Free health care for under-fives, expectant and recent mothers? Evaluating the impact of Sierra Leone's free health care initiative.

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

Impact of health financing policies in Cambodia: a 20 year experience

Improving financial access to services is an essential part of extending universal health coverage in low resource settings. In Cambodia, high out of pocket spending and low levels of utilisation have impeded the expansion of coverage and improvement in health outcomes. For twenty years a series of health financing policies have focused on mitigating costs to increase access particularly by vulnerable groups. Demand side financing policies including health equity funds, vouchers and community health insurance have been complemented by supply side measures to improve service delivery incentives through contracting. Multiple rounds of the Cambodia Socio-Economic Survey are used to investigate the impact of financing policies on health service utilisation and out of pocket payments both over time using commune panel data from 1997 to 2011 and across groups using individual data from 2004 to 2009. Policy combinations including areas with multiple interventions were examined against controls using difference-in-difference and panel estimation. Widespread roll-out of financing policies combined with user charge formalisation has led to a general reduction in health spending by the poor. Equity funds are associated with a reduction in out of pocket payments although the effect of donor schemes is larger than those financed by government. Vouchers, which are aimed only at reproductive health services, has a more modest impact that is enhanced when combined with other schemes. At the aggregate level changes are less pronounced although there is evidence that policies take a number of years to have substantial effect. Health financing policies and the supportive systems that they require provide a foundation for more radical extension of coverage already envisaged by a proposed social insurance system. A policy challenge is how disparate mechanisms can be integrated to ensure that vulnerable groups remain protected

Supporting the Success of First-Generation College Students: Challenges and Solutions

 First-generation college students (FGCS) face a unique set of challenges that can hinder their academic, financial, and social success in higher education. These challenges often stem from a lack of familial academic experience, limited financial resources, and unfamiliarity with institutional systems. This paper explores the multifaceted barriers encountered by FGCS, including academic preparedness gaps, financial stressors, social isolation, and conflicting family expectations. Drawing from research and personal experience, it also proposes practical, evidence-based solutions that student affairs professionals can implement to improve outcomes for FGCS. These include bridge programs, peer mentorship, financial literacy initiatives, culturally responsive support services, and family engagement strategies. The paper advocates for a holistic and inclusive approach to student support that empowers FGCS to thrive academically and personally throughout their college journey

Changes in catastrophic health expenditure in post-conflict Sierra Leone: an Oaxaca-blinder decomposition analysis.

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

Assessment of Subsidies for Construction Businesses in Nigeria: Evolution from an Oil-Based Economy to an Infrastructural-Based Economy

Subsidies are financial or non-financial aids or support given to an economic sector, individual or organization by their government to promote the economy and achieve specific policy objectives. This study assessed the use of subsidies for construction businesses in Nigeria with a view to revolutionize the country from oil-based economy to infrastructural-based economy. A structured questionnaire was self- administered to 404 construction business stakeholders with 304 (75%) retrieved from the respondents. Findings revealed that buying and selling of construction materials with Mean Score (MS) of 3.97 is the most successful construction businesses in Nigeria. The major factors considered in rating construction business performance are profitability to the investor (MS=3.70), resource management and control (MS=3.68), and cost performance (MS=3.63). The study concluded that the establishment of construction related institutions (MS=3.97), enforcement of health, safety, and hazards prevention policies (MS=3.91), exchange rate moderation for construction business (MS=3.86), and implementation of the National Building Code (NBC) (MS=3.85) will grow the infrastructural economy. The study recommended that construction business subsidies will only be effective, if resources are adequately managed, fraudulent practices are curbed, high cost of construction materials reduced and corruption are decimated. In addition, currency should be stabilised to reduce inflation of the prices of construction materials

