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Bou-Karroum L, Iaia DG, El-Jardali F, Abou Samra C, Salameh S, Sleem Z, Masri R, Harb A, Hemadi N, Hilal N, Hneiny L, Nassour S, Shah MG, Langlois EV. Financing for equity for women's, children's and adolescents' health in low- and middle-income countries: A scoping review. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003573. [PMID: 39264949 PMCID: PMC11392393 DOI: 10.1371/journal.pgph.0003573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 07/15/2024] [Indexed: 09/14/2024]
Abstract
Over the past few decades, the world has witnessed considerable progress in women's, children's and adolescents' health (WCAH) and the Sustainable Development Goals (SDGs). Yet deep inequities remain between and within countries. This scoping review aims to map financing interventions and measures to improve equity in WCAH in low- and middle-income countries (LMICs). This scoping review was conducted following Joanna Briggs Institute (JBI) guidance for conducting such reviews as well as the PRISMA Extension for Scoping Reviews (PRISMA-ScR) for reporting scoping reviews. We searched Medline, PubMed, EMBASE and the World Health Organization's (WHO) Global Index Medicus, and relevant websites. The selection process was conducted in duplicate and independently. Out of 26 355 citations identified from electronic databases, relevant website searches and stakeholders' consultations, 413 studies were included in the final review. Conditional cash transfers (CCTs) (22.3%), health insurance (21.4%), user fee exemptions (18.1%) and vouchers (16.9%) were the most reported financial interventions and measures. The majority were targeted at women (57%) and children (21%) with others targeting adolescents (2.7%) and newborns (0.7%). The findings highlighted that CCTs, voucher programs and various insurance schemes can improve the utilization of maternal and child health services for the poor and the disadvantaged, and improve mortality and morbidity rates. However, multiple implementation challenges impact the effectiveness of these programmes. Some studies suggested that financial interventions alone would not be sufficient to achieve equity in health coverage among those of a lower income and those residing in remote regions. This review provides evidence on financing interventions to address the health needs of the most vulnerable communities. It can be used to inform the design of equitable health financing policies and health system reform efforts that are essential to moving towards universal health coverage (UHC). By also unveiling the knowledge gaps, it can be used to inform future research on financing interventions and measures to improve equity when addressing WCAH in LMICs.
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Affiliation(s)
- Lama Bou-Karroum
- Faculty of Health Sciences, Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon
- Knowledge to Policy (K2P) Center, American University of Beirut, Beirut, Lebanon
| | - Domenico G Iaia
- Partnership for Maternal Newborn and Child Health, World Health Organisation, Geneva, Switzerland
| | - Fadi El-Jardali
- Faculty of Health Sciences, Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon
- Knowledge to Policy (K2P) Center, American University of Beirut, Beirut, Lebanon
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
| | - Clara Abou Samra
- Faculty of Health Sciences, Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon
- Knowledge to Policy (K2P) Center, American University of Beirut, Beirut, Lebanon
| | - Sabine Salameh
- Faculty of Health Sciences, Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon
- Knowledge to Policy (K2P) Center, American University of Beirut, Beirut, Lebanon
| | - Zeina Sleem
- Faculty of Health Sciences, Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon
- Knowledge to Policy (K2P) Center, American University of Beirut, Beirut, Lebanon
| | - Reem Masri
- Faculty of Health Sciences, Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon
- Knowledge to Policy (K2P) Center, American University of Beirut, Beirut, Lebanon
| | - Aya Harb
- Knowledge to Policy (K2P) Center, American University of Beirut, Beirut, Lebanon
| | - Nour Hemadi
- Knowledge to Policy (K2P) Center, American University of Beirut, Beirut, Lebanon
| | - Nadeen Hilal
- Department of Internal Medicine, Ain Wazein Medical Village, Ain Wazein, Lebanon
| | - Layal Hneiny
- Saab Medical Library, American University of Beirut, Beirut, Lebanon
| | - Sahar Nassour
- Faculty of Health Sciences, Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon
- Knowledge to Policy (K2P) Center, American University of Beirut, Beirut, Lebanon
| | - Mehr Gul Shah
- Partnership for Maternal Newborn and Child Health, World Health Organisation, Geneva, Switzerland
| | - Etienne V Langlois
- Partnership for Maternal Newborn and Child Health, World Health Organisation, Geneva, Switzerland
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Meda IB, Kouanda S, Ridde V. Effect of cost-reduction interventions on facility-based deliveries in Burkina Faso: a controlled interrupted time-series study with multiple non-equivalent dependent variables. J Epidemiol Community Health 2023; 77:133-139. [PMID: 36539278 PMCID: PMC9933164 DOI: 10.1136/jech-2022-218794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Evaluating health intervention effectiveness in low-income countries involves many methodological challenges to be addressed. The objective of this study was to estimate the sustained effects of two interventions to improve financial access to facility-based deliveries. METHODS In an innovative controlled interrupted time-series study with primary data, we used four non-equivalent dependent variables (antenatal care) as control outcomes to estimate the effects of a national subsidy for deliveries (January 2007-December 2013) and a local 'free delivery' intervention (June 2007-December 2010) on facility-based deliveries. The statistical analysis used spline linear regressions with random intercepts and slopes. RESULTS The analysis involved 20 877 observations for the national subsidy and 8842 for the 'free delivery' intervention. The two interventions did not have immediate effects. However, both were associated with positive trend changes varying from 0.21 to 0.52 deliveries per month during the first 12 months and from 0.78 to 2.39 deliveries per month during the first 6 months. The absolute effects, evaluated 84 and 42 months after introduction, ranged from 2.64 (95% CI 0.51 to 4.77) to 10.78 (95% CI 8.52 to 13.03) and from 9.57 (95% CI 5.97 to 13.18) to 14.47 (95% CI 10.47 to 18.47) deliveries per month for the national subsidy and the 'free delivery' intervention, respectively, depending on the type of antenatal care used as a control outcome. CONCLUSION The results suggest that both interventions were associated with sustained non-linear increases in facility-based deliveries. The use of multiple control groups strengthens the credibility of the results, making them useful for policy makers seeking solutions for universal health coverage.
