Strengthening the Bank's population work in the nineties

This paper argues that the Bank should give renewed priority to population matters and accelerate the current upward trend in lending for family planning programs in the 1990s. It is timely for two reasons. First, the need for bank action in population will increase in the 1990s as a result of growing unmet demand for family planning and stagnant bilateral assistance levels. Second, there is evidence that the initial effects of the 1987 World Bank reorganization have been to strengthening the potential for population work by integrating it more fully with economic analysis and overall country programming, but some further adjustments would assure that the potential could be realized. As the largest and most influential international development organization, there is an important leadership role for the Bank in promoting population policy analysis, dialogue, and in financing family planning programs.Adolescent Health,Health Monitoring&Evaluation,Agricultural Research,Reproductive Health,Early Child and Children's Health

Maintaining Momentum to 2015? An impact evaluation of interventions to improve maternal and child health and nutrition in Bangladesh

Bangladesh has experienced rapid fertility decline and reductions in under-five mortality over the last three decades. This impact study unravels the various factors behind these changes. Economic growth has been important, but so have major public sector interventions, notably reproductive health and immunization, supported by external assistance from the World Bank and other agencies. By contrast, nutrition began to improve only in the 1990s and remains high. The Bangladesh Integrated Nutrition Program (BINP) has played a small role, if any, in this progress, which is mainly attributable to higher agricultural productivity.Bangladesh, mortality, fertility, nutrition, health, population

Analyzing urban poverty: a summary of methods and approached

In recent years an extensive body of literature has emerged on the definition, measurement and analysis of poverty. Much of this literature focuses on analyzing poverty at the national level, or spatial disaggregation by general categories of urban or rural areas with adjustments made for regional price differentials. Yet for an individual city attempting to tackle the problems of urban poverty, this level of aggregation is not sufficient for answering specific questions such as where the poor are located in the city, whether there are differences between poor areas, if access to services varies by subgroup, whether specific programs are reaching the poorest, and how to design effective poverty reduction programs and policies. Answering these questions is critical, particularly for large, sprawling cities with highly diverse populations and growing problems of urban poverty. Understanding urban poverty presents a set of issues distinct from general poverty analysis and thus may require additional tools and techniques. This paper summarizes the main issues in conducting urban poverty analysis, with a focus on presenting a sample of case studies from urban areas that were implemented by a number of different agencies using a range of analytical approaches for studying urban poverty. Specific conclusions regarding design and analysis, data, timing, cost, and implementation issues are discussed.Public Health Promotion,Poverty Reduction Strategies,Health Economics&Finance,Poverty Monitoring&Analysis,Health Monitoring&Evaluation,Urban Partnerships&Poverty,Poverty Reduction Strategies,Health Economics&Finance,Poverty Assessment,City Development Strategies

Universal Coverage in Developing Countries: A Summative Evaluation of Maternal Policies in Ghana and Burkina Faso

The Word Health Organization (WHO) has declared health to be a fundamental human right, yet more than 400 million people around the world do not have access to essential health services. Millions of Africans are unable to access or afford needed services without sustaining economic hardship. Sub-Saharan Africa is behind the rest of the world on coverage of essential health services such as planning, immunization, and sanitation and continues to grapple with higher rates of child mortality, maternal death, and communicable diseases. Despite bearing 25 percent of the world’s disease burden, the region only retains 3 percent of its doctors. Universal health coverage (UHC) has gained attention in recent years as a viable means of ensuring access to care for all, including the most vulnerable and those residing in developing parts of the world. The underlying assumption is that by assuring basic health care coverage for all, UHC can minimize impoverishment resulting from catastrophic health expenditures. Many low-income countries have taken the lead in implementing universal health coverage reforms, among them Ghana and Burkina Faso – a Sub-Saharan country. Ghana passed the National Health Insurance Scheme (NHIS) in 2003 with the aim of moving towards universal health care coverage and improving the quality of health of its population. Ghana’s NHIS is a tax-funded national health insurance system that provides financial protection and expands health care coverage to the citizenry (Health Systems 20/20 Project and Research & Development Division of the Ghana Health Service, 2009). In 2008, this law was amended to include a maternal free care policy that extended care services to all pregnant women and their newborns free of charge. On the other side, Burkina Faso adopted a policy in 2006 that subsidized deliveries and emergency obstetric care. The subsidy for deliveries and emergency obstetric and neonatal care (EmONC) funds 80% of deliveries and caesarean sections, and the patient pays the remainder 20%. The policy entirely exempts those categorized as “the poorest.” Contrary to Ghana, the country did not receive all the support required in formulating the plan, and those in charge had to learn through trial and error. This study will evaluate the effectiveness of each program separately at increasing the utilization of maternal health services and at improving child health outcomes. The outcomes evaluated include antenatal, perinatal, and postnatal health care utilization and neonatal and infant mortality

Why are West African children underweight?

