International Development

Evaluation Of A Maternal Health Program In Uganda And Zambia Finds Mixed Results On Quality Of Care And Satisfaction

Evaluation Of A Maternal Health Program In Uganda And Zambia Finds Mixed Results On Quality Of Care And Satisfaction
Health Affairs, March 2016 vol. 35 no. 3 510-519, doi:10.1377/hlthaff.2015.0902

Margaret E. Kruk, Daniel Vail, Katherine Austin-Evelyn, Lynn Atuyambe, Dana Greeson, Karen Ann Grépin, Simon P. S. Kibira, Mubiana Macwan’gi, Tsitsi B. Masvawure, Miriam Rabkin, Emma Sacks, Joseph Simbaya and Sandro Galea
03/01/2016

Saving Mothers, Giving Life is a multidonor program designed to reduce maternal mortality in Uganda and Zambia. We used a quasi-random research design to evaluate its effects on provider obstetric knowledge, clinical confidence, and job satisfaction, and on patients’ receipt of services, perceived quality, and satisfaction. Study participants were 1,267 health workers and 2,488 female patients. Providers’ knowledge was significantly higher in Ugandan and Zambian intervention districts than in comparison districts, and in Uganda there were similar positive differences for providers’ clinical confidence and job satisfaction. Patients in Ugandan intervention facilities were more likely to give high ratings for equipment availability, providers’ knowledge and communication skills, and care quality, among other factors, than patients in comparison facilities. There were fewer differences between Zambian intervention and comparison facilities. Country differences likely reflect differing intensity of program implementation and the more favorable geography of intervention districts in Uganda than in Zambia. National investments in the health system and provider training and the identification of intervention components most associated with improved performance will be required for scaling up and sustaining the program.

The Impact of income and non-income shocks on child labour: Evidence from a panel survey of Tanzania

The Impact of income and non-income shocks on child labour: Evidence from a panel survey of Tanzania
World Development, Volume 67, Pages 1-534 (March 2015).

Dehejia, Rajeev
10/26/2015

This paper investigates the impact of income and non-income shocks on child labor using a model in which the household maximizes utility from consumption as well as human capital development of the child. We also investigate if access to credit and household assets act as buffers against transitory shocks. Our results indicate significant effects of agricultural shocks on the child’s overall work hours and agricultural work hours, with higher effects for boys. Crop shocks also have significant adverse effects on school attendance, with girls experiencing a more-than 70% increase in the probability of quitting schooling. The results also indicate that access to a bank account has a buffering effect on the impact of shocks on child hunger. Having a bank account reduces both male child labor and household work hours of a girl child. While assets reduce working hours of girls, we do not find it having a significant effect on boys. We also do not see assets to act as a buffer against shocks

The Link Between Manufacturing Growth and Accelerated Services Growth in India

The Link Between Manufacturing Growth and Accelerated Services Growth in India
forthcoming in Economic Development and Cultural Change.

Dehejia, Rajeev
10/26/2015

The impact of trade liberalization on manufacturing growth has been widely studied in the literature. What has gone unappreciated is that accelerated manufacturing growth has also been accompanied by accelerated services growth. Using firm-level data from India, we find a positive spillover from manufacturing growth to gross value added, wages, employment, and worker productivity in services, especially large urban firms and in service sectors whose output is used as a manufacturing input.

A comparative analysis of hospital readmissions in France and the US

A comparative analysis of hospital readmissions in France and the US

Gusmano, MK, Rodwin, VG, Weisz, D, Cottenet, J, and Quantin, C.
10/04/2015

Policymakers in the US and France are struggling to improve coordination among
hospitals and other health care providers. A comparison of hospital readmission rates, and the factors that may explain them, can provide important insights about the French and US health care systems. In addition, it illustrates a methodological approach to comparative research: how an empirical inquiry along a single indicator can reveal broader issues about system-wide differences across health care systems and policy. Using data from three French regions, the article extends a
previous national-level comparison indicating that rates of hospital readmission for the population aged 65+ are lower in France than in the US. In addition, we extend the range of variables available in the national comparison by drawing on neighborhood-level income data available from a previous study of access to primary care among three French regions. Within France, the odds of surgical hospital readmission are significantly lower in private for-profit hospitals compared with public hospitals. Patients who live in lower income neighborhoods are also more likely to be readmitted for medical and surgical conditions than are patients living in higher income neighborhoods, but this income effect is weaker than in the US. The article concludes with a discussion of how these findings reflect broader system-wide differences between the US and French health systems and the ways in which policymakers attempt to coordinate hospitals and community based services.

