Trends in and Correlates of Short-Acting Contraceptive Stock-Outs: Multicountry Analysis of Performance Monitoring for Action Agile Platform Data

Understanding trends in contraceptive stock-outs, as well as their structural and demand-side correlates, is critical for policymakers and program managers to identify strategies to further anticipate, reduce, and prevent stock-outs. We analyzed trends as well as supply- and demand-side correlates of short-acting contraceptive method stock-outs by using data from multiple rounds of Performance Monitoring for Action Agile surveys. These data longitudinally measured contraceptive availability over 2 years (between November 2017 and January 2020) across 2,134 public and private service delivery points (SDPs) from urban areas of 5 countries (Burkina Faso, Democratic Republic of the Congo [DRC], India, Kenya, and Nigeria). For each country, we analyzed the trends and used multilevel mixed-effect logistic regression to model the odds of short-acting contraceptive stock-outs, adjusting for key structural and demand-side factors of the SDPs. Stock-outs in short-acting contraceptive methods were common in health facilities and varied markedly, ranging from as low as 2.9% (95% confidence interval [CI]=1.7%, 5.1%) in India to 51.0% (95% CIs=46.8%, 56.0%) in Kenya. During the observation period, stock-out rates decreased by 28% in the SDP samples in India (aOR=0.72, P<.001) and 8% in Nigeria (aOR=0.92, P<.001) but increased by 15% in DRC (aOR=1.15; P=036) and 5% in Kenya (aOR=1.05, P=003) with each round of data collection. Correlates of stock-out rates included the facility managerial authority (private versus public), whether the facility was rated high quality, whether the facility was at an advanced tier, and whether there was high demand for short-acting contraceptives. In conclusion, stock-outs of short-acting contraceptives are still common in many settings. Measuring and monitoring contraceptive stock-outs is crucial for identifying and addressing issues related to the availability and supply of short-acting contraceptives.

Issues and Challenges Pertaining to Financing in Providing Pricing Transparency in the American Health Care Industry

In January 2021, hospitals and payer-specific entities in the United States were mandated to comply with the new pricing transparency rules. These rules applied to all standard charges a hospital applied to services provided to and for a consumer. From a financial perspective, the issue of price transparency in health care has for several decades surfaced as a legitimate concern of consumers, health care providers and payers. The aim of this article is to historically examine where and how pricing in health care began and to illustrate financial issues leading up to the current transparency in pricing required by health care payers and providers. A comparative analysis of issues and challenges pertaining to the transparency in pharmaceutical product pricing between the United States and India is also provided in brief.

Health System Financing: A Comparative Analysis of India and Saudi Arabia

The objective of this study is to provide a comparative analysis of the health financing systems in India and the Kingdom of Saudi Arabia (KSA) across three major domains: resource mobilisation, pooling of resources and purchase of health services. This is an observational study using secondary data collected from international organisations, ministries of health and other government and non-government agencies in India and KSA. The study revealed that India has a very low expenditure on healthcare and markedly lower health outcomes compared to KSA. Although India’s health financing system has undergone notable changes in the last two decades, it is lagging behind in many health financing system parameters. However, the share of government expenditure on current health expenditure has been increasing steadily with higher allocations to primary and secondary care. By expanding health insurance coverage and sustainable public health funding, it is likely that India will make significant progress towards achieving UHC.

Universalising Healthcare in India: Managing the Provider–Purchaser Split

Several countries with diverse health systems have achieved universalization (UHC). The trajectory towards universal coverage almost always has three typical features: (i) a political process driven by a range of regulatory changes to simplify access; (ii) an increase in health spending; (iii) an increase in the share of pooled spending rather than paid out-of-pocket. Therefore, a study was undertaken to understand the extent of the provider-purchaser relationship of governments to achieve UHC while reforming healthcare.

The present paper focuses on extensive secondary research across countries and evaluates the experiences of select developed and developing economies with India’s experiments on- Financing mechanisms, management arrangements, governance and health outcomes; to offer a comparison of practices and their impact. While Italy, the UK, Germany, Australia, Japan, Canada and most recently China are countries that have achieved UHC; countries like USA and Brazil are on the verge of achieving UHC. These nine countries represent the entire spectrum of pure purchasing models, mixed and pure provisioning models to help us leverage from their experience.

All countries that have attained UHC have a well-defined package of services that the government commits to fund and provide for (both public and private). Additionalities around wellness and cosmetic care is managed through supplementary insurance. Overall funding is through an autonomous body, at arm’s length of government; primarily to govern and manage the state’s health priorities. And the government purely behaves as a regulator setting policy and giving directions to the providers.

However, ensuring the sustenance of such a mixed model requires; (i) a well-regulated ecosystem that thrives on evidence, (ii) the governments must clearly define the role/s of each stakeholder and hold them accountable for their deliverables in attaining UHC.

