Repository logo
 

The Institute for Global Health and Development

Permanent URI for this collectionhttps://eresearch.qmu.ac.uk/handle/20.500.12289/9

Browse

Author: search.filters.author.Witter, SophieHas files: No

Search Results

Now showing 1 - 10 of 22
  • No Thumbnail Available
    Item
    Health financing
    (Oxford University Press, 2025-05-02) Witter, Sophie
  • No Thumbnail Available
    Item
    Health Economics
    (Oxford University Press, 2025-05-02) Witter, Sophie
  • No Thumbnail Available
    Item
    Driving universal health reforms through crises and shocks: Final report on the work of the Chatham House Commission for Universal Health
    (Royal Institute of International Affairs, 2024-06-20) Yates, Robert; Witter, Sophie; Hunsaker, Brooke
    Universal health coverage (UHC) is achieved when everyone receives the health services they need, free at the point of delivery. Target 3.8 of the Sustainable Development Goals sets the ambition for all countries to achieve UHC by 2030, but global indicators for health coverage and financial protection have been lagging since 2015. The series of crises and shocks the world has suffered in recent years – including disease outbreaks, financial crises, multiple conflicts and the deepening impacts of climate change – have raised fears that commitments to UHC will be seriously undermined. In 2022, in light of these concerns, Chatham House established the Commission for Universal Health to look at ways to support countries in maintaining and accelerating progress towards UHC. Drawing on the work of the commission, this report explores examples of where, and how, conditions of crisis and shock have had a catalytic role in driving universal health initiatives, and offers recommendations for leaders currently considering launching or expanding UHC reforms. The report endorses the World Health Organization’s finding that investment of an additional 1 per cent of GDP for primary healthcare is a realistic target for countries transitioning to UHC. While acknowledging that affordability is a legitimate concern for many countries at a time of resource constraints, the authors argue that universal entitlement is not necessarily about spending more. Instead, it is about spending money better: by pooling resources, UHC offers the possibility of providing better healthcare for more people more cost-effectively than alternative financing models.
  • No Thumbnail Available
    Item
    In-service Training of Maternal Health Workers in Rural Areas in Vietnam: Is it Relevant, Timely and Effective? A Mixed-method Study
    (SAGE, 2023-09-30) Thu, Nguyen Thi Hoai; McDonald, Fiona; Witter, Sophie; Anh, Bui Thi My; Wilson, Andrew
    Training is widely considered to contribute to the ‘can do’ and ‘will do’ capacities of health workers. Having appropriately skilled health workers is recognised as critical to assuring quality health services. This study examined the relevance of in-service training (IST) provided to maternal health workers (MHW) in rural Vietnam. A mixed method approach was used involving a survey of 240 health workers providing maternal health services and managers and 43 in-depth interviews of health workers and managers from 5 health districts across two provinces in Vietnam. Although two thirds of participants reported accessing IST within the previous 12 months, only 53.3% attended maternal health training. Factors related to the self-reported ability to perform Essential Obstetric Care (EOC) include: Being trained on EOC; Work experience; and Qualifications of MHWs. Participants reported that the IST was irrelevant to their actual needs, while managers reported frustration that IST programs were scheduled haphazardly, dependent on budget availability. In conclusion, in-service training programs should be designed taking into account the needs of the workforce and managers in terms of content, mode of delivery, scheduling and follow-up. Poorly planned and inappropriately delivered training may contribute to a perceived inability to provide EOC.
  • No Thumbnail Available
    Item
    The experience of Ghana in implementing a user fee exemption policy to provide free delivery care
    (Elsevier, 2007) Witter, Sophie; Arhinful, Daniel Kojo; Kusi, Anthony; Zakariah-Akoto, Sawudatu
    In resource-poor countries, the high cost of user fees for deliveries limits access to skilled attendance, and contributes to maternal and neonatal mortality and the impoverishment of vulnerable households. A growing number of countries are experimenting with different approaches to tackling financial barriers to maternal health care. This paper describes an innovative scheme introduced in Ghana in 2003 to exempt all pregnant women from payments for delivery, in which public, mission and private providers could claim back lost user fee revenues, according to an agreed tariff. The paper presents part of the findings of an evaluation of the policy based on interviews with 65 key informants in the health system at national, regional, district and facility level, including policymakers, managers and providers. The exemption mechanism was well accepted and appropriate, but there were important problems with disbursing and sustaining the funding, and with budgeting and management. Staff workloads increased as more women attended, and levels of compensation for services and staff were important to the scheme's acceptance. At the end of 2005, a national health insurance scheme, intended to include full maternal health care cover, was starting up in Ghana, and it was not yet clear how the exemptions scheme would fit into it.
