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health care

How and why do countries vary so much in their use of health services?

Adam Wagstaff's picture

I’ve been struck recently by how little we (or at least I) seem to know about variations in use of health services across the world, and what drives them. Do people in, say, India or Mali use doctors “a lot” or “a little”. Even harder: do they “overuse” or “underuse” doctors? At least we could say whether doctor utilization rates in these countries are low or high compared to the rate for the developing world as a whole. But typically we don’t actually make such comparisons – we don’t have the numbers at our fingertips. Or at least I don’t.

I’m also struck by how strongly people feel about the factors that shape people’s use of services and what the consequences are. There are some who argue that the health problems in the developing world stem from people not getting care, and that people don’t get care because of shortages of doctors and infrastructure. There are others who argue that doctors are in fact quite plentiful – in principle; the problem is that in practice doctors are often absent from their clinic and people don’t get care at the right moment. There are others who argue that doctors are plentiful even in practice and people do get care; the problem is that the quality of the care is shockingly bad. Who’s right?

Preventing Maternal Mortality - A Yardstick for Social Justice

Patricio V. Marquez's picture

I was glad to read the announcement made by World Bank President, Dr. Jim Kim, at the start of this year’s UN General Assembly meetings, about the Bank’s projected financing support through the end of 2015 to help developing countries reach the Millennium Development Goals (MDGs) for women and children’s health.  As we move toward the culmination of the MDGs in 2015 and beyond, preventing maternal and child deaths should be seen by all government delegations and their partners in the international development community as a clear yardstick to measure their commitment for creating more just and inclusive societies.

Learning from Data-Driven Delivery

Aleem Walji's picture

Given confusion around the phrase “science of delivery,” it’s important to state that delivery science is not a “one-size-fits-all” prescription based on the premise that what works somewhere can work anywhere. And it does not profess that research and evidence ensure a certain outcome.
 
A few weeks ago, the World Bank and the Korea Development Institute convened a global conference on the science of delivery. Several development institutions assembled including the Gates Foundation, the Grameen Foundation, UNICEF, the Dartmouth Center for Health Care Delivery Science, and the mHealth Alliance. We discussed development opportunities and challenges when focusing on the extremely poor, including experiments in health care, how technology is reducing costs and increasing effectiveness, and the difficulty of moving from successful pilots to delivery at scale.
 
The consensus in Seoul was that a science of delivery underscores the importance of a data-driven and rigorous process to understand what works, under what conditions, why, and how. Too often in international development, we jump to conclusions without understanding counterfactuals and assume we can replicate success without understanding its constituent elements.

Can informal health entrepreneurs help increase access to health services in rural areas?

Jorge Coarasa's picture


New approaches to medical care can improve health outcomes (Credit: World Bank, Flickr)

In many poor countries, a large proportion of health services is provided by the private sector, including services to the poor. However, the private sector is highly fragmented and the quality of services varies widely. Private health markets consist of providers with very diverse levels of qualification, ranging from formally trained doctors with medical degrees to informal practitioners without any formal medical training. According to Jishnu Das, in rural Madhya Pradesh— one of the poorest states in India, households can access on average 7.5 private providers, 0.6 public providers and 3.04 public paramedical staff. Of those identified as doctors, 65% had no formal medical training and of every 100 visits to healthcare providers, eight were to the public sector and 70 to untrained private sector providers.

Jim Yong Kim: Targets Will Help Fight Against Poverty

Jim Yong Kim's picture

MADRID -- One thousand days. That's all we have left to meet the Millennium Development Goals, a series of commitments to improve the lives of families in the developing world. I was just in Madrid to attend the United Nations' Chief Executives Board -- the heads of the UN agencies -- and we talked about the importance of setting targets to spur urgent action. Watch the video blog below to learn more.

Law and Development from the Ground Up: Bridging Health Care by the Sewa River

Margaux Hall's picture

In Sierra Leone's rainy season, the Sewa River, feared by many locals for its powerful currents, floods over its banks separating entire villages from basic services.  Konta health clinic in Kenema district operates near the shores of the Sewa, and during the six-month rainy season, five of Konta’s 17 dependent villages cannot access the clinic.  If women in those villages give birth during the rains, they entrust care to traditional birth attendants; if children fall ill, they turn to traditional medicine, stockpiled drugs, and, often, prayer.  As one woman explained during a recent community meeting in Konta, these are the only options, even if the all-too-frequent consequence is death.  Hearing her account, it’s difficult not to feel a strong sense of injustice, even in an incredibly resource-constrained country like Sierra Leone.  But is there a role for the law in remedying this situation?

Poverty measurement, electricity generation, emissions, universal health care, greenhouse issues and financial literacy

Merrell Tuck-Primdahl's picture

This week, amidst fireworks and stultifying Washington heat, five Policy Research Working Papers were published. They cover weakly relative poverty measures, PPPs in electricity generation, carbon emissions, universal health care, financial literacy, and economic analysis of projects in a greenhouse world.

    Do Informed Citizens Receive More, or Pay More?

    Philip Keefer's picture

    One widely-accepted political economy research finding is that informed citizens receive greater benefits from government transfer programs. The evidence for the impact of information comes from particular contexts—disaster relief in India and welfare payments in the USA during the Great Depression.  Do other contexts yield similar results?  New research on the distribution of anti-malaria bed nets in Benin suggests:  “No.”  Instead, local health officials charged more informed households for bed nets that they could have given them for free.

    The Benin context differs in three ways.  First, the policy is not the distribution of cash, but of health benefits.  Households’ access to information then influences not only their knowledge of government programs to distribute such benefits, but also the value they place on them. 

    Second, the political context also differs.  In younger democracies, like Benin’s, citizens are more likely to confront additional obstacles, besides a lack of information, in their efforts to extract promised benefits from government.

    Beyond Universal Coverage Part II

    Adam Wagstaff's picture

    Quantity inequalities may be dwarfed by quality inequalities

    In my last post on UC I argued that UC is best thought of as a means to achieving lower inequalities and improved financial protection in the health sector, but that in practice UC is unlikely to be sufficient – and may not even be necessary – for us to achieve these goals.

    In this post, I argue that our focus on narrowing inequalities in the quantity of care is leading us to ignore another and potentially more important type of inequality in the health sector: inequality in the quality of care.

    Beyond Universal Coverage Part I

    Adam Wagstaff's picture

    Health sector inequalities and financial protection – is UC enough?

    Since the publication of the 2010 World Health Report “Health Systems Financing: The Path to Universal Coverage”, the “universal coverage” (UC) agenda has accelerated worldwide.

    In this post, I ask how far UC is likely to narrow health sector inequalities and improve financial protection. In the next two I pick up a couple of other themes: the need to look beyond the quantity of care to the quality of care; and how far we should try to incorporate the cost of forgone care into a measure of financial protection.


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