Does health sector aid matter? Evidence from time-series data analysis in Ethiopia

Aims: Development assistance for health is an important part of financing health care in developing countries. In spite of the increasing volumes in absolute terms in development assistance for health, there are controversies on their effect on health outcomes. Therefore, this study aims to analyze the effect of development assistance for health on health status in Ethiopia. Methods: Using dynamic time series analytic approach for the period 1978-2013, this paper examines whether development assistance for health has contributed for health status change in Ethiopia. While life expectancy at birth was used as a measure of health status, vector error correction model was used for the analysis. Results: Development assistance for health expenditure (lagged one and two years) had a significant positive effect on life expectancy at birth in Ethiopia. Other things being equal, a 1% increase in per capita development assistance for health leads to 0.026 years improvement in life expectancy at birth (P<0.001) in the immediate year following the period of assistance, and 0.008 years (P=0.025) in the immediate two years following the provision of assistance. Conclusion: This study indicates that, seemingly, development assistance for health has significant favourable effect in improving health status in Ethiopia. The policy implication of this finding is development assistance for the health should continue as an interim means to an end. &nbsp

The association between substance abuse and HIV infection among people visiting HIV counselling and testing centres in Addis Ababa, Ethiopia

No Abstract.Ethiopian Journal of Health Development Vol. 19 (2) 2005: 116-12

Knowledge, attitude, and practice of residents in medical research and barriers: A cross-sectional survey at Tikur Anbessa Specialized Hospital

Background: Research activity is an important component of postgraduate training in medical institutions. However, only a few residents of Tikur Anbessa Specialized Hospital were able to publish research papers. Lack of funding and time, poor infrastructure, belief about research, and inadequate research knowledge and methodology were reported to be among the hindering reasons.Objective: The objective of this study was to determine the level of knowledge, attitude, practice, and barriers to conduct research among clinical residents.Methods: Three hundred and forty-four residents from 13 clinical departments were enrolled in a cross-sectional descriptive study conducted during December 2015 - May 2016. Participants of this study were determined using convenient sampling technique. This means that residents who showed willingness to participate in the study were included. Data were collected using standardized field tested questionnaire. After collecting the responses they were entered into SPSS (version 20) software. Descriptive statistics, one sample-T, and Pearson’s chi-square tests were used to analyze the data and report the finding.Results: Mean Knowledge score was 34.6% for all participants. Knowledge score was significantly better among females compared to males (p-value < 0.01 (95% CI: 0.32-0.85). Attitude towards research undertaking was positive with mean score of 3.8 (95 % CI: 3.75-3.86). Research practice (presentations and previous publications) were found to be very low (27.6% and 2% respectively). Research training received during graduate training was positively correlated with publications (practice) (p < 0.01). Inadequate financial and mentor support as well as lack of access to research equipment were found to be the main barriers the study participants face to conduct clinical research.Conclusion: Participants’ attitude towards research was positive, but their knowledge of research made their practice inadequate. There is a need for filling the gap between high level of positive attitude, low research knowledge and low research practice. This can perhaps be achieved through increasing their training during their graduate studies. Improving research equipment and the resident’s access to financial and better research mentorship are recommended to raise their knowledge and research practice. [Ethiop. J. Health Dev. 2017;31(4):259-265]Keywords: Medical research, Knowledge, Attitude, Post graduate training, Ethiopi

Does health sector aid matter? Evidence from time-series data analysis in Ethiopia

Aims: Development assistance for health is an important part of financing health care in developing countries. In spite of the increasing volumes in absolute terms in development assistance for health, there are controversies on their effect on health outcomes. Therefore, this study aims to analyze the effect of development assistance for health on health status in Ethiopia.Methods: Using dynamic time series analytic approach for the period 1978-2013, this paper examines whether development assistance for health has contributed for health status change in Ethiopia. While life expectancy at birth was used as a measure of health status, vector error correction model was used for the analysis.Results: Development assistance for health expenditure (lagged one and two years) had a significant positive effect on life expectancy at birth in Ethiopia. Other things being equal, a 1% increase in per capita development assistance for health leads to 0.026 years improvement in life expectancy at birth (P<0.001) in the immediate year following the period of assistance, and 0.008 years (P=0.025) in the immediate two years following the provision of assistance.Conclusion: This study indicates that, seemingly, development assistance for health has significant favourable effect in improving health status in Ethiopia. The policy implication of this finding is development assistance for the health should continue as an interim means to an end.

