International Development

Power and Priorities: The Growing Pains of Global Health; Comment on “Knowledge, Moral Claims and the Exercise of Power in Global Health”

Power and Priorities: The Growing Pains of Global Health; Comment on “Knowledge, Moral Claims and the Exercise of Power in Global Health”
Int J Health Policy Manag 2015, 4(x), 1–2

Karen A. Grépin
03/05/2015

Shiffman has argued that some actors have a great deal of power in global health, and that more reflection is needed on whether such forms of power are legitimate. Global health is a new and evolving field that builds upon the historical fields of public and international health, but is more multi-disciplinary and inter-disciplinary in nature. This article argues that the distribution of power in some global health institutions may be limiting the contributions of all researchers in the field

Why Theory and Practice are Different: The Gap Between Principles and Reality in Subnational Revenue Systems

Why Theory and Practice are Different: The Gap Between Principles and Reality in Subnational Revenue Systems
In Richard Bird and Jorge Martinez Vazquez, eds. Taxation and Development: The Weakest Link. (Cheltenham, UK and Northampton, MA: Edward Elgar, 2014).

Paul Smoke
11/26/2014

Ensuring adequate subnational revenues is a core concern of fiscal decentralization. Available empirical evidence suggests that subnational revenue generation in developing countries rarely meets needs and expectations, even where conventional advice has been or seems to have been followed. Are mainstream principles inappropriate, or are they just poorly applied? This chapter argues that both factors are often at play. Basic principles can be challenging to use, ignore certain critical factors, and say nothing about implementing the often demanding reforms they call for. The chapter outlines and illustrates common factors and dynamics at play and suggests how policy analysts might use and move beyond the mainstream principles to define more pragmatic and sustainable paths to subnational revenue reforms.

Credit is Not a Right [REVISED]

Credit is Not a Right [REVISED]
Forthcoming in volume edited by Tom Sorell and Luis Cabrera: Microfinance, Rights, and Global Justice. Cambridge University Press.

Gershman, John and Jonathan Morduch
09/15/2014

Muhammad Yunus, the microcredit pioneer, has proposed that access to credit should be a human right. We approach the question by drawing on fieldwork and empirical scholarship in political science and economics. Evidence shows that access to credit may be powerful for some people some of the time, but it is not powerful for everyone all of the time, and in some cases it can do damage. Yunus’s claim for the power of credit access has yet to be widely verified, and most rigorous studies find microcredit impacts that fall far short of the kinds of empirical assertions on which his proposal rests. We discuss ways that expanding the domain of rights can diminish the power of existing rights, and we argue for a right to non-discrimination in credit access, rather than a right to credit access itself.

 

Using Comparative Analysis to Address Health System Caricatures

Using Comparative Analysis to Address Health System Caricatures
International Journal of Health Services, Volume 44, Number 3, Pages 547–559, 2014. Baywood Publishing Co., Inc. doi: http://dx.doi.org/10.2190/HS.44.3.g

Michael K. Gusmano, Victor G. Rodwin, and Daniel Weisz
07/29/2014

To learn from health care systems abroad, we must move beyond simplistic characterizations and compare different systems with respect to salient performance measures. Despite findings from recent cross-national studies suggesting that many health care systems outperform the United States, claims by U.S. public officials often fail to acknowledge the actual accomplishments of health care systems abroad. We document significant variation among the United States and France, Germany, and England, which provide universal coverage, albeit in different ways. As previously documented, the United States has the highest rate of mortality amenable to health care. We extend this work by adding two indicators: (a) access to timely and effective primary care as measured by hospital discharges for avoidable hospital conditions; and (b) use of specialty services as indicated by coronary revascularization (bypass surgery and angioplasty), adjusted for the burden of coronary artery disease. Our findings indicate that: (a) the United States suffers the gravest consequences of financial barriers to primary care; (b) in all four countries, older people (65+) receive fewer revascularizations than their younger counterparts once we account for disease burden; and (c) in France, patients receive the most revascularizations, after adjusting for the burden of disease.

Decentralization in Uganda: Reforms, Reversals, and an Uncertain Future

Decentralization in Uganda: Reforms, Reversals, and an Uncertain Future
In Tyler Dickovich and James Wunsch, eds., Decentralization in Africa: A Comparative Perspective. (Boulder, CO: Lynne Rienner Publishers, 2014).

Smoke, P., W. Muhumuza and E. Ssewankambo
07/25/2014

Uganda was long considered one of the most successful cases of public sector devolution in the developing world. The post-conflict national government began robust empowerment of local governments in the early 1990s. The drive for reform emerged largely from domestic political forces with little involvement of the external donor agencies that have often promoted decentralization in countries with similar development profiles. Two decades after this highly touted reform began, the system has severely deteriorated on almost every aspect by which decentralization is usually judged. This chapter documents the economic, political and social dynamics that led to the rise of decentralization and also laid the foundation for its decline. The chapter concludes by suggesting possible future scenarios for the intergovernmental system in Uganda and drawing potential lessons for other countries considering such bold reforms.

