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31. Quality and Accountability in Healthcare Delivery: Audit Evidence from Primary Care Providers in India

Author:
Jishnu Das, Alaka Holla, Aakash Mohpal, and Karthik Muralidharan
Publication Date:
02-2015
Content Type:
Working Paper
Institution:
Centre for Policy Research, India
Abstract:
We present among the first direct evidence on the quality of healthcare in low-income settings using a unique and original set of audit studies, where standardized patients were presented to a nearly-representative sample of rural public and private primary care providers in the Indian state of Madhya Pradesh. We report three main findings. First, private providers are mostly unqualified but spent more time with patients, and completed more items on a checklist of essential history and examination items than public providers, while being no different in their diagnostic and treatment accuracy. Second, we identify the private practices of qualified public sector doctors, and show that the same doctors exert higher effort and are more likely to provide correct treatment in their private practices. Third, we find a strong positive correlation between provider effort and prices charged in the private sector, whereas we find no correlation between effort and wages in the public sector. Our results suggest that market-based accountability in the unregulated private sector may be providing better incentives for provider effort than administrative accountability in the public sector in this setting. While the overall quality of care is low in both the public and private sectors, these differences in provider effort may partly explain the dominant market share of fee-charging private providers even in the presence of a system of free public healthcare.
Topic:
Government, Health, Privatization, Health Care Policy, Social Policy, and Rural
Political Geography:
South Asia, India, and Asia

32. East-West Center Working Papers, Environmental Change, Vulnerability, and Governance Series

Author:
Alex S. Forster
Publication Date:
03-2014
Content Type:
Working Paper
Institution:
East-West Center
Abstract:
North Korea is an extremely isolated and impoverished nation. While its political elites are able to enjoy some degree of luxury in spite of UN sanctions, the lower classes suffer from shortages of food, electricity, healthcare, and other basic needs. Many of the lower class and fringe populations reside in rural areas with limited infrastructure, and rely on black markets to survive. Their situation could be dramatically improved if electricity could be provided to their communities to power heating, health clinics, manufacturing facilities, fertilizer plants, and water pumps for agricultural irrigation.
Topic:
Health, Food, and Sanctions
Political Geography:
Asia and United Nations

33. People with Disabilities in a Changing North Korea

Author:
Katharina Zellweger
Publication Date:
01-2014
Content Type:
Working Paper
Institution:
Walter H. Shorenstein Asia-Pacific Research Center
Abstract:
"People with Disabilities in a Changing North Korea" details the situation that people with disabilities face in the Democratic People's Republic of North Korea (DPRK). Despite its reputation as a repressive, closed society where human rights are routinely abused, there are in fact institutions in the DPRK that work to address the needs of the disabled, and a number of non-governmental organizations providing aid to disabled people are active in the country. In this paper, Katharina Zellweger attempts to provide "an informed and balanced view of what it means to live with disabilities in North Korea and current work to assist the disabled."
Topic:
Health, Human Welfare, and Governance
Political Geography:
Asia and North Korea

34. Insecticide Resistance and Malaria A Threat Decades in the Making

Author:
William G. Brogdon, Anthony Fiore, S.P. Kachur, Laurence Slutsker, and Robert A. Wirtz
Publication Date:
12-2014
Content Type:
Working Paper
Institution:
Center for Strategic and International Studies
Abstract:
Insecticide (DDT) use to control malaria was first employed successfully in the antimalaria program in Greece in 1947. By 1951, DDT success in controlling malaria was reported in 22 countries. However, that year also saw the first report of DDT resistance, in Anopheles sacharovi in Greece. By 1954, resistance to DDT among mosquitos was known to be a global problem, documented in Europe, the Americas, Africa, and Asia. The World Health Organization–led Global Malaria Eradication Program (GMEP) began in 1955, when resistance was already pronounced worldwide. Scientists did not identify the underlying biochemical mechanism contributing to insecticide resistance until 1958. By then, insecticide resistance was recognized by many to be a major contributor to the ultimate dismantling of GMEP, given the limited capabilities and knowledge of the time. Consequently, the global focus shifted from malaria “eradication” to malaria “control” in the late 1960s.
Topic:
Environment, Health, and Infectious Diseases
Political Geography:
Africa, Greece, and Asia