Modern contraceptive availability and stockouts: a multi-country analysis of trends in supply and consumption

Approximately 214 million women of reproductive age lack adequate access to contraception for their family planning needs, yet patterns of contraceptive availability have seldom been examined. With growing demand for contraceptives in some areas, low contraceptive method availability and stockouts are thought to be major drivers of unmet need among women of reproductive age, though evidence for this is limited. In this research, we examined trends in stockouts, method availability and consumption of specific contraceptive methods in urban areas of four sub-Saharan African countries (Burkina Faso, Democratic Republic of Congo, Kenya and Nigeria) and India. We used representative survey data from the Performance Monitoring for Action Agile Project that were collected in quarterly intervals at service delivery points (SDP) stratified by sector (public vs private), with all countries having five to six quarters of surveys between 2017 and 2019. Among SDPs that offer family planning, we calculated the percentage offering at least one type of modern contraceptive method (MCM) for each country and quarter, and by sector. We examined trends in the percentage of SDPs with stockouts and which currently offer condoms, emergency contraception, oral pills, injectables, intrauterine devices and implants. We also examined trends of client visits for specific methods and the resulting estimated protection from pregnancy by quarter and country. Across all countries, the vast majority of SDPs had at least one type of MCM in-stock during the study period. We find that the frequency of stockouts varies by method and sector and is much more dynamic than previously thought. While the availability and distribution of long-acting reversible contraceptives (LARCs) were limited compared to other methods across countries, LARCs nonetheless consistently accounted for a larger portion of couple years of protection. We discuss findings that show the importance of engaging the private sector towards achieving global and national family planning goals.

Summer Temperature and All-cause Mortality from 2006 to 2015 for Smart City Jaipur, India

A considerable association between temperature and all-cause mortality has been documented in various studies. Further insights can be obtained from studying the impact of temperature and heat index (HI) for Jaipur city’s all-cause mortality. The objective of this work was to assess the association between the extreme heat (daily maximum temperature, daily minimum temperature, daily mean temperature, relative humidity and HI) and all-cause mortality for summer months (March to June) from 2006 to 2015 for urban population of Jaipur. For summer months, we collected the data on various temperature and all-cause mortality parameters for at least 10 years. The student’s t-test and ANOVA were used to analyse variations in mean temperature, maximum temperature and HI. The Pearson correlation coefficient was used to study the relationship between ambient heat and lag time effect all-cause mortality. A total of 75,571 deaths (all-cause mortality) for 1,203 summer days (2006–2015) were analysed in relation to temperature and relative humidity. The mean daily all-cause mortality has been estimated at 62.8 ± 15.2 for the study period. There is a significant increase of 39% per day all-cause mortality at the maximum temperature of 45 °C and above. However only 10% rise per day all-cause mortality for extreme danger days (HI > 54 °C). The mean daily all-cause mortality shows a significant association with daily maximum temperature ( F = 34.6, P < .0001) and HI (discomfort index) from caution to extreme danger risk days ( F = 5.0, P < .0019). The lag effect of extreme heat on all-cause mortality for the study period (2006 to 2015) was at a peak period on the same day of the maximum temperature ( r = 0.245 at P < .01) but continues up to four days. The study concludes that the effect of ambient heat on all-cause mortality increase is clearly evident (rise of 39% deaths/day). Accordingly, focus should be put on developing adaptation measures against ambient heat. This analysis may satisfy policy makers’ needs. Extreme heat-related mortality needs further study to reduce adverse effects on health among Jaipur’s urban population.

COVID-19 Pandemic: Lessons for the Health Systems

The COVID-19 pandemic caused by a novel virus SARS-CoV-2 has swept the world, leaving behind a trail of free-falling economy, misery and death. The most vulnerable are the hardest hit—the elderly, those with chronic noncommunicable diseases and the poor and marginalised in society. The experience of various countries in handling the pandemic has shown that robustness of health system with surge capacity is critical to take the pandemic head-on. In the process important lessons for health systems have emerged. Countries with political leaders who led with a principled approach, while adopting an early and comprehensive strategy to contain the virus, have done better. Vulnerable populations should not be left to be further marginalised. To deal with the ‘infodemic’, communities should be engaged early. For successful handling of future challenges investment in public health is a must. National readiness and response capacity for epidemic control and disease surveillance need to be strengthened, leveraging modern technology. Institutional capacity building, pooling resources and harnessing innovations through partnerships would be key for mounting effective response now and in the future.

Mapping of Household Surveys to Measure Barriers to Access to Maternal and Child Health Services in India

Objective:

To map the range of access barrier indicators for which data can be derived from the three most common health related household surveys in India.