Maternal Education and Child Mortality in Zimbabwe

Maternal Education and Child Mortality in Zimbabwe
10.1016/j.jhealeco.2015.08.003

Grépin, KA, Bharadwaj, P.
08/24/2015

In 1980, Zimbabwe rapidly expanded access to secondary schools, providing a natural experiment to estimate the impact of increased maternal secondary education on child mortality. Exploiting age specific exposure to these reforms, we find that children born to mothers most likely to have benefited from the policy were about 21% less likely to die than children born to slightly older mothers. We also find that increased education leads to delayed age at marriage, sexual debut, and first birth and that increased education leads to better economic opportunities for women. We find little evidence supporting other channels through which increased education might affect child mortality. Expanding access to secondary schools may greatly accelerate declines in child mortality in the developing world today.

Credit is Not a Right

Credit is Not a Right
in Microfinance, Rights, and Global Justice (edited by Tom Sorell and Luis Cabrera). Cambridge University Press.

Gershman, John and Jonathan Morduch
08/01/2015

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.

 

Report on avoidable hospitalizations in the Greater Paris Region (French)

Report on avoidable hospitalizations in the Greater Paris Region (French)
Les hospitalisations potentiellement évitables (HPE), nécessaires au moment de l’admission à l’hôpital, pourraient être évitées par une prise en charge appropriée des soins de premier recours. Quel est l’apport de l’indicateur des HPE dans un diagnostic territorial et dans l’évaluation des parcours de soins?

Laborde, C. and Rodwin, VG.
07/01/2015

Les hospitalisations potentiellement évitables (HPE), nécessaires au moment de l’admission à l’hôpital, pourraient être évitées par une prise en charge appropriée des soins de premier recours. Quel est l’apport de l’indicateur des HPE dans un diagnostic territorial et dans l’évaluation des parcours de soins?

Link to 2 page abstract

Factors influencing modes of transport and travel time for obstetric care: a mixed methods study in Zambia and Uganda

Factors influencing modes of transport and travel time for obstetric care: a mixed methods study in Zambia and Uganda
Health Policy & Planning

Sacks, E, Vail, D, Austin-Evelyn, K, Greeson, D, Atuyambe, L, Macwan’gi, M, Kruk, ME, Grépin, KA.
06/30/2015

Transportation is an important barrier to accessing obstetric care for many pregnant and postpartum women in low-resource settings, particularly in rural areas. However, little is known about how pregnant women travel to health facilities in these settings. We conducted 1633 exit surveys with women who had a recent facility delivery and 48 focus group discussions with women who had either a home or a facility birth in the past year in eight districts in Uganda and Zambia. Quantitative data were analysed using univariate statistics, and qualitative data were analysed using thematic content analysis techniques. On average, women spent 62–68 min travelling to a clinic for delivery. Very different patterns in modes of transport were observed in the two countries: 91% of Ugandan women employed motorized forms of transportation, while only 57% of women in Zambia did. Motorcycle taxis were the most commonly used in Uganda, while cars, trucks and taxis were the most commonly used mode of transportation in Zambia. Lower-income women were less likely to use motorized modes of transportation: in Zambia, women in the poorest quintile took 94 min to travel to a health facility, compared with 34 for the wealthiest quintile; this difference between quintiles was ∼50 min in Uganda. Focus group discussions confirmed that transport is a major challenge due to a number of factors we categorized as the ‘three A’s:’ affordability, accessibility and adequacy of transport options. Women reported that all of these factors had influenced their decision not to deliver in a health facility. The two countries had markedly different patterns of transportation for obstetric care, and modes of transport and travel times varied dramatically by wealth quintile, which policymakers need to take into account when designing obstetric transport interventions.

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