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Assessing the impact of measurement error in household consumption on estimates of catastrophic health expenditure in India
No full textThe National Sample Survey (NSS) collects reliable data on morbidity, health care, and health spending through its annual multi-subject and multi-round health surveys. Evidences from these surveys have been extensively used for research and policy. While these surveys collect comprehensive information on morbidity, hospitalisation, health expenditure, information on household consumption expenditure (which is used to explain the economic gradient in health outcomes) is collected through a single question. Literature suggests that having a single question on consumption expenditure results in measurement errors. In this paper, we examine the effect of measurement errors of household consumption expenditure on estimates of catastrophic health expenditure (CHE) in India using data from the 68th round of the consumption survey (2011–12) and the 71st round of the health survey (2014), carried out by the National Sample Survey (NSS). The consumption survey canvassed a detailed schedule on consumption and interviewed 101,651 households, whereas the health survey interviewed 65,932 households from across the country. Descriptive statistics, estimates of CHE, and logistic regression models were used in the analysis. We used both the budget share approach and the capacity-to-pay approach for estimating CHE. The NSS health survey was found to have underestimated monthly per capita consumption expenditure (MPCE) in India by 32%, with the level of underestimation being significant across the states. Using the budget share approach, the CHE of India in 2014–15 was estimated at 23.4% without adjusting for the underestimation of consumption and 21.1% after adjusting for it. Similarly, using the capacity-to-pay approach, CHE was estimated to be 13.4% without adjustment and 10.4% with adjustment. The estimates differed considerably across the states. In general, it was observed that the use of a single question on consumption overestimated CHE in India. The pattern was similar regarding the intensity of CHE. The predictors of CHE were similar using both the methods, but the unadjusted estimates of CHE showed significantly higher predicted probabilities of incurring CHE across household characteristics. It is recommended to include disaggregated questions on household consumption in the future rounds of the NSS-based health surveys. Researchers using NSS data need to be aware of the effect of measurement errors of consumption expenditure on estimates of catastrophic expenditure. Adjusting for the underestimation of MPCE may improve the estimation of CHE in India
The Population, Environmental Risks, and Climate Crisis (PERCC) Initiative
Get PDFThis brief describes the Population Council\u27s PERCC initiative which conducts rigorous, innovative, cross-disciplinary social science research; uses it to build publicly accessible datasets, tools, and models; and utilizes our findings and insights to help shape climate adaptation policy at every level, from municipalities to national strategies and United Nations agencies. The Council’s approach is underpinned by a climate justice lens, acknowledging that those who contribute the least to climate change are disproportionately harmed
Création et mise en œuvre d\u27un réseau de jeunes pour la prévention du VIH : Une étude de cas sur l\u27engagement significatif des jeunes au Zimbabwe
Get PDFCommentary: Multipurpose prevention technologies—What about sexually transmitted infections?
No full textDemographic trends and population health: Tackling inequality in a world of eight billion people
No full textQualitative research on Breakthrough ACTION’s Advocacy Core Group Model for integrated social behavior change programming in Nigeria
Get PDFThis report presents the results of a qualitative assessment conducted by Breakthrough RESEARCH/Nigeria of the Advocacy Core Group (ACG) model implemented by Breakthrough ACTION/Nigeria. The goal of the study was to examine, through qualitative inquiry, the operation and potential effectiveness of the ACG model, which works through key opinion leaders and influencers to influence community-level health norms and individual behaviors, focusing specifically on the uptake of essential reproductive, maternal, newborn, and child health services. Results inform Breakthrough ACTION/Nigeria’s program implementation and contribute toward the broader social and behavior change (SBC) implementation science literature surrounding the roles, effectiveness, successes, and challenges of leveraging religious and traditional leaders and social structures to improve social normative environments for health. The work further addresses issues surrounding the ACG model within the context of integrated SBC programming. Research was undertaken in two phases to provide a comprehensive and additive approach to the qualitative evaluation. Researchers sought to examine the effectiveness, success, and challenges of the ACG approach, particularly in the context of integrated SBC programming across health areas, per the approved study protocol
Halftime for SDGs: Maternal and Newborn Health—Best Investment Paper