The incidence of underweight amongst children under five in Western Africa has been increasing over the last decade (UNICEF, 2002). In Asia, where about two thirds of the world's underweight children live, the rate of underweight declined from about 36 per cent to some 29 per cent between 1990 and 2000. In sub-Saharan Africa, the absolute number of underweight children has increased and is now about 36 per cent. Using new data from Demographic and Health Surveys, I estimate the probability of underweight or a sample of West African children, controlling for selective survival

Modelling trends, determinants and health effects of infant and young child feeding practices in Ethiopia from 2000 to 2016

Optimal infant and young child feeding (IYCF) practices during the first two years of life (1000 days from conception to the second year postpartum) are associated with a reduced risk of adverse health and developmental outcomes in children. Optimally breastfed children have less risk of mortality and morbidity from infectious diseases such as diarrhoea, pneumonia, otitis media and measles. Appropriate complementary feeding of children aged 6–23 months also decreases the risk of childhood malnutrition such as stunting, wasting, underweight and micronutrient deficiency. However, in Ethiopia, the prevalence of optimal IYCF practices (including early initiation of breastfeeding [EIBF], exclusive breastfeeding [EBF], the introduction of complementary foods, minimum dietary diversity [MDD] and minimum acceptable diet [MAD]) are well below the national and global nutritional targets. In connection to this and the ongoing natural and man-made disasters (e.g., internal conflicts and internal displacements), more than five million children are stunted in Ethiopia, and diarrhoea and pneumonia together accounted for more than one-third of under-five deaths. Despite many subnational studies that have been conducted in Ethiopia, there are several gaps in the knowledge base of IYCF practices, including their health outcomes of childhood infections and malnutrition among children under two years of age. The present thesis used a series of five studies to investigate: i) the trends and determinants of EIBF and EBF in Ethiopia from 2000 to 2016; ii) the trends and associated factors of complementary feeding practices in Ethiopia from 2005 to 2016; iii) associations between IYCF practices, and ARI and diarrhoea in Ethiopia; iv) the geospatial variations and determinants of childhood stunting in Ethiopia, and v) a systematic review of child health interventions to improve IYCF practices in Ethiopia. Findings from the current thesis suggest the need for IYCF policy and strategy in Ethiopia. The IYCF policy and strategy describes the Government of Ethiopia's position on IYCF and clarifies the main strategies that need to be used and interventions to be implemented to meet the national IYCF policy objectives. The policy and strategy also provide direction on how to conduct advocacy and resource mobilisation, coordinate activities across stakeholders, and guide the monitoring and evaluation for protecting, supporting and promoting IYCF practices in Ethiopia

Child undernutrition in South Asia : a multidimensional analysis

South Asia has one of the largest populations of undernourished children in the world. Undernutrition continues to pose a major threat to this region’s economic and social growth. The aim of this PhD was threefold: (i) to identify factors and drivers of child undernutrition across South Asia; (ii) to generate evidence that will inform the prioritization of nutrition related programs and policies; and (iii) to identify gaps and opportunities for accelerating national and international nutrition agenda. This study used a multidimensional approach encompassing a systematic review of literature, pooled analysis using data from the Demographic Health Survey (DHS) and mapping of national nutrition policies and programs. First, a systematic review of literature, with a meta-ethnographic analysis was performed to understand the factors and identify priorities for hidden hunger and child undernutrition in South Asia. The meta-ethnographic findings from the systematic review led to the amendment of the UNICEF conceptual framework for child undernutrition. This amended model proposes to mainstream context-specific nutrition behavioural change interventions along with nutrition specific and sensitive interventions that target gender, social and cultural factors, and norms. There is limited literature to understand region-specific factors of child undernutrition, hence making it difficult to generalise findings. Lastly, most of these studies did not study child stunting and wasting for all ages groups of children <5years. To fill this gap, this thesis study undertook a pooled analysis of the Demographic and Health Survey (DHS) data (2014-2018) to understand the region-specific factors associated with child stunting and wasting. Lastly, to understand the program and policy responses to address undernutrition in children across South Asia this study conducted a policy and program mapping review. Mapping these initiatives allowed to track country-wise efforts of maternal and child undernutrition towards the Global Nutrition Targets in 2025 and the Sustainable Development Goals in 2030. Overall, findings from this thesis contribute to understanding region-specific drivers of child undernutrition and can be used to inform future programs and policies. Study findings suggest an integrated nutrition strategy that includes gender and socio-cultural practices and norms may lead to improved nutrition outcomes for children. Findings encourage mainstreaming women’s health and address child undernutrition through a gender lens as a pathway to sustainable change at the community level. This research is timely in generating evidence to contribute towards the Global Nutrition Targets by 2025 and Sustainable Development Goals by 2030

Geospatial modeling of child mortality across 27 countries in Sub-Saharan Africa

Preventable mortality of children has been targeted as one of the UN’s Sustainable Development Goals for the 2015-30 period. Global decreases in child mortality (4q1) have been seen, although sub-Saharan Africa remains an area of concern, with child mortality rates remaining high relative to global averages or even increasing in some cases. Furthermore, the spatial distribution of child mortality in sub-Saharan Africa is highly heterogeneous. Thus, research that identifies primary risk factors and protective measures in the geographic context of sub-Saharan Africa is needed. In this study, household survey data collected by The Demographic and Health Surveys (DHS) Program aggregated at DHS sub-national area scale are used to evaluate the spatial distribution of child mortality (age 1 to 4) across 27 sub-Saharan Africa countries in relation to a number of demographic and health indicators collected in the DHS surveys. In addition, this report controls for spatial variation in potential environmental drivers of child mortality by modeling it against a suite of geospatial datasets. These datasets vary across the study area in an autoregressive spatial model that accounts for the spatial autocorrelation present in the data. This study shows that socio-demographic factors such as birth interval, stunting, access to health facilities and literacy, along with geospatial factors such as prevalence of Plasmodium falciparum malaria, variety of ethnic groups, mean temperature, and intensity of lights at night can explain up to 60% of the variance in child mortality across 255 DHS sub-national areas in the 27 countries. Additionally, three regions - Western, Central, and Eastern Africa - have markedly different mortality rates. By identifying the relative importance of policy-relevant socio-demographic and environmental factors, this study highlights priorities for research and programs targeting child mortality over the next decade. <br/