Exploring the complex remuneration of health workers in Sierra Leone.

The financial remuneration of health workers (HWs) is a key concern to address human resources challenges in many low-income countries. Analyzing the entire set of payments available to HWs is critical to understand the incentives they face, their motivation and performance, and ultimately to devise effective health workforce reforms. In this thesis, I investigate these issues by exploring the complex remuneration of HWs in Sierra Leone, defined as all income sources, both formal (salary, allowances, performance bonus) and informal (per diems, top-ups, private practice, nonhealth activities and illegal incomes). The study adopts a mixed-method approach. At central level, 23 key informants were conducted along with a stakeholder mapping workshop and a documentary review. At district level, 18 key informants were interviewed. Quantitative data were collected through a cross-sectional survey of 266 public HWs at primary healthcare level in three districts. Additionally, HWs were given a logbook to daily record their activities and incomes. Quantitative data at individual level were complemented with 39 in-depth interviews with a sub-sample of the same HWs. The analysis carried out in this thesis, first, sets the background to the complex remuneration by describing the incentive environment available to HWs as it developed during the post-conflict period, through policy-making processes at macro (central) level. It then investigates how the political economy dynamics between District Health Teams and NGOs at meso (district) level contribute to re-shape the incentive package. Moving to the micro (HW) level, I estimate the absolute and relative contribution of each income and I find that, while earnings from salary represent the largest share, HWs’ income is fragmented and composed of a variety of payments. Further data analysis shows that the determinants of the incomes are not in line with policies defined at national level and are influenced by the district of posting. Furthermore, the HWs’ narratives reveal the relevance of the features of each of their incomes (e.g., amount, regularity, reliability, ease of access, etc.) and the income use strategies through which HWs ‘manage’. Finally, I investigate whether the complex remuneration affects what HWs do or if there are other factors which constrain and/or influence HWs’ activities and service delivery. Findings from this research have important implications for how we go about (re)thinking financial incentive strategies. HWs’ income comes from a variety of sources, which they use differently. This questions the assumption of the fungibility of payments and highlights the potential consequences of increasing one rather than another of HWs’ incomes. Moreover, it is shown that the alignment of policies and incentive packages at central level may not be sufficient as dynamics at district level play a key role in influencing both HWs’ incomes as well as the activities they perform, thus effectively modifying incentive package and service delivery. From a methodological perspective, this thesis contributes to developing data collection and analysis techniques on the complex remuneration of HWs, which are relevant for a potential cross-country research agenda

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

Non-Coding RNA Prediction and Verification in Saccharomyces cerevisiae

Non-coding RNA (ncRNA) play an important and varied role in cellular function. A significant amount of research has been devoted to computational prediction of these genes from genomic sequence, but the ability to do so has remained elusive due to a lack of apparent genomic features. In this work, thermodynamic stability of ncRNA structural elements, as summarized in a Z-score, is used to predict ncRNA in the yeast Saccharomyces cerevisiae. This analysis was coupled with comparative genomics to search for ncRNA genes on chromosome six of S. cerevisiae and S. bayanus. Sets of positive and negative control genes were evaluated to determine the efficacy of thermodynamic stability for discriminating ncRNA from background sequence. The effect of window sizes and step sizes on the sensitivity of ncRNA identification was also explored. Non-coding RNA gene candidates, common to both S. cerevisiae and S. bayanus, were verified using northern blot analysis, rapid amplification of cDNA ends (RACE), and publicly available cDNA library data. Four ncRNA transcripts are well supported by experimental data (RUF10, RUF11, RUF12, RUF13), while one additional putative ncRNA transcript is well supported but the data are not entirely conclusive. Six candidates appear to be structural elements in 5′ or 3′ untranslated regions of annotated protein-coding genes. This work shows that thermodynamic stability, coupled with comparative genomics, can be used to predict ncRNA with significant structural elements

Backbending, seniority, and Pauli blocking of pairing correlations at high rotational frequencies in rapidly rotating nuclei

Garrett et al. systematically investigated band-crossing frequencies resulting from the rotational alignment of the first pair of i13/2 neutrons (AB) in rare-earth nuclei. In that study, evidence was found for an odd-even neutron number dependence attributed to changes in the strength of neutron pairing correlations. The present paper carries out a similar investigation at higher rotational frequencies for the second pair of aligning i13/2 neutrons (BC). Again, a systematic difference in band-crossing frequencies is observed between odd-N and even-N Er, Yb, Hf, and W nuclei, but in the BC case, it is opposite to the AB neutron-number dependence. These results are discussed in terms of a reduction of neutron pairing correlations at high rotational frequencies and of the effects of Pauli blocking on the pairing field by higher-seniority configurations. Also playing a significant role are the changes in deformation with proton and neutron numbers, the changes in location of single-particle orbitals as a function of quadrupole deformation, and the position of the Fermi surface with regard to the various ω components of the neutron i13/2 shell

Shedding Light on the Galaxy Luminosity Function

From as early as the 1930s, astronomers have tried to quantify the statistical nature of the evolution and large-scale structure of galaxies by studying their luminosity distribution as a function of redshift - known as the galaxy luminosity function (LF). Accurately constructing the LF remains a popular and yet tricky pursuit in modern observational cosmology where the presence of observational selection effects due to e.g. detection thresholds in apparent magnitude, colour, surface brightness or some combination thereof can render any given galaxy survey incomplete and thus introduce bias into the LF. Over the last seventy years there have been numerous sophisticated statistical approaches devised to tackle these issues; all have advantages -- but not one is perfect. This review takes a broad historical look at the key statistical tools that have been developed over this period, discussing their relative merits and highlighting any significant extensions and modifications. In addition, the more generalised methods that have emerged within the last few years are examined. These methods propose a more rigorous statistical framework within which to determine the LF compared to some of the more traditional methods. I also look at how photometric redshift estimations are being incorporated into the LF methodology as well as considering the construction of bivariate LFs. Finally, I review the ongoing development of completeness estimators which test some of the fundamental assumptions going into LF estimators and can be powerful probes of any residual systematic effects inherent magnitude-redshift data.Comment: 95 pages, 23 figures, 3 tables. Now published in The Astronomy & Astrophysics Review. This version: bring in line with A&AR format requirements, also minor typo corrections made, additional citations and higher rez images adde