Browsing by Person "Edoka, Ijeoma P."

Now showing 1 - 7 of 7

Analyzing markets for health workers : insights from labor and health economics
(The World Bank, 2014) Scott, Anthony; McPake, Barbara; Edoka, Ijeoma P.
Improving equitable access to quality health services is one of the main pillars of the World Bank Health, Nutrition, and Population Strategy. The Bank gives high priority to ensuring equitable and sustainable improvements in health outcomes with particular attention to enhancing the well-being of the poor and vulnerable population as part of its primary mission to reduce poverty and promote shared prosperity across the globe. Within this framework, the Bank supports the aspirations of developing countries toward universal health coverage as an important goal that will contribute to each country's efforts in ensuring inclusive and sustainable development. The Bank has identified the inadequate availability of health services and health workers, especially in rural and remote areas, as well as weak management and limited incentives-often not linked to performance-as some of the leading causes of the poor performance of health systems. The Human Resources for Health (HRH) program at the World Bank has been established to assist countries to carry out critical upstream analytic work that will inform health policy and improve the performance of health systems in an equitable and sustainable manner. The focus of the HRH program is on areas where the World Bank has a comparative advantage, including labor market analysis, the synergies between HRH and health financing policies, HRH budget and cost analysis, and assessment of health worker incentives and evaluation of performance-based pay policies. This publication is part of the Bank's multiyear program to enhance its knowledge of HRH policies. The program's ultimate objective is to strengthen knowledge and capacity to collect evidence, analyze, and evaluate the effectiveness of HRH interventions in the context of a country's health system strengthening strategy. It specifically addresses the theoretical and empirical evidence on health labor markets in low- and middle-income countries. Health labor market analysis has much to contribute to resolving globally widespread HRH problems, and continuing neglect of these problems provides some explanation for their persistence. Policy makers in countries promulgating or refining strategies for achieving universal health coverage will find it important to understand how key elements in their health labor market are likely to interact and how these interactions could help-or hinder-progress toward universal health coverage. These interactions are complex and multidimensional, and this publication highlights some areas where forces in the health labor market matter most.
Changes in catastrophic health expenditure in post-conflict Sierra Leone: An Oaxaca-blinder decomposition analysis
(BioMed Central, 2017-09-04) Edoka, Ijeoma P.; McPake, Barbara; Ensor, Tim; Amara, Rogers; Edem-Hotah, Joseph
Background At the end of the eleven-year conflict in Sierra Leone, a wide range of policies were implemented to address both demand- and supply-side constraints within the healthcare system, which had collapsed during the conflict. This study examines the extent to which households' exposure to financial risks associated with seeking healthcare evolved in post-conflict Sierra Leone. Method This study uses the 2003 and 2011 cross-sections of the Sierra Leone Integrated Household Survey to examine changes in catastrophic health expenditure between 2003 and 2011. An Oaxaca-Blinder decomposition approach is used to quantify the extent to which changes in catastrophic health expenditure are attributable to changes in the distribution of determinants (distributional effect) and to changes in the impact of these determinants on the probability of incurring catastrophic health expenditure (coefficient effect). Results The incidence of catastrophic health expenditure decreased significantly by 18% from approximately 50% in 2003 t0 32% in 2011. The decomposition analysis shows that this decrease represents net effects attributable to the distributional and coefficient effects of three determinants of catastrophic health expenditure - ill-health, the region in which households reside and the type of health facility used. A decrease in the incidence of ill-health and changes in the regional location of households contributed to a decrease in catastrophic health expenditure. The distributional effect of health facility types observed as an increase in the use of public health facilities, and a decrease in the use of services in facilities owned by non-governmental organizations (NGOs) also contributed to a decrease in the incidence of catastrophic health expenditure. However, the coefficient effect of public health facilities and NGO-owned facilities suggests that substantial exposure to financial risk remained for households utilizing both types of health facilities in 2011. Conclusion The findings support the need to continue expanding current demand-side policies in Sierra Leone to reduce the financial risk of exposure to ill health.
Cost-effectiveness of community-based practitioner programmes in Ethiopia, Indonesia and Kenya
(World Health Organization, 2015-08-03) McPake, Barbara; Edoka, Ijeoma P.; Witter, Sophie; Kielmann, Karina; Taegtmeyer, Miriam; Dieleman, Marjolein; Vaughan, Kelsey; Gama, Elvis; Kok, Maryse; Datiko, Daniel; Otiso, Lillian; Ahmed, Rukhsana; Squires, Neil; Suraratdecha, Chutima; Cometto, Giorgio
Objective To assess the cost-effectiveness of community-based practitioner programmes in Ethiopia, Indonesia and Kenya. Methods Incremental cost-effectiveness ratios for the three programmes were estimated from a government perspective. Cost data were collected for 2012. Life years gained were estimated based on coverage of reproductive, maternal, neonatal and child health services. For Ethiopia and Kenya, estimates of coverage before and after the implementation of the programme were obtained from empirical studies. For Indonesia, coverage of health service interventions was estimated from routine data. We used the Lives Saved Tool to estimate the number of lives saved from changes in reproductive, maternal, neonatal and child health-service coverage. Gross domestic product per capita was used as the reference willingness-to-pay threshold value. Findings The estimated incremental cost per life year gained was 82 international dollars ($)in Kenya, $999 in Ethiopia and $3396 in Indonesia. The results were most sensitive to uncertainty in the estimates of life-years gained. Based on the results of probabilistic sensitivity analysis, there was greater than 80% certainty that each programme was cost-effective. Conclusion Community-based approaches are likely to be cost-effective for delivery of some essential health interventions where community-based practitioners operate within an integrated team supported by the health system. Community-based practitioners may be most appropriate in rural poor communities that have limited access to more qualified health professionals. Further research is required to understand which programmatic design features are critical to effectiveness.