Cancer mortality distribution in South Africa, 1997–2016

IntroductionThe mortality data in South Africa (SA) have not been widely used to estimate the patterns of deaths attributed to cancer over a spectrum of relevant subgroups. There is no research in SA providing patterns and atlases of cancer deaths in age and sex groups per district per year. This study presents age-sex-specific geographical patterns of cancer mortality at the district level in SA and their temporal evolutions from 1997 to 2016.MethodsIndividual mortality level data provided by Statistics South Africa were grouped by three age groups (0–14, 15–64, and 65+), sex (male and female), and aggregated at each of the 52 districts. The proportionate mortality ratios (PMRs) for cancer were calculated per 100 residents. The atlases showing the distribution of cancer mortality were plotted using ArcGIS. Spatial analyses were conducted through Moran's I test.ResultsThere was an increase in PMRs for cancer in the age groups 15–64 and 65+ years from 2006 to 2016. Ranges were 2.83 (95% CI: 2.77–2.89) −4.16 (95% CI: 4.08–4.24) among men aged 15–64 years and 2.99 (95% CI: 2.93–3.06) −5.19 (95% CI: 5.09–5.28) among women in this age group. The PMRs in men and women aged 65+ years were 2.47 (95% CI: 2.42–2.53) −4.06 (95% CI: 3.98–4.14), and 2.33 (95% CI: 2.27–2.38) −4.19 (95% CI: 4.11–4.28). There were considerable geographical variations and similarities in the patterns of cancer mortality. For the age group 15–64 years, the ranges were 1.18 (95% CI: 0.78–1.71) −8.71 (95% CI: 7.18–10.47), p < 0.0001 in men and 1.35 (95% CI: 0.92–1.92) −10.83 (95% CI: 8.84–13.14), p < 0.0001 in women in 2016. There were higher PMRs among women in the Western Cape, Northern Cape, North West, and Gauteng compared to other areas. Similar patterns were also observed among men in these provinces, except in North West and Gauteng.ConclusionThe identification of geographical and temporal distributions of cancer mortality provided evidence of periods and districts with similar and divergent patterns. This will contribute to understanding the past, present, future trends and formulating interventions at a local level

Ill health and agricultural production: Evidence from Kogi State of Nigeria

This study was carried out to analyse the impact of ill health on agricultural outputs in rural areas of Kogi state, central Nigeria. The motivation derives from the fact that rural areas which are strategically important for national food security are more prone to health hazards as a result of the poor nature of health services arising partly from neglect by government. The objectives were to present the socioeconomic characteristics of the rural farm households and identify the prevailing health and agricultural  production nexus in the area. The use of multistage random sampling procedure was employed in the selection of 263 rural households for questionnaire administration in order to elicit relevant data related to their farming enterprises and health. The use of descriptive statistics and  production function analysis were employed. The study revealed that the  average age of the household heads was 46.4 years while the average household size was 6.5 persons. Also, the average farm size was 1.43 ha and the average number of years of formal education was found to be7.4. Furthermore, the study revealed that the most prominent disease conditions affecting farm families were malaria fever, typhoid fever and diarrhea and these led to an average of 8.2 days reduction in time  available for farm work in a farming season. Result from the production function analysis revealed that the elasticities of farm size (0.419), family size (0.099), number of contacts with extension staff (0.018), labour  (0.012) and naira amount of credit accessed (0.25) were positively signed and significant at 1%, 10%, 1%, 5% and 1% respectively; while number of days of farm work lost to ill health was negatively signed (- 0.09) and significant at 5%. Findings suggest that focusing on number of days of farming activities lost to ill health in a household might help elicit a clearer picture of the effect of transient ill health on agricultural production. More research and development effort in the provision of and accessibility to health care in the rural areas in order to reduce the incidence of diseases are recommended. Such efforts should also include the provision of adequate health and environmental education for the rural population as the most common ailments discovered in the study area are actually hygiene and environment related.Key words: Health, labour, rural, farm, outpu

ANALYSIS OF PROFITABILITY OF TOMATO (Lycopersicum spp) MARKETING AMONG RURAL WOMEN IN OLAMABORO LOCAL GOVERNMENT AREA OF KOGI STATE-NIGERIA

