type of psychosocial problem was significantly (p < 0.05) associated with an increased odds of experiencing another type of problem. Persons with 3 or more psychosocial problems were significantly more likely to report sexual and injection risk behaviors and were less likely to be adherent to HIV medications. Persons with 4 or more problems were less likely to be virally suppressed. Reporting any problems was associated with not currently taking HIV medications. Our findings highlight the association of syndemics not only with risk behaviors, but also with outcomes related to the continuum of care for HIV-positive persons.

Comparison of rehospitalization rates in France and the United States

Comparison of rehospitalization rates in France and the United States
Gusmano, MK, et al. Journal of Health Services Research & Policy; 20(1): 18-25.

Gusmano, MK. Rodwin, VG. Weisz, D. Cottenet, J. and Quantin, C.
09/24/2014

Objective: To compare rates of 30-day all-cause rehospitalization in France and the US among patients aged 65 years and older and explain any difference between the countries.

Methods: To calculate rehospitalization rates in France, we use an individual identifying variable in the national hospital administrative dataset to track unique individuals aged 65 years or more hospitalized in France in 2010. To calculate the proportion of rehospitalized patients (65þ) who received outpatient visits between the time of initial discharge and rehospitalization, we linked the hospital database with a database that includes all medical and surgical admissions. We used step by step regression models to predict rehospitalization.

Results: Rates of rehospitalization in France (14.7%) are lower than among Medicare beneficiaries in the US (20%). We find that age, sex, patient morbidity and the ownership status of the hospital are all correlated with rehospitalization in France.

Conclusions: Lower rates of rehospitalization in France appear to be due to a combination of better access to primary care, better health among the older French population, longer lengths of stay in French hospitals and the fact that French nursing homes do not face the same financial incentive to rehospitalize residents.

Presenting Quality Data to Vulnerable Groups: Charts, Summaries or Behavioral Economic Nudges?

Presenting Quality Data to Vulnerable Groups: Charts, Summaries or Behavioral Economic Nudges?
Elbel B, Schlesinger M. Responsive Consumerism: Empowerment in Markets for Health Plans. The Milbank Quarterly. 2009; 87(3): 633-682.

Elbel B, Gillespie C, Raven MC.
09/10/2014

OBJECTIVES:

Despite the increased focus on health care consumers' active choice, not enough is known about how to best facilitate the choice process. We sought to assess methods of improving this process for vulnerable consumers in the United States by testing alternatives that emphasize insights from behavioral economics, or 'nudges'.

METHODS:

We performed a hypothetical choice experiment where subjects were randomized to one of five experimental conditions and asked to choose a health center (location where they would receive all their care). The conditions presented the same information about health centers in different ways, including graphically as a chart, via written summary and using behavioral economics, 'nudging' consumers toward particular choices. We hypothesized that these 'nudges' might help simplify the choice process. Our primary outcomes focused on the health center chosen and whether consumers were willing to accept 'nudges'.

RESULTS:

We found that consumer choice was influenced by the method of presentation and the majority of consumers accepted the health center they were 'nudged' towards.

CONCLUSIONS:

Consumers were accepting of choices grounded in insights from behavioral economics and further consideration should be given to their role in patient choice.

Pages

Subscribe to Health Policy