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Affiliation(s)
- Ivlabèhiré Bertrand Meda
- Département Biomédical, Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso .,Institut Africain de Santé Publique (IASP), Ouagadougou, Burkina Faso
| | - Seni Kouanda
- Département Biomédical, Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso,Institut Africain de Santé Publique (IASP), Ouagadougou, Burkina Faso
| | - Valéry Ridde
- Centre Population et Développement (CEPED), Inserm, IRD, Université Paris Cité, F-75006 Paris, France
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Jacobs C, Musukuma M, Sikapande B, Chooye O, Wehrmeister FC, Boerma T, Michelo C, Blanchard AK. How Zambia reduced inequalities in under-five mortality rates over the last two decades: a mixed-methods study. BMC Health Serv Res 2023; 23:170. [PMID: 36805693 PMCID: PMC9940360 DOI: 10.1186/s12913-023-09086-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 01/19/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Zambia experienced a major decline in under-five mortality rates (U5MR), with one of the fastest declines in socio-economic disparities in sub-Saharan Africa in the last two decades. We aimed to understand the extent to which, and how, Zambia has reduced socio-economic inequalities in U5MR since 2000. METHODS Using nationally-representative data from Zambia Demographic Health Surveys (2001/2, 2007, 2013/14 and 2018), we examined trends and levels of inequalities in under-five mortality, intervention coverage, household water and sanitation, and fertility. This analysis was integrated with an in-depth review of key policy and program documents relevant to improving child survival in Zambia between 1990 and 2020. RESULTS The under-five mortality rate (U5MR) declined from 168 to 64 deaths per 1000 live births between 2001/2 and 2018 ZDHS rounds, particularly in the post-neonatal period. There were major reductions in U5MR inequalities between wealth, education and urban-rural residence groups. Yet reduced gaps between wealth groups in estimated absolute income or education levels did not simultaneously occur. Inequalities reduced markedly for coverage of reproductive, maternal, newborn and child health (RMNCH), malaria and human immunodeficiency virus interventions, but less so for water or sanitation and fertility levels. Several policy and health systems drivers were identified for reducing RMNCH inequalities: policy commitment to equity in RMNCH; financing with a focus on disadvantaged groups; multisectoral partnerships and horizontal programming; expansion of infrastructure and human resources for health; and involvement of community stakeholders and service providers. CONCLUSION Zambia's major progress in reducing inequalities in child survival between the poorest and richest people appeared to be notably driven by government policies and programs that centrally valued equity, despite ongoing gaps in absolute income and education levels. Future work should focus on sustaining these gains, while targeting families that have been left behind to achieve the sustainable development goal targets.
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Affiliation(s)
- Choolwe Jacobs
- School of Public Health, University of Zambia, Box 50110, Lusaka, Zambia.
| | - Mwiche Musukuma
- School of Public Health, University of Zambia, Box 50110, Lusaka, Zambia
| | | | | | | | | | - Charles Michelo
- School of Public Health, University of Zambia, Box 50110, Lusaka, Zambia
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Noghanibehambari H, Salari M, Tavassoli N. Maternal human capital and infants' health outcomes: Evidence from minimum dropout age policies in the US. SSM Popul Health 2022; 19:101163. [PMID: 35855970 PMCID: PMC9287432 DOI: 10.1016/j.ssmph.2022.101163] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 11/29/2022] Open
Abstract
The purpose of this cross-sectional study is to examine the causal relationship of maternal education and infants' health outcomes. Using birth certificate data over the years 1970-2004 and exploiting the space-time variation in Minimum Dropout Age laws to solve the endogeneity of education, we find a sizeable effect of mothers' education on their birth outcomes. An additional year of maternal education is associated with a reduction in incidences of low birth weight and preterm birth by 15.2 and 12.7 percent, respectively. The estimates are robust across various specifications and even when allowing mothers' cohort-of-birth to vary across regions. The results suggest that the candidate mechanisms of impact include improvements in timing, quantity, and quality of prenatal care, lower negative health behavior during pregnancy such as smoking and drinking, and higher spousal education.
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Affiliation(s)
- Hamid Noghanibehambari
- Center for Demography of Health and Aging, University of Wisconsin-Madison, Madison, WI, 53706, USA
| | - Mahmoud Salari
- Department of Accounting, Finance, and Economics, California State University Dominguez Hills, Carson, CA, 90747, USA
| | - Nahid Tavassoli
- Department of Economics, University of Wisconsin Milwaukee, Milwaukee, WI, 53211, USA
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