Bypassing Health Centers in Tanzania: Revealed Preferences for Observable and Unobservable

When patients bypass on one health facility to seek health care at another, strong preference are revealed. This paper advances the view that the patterns of bypassing observed in Iringa Rural district in Tanzania show evidence of patients understanding of various measures of quality at the facilities that they visit and bypass. Importantly some of these measures are "unobservable", meaning that we do not expect patients to be able to evaluate whether or not these types of quality are present just from visiting a center. We use two data sets on various features of health facilities including consultation quality and prescription quality as evaluated by a team of clinicians. This is matched with data collected from health center registers that included the symptoms of patients and the village they traveled from. The register data is transformed into a patient-based sample and we use a multinomial/conditional logit regression on patient choice of provider to show the relationship between patient behavior and objective measure of technical quality in the health facilities. Patients seek facilities that provide high quality consultations, are staffed by more knowledgeable physicians, observe prescription practices and are polite. They avoid facilities that use injections too liberally or over-prescribe medicatio

Bypassing health centers in Tanzania: Revealed preferences for observable and unobservable quality

When patients bypass one health facility to seek health care at another, strong preferences are revealed. This paper advances the view that the patterns of bypassing observed in Iringa Rural district in Tanzania show evidence of patients' understanding of various measures of quality at the facilities that they visit and bypass. Importantly some of these measures are 'unobservable,' meaning that we do not expect patients to be able to evaluate whether or not these types of quality are present just from visiting a center. We use two data sets on various features of health facilities including consultation quality and prescription quality as evaluated by a team of clinicians. This is matched with data collected from health center registers that included the symptoms of patients and the village they traveled from. The register data is transformed into a patient-based sample and we use a multinomial/conditional logit regression on patient choice of provider to show the relationship between patient behavior and objective measure of technical quality in the health facilities. Patients seek facilities that provide high quality consultations, are staffed by more knowledgeable physicians, observe prescription practices, and are polite. They avoid facilities that use injections too liberally or over-prescribe medication

Validity and reliability of the Amharic version of the Schwartz Center Compassionate Care Scale

Background Compassionate care is the sensitivity shown by health care providers to understand another person’s suffering and a willingness to help and to promote the well being of that person. Although monitoring of compassionate care is key to ensuring patient-centered care, there is no validated tool in the Ethiopian context that can be applied to measure compassionate care. Therefore, this study aimed to assess the structural validity and reliability of the 12-item Schwartz Center Compassionate Care Scale® (SCCCS) in the Ethiopian context. Methods The structural validity and reliability of the 12-item Schwartz Center Compassionate Care Scale® were investigated in a sample of 423 oncology patients in the adult Oncology department of Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia. The internal consistency of the instrument was examined based on Cronbach’s alpha coefficient, and the structural validity was evaluated by subjecting the items of the instrument to factor analysis. Statistical analysis was made using SPSS version 23.0. Results We have found that the Schwartz Center Compassionate Care scale is a two-factor structure (recognizing suffering and acting to relieve suffering). The scale has high overall scale reliability, which was 0.88, and subscale reliability of 0.84 for both recognizing suffering and acting to relieve suffering factors. Conclusions The Schwartz Center Compassionate Care Scale has high internal consistency and acceptable structural validity value. The tool can be used to measure compassionate care practice in the Ethiopian context.publishedVersio

Factors Influencing People\u2019s Willingness-to-buy Insecticide-treated Bednets in Arbaminch Zuria District, Southern Ethiopia