35. U.S. Support Essential to Ambitious Global Introduction of Inactivated Polio Vaccine

Author:
Nellie Bristol
Publication Date:
12-2014
Content Type:
Working Paper
Institution:
Center for Strategic and International Studies
Abstract:
Earlier this fall, Nepal became the first low - income country to introduce the inactivated polio vaccine (IPV) into its immunization system. Many more countries will have to follow suit to meet the ambitious deadlines laid out in the Global Polio Eradication Initiative's (GPEI) Polio Eradication Endgame Strategic Plan 2013 – 2018. The plan calls for global introduction of at least one dose of IPV into routine childhood immunization schedules followed by eventual withdrawal of the widely used oral polio vaccine (OPV). Currently, 75 mostly high - and middle - income countries use the injectable IPV in their immunization systems, leaving 119 that need to do so by the end of 2015 to keep with the plan's schedule.
Topic:
Health and Health Care Policy
Political Geography:
Asia and Nepal

36. Perceived Risk of Avian Influenza in Poultry Varies with Urbanization in Vietnam

Author:
Jefferson Fox, Melissa L. Finucane, Sumeet Saksena, Nghiem Tuyen, James H. Spencer, Nguyen Lam, Trinh Dinh Thau, Tran Duc Vien, and Nancy D. Lewis
Publication Date:
10-2014
Content Type:
Working Paper
Institution:
East-West Center
Abstract:
Highly pathogenic avian influenza (HPAI) is an important public health concern because of its potential to cause widespread morbidity and mortality in humans and poultry and associated devastating economic losses. In this study we examined how perceptions of and response to the risk of HPAI in poultry vary across communes/wards in the north of Vietnam at different levels of urbanization (rural, transitional, urban). We conducted a quantitative household survey with 1073 respondents. Results suggested that the perceived risk of HPAI in poultry was highest in transitional and rural settings. Respondents in these settings were more likely than respondents in urban settings to agree that the process of change (in urbanization, agricultural practices, or natural habitat) increased the likelihood of an outbreak of HPAI in poultry. Compared with others, respondents in transitional areas reported that they do less planning and perceive vaccines to be more effective, while respondents in rural areas reported less perceived ability to separate infected poultry from others. We also found that the inability to respond is not necessarily because of an inability to perceive change but because, rapid and extensive change poses different challenges for poultry management as communes move from rural to transitional to urban settings. Our results suggest that public and animal health campaigns could be tailored in a way that recognizes the needs of poultry raisers in different settings.
Topic:
Health, Infectious Diseases, and Urbanization
Political Geography:
Asia and Vietnam

37. Role of Urbanization, Land-Use Diversity, and Livestock Intensification in Zoonotic Emerging Infectious Diseases

Author:
Jefferson Fox, Duong Nong, Miguel Castrence, James Spencer, Sumeet Saksena, Nguyen Lam, Tran Duc Vien, Michael Epprecht, Chinh Tran, Melissa Finucane, and Bruce Wilco
Publication Date:
10-2014
Content Type:
Working Paper
Institution:
East-West Center
Abstract:
Emerging infectious diseases (EIDs) continue to significantly threaten human and animal health. While there has been some progress in identifying underlying proximal driving forces and causal mechanisms of disease emergence, the role of distal factors is most poorly understood. This article focuses on analyzing the statistical association between highly pathogenic avian influenza (HPAI) H5N1 and urbanization, land-use diversity and poultry intensification. A special form of the urban transition—peri-urbanization—was hypothesized as being associated with 'hot-spots' of disease emergence. Novel metrics were used to characterize these distal risk factors. Our models, which combined these newly proposed risk factors with previously known natural and human risk factors, had a far higher predictive performance compared to published models for the first two epidemiological waves in Viet Nam. We found that when relevant risk factors are taken into account, urbanization is generally not a significant independent risk factor. However, urbanization spatially combines other risk factors leading to peri-urban places being the most likely 'hot-spots'. The work highlights that peri-urban areas have highest levels of chicken density, duck and geese flock size diversity, fraction of land under rice, fraction of land under aquaculture compared to rural and urban areas. Land-use diversity, which has previously never been studied in the context of HPAI H5N1, was found to be a significant risk factor. Places where intensive and extensive forms of poultry production are collocated were found to be at greater risk
Topic:
Health, Infectious Diseases, and Urbanization
Political Geography:
United States and Asia