  • No Thumbnail Available
    Item
  • No Thumbnail Available
    Item
  • No Thumbnail Available
    Item
    Start-stop funding, its causes and consequences: a case study of the delivery exemptions policy in Ghana.
    (Wiley InterScience, 2007-04) Witter, Sophie; Adjei, Sam
    This article looks at the issue of sustaining funding for a public programme through the case study of the delivery exemptions policy in Ghana. The Government of Ghana introduced the policy of exempting users from delivery fees in September 2003 in the four most deprived regions of the country, and in April 2005 it was extended to the remaining six regions in Ghana. The aim of the policy of free delivery care was to reduce financial barriers to using maternity services. Using materials from key informant interviews at national and local levels in 2005, the article examines how the policy has been implemented and what the main constraints have been, as perceived by different actors in the health system. The interviews show that despite being a high-profile public policy and achieving positive results, the delivery exemptions policy quickly ran into implementation problems caused by inadequate funding. They suggest that facility and district managers bear the brunt of the damage that is caused when benefits that have been promised to the public cannot be delivered. There can be knock-on effects on other public programmes too. Despite these problems, start-stop funding and under-funding of public programmes is more the norm than the exception. Some of the factors causing erratic funding-such as party politics and intersectoral haggling over resources-are unavoidable, but others, such as communication and management failures can and should be addressed.
  • No Thumbnail Available
    Item
    Tuberculosis patient adherence to direct observation: results of a social study in Pakistan.
    (Oxford University Press, 2006) Khan, M. A.; Walley, J. D.; Witter, Sophie; Shah, S. K.; Javeed, S.
    A randomized controlled trial was carried out in Pakistan in 1999 to establish the effectiveness of the direct observation component of DOTS programmes. It found no significant differences in cure rates for patients directly observed by health facility workers, community health workers or by family members, as compared with the control group who had self-administered treatment. This paper reports on the social studies which were carried out during and after this trial, to explain these results. They consisted of a survey of all patients (64% response rate); in-depth interviews with a smaller sample of different types of patients; and focus group discussions with patients and providers. One finding was that of the 32 in-depth interview patients, 13 (mainly from the health facility observation group) failed to comply with their allocated DOT approach during the trial, citing the inconvenience of the method of observation. Another finding was that while patients found the overall TB care approach efficient and economical in general, they faced numerous barriers to regular attendance for the direct observation of drug-taking (most especially, time, travel costs, ill health and need to pursue their occupation). This may be one of the reasons why there was no overall benefit from direct observation in the trial. Provider attitudes were also poor: health facility workers expressed cynical and uncaring views; community health workers were more positive, but still arranged direct observation to suit their, rather than patients', schedules. The article concludes that direct observation, if used, should be flexible and convenient, whether at a health facility close to the patient's home or in the community. The emphasis should shift in practice from tablet watching towards treatment support, together with education and other adherence measures.
  • No Thumbnail Available
    Item
    Maternal fee exemption in Senegal: is the policy a success
    (2009-02) Witter, Sophie; Drame, Fatoumata Bintou; Cross, Suzanne
    This article describes a qualitative research component of an evaluation of the national free delivery and caesarean policy (FDCP) in Senegal. Its aim was to establish community awareness and views on the policy, as well as perceived changes to cost and quality of services. 106 community representatives participated in in-depth interviews and focus group discussions in four FDCP regions in November and December 2006. Awareness of the policy was patchy and respondents found that the concept of 'free' services was inappropriate even in theory, given that only certain costs were covered by the policy. In practice most reported that costs had not reduced significantly as a result of the policy, with the exception of caesareans in some areas. Transport and drugs are the major costs for households and neither is adequately covered by the FDCP. In some cases drugs costs have even risen. Moreover those living in remote areas are unable to benefit from this facility-based subsidy. Gender differences in relation to payment and decision making around delivery were also found. Policies to increase access to skilled care at delivery by reducing household costs need to target the core costs, such as drugs, and also to increase the predictability of charges. Extending infrastructure and addressing demand side costs are additional essential elements to reach the poorest in the community.