In the last decade, Zimbabwe has undertaken substantial changes and implemented new initiatives to improve health system performance and services delivery, including results-based financing in rural ...health facilities. This study aims to examine the utilization of health services and level of financial risk protection of Zimbabwe's health system. Using a multistage sampling approach, 7,135 households with a total of 32,294 individuals were surveyed in early 2016 on utilization of health services, out-of-pocket (OOP) health expenditure, and household consumption (as a measure of living standards) in 2015. The study found that the outpatient visits were favorable to the poor but the poorest had less access to inpatient care. In 2015, household OOP expenditure accounted for about one quarter of total health expenditure in Zimbabwe and 7.6% of households incurred catastrophic health expenditure (CHE). The incidence of CHE was 13.4% in the poorest quintile in comparison with 2.8% in the richest. Additionally, 1.29% of households fell into poverty due to health care-related expenditures. The study suggests that there are inequalities in utilization of health services among different population groups. The poor seeking inpatient care are the most vulnerable to CHE.
The effect of performance-based financing (PBF) on patients' perception of primary health care services in developing countries in not well documented. Data from a randomized impact evaluation in ...Rwanda conducted between 2006 and 2008 in 157 primary level facilities is used to explore patients' satisfaction with clinical and non-clinical services and quantify the contribution of individual and facility characteristics to satisfaction including PBF. Improvements in productivity, availability and competences of the health workforce following the implementation of PBF have a positive effect on patients' satisfaction with clinical services even if patients' satisfaction is not tied to a reward. The positive effect of PBF on non-clinical dimensions of satisfaction also suggests that PBF incentivizes providers to raise patients' satisfaction with non-clinical services if it is associated with future financial gains. It is recommended that low and middle income countries build on the experience from high income countries to better listen to patients' voice in general and include an assessment of patients' satisfaction in incentive mechanisms as a way to increase the benefits of the strategy.
•Patients in Rwanda are satisfied with all dimensions of care, except for waiting time.•Productivity gains resulting from PBF are not achieved at the expense of patients' satisfaction.•Better productivity, availability and competences have a positive effect on satisfaction.•Patients' satisfaction should be measured more systematically in LIC and PBF schemes.
More than 20 countries in Africa are scaling up performance-based financing (PBF), but its impact on equity in access to health services remains to be documented. This paper draws on evidence from ...Rwanda to examine the capacity of PBF to ensure equal access to key health interventions especially in rural areas where most of the poor live. Specifically, it focuses on maternal and child health services, distinguishing two wealth groups, and uses data from a rigorous impact evaluation. Difference-in-difference technique is used, and different model specifications are tested: control for unobserved heterogeneity and common random error using linear probability model, seemingly unrelated regression equations, and clustering and fixed effects. Results suggest that in Rwanda, PBF improved efficiency rather than equity for most health services. We find that PBF achieved efficiency gains by improving access to health services for those easier to reach, generally the relatively more affluent. It turns out to be less effective in reaching the poorest. Our results illustrate the advantages of rigorous randomized impact evaluation data as results published earlier using a nationally representative survey (Demographic and Health Survey) were not able to capture the pro-rich nature of the PBF scheme in Rwanda. Our paper advocates for building mechanisms targeting the vulnerable groups in PBF strategies. It also highlights the need to understand the impact of PBF together with the specific development of health insurance coverage and the organization of the health system.
Health systems worldwide fail to produce optimal health outcomes, and successive reforms have sought to make them more efficient, more equitable and more responsive. The overarching objective of this ...thesis is to explore how to motivate healthcare providers in improving performance in service delivery in low income countries. The thesis explores whether financial incentives for healthcare providers raise productivity and how they may affect equity in utilization of healthcare services and responsiveness to patients’ needs. The thesis argues that, as performance-based financing (PBF) focuses on supply side barriers, it may lead to efficiency gains rather than equity improvements. It uses data from a randomized controlled impact evaluation in Rwanda to generate robust evidence on performance-based financing and address a gap in the knowledge on its unintended consequences. Statistical methods are used to analyze four aspects: the impact on health workforce productivity; the impact on health workforce responsiveness; the impact on equity in utilization of basic health services; and, the impact on spatial disparities in the utilization of health services. Findings indicate that performancebased financing has a positive impact on efficiency: it raises health workforce productivity through higher workload and lower absenteeism; and, it encourages healthcare providers to be more responsive which positively impacts the quality of care perceived by patients. Findings also indicate that the impact on equity is uncertain as PBF can deter equity in access for the poorest in the absence of a compensating mechanism; however, PBF is a powerful reform catalyzer and can reduce inequalities between regions and households when combined with appropriate reforms that control for its potential perverse effects. This thesis advocates that strategies aiming to raise healthcare providers’ motivation should be used to raise performance in service delivery in low-income countries with particular attention to their effect on end users.