38. Empirical Investigation of Declining Childbirth: Psychosocial and Economic Conditions in Japan

Author:
Tetsuji Yamada, Chia-Ching Chen, Chie Hanaoka, and Seiritsu Ogura
Publication Date:
08-2013
Content Type:
Working Paper
Institution:
Walter H. Shorenstein Asia-Pacific Research Center
Abstract:
Background: For the past two decades, more and more women in certain European countries, Japan, and the United States are giving birth to their first child at a considerably later age than ever before. It remains unclear as to what extent this age-related general fertility decline is affected by changing social and cultural norms. Method: The Global Centers of Excellence Survey was conducted by Osaka University in Japan (n=5313) in 2009. Multivariate regression analyses were conducted to examine the impact of psychosocial norms, cultural differences, and economic conditions on the perception of childbearing. Results: The findings suggest that a subjective measure of happiness has a significant influence on childbearing. A society with income inequalities between classes discourages childbearing. It is observed that women's higher labor force participation generates a negative impact on motherchild relations which causes discouragement of childbearing. A higher female labor force participation stemmed from a transition of a traditional society into a modern and marketoriented society discourages childbearing. Conclusions/implications: A woman's decision to delay childbearing is based on her perception of psychosocial norms with surrounding economic environment and her own value of opportunity in the market oriented society. Childbearing also imposes psycho-economic burdens on the working population under mix of a traditional, patriarchal society, and a modern market oriented framework. Childbearing incentives could be a strategic policy to encourage positive attitudes of childbearing in general and proper welfare policy, labor law(s), employment conditions, and social security system for a working mother with a child or children.
Topic:
Economics, Gender Issues, Health, Poverty, Social Stratification, and Labor Issues
Political Geography:
United States, Japan, Europe, Israel, and Asia

39. State Health Insurance and Out-of-Pocket Health Expenditures in Andhra Pradesh, India

Author:
Victoria Fan, Anup Karan, and Ajay Mahal
Publication Date:
06-2012
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
In 2007, the state of Andhra Pradesh in southern India began rolling out the Aarogyasri health insurance to reduce catastrophic health expenditures in households “below the poverty line.” We exploit variation in program roll-out over time and districts to evaluate the impacts of the scheme using difference-in-differences. Our results suggest that, within the first year of implementation, Phase I of Aarogyasri significantly reduced out-of-pocket inpatient expenditures and, to a lesser extent, outpatient expenditures. These results are robust to checks using quantile regression and matching methods. No clear effects on catastrophic health expenditures or medical impoverishment are seen. Aarogyasri is not benefiting scheduled caste and scheduled tribe households as much as the rest of the population.
Topic:
Health, Poverty, and Health Care Policy
Political Geography:
India, Asia, and Andhra Pradesh

40. Pigs, People and a Pandemic: Communicating Risk in a City-state

Author:
K. U. Menon
Publication Date:
03-2011
Content Type:
Working Paper
Institution:
Centre for Non-Traditional Security Studies (NTS)
Abstract:
The 2009 H1N1 influenza pandemic, also known as the swine flu pandemic, was a test of risk communications methodology and processes. Governments were called upon to make tough decisions in the absence of substantive epidemiological data and baffling case fatality rates (CFRs). While New York adopted mitigation measures, Hong Kong and Singapore followed aggressive containment protocols. Recent studies however suggest that the benefits of such measures – achieved at great cost and allocation of resources – are minimal. This review looks primarily at the experience of a small city-state, Singapore, and compares it with two other equally densely populated cities – New York and Hong Kong – and how all three confronted the challenge and the lessons to be drawn from their experience in risk communications. Communicating risk required deft handling by political leaders and officials to persuade people to adopt strict measures. In the wake of the 2003 severe acute respiratory syndrome (SARS) epidemic, there were high expectations in Hong Kong and Singapore for visible containment measures to continue in the event of future pandemics even when benefits were known to be minimal. Cultural differences may explain the receptivity of the populace in these countries to the stiff measures put in place to contain the disease. However, this requires further study.
Topic:
Health
Political Geography:
Israel, Asia, and Southeast Asia