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1. Pay for Performance for Prenatal Care and Newborn Health: Evidence from a Developing Country

Author:
Maria Laura Alzúa and Noemi Katzkowicz
Publication Date:
12-2020
Content Type:
Working Paper
Institution:
Center for Distributive, Labor and Social Studies (CEDLAS)
Abstract:
Empirical literature analyzing the effect of pay-for-performance programs (P4P) for healthcare providers on maternal care and newborn health outcomes is scarce. In 2008, Uruguay’s Ministry of Public Health implemented a P4P called Metas Asistenciales (Healthcare Goals), a country-wide program that grants healthcare providers an economic incentive for complying with certain maternal and newborn healthcare goals. Health organizations use these funds to provide maternal and child health services. Using administrative records and a difference-in-difference methodology, we evaluate the effect of the Metas Asistenciales program on maternal and newborn health outcomes. We find that in the institutions affected by the program, 10 percentage points more women received an adequate number of prenatal checkups and pregnancy detection in the first trimester improved by 5 percentage points. We also found better results among newborns for indicators related to birth weight, premature births, and stillbirths. In sum, the program had a positive, significant impact on the rate of pregnant women’s utilization of health services and on newborn health outcomes. This study thus provides evidence supporting the idea that economic incentives are a promising tool for incentivizing healthcare providers to achieve better health services in developing countries.
Topic:
Health, Health Care Policy, Children, and Birthing
Political Geography:
South America and Uruguay

2. China’s Declining Birth Rate and Changes in CCP Population Policies

Author:
Linda Zhang
Publication Date:
02-2020
Content Type:
Journal Article
Journal:
China Brief
Institution:
The Jamestown Foundation
Abstract:
Demography may not be destiny, but China has always been conscious of rearing the next generation. One of the three unfilial acts, according to the ancient Chinese philosopher Mencius, is the failure to bear a son. The Chinese have traditionally viewed offspring as a form of wealth, and have placed immense value on fecundity. [1] Despite such traditional beliefs, in the years after the Cultural Revolution senior officials of the Chinese Communist Party (CCP) feared that overpopulation would exhaust the country’s scarce resources. In 1980, the CCP formally implemented the One Child Policy (独生子女政策, Dusheng Zi Nu Zhengce), or OCP, a national family planning policy that limited parents to only one child (Xinhua, November 16, 2015). However, after over three decades of efforts to reduce population growth, People’s Republic of China (PRC) officials are now concerned about a shrinking workforce and an aging population. The CCP leadership repealed OCP in 2015, but the fertility rate in China is nowhere near pre-OCP levels. Furthermore, the PRC has seen a significant decline in birth rate in recent years (see discussion below). The true extent of the decline is impossible to verify, but the downward trend in birth numbers is worrisome. This article examines both official PRC statistics on total birth numbers for recent years, as well as discussions among Chinese netizens using unconfirmed statistics, to analyze the deep uncertainties surrounding China’s demographic and political future.
Topic:
Population, Domestic Policy, Birthing, and Birth Rates
Political Geography:
China and Asia

3. How Individuals’ Birth Weight and Later Risk Factors Interact to Determine Their Risk of Cardiovascular Disease: A Longitudinal Study in the Philippines

Author:
Marjorie Pajaron
Publication Date:
12-2018
Content Type:
Working Paper
Institution:
Walter H. Shorenstein Asia-Pacific Research Center
Abstract:
Cardiovascular diseases (CVDs), which are disorders of the heart and blood vessels, are the world’s leading cause of death (WHO, 2016). The transition from infectious diseases to non-communicable diseases (NCDs), primarily CVDs, as the primary cause of mortality and morbidity worldwide— combined with the economic burden associated with heart-related diseases—prompted the World Health Organization (WHO) and its regional offices to identify CVDs’ risk factors (WHO, 2016). This paper examines these risk factors with a focus on the fetal environment and its interaction with adult body mass index (BMI), using longitudinal data from the Cebu Longitudinal Health and Nutrition Survey (CLHNS). Using a Cox proportional hazards model to estimate hazard ratios adjusted for age and risk factors in adulthood, such as cigarette smoking, the results suggest that there is a positive association between birth weight and heart disease. In addition, when birth weight is interacted with BMI, raised blood pressure is found to be higher among those who were bigger infants at birth and grew to be lighter adults, suggesting centile crossing. Probit models are also used for sensitivity analysis, and the results are consistent with those of the hazards model. Other factors such as adult obesity and a smoking habit are also positively associated with hypertension and CVD.
Topic:
Health, Medicine, Risk Factors, and Birthing
Political Geography:
Global Focus