Methods:

A mapping review study was conducted to identify access dimensions and indicators of access barriers for maternal and child health (MCH) services included in three household surveys in India: National Family Health Survey (NFHS), District Level Household and Facility Survey (DLHS) and Annual Health Survey (AHS).

Results:

The Tanahashi framework for effective coverage of health services was used in this study, and 12 types of access barriers were identified, from which 23 indicators could be generated. These indicators measure self-reported access barriers for unmet healthcare needs through delayed care, as well as forgone care, and unsatisfactory experiences during health service provision. Multiple barriers could be identified, although there was marked heterogeneity in variables included and how barriers were measured.

Conclusions:

This study identified tracer indicators that could be used in India to monitor the population that experiences healthcare needs but fails to seek and obtain appropriate healthcare, and determine what the main barriers are. The surveys identified are well validated and allow the disaggregation of these indicators by equity stratifiers. Given the variability of the frequency and methodologies used in these surveys, comparability could be limited.

Performance monitoring and accountability: The Agile Project's protocol, record and experience

The Performance Monitoring and Accountability 2020 (PMA2020) project implemented a multi-country sub-project called PMA Agile, a system of continuous data collection for a probability sample of urban public and private health facilities and their clients that began November 2017 and concluded December 2019.  The objective was to monitor the supply, quality and consumption of family planning services.  In total, across 14 urban settings, nearly 2300 health facilities were surveyed three to six times in two years and a total sample of 48,610 female and male clients of childbearing age were interviewed in Burkina Faso, Democratic Republic of Congo, India, Kenya, Niger and Nigeria.  Consenting female clients with access to a cellphone were re-interviewed by telephone after four months; two rounds of the client exit, and follow-up interviews were conducted in nearly all settings.  This paper reports on the PMA Agile data system protocols, coverage and early experiences.  An online dashboard is publicly accessible, analyses of measured trends are underway, and the data are publicly available.

Effect of COVID-19 on Economy in India: Some Reflections for Policy and Programme

The outbreak of COVID-19 brought social and economic life to a standstill. In this study the focus is on assessing the impact on affected sectors, such as aviation, tourism, retail, capital markets, MSMEs, and oil. International and internal mobility is restricted, and the revenues generated by travel and tourism, which contributes 9.2% of the GDP, will take a major toll on the GDP growth rate. Aviation revenues will come down by USD 1.56 billion. Oil has plummeted to 18-year low of $ 22 per barrel in March, and Foreign Portfolio Investors (FPIs) have withdrawn huge amounts from India, about USD 571.4 million. While lower oil prices will shrink the current account deficit, reverse capital flows will expand it. Rupee is continuously depreciating. MSMEs will undergo a severe cash crunch. The crisis witnessed a horrifying mass exodus of such floating population of migrants on foot, amidst countrywide lockdown. Their worries primarily were loss of job, daily ration, and absence of a social security net. India must rethink on her development paradigm and make it more inclusive. COVID 19 has also provided some unique opportunities to India. There is an opportunity to participate in global supply chains, multinationals are losing trust in China. To ‘Make in India’, some reforms are needed, labour reforms being one of them.

Performance monitoring and accountability: The Agile Project’s protocol, record and experience

The Performance Monitoring and Accountability 2020 (PMA2020) project implemented a multi-country sub-project called PMA Agile, a system of continuous data collection for a probability sample of urban public and private health facilities and their clients that began November 2017 and concluded December 2019.  The objective was to monitor the supply, quality and consumption of family planning services.  In total, across 14 urban settings, nearly 2300 health facilities were surveyed three to six times in two years and a total sample of 48,610 female and male clients of childbearing age were interviewed in Burkina Faso, Democratic Republic of Congo, India, Kenya, Niger and Nigeria.  Consenting female clients with access to a cellphone were re-interviewed by telephone after four months; two rounds of the client exit, and follow-up interviews were conducted in nearly all settings.  This paper reports on the PMA Agile data system protocols, coverage and early experiences.  An online dashboard is publicly accessible, analyses of measured trends are underway, and the data are publicly available.

A study on patient satisfaction at a multi super specialty hospital in Delhi

The main objective of the study was to assess the level of satisfaction in terms of various quality dimensions among the patients in the study hospital. Data were collected from inpatients through structured questionnaire on eight quality dimensions such as general satisfaction, technical quality, interpersonal manner, communication, financial aspects, time spent with doctors, accessibility and convenience, and hospital services. In total, 100 inpatients were included from three departments with highest patient inflow: medicine, gynecology, and surgery. Most of the respondents were male and belongs to the age group of 31-45 years. Findings depict that highest level of satisfaction was found for interpersonal manner (86.3%) followed by communication (85.4%), general satisfaction (79.3%), and technical quality (77.3%). Least level of satisfaction was found for financial aspects (61.6%), followed by hospital services (68%), accessibility and convenience (73.5%), and time spent with doctor (76.9%).