Health systems worldwide fail to produce optimal health outcomes, and successive reforms have sought to make them more efficient, more equitable and more responsive. The overarching objective of this ...thesis is to explore how to motivate healthcare providers in improving performance in service delivery in low income countries. The thesis explores whether financial incentives for healthcare providers raise productivity and how they may affect equity in utilization of healthcare services and responsiveness to patients’ needs. The thesis argues that, as performance-based financing (PBF) focuses on supply side barriers, it may lead to efficiency gains rather than equity improvements. It uses data from a randomized controlled impact evaluation in Rwanda to generate robust evidence on performance-based financing and address a gap in the knowledge on its unintended consequences. Statistical methods are used to analyze four aspects: the impact on health workforce productivity; the impact on health workforce responsiveness; the impact on equity in utilization of basic health services; and, the impact on spatial disparities in the utilization of health services. Findings indicate that performancebased financing has a positive impact on efficiency: it raises health workforce productivity through higher workload and lower absenteeism; and, it encourages healthcare providers to be more responsive which positively impacts the quality of care perceived by patients. Findings also indicate that the impact on equity is uncertain as PBF can deter equity in access for the poorest in the absence of a compensating mechanism; however, PBF is a powerful reform catalyzer and can reduce inequalities between regions and households when combined with appropriate reforms that control for its potential perverse effects. This thesis advocates that strategies aiming to raise healthcare providers’ motivation should be used to raise performance in service delivery in low-income countries with particular attention to their effect on end users.
ENERGY CONSUMPTION AND HEALTH OUTCOMES IN AFRICA Youssef, Adel Ben; Lannes, Laurence; Rault, Christophe ...
The Journal of energy and development,
09/2016, Volume:
41, Issue:
1/2
Journal Article
Peer reviewed
Open access
We examine causal links between energy consumption and health indicators (Mortality rate under-5, life expectancy, greenhouse effect, and government expenditure per capita) for a sample of 16 African ...countries over the period 1971-2010 (according to availability of countries' data). We use the panel-data approach of Kónya (2006), which is based on SUR systems and Wald tests with country specific bootstrap critical values. Our results show that health and energy consumption are strongly linked in Africa. Unilateral causality is found from energy consumption to life expectancy and child under-5 mortality for Senegal, Morocco, Benin, DRC, Algeria, Egypt, and South Africa. At the same time, we found a bilateral causality between energy consumption and health indicators in Nigeria. In particular, our findings suggest that electricity consumption Granger causes health outcomes for several African countries.
We examine causal links between energy consumption and health indicators (Mortality rate under-5, life expectancy, greenhouse effect, and government expenditure per capita) for a sample of 16 African ...countries over the period 1971-2010 (according to availability of countries' data). We use the panel-data approach of Konya (2006), which is based on SUR systems and Wald tests with country specific bootstrap critical values. Our results show that health and energy consumption are strongly linked in Africa. Unilateral causality is found from energy consumption to life expectancy and child under-5 mortality for Senegal, Morocco, Benin, DRC, Algeria, Egypt, and South Africa. At the same time, we found a bilateral causality between energy consumption and health indicators in Nigeria. In particular, our findings suggest that electricity consumption Granger causes health outcomes for several African countries.
Display omitted
•Liver-related prognosis in non-alcoholic fatty liver disease (NAFLD) is impaired in patients with advanced fibrosis.•FibroMeterVCTE is a new test combining blood markers and ...elastography.•FibroMeterVCTE outperforms other fibrosis tests for the diagnosis of advanced fibrosis in NAFLD.•Algorithms using FibroMeterVCTE as a second-line test provide 90% diagnostic accuracy.