4. The Impact of Energy Access on Mothers’ Health, Labor, and Time Allocation

Author:
Marjorie Pajaron
Publication Date:
12-2018
Content Type:
Working Paper
Institution:
Walter H. Shorenstein Asia-Pacific Research Center
Abstract:
This paper shows that, for mothers in Cebu, Philippines, access to electricity and the type of cooking fuel used at home affect both health outcomes and also how time is allocated, including for paid work. First, the use of fuelwood for cooking adversely affects the health of mothers, who are traditionally responsible for cooking and are often at home, taking care of their families. This result is consistent across different econometric specifications. Second, shifting to a more efficient source of energy allows women more time to be engaged in the labor force, including in micro enterprises. It also enables them to reallocate their time and efforts away from household chores (cooking, tending animals, and childcare) toward caring for themselves (improved personal hygiene and rest). Drafting and strengthening existing gender-sensitive energy policies and programs can, therefore, help the welfare of mothers in the Philippines, where 54% of households rely on fuelwood, and where the resulting indoor air pollution has a particularly adverse impact on women.
Topic:
Gender Issues, Health, and Birthing
Political Geography:
Philippines and Asia-Pacific

5. Unifying Social Identity: Community Skilled Birth Attendant

Author:
Ahrafuzzaman Khan and Md. Kamruzzaman
Publication Date:
07-2017
Content Type:
Working Paper
Institution:
BRAC Institute of Governance and Development (BIGD), Brac University
Abstract:
Homebirth is regarded as the gold standard and the premier standard of birth. Community Skilled Birth Attendants (CSBA) received a six-month training in and out of class at skilled birth attendant (SBA) training institutes, approved by the Government of the People’s Republic of Bangladesh. The trainees are involved in assisting the safe and clean delivery at home in rural Bangladesh. Many CSBAs are engaged in Government and non-government organizations in relation to providing birth attendant services in rural Bangladesh. The intention of HNPP, BRAC is to increase the number of CSBA in order to achieve MDG 5. The study explored the process of social identification of CSBAs. The notion of social identity has delineated a comprehensive account of social relations in the theory of practice of Pierre Bourdieu. Moreover, social relations explained the process of social identification employing the concept of self-categorization and social categorization. The study employed qualitative methods to explore the mechanisms of internal and social categorization of CSBAs. The findings reveal that CSBAs are known as BRAC health cadres in the community. They are struggling to establish their identity as trained midwives in the community. Despite some challenges of their professions, CSBAs are respected as ‘dactar or nurse apa’ by the villages. Professional training on SBA enables them to generate income and social prestige. TBAs and village doctors create constraints to perform the professional responsibilities of the CSBA in the community. On the other hand, the villagers are still bewildered about the terms as well as the roles and responsibilities of Shasthya Shebika (SS), Newborn Health Workers (NHWs), Shasthya Kormi (SK) and CSBA of HNPP, BRAC. They are confused about whether health providers of BRAC are required to pay for assisting home birth. The villagers also perceive that assisting to homebirth is considered a social norm rather than professional duty. Moreover, the villagers hardly found government service providers in this regard. Therefore, the study has outlined a number of recommendations for strengthening the profession of CSBAs of HNPP in BRAC.
Topic:
Identity, Birthing, Skills, and Care
Political Geography:
Bangladesh and South Asia