This study assessed the constraints to tomato marketing among rural women in Olamaboro Local Government Area of Kogi State, Nigeria. Specifically, the study looked at the cost and returns of tomato marketing; ascertained the effects of tomato marketers’ socioeconomic variables on their income; and identified major constraints to tomato marketing. These objectives were delineated to address the problems of tomato perishability due to absence of storage facilities and paucity of market information among the marketers. A purposive random sampling technique was used to select 120 respondents for the study. Primary data obtained through structured questionnaire were analyzed using descriptive statistics, gross margin model, Ordinary Least Square (OLS) multiple regression model, and mean score from Likert type of scale. Findings of this study revealed that 65.1% of rural women involved in tomato marketing were in their active age of 32 years with a mean household size of 7 members, and an average marketing experience of 11 years. Most (73.3%) had no extension contacts. The gross margin analysis indicated a gross margin from tomato marketing per month of N54, 745 with a benefit cost ratio of N1.90k. Estimates of the OLS revealed that the semi-log was chosen as the lead equation due to its R2 of 0.877which implied that about 88% of the variation in the changes in income from tomato marketing is influenced by the independent variables considered. The results showed that years of schooling, household size, and marketing experience positively influenced the income from tomato marketing at 1% level of significance. Major constraints faced by women involved in tomato marketing in the area included high perishability of tomatoes (M = 3.4), poor storage facilities (M= 3.4), disease and pest infestation (M = 3.3), high transportation cost and low price of tomato (M = 3.2 respectively), high labour cost and lack of operational cost constituted (M = 3.1 respectively). The study therefore recommends that tomato marketers should expand their scale of operation as this will enable them enjoy economies of scale with positive effects on increased income, while both the Kogi State and Federal governments should improve rural infrastructure to address marketers’ associated problems such as storage facilities, good road networks, markets and power supply

Pancreatic cancer mortality in South Africa: A case-control study

Background. There are variations in the numbers of pancreatic cancer deaths reported annually in South Africa (SA). Since pancreatic cancer deaths occurred in SA from 1997 to 2016, the number of cases has hugely increased, and reached 23 581 in both sexes. Sex differences are likely to contribute to the variations in the strength of associations between the risk factors and pancreatic cancer mortality. Objective. To identify factors associated with an increased risk of pancreatic cancer mortality in SA. Methods. A matched case-control study with 1:1 matching was conducted using data collected by Statistics SA from 1997 to 2016. Controls were randomly selected to be as similar as possible to the cases, and matched by age, sex and year of death. Conditional logistic regression was used to identify factors associated with pancreatic cancer mortality. Results. This case-control study comprised a final selection of 23 581 cases (12 171 males and 11 410 females) and 23 581 controls (12 171 males and 11 410 females). A significantly increased risk of pancreatic cancer mortality was observed among males who were managers (odds ratio (OR) 2.99; 95% confidence interval (CI) 1.36 - 6.60; p=0.006) and craft and related trade workers (OR 1.89; 95% CI 1.14 - 3.14; p=0.013). Elevated risks of pancreatic cancer mortality were also found among females who were managers (OR 6.13; 95% CI 1.32 - 28.52; p=0.021), professionals (OR 2.12; 95% CI 1.24 - 3.63; p=0.006), clerical support workers (OR 3.78; 95% CI 1.79 - 7.98; p=0.001) and elementary occupation workers (OR 1.41; 95% CI 0.99 - 2.00; p=0.059). Smoking was significantly associated with pancreatic cancer mortality in females (OR 1.36; 95% CI 1.02 - 1.82; p=0.039). Working in several occupations was associated with an increased risk of pancreatic cancer mortality in males (OR 1.31; 95% CI 1.01 - 1.71; p=0.045) and females (OR 1.66; 95% CI 1.30 - 2.12; p<0.001). Conclusion. Smoking and certain occupations increased the risk of pancreatic cancer mortality. Further research is needed to evaluate the associations between other extrinsic and intrinsic factors and pancreatic cancer mortality