‘Big Push’ To Reduce Maternal Mortality In Uganda And Zambia Enhanced Health Systems But Lacked A Sustainability Plan

‘Big Push’ To Reduce Maternal Mortality In Uganda And Zambia Enhanced Health Systems But Lacked A Sustainability Plan
doi: 10.1377/hlthaff.2013.0637 Health Aff June 2014 vol. 33 no. 6 1058-1066

Margaret E. Kruk, Miriam Rabkin, Karen Ann Grépin, Katherine Austin-Evelyn, Dana Greeson, Tsitsi Beatrice Masvawure, Emma Rose Sacks, Daniel Vail and Sandro Galea
06/01/2014

In the past decade, “big push” global health initiatives financed by international donors have aimed to rapidly reach ambitious health targets in low-income countries. The health system impacts of these efforts are infrequently assessed. Saving Mothers, Giving Life is a global public-private partnership that aims to reduce maternal mortality dramatically in one year in eight districts in Uganda and Zambia. We evaluated the first six to twelve months of the program’s implementation, its ownership by national ministries of health, and its effects on health systems. The project’s impact on maternal mortality is not reported here. We found that the Saving Mothers, Giving Life initiative delivered a large “dose” of intervention quickly by capitalizing on existing US international health assistance platforms, such as the President’s Emergency Plan for AIDS Relief. Early benefits to the broader health system included greater policy attention to maternal and child health, new health care infrastructure, and new models for collaborating with the private sector and communities. However, the rapid pace, external design, and lack of a long-term financing plan hindered integration into the health system and local ownership. Sustaining and scaling up early gains of similar big push initiatives requires longer-term commitments and a clear plan for transition to national control.

The global cancer divide: relationships between national healthcare resources and cancer outcomes in high-income vs. middle- and low-income countries

The global cancer divide: relationships between national healthcare resources and cancer outcomes in high-income vs. middle- and low-income countries
Journal of Epidemiology & Global Health, Vol 4, no. 2, pp. 115-124. DOI: 10.1016/j.jegh.2013.10.004

Batouli, A., P. Jahanshahi, C.P. Gross, D.V. Makarov, and J.B.Yu
06/01/2014

Background: Cancer continues to rise as a contributor to premature death in the developing world. Despite this, little is known about whether cancer outcomes are related to a country’s income level, and what aspects of national healthcare systems are associated with improved cancer outcomes.

Methods: The most recent estimates of cancer incidence and mortality were used to calculate mortality-to-incidence ratio (MIR) for the 85 countries with reliable data. Countries were categorized according to high-income (Gross Domestic Product (GDP) > $15,000) or middle/low-income (GDP < $15,000), and a multivariate linear regression model was used to determine the association between healthcare system indicators and cancer MIR. Indicators study included per capita GDP, overall total healthcare expenditure (THE), THE as a proportion of GDP, total external beam radiotherapy devices (TEBD) per capita, physician density, and the year 2000 WHO healthcare system rankings.

Results: Cancer MIR in high-income countries (0.47) was significantly lower than that of middle/low-income countries (0.64), with a p < 0.001. In high-income countries, GDP, health expenditure and TEBD showed significant inverse correlations with overall cancer MIR. A $3040 increase in GDP (p = 0.004), a $379 increase in THE (p < 0.001), or an increase of 0.59 TEBD per 100,000 population (p = 0.027) were all associated with a 0.01 decrease in cancer MIR. In middle/low-income countries, only WHO scores correlated with decreased cancer MIR (p = 0.022); 12 specific cancer types also showed similar significant correlations (p < 0.05) as overall cancer MIR.

Conclusions: The analysis of this study suggested that cancer MIR is greater in middle/low-income countries. Furthermore, the WHO healthcare score was associated with improved cancer outcomes in middle/low-income countries while absolute levels of financial resources and infrastructure played a more important role in high-income countries.

Is Micro Too Small? Microcredit vs. SME Finance

Is Micro Too Small? Microcredit vs. SME Finance
World Development 43: 288-297. 2013.

Bauchet, Jonathan and Jonathan Morduch
12/15/2013

Microcredit and SME finance are often pitched as alternative strategies to create employment opportunities in low-income communities. So far, though, little is known about how employment patterns compare. We integrate evidence from three surveys to show that, compared to Bangladeshi microcredit customers, typical SME employees in Bangladesh have more education and professional skills, and live in households that are notably less poor. SME jobs also require long work weeks, clashing with family responsibilities. The evidence from Bangladesh rejects the idea that SME finance more efficiently creates jobs for the population currently served by microcredit.

Hospitalization for Ambulatory-care sensitive conditions (ACSC) in Ile de France: A view from across the Atlantic

Hospitalization for Ambulatory-care sensitive conditions (ACSC) in Ile de France: A view from across the Atlantic
Revue française des affaires sociales 2013/3 (n° 3)

Rodwin, V., Gusmano, M. and Weisz, D.
12/03/2013

This article presents an indicator used in the United States and other OECD nations (hospitalizations for ambulatory-care sensitive conditions – ACSC) to assess access to primary care services and their capacity to handle a set of medical conditions before they require acute hospital treatment. Based on a study of Ile de France, which relies on residence-based hospital discharge data on patient diagnoses and treatments, the indicator identifies areas where hospitalizations for ACSC appear particularly high. Such hospital stays are considered potentially avoidable. Based on data from the Programme de m.dicalisation des syst.mes d’information (PMSI), disparities are measured. We rely on logistic regression analysis to identify a range of individual factors and neighborhood-level factors that explain these disparities. Access to primary care appears to be worse among residents in areas with average household income in the lowest quartile and among those hospitalized in public hospitals. This raises an important question for the future of health policy. Should areas with higher hospital discharge rates of ACSC be understood as having populations with poor health-seeking behaviors or health care systems not well enough organized to target higher-risk populations?

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