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Where in the world is a hospitalization least affordable?

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In the developing world, a hospitalization is one of the things that families – especially poor ones – fear most. This came through in country after country in the World Bank’s Voices of the Poor exercise. Here are just some examples:

A man from Ghana is quoted as saying: “Take the death of this small boy this morning, for example. The boy died of measles. We all know he could have been cured at the hospital. But the parents had no money and so the boy died a slow and painful death, not of measles, but out of poverty.”

The researchers write that in Lahore, Pakistan, “a father explained that it had taken him eight years to repay debts acquired after he, his wife, and two of their children had been hospitalized.”

Shocking facts about primary health care in India, and their implications

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There’s nothing quite like a cold shower of shocking statistics to get you thinking. A paper that came out in Health Affairs today, written by my colleague Jishnu Das and his collaborators, is just such a cold shower.

Fake patients
Das and his colleagues spent 150 hours training each of 22 Indians to be credible fake patients. These actors were then sent into the consulting rooms of 305 medical providers – some in rural Madhya Pradesh (MP), others in urban Delhi – to allow the study team to assess the quality of care that the providers were delivering.

A lot of thought went into just what conditions the fake patients should pretend to have. The team wanted the conditions to be common, and to be ones that had established medical protocols with government-provided treatment checklists. The fake patients shouldn’t be subjected to invasive exams, and they needed to be able to be able to credibly describe invisible symptoms.

When the snow fell on health systems research: a symposium sketch

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Editor's warning: The author wrote this post after hitting his head and suffering some memory loss, and the World Bank cannot vouch for the accuracy of everything reported in it.

It was the perfect finale. In the vast high-tech auditorium of Beijing's International Convention Center, the audience jostled in the queue to pose questions to the final plenary panel of the Second Global Symposium on Health Systems Research

First came an elderly lady from the Indian subcontinent who asked why the panelists were so old. "How can we address the issues of tomorrow with the experts of yesterday? If we're going to be serious about universal health coverage, we need youth!" The crowd -- mostly young -- signaled their approval. A middle-aged gentleman from South Africa  tried to engage the panel on the damages inflicted on world nutrition by the global food corporations. Warming to his theme of corporate neocolonialism, land grabs, and genetically modified foods, he invoked the memory of Lenin. "That's Vladimir Lenin", he explained to the crowd, "not John Lennon." "Vladimir who? John who?" wondered the youthful crowd. The chair, the ever-youthful Lancet Editor-in-Chief Richard Horton, whose favored medium is Twitter, asked the gentleman to keep his comments tweet-length. A young woman from Britain's aid agency, DfID, eventually wrestled the mike from Lenin's apologist, and said what was on everyone's mind. "Richard, Dear Leader.", she urged, "Tell us your thoughts. It's you we want to hear!"

How can health systems “systematic reviews” actually become systematic?

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From Karl Pillemer’s post on Cornell’s Evidence-Based Living blogIn my post “Should you trust a medical journal?” I think I might have been a bit unfair. Not on The Lancet, which I have since discovered, via comments on David Roodman’s blog, has something of a track record of publishing sensational but not exactly evidence-based social science articles, but rather on Ernst Spaan et al. for challenging the systematicness of their systematic review of health insurance impacts in developing countries. It’s not that I now think Spaan et al. did a wonderful job. It’s just that I think they probably shouldn’t have been singled out in the way they were.

Who’s writing what in the ‘Knowledge Bank’? And is it being used?

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An organization with ‘motor company’ in its name might produce several types of vehicle (cars, trucks, etc.) in several variations (models) at several different plants, and might sell these vehicles in several different regions of the world. The company wouldn’t last long if it didn’t know how many of each model – and at what cost – it was producing in each plant, and how many – and at what price – it was selling in each region. In the World Bank – where we like to think of ourselves as the ‘knowledge bank’ – we produce several types of document in several vice presidencies (VPUs) and we make them available in hard copy and in electronic format in all regions of the world. Yet as far as I know we don’t systematically track how many of each document type each VPU produces, let alone how successful each is in terms of sales and downloads. We have these data for World Bank books, but they’re a small fraction of our overall document output.

The lack of data ought to make it hard to think about how the institution might do things differently in its knowledge work to serve developing countries better. What type of Bank documents are produced most? And which are used most? Which VPUs are the big producers of knowledge? Which document types are downloaded most? Which VPUs produce the most downloaded documents?

Should you trust a medical journal?

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While we non-physicians may feel a bit peeved when we hear “Trust me, I’m a doctor”, our medical friends do seem to have evidence on their side. GfK, apparently one of the world’s leading market research companies, have developed a GfK Trust Index, and yes they found that doctors are one of the most trusted professions, behind postal workers, teachers and the fire service. World Bank managers might like to know that bankers and (top) managers come close to the bottom, just above advertising professionals and politicians.

Given the trust doctors enjoy, the recent brouhaha over allegations of low quality among some of the social science articles published in medical journals must be a trifle embarrassing to the profession. Here’s the tale so far, plus a cautionary note about a recent ‘systematic review’.

Tracking withdrawals from the ‘Knowledge Bank’

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As I reported in my last post, Jim Kim’s arrival as World Bank President has reinvigorated the debate about the idea of the World Bank being a ‘knowledge bank’. In the post, I argued that the knowledge produced by the Bank – whether gleaned from its lending operations, or from its research and other analytic work – is a global public good, and that we should therefore assess the success of the institution in its knowledge work not in terms of how specific ‘client’ governments value the outputs of its knowledge work but rather in terms of how people around the world use and value them.

So what exactly is a “knowledge bank”?

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Unsurprisingly, with the recent arrival of a new president fresh from the groves of academia, the halls and meeting rooms of the World Bank are buzzing once again with talk of the “Knowledge Bank” or KB for short. But what exactly is a “knowledge bank”?

To my mind the paper that pins the idea down best is “Positioning the World Bank” by Chris Gilbert, Andrew Powell and David Vines in the Economic Journal in 1999.

Knowledge as a public good
Gilbert & Co argue that knowledge about best-practice development is a global public good – the entire world stands to benefit from it, even though some may benefit from it more than others. Given the public good character of global knowledge on development, too little of it would appear if production were left to the free market.

Measuring universal health coverage – plus ça change?

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In case you hadn’t noticed, there’s a growing clamor for a global commitment to universal health coverage (UHC). You might have seen the recent special issue of the Lancet on “the struggle for UHC”. Inevitably, accompanying this clamor, there’s been a lot of wracking of brains on how to measure progress toward UHC. With the excitement of a new political agenda, there’s understandably a desire to carve out a new measurement agenda too. While not wanting dampen people’s enthusiasm for the UHC cause, I would like us to reflect whether on the measurement agenda we’re building enough on what’s been done before.

Yet more on coping with information overload with an iPad

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Last year I wrote a couple of posts on coping with information overload using an iPad, one in July and the other in December. The iPad world continues to develop apace, so  here's a quick update, this one - as requested - complete with links to the apps. 

International development apps

In my last post, I covered three World Bank apps: InfoFinder, which allows you to search in the Bank's documents and reports database, DataFinder which gets you into the Bank's data vaults, and WB Finances which shows you what the Bank is doing in its operational work. The Bank's latest iPad app is the 2012 World Development Report which contains the text of the report plus various additional features. While not an iPad app, the Bank's Open Knowledge Repository is quite iPad-friendly and a great way to search for and access World Bank publications.

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