Get PDFEach year, 295,000 women die during and just after pregnancy, and 2.4 million babies die in the first month of their lives. In 2019, 2,160,000 neonatal deaths and 275,000 maternal deaths occurred in low- income and lower-middle income countries alone, translating to a welfare loss equivalent to 36 billion for neonatal and maternal deaths respectively. The total loss was 3.2 billion per year more investment and will deliver benefits worth 25bn annually. For every 87. The benefit-cost ratio (BCR) is 87
Amref Alternative Rites of Passage (ARP) model for female genital mutilation/cutting, teenage pregnancies, and child, early and forced marriages in Kenya: A stepped-wedge cluster randomised controlled trial protocol
No full textBackground: The Amref Alternative Rites of Passage (ARP) model was initiated in 2009. To date, about 20,000 girls have been supported by their communities to denounce female genital mutilation/cutting (FGM/C) and graduate into ‘maturity’ through ARP. While this intervention has been implemented for decades, there is limited evidence of its effectiveness in ending FGM/C. In order to ascertain the effectiveness of this intervention, Amref has developed a digital tracking tool to follow up on girls who have and haven’t gone through the ARP. The key research question is: what effect does ARP have on incidences of FGM/C, teenage pregnancy and child, early and forced marriages among adolescent girls and young women? Methods: The study will adopt a stepped-wedge cluster randomised controlled trial design to assess the effectiveness of the ARP model on the incidence of FGM/C; teenage pregnancy; child, early and forced marriage; and educational attainment. We selected one cluster in Kajiado County where recent ARPs have been conducted as the intervention site at the beginning of the study and 3 wards/clusters in Narok County as control sites. Approximately 604 girls aged 10-18 years who reside in selected sites/clusters in Kajiado and Narok counties will be recruited and followed up for 3 years post-exposure. Quantitative data analysis will be conducted at bivariate and multivariate levels. Content/thematic analysis approach will be used to analyse qualitative data. Ethics and dissemination: The study obtained ethical approval from the Amref Ethics and Scientific Review Committee (AMREF-ESRC P1051-2021). The findings of this study will be shared with local, national and regional stakeholders working in ending FGM/C, teenage pregnancy, and child, early and forced marriages. Registration: Pan-African Clinical Trials Registry (PACTR202208731662190)
Quality of care is perceived to be high with community-based antiretroviral therapy (ART) services for female sex workers in Tanzania: Qualitative findings from a pilot implementation science study
No full textThis qualitative study reports on female sex workers’ (FSWs) perceptions of the quality of antiretroviral therapy (ART) services they received as part of a community-based ART distribution intervention compared to services received by FSWs in the standard of care (SOC) arm. In-depth interviews were conducted with 24 participants to explore their perceptions of the quality of ART services. Data was analyzed using a quality-of-care framework that included but was not limited to, domains of accessibility, effective organization of care, package of services, and patient-centered care. Overall, FSWs in the intervention arm reported community-based ART services to be highly accessible, organized, and effective, and they highly valued the patient-centered care and high level of privacy. Community-based ART programs for FSWs can have high quality-of-care, which can have a positive effect on HIV treatment outcomes for FSWs
Women\u27s groups, covariate shocks, and resilience: An evidence synthesis of past shocks to inform a response to COVID-19
No full textBackground: Interventions with women’s groups are increasingly seen as an important strategy for advancing women’s empowerment, health, and economic outcomes in low- and middle-income countries, with the potential to increase the resiliency of members and their communities during widespread covariate shocks, such as coronavirus disease 2019 (COVID-19). Methods: This evidence synthesis compiles evidence from past shocks on women’s group activities and the extent to which women’s groups mitigate the effects of shocks on members and communities. We reviewed 90 documents from academic databases, organizational reports, and additional gray literature, and included literature diverse in geography, type of women’s group, and shock. Results: The literature suggests that covariate shocks tend to disrupt group activities and reduce group resources, but linkages to formal institutions can mitigate this impact by extending credit beyond the shock-affected resource pool. Evidence was largely supportive of women’s groups providing resilience to members and communities, though findings varied according to shock severity, group purpose and structure, and outcome measures. Further, actions to support individual resilience during a shock, such as increased payment flexibility, may run counter to group resilience. The findings of the evidence synthesis are largely consistent with emerging evidence about women’s groups and COVID-19 in South Asia and sub-Saharan Africa. Conclusions: We finalize the paper with a discussion on policy implications, including the importance of sustainable access to financial resources for women’s group members; equity considerations surrounding the distribution of group benefits and burdens; and the potential for meaningful partnerships between women’s groups and local governments and/or non-governmental organizations (NGOs) to enhance community response amidst crises