Economic Evaluation of Community Based in Low and Middle Income Countries: A literature review, country case studies and a generalized cost-effectiveness model
(World Health Organization, 2015-09) McPake, Barbara; Edoka, Ijeoma P.; Witter, Sophie; Kielmann, Karina
Community-based strategies play a significant role in many health systems in low- and middle-income countries, especially in light of critical shortages in the health workforce. The term community health worker has been used to refer to volunteers and salaried, professional or lay health workers with a wide range of training, experience, scope of practice and integration in health systems. In the context of this study, we use the term community-based practitioner (CBPs) to reflect the diverse nature of these cadres of health workers. CBPs provide preventive, promotive, curative and palliative services across a range of areas, including reproductive, maternal, newborn and child health, HIV, tuberculosis, malaria, control of other endemic diseases, and noncommunicable diseases. Significant evidence has emerged over the past two decades on their effectiveness, which has triggered interest in the potential to use their services to expand access to care, in particular in rural and underserved areas where deployment and retention of more qualified health workers is problematic. Calls have been made to integrate CBP programmes in human resources and health strategies, and to scale up rapidly the extent and coverage of CBP initiatives. There is, however, a dearth of evidence on whether investment in CBPs, from a system perspective, represents good value for money. This study was therefore commissioned in order to address the relative lack of information on their cost-effectiveness to meet health systems goals.
Free health care for under-fives, expectant and recent mothers? Evaluating the impact of Sierra Leone's free health care initiative
(BioMed Central, 2016-05-23) Edoka, Ijeoma P.; Ensor, Tim; McPake, Barbara; Amara, Rogers; Tseng, Fu-Min; Edem-Hotah, Joseph
This study evaluates the impact of Sierra Leone's 2010 Free Health Care Initiative (FHCI). It uses two nationally representative surveys to identify the impact of the policy on utilisation of maternal care services by pregnant women and recent mothers as well as the impact on curative health care services and out-of-pocket payments for consultation and prescription in children under the age of 5 years. A Regression Discontinuity Design (RDD) is applied in the case of young children and a before-after estimation approach, adjusted for time trends in the case of expectant and recent mothers. Our results suggest that children affected by the FHCI have a lower probability of incurring any health expenditure in public, non-governmental and missionary health facilities. However, a proportion of eligible children are observed to incur some health expenditure in participating facilities with no impact of the policy on the level of out-of-pocket health expenditure. Similarly, no impact is observed with the utilisation of services in these facilities. Utilisation of informal care is observed to be higher among non-eligible children while in expectant and recent mothers, we find substantial but possibly transient increases in the use of key maternal health care services in public facilities following the implementation of the FHCI. The diminishing impact on utilisation mirrors experience in other countries that have implemented free health care initiatives and demonstrates the need for greater domestic and international efforts to ensure that resources are sufficient to meet increasing demand and monitor the long run impact of these policies.
Implications of Misclassification Errors in Empirical Studies of Adolescent Smoking Behaviours
(John Wiley & Sons, 2016-02-19) Edoka, Ijeoma P.
Misclassification errors in a dependent variable can introduce attenuation bias to covariate effects in a binary choice model. Misreporting of smoking behaviours by adolescents has been widely documented. However, the consequence in empirical studies of adolescent smoking participation has received little attention. This study uses the Health Survey for England (HSE) to investigate the extent and implication of misclassification errors in self-reported smoking among adolescents aged 11-15 years. The HSE contains both a self-reported smoking component and an objective measure of smoking obtained from saliva cotinine assays. Saliva cotinine concentration ≥12 ng/ml is considered the 'true' indicator of adolescent smoking participation against which self-reported smoking is compared. The findings show that smoking is misreported in this age group, resulting in a downwards bias of marginal effect estimates. Given the widespread use of self-reported smoking data, this study explores the performance of the Hausman, Abrevaya and Scott-Morton-modified maximum likelihood estimation (HAS approach) in recovering true estimates of covariate effects. In this context, the HAS approach performs better when the misclassification probabilities are treated as constants compared with when they are treated as conditionally dependent parameters. © 2016 John Wiley & Sons, Ltd.
Universal health coverage reforms: Implications for the distribution of the health workforce in low and middle-income countries
(World Health Organization, 2014-07) McPake, Barbara; Edoka, Ijeoma P.
To achieve universal health coverage (UHC), a range of health-financing reforms, including removal of user fees and the expansion of social health insurance, have been implemented in many countries. While the focus of much research and discussion on UHC has been on the impact of health-financing reforms on population coverage, health-service utilization and out-of-pocket payments, the implications of such reforms for the distribution and performance of the health workforce have often been overlooked. Shortages and geographical imbalances in the distribution of skilled health workers persist in many low- and middle-income countries, posing a threat to achieving UHC. This paper suggests that there are risks associated with health-financing reforms, for the geographical distribution and performance of the health workforce. These risks require greater attention if poor and rural populations are to benefit from expanded financial protection. Key words: health-care financing policies, health insurance schemes, human resources for health, geographical imbalances in the distribution of health workers, universal health coverage, user fees