Advanced liver fibrosis is an important diagnostic target in non-alcoholic fatty liver disease (NAFLD) as it defines the subgroup of patients with impaired prognosis. The non-invasive diagnosis of advanced fibrosis is currently limited by the suboptimal positive predictive value and the grey zone (representing indeterminate diagnosis) of fibrosis tests. Here, we aimed to determine the best combination of non-invasive tests for the diagnosis of advanced fibrosis in NAFLD.
A total of 938 patients with biopsy-proven NAFLD were randomized 2:1 into derivation and validation sets. All patients underwent liver stiffness measurement with vibration controlled transient elastography (VCTE) and blood fibrosis tests (NAFLD fibrosis score, Fibrosis-4 FIB4, Fibrotest, Hepascore, FibroMeter). FibroMeterVCTE, which combines VCTE results and FibroMeter markers in a single test, was also calculated in all patients.
For the diagnosis of advanced fibrosis, VCTE was significantly more accurate than the blood tests (area under the receiver operating characteristic curve AUROC: 0.840 ± 0.013, p ≤0.005). FibroMeter was the most accurate blood test (AUROC: 0.793 ± 0.015, p ≤0.017). The combinatory test FibroMeterVCTE outperformed VCTE and blood tests (AUROC: 0.866 ± 0.012, p ≤0.005). The sequential combination of FIB4 then FibroMeterVCTE (FIB4-FMVCTE algorithm) or VCTE then FibroMeterVCTE (VCTE-FMVCTE algorithm) provided an excellent diagnostic accuracy of 90% for advanced fibrosis, with liver biopsy only required to confirm the diagnosis in 20% of cases. The FIB4-FMVCTE and VCTE-FMVCTE algorithms were significantly more accurate than the pragmatic algorithms currently proposed.
The sequential combination of fibrosis tests in the FIB4-FMVCTE and VCTE-FMVCTE algorithms provides a highly accurate solution for the diagnosis of advanced fibrosis in NAFLD. These algorithms should now be validated for the diagnosis of advanced liver fibrosis in diabetology or primary care settings.
The evaluation of liver fibrosis is mandatory in non-alcoholic fatty liver disease (NAFLD), as advanced fibrosis identifies the subgroup of patients with impaired prognosis. FibroMeterVCTE is a new fibrosis test combining blood markers and the result of vibration controlled transient elastography (VCTE) into a single diagnostic test. Our results show that FibroMeterVCTE outperforms other blood fibrosis tests and VCTE alone for the diagnosis of advanced fibrosis in a large multi-centric cohort of 938 patients with biopsy-proven NAFLD. Sequential algorithms using a simple blood test or VCTE as a first-line procedure, then FibroMeterVCTE as a second-line test accurately classified 90% of patients.
Although the elaborate combination of histone and non-histone protein complexes defines chromatin organization and hence regulates numerous nuclear processes, the role of chromatin organizing ...proteins remains unexplored at the organismal level. The highly abundant, multifunctional, chromatin-associated protein and transcriptional coactivator positive coactivator 4 (PC4/Sub1) is absolutely critical for life, because its absence leads to embryonic lethality. Here, we report results obtained with conditional PC4 knock-out (PC4f/f Nestin-Cre) mice where PC4 is knocked out specifically in the brain. Compared with the control (PC4+/+ Nestin-Cre) mice, PC4f/f Nestin-Cre mice are smaller with decreased nocturnal activity but are fertile and show no motor dysfunction. Neurons in different areas of the brains of these mice show sensitivity to hypoxia/anoxia, and decreased adult neurogenesis was observed in the dentate gyrus. Interestingly, PC4f/f Nestin-Cre mice exhibit a severe deficit in spatial memory extinction, whereas acquisition and long term retention were unaffected. Gene expression analysis of the dorsal hippocampus of PC4f/f Nestin-Cre mice revealed dysregulated expression of several neural function-associated genes, and PC4 was consistently found to localize on the promoters of these genes, indicating that PC4 regulates their expression. These observations indicate that non-histone chromatin-associated proteins like PC4 play a significant role in neuronal plasticity.
PDF