Promoting self-financing healthcare helps restore efficiency and equity to national health systems. This study was conducted in malaria-endemic areas of southern Ethiopia to assess the bednet possession of the community, determine the people\u2019s willingness-to-pay for insecticide-treated bednets (ITNs), and identify what factors influence it. The study provided relevant information for programme planners and policymakers for evidence-based decision-making. This quantitative cross-sectional community-based study was conducted in four selected malarious Kebeles of Arbaminch Zuria district using a pretested interview-administered structured questionnaire. In total, 982 household heads were interviewed. The community\u2019s willingness-to-pay was assessed by contingent valuation technique using binary with follow-up method. The advantage, the distribution, and the payment mechanism were explained, and three different qualities of ITN were shown by constructing a hypothetical market scenario. Of the 982 respondents, 466 (47.5%) households had at least one functional bednet. Of 849 children aged less than five years in the 982 households, 185 (21.8%) slept under a net the night preceding the survey. The results of the study revealed that around 86% of the respondents were willing to buy ITNs. The average maximum willingness-to-pay for three different types of bednets was statistically different. The maximum amount the people were willing to pay was US$3.3 for a blue conical ITN, US$ 3.2 for a white conical one, and US$ 1.7 for a blue rectangular ITN. The community\u2019s willingness-to-pay was significantly affected by gender, educational status, perceived benefit of ITN, previous source of bednet, and characteristics of bednet. The results showed that a significant proportion of the community people were willing to pay for ITNs. Therefore, introducing a subsidized ITN market rather than free distribution for all should be considered to ensure sustainability and self-reliance in the prevention and control of malaria

Factors Predisposing Out-of-School Youths to HIV/AIDS-related Risky Sexual Behaviour in Northwest Ethiopia

Ethiopia is a developing country with a demographic profile dominated by a young population. Due to biological, psychological, sociocultural and economic factors, young people, particularly those aged 15–24 years, are generally at a high risk of HIV/AIDS and other reproductive health problems. This paper presents results of a cross-sectional descriptive study conducted in Bahir Dar town, northwest Ethiopia, to assess factors that predispose out-of-school youths to HIV/AIDS-related risk behaviours. Both quantitative and qualitative data-collection methods were employed to conduct the study. For quantitative data collection, a household interview survey was conducted among 628 out-of-school youths, aged 15–24 years, within the 17 kebeles (villages) of the town. The number of respondents in each kebeles was assigned proportional to the size of kebeles, and the required numbers of respondents within each kebeles were selected through a systematic random-sampling technique. Qualitative data were collected by conducting five focus-group discussions with 46 participants and in-depth interviews with 10 participants. Institutional ethical clearance and informed verbal consent from the study participants were obtained before undertaking the study. Of the 628 study subjects, 64.8% had experienced sexual intercourse at the time of the survey. The mean age at first sexual commencement was 17.7 (+2) years. Of those sexually active, 33% had sexual intercourse with non-regular partners (the proportions were 40.6% among males and 24.7% among females, suggesting that males tended to be about two times more likely to have sex with non-regular sexual partners than females (odds ratio=1.78, with 95% confidence interval 1.16−2.73). Furthermore, consistent condom-use among those who had sex in exchange for money was low (36%). Alcohol intake, chewing of khat (a green leaf), low educational background, and being male were significantly associated with having sex with either a commercial or a non-regular sexual partner. In view of the magnitude of high-risk sexual behaviours among out-of-school youths that may expose them to HIV/AIDS and other sexually transmitted infections, efforts need to be exerted to deal with the identified predisposing factors and to address the problems of idleness, lack of jobs, and hopelessness

Explaining changes in educational disparities in competent maternal health care services in urban and rural areas in Ethiopia

IntroductionAggregate statistics of maternal health care services have improved in Ethiopia. Nevertheless, the country has one of the lowest Universal Health Coverage (UHC) service coverage indices, with slight improvement between 2000 and 2019. There are disparity studies that focus on a single dimension of inequality. However, studies that combine multiple dimensions of inequality simultaneously may have important policy implications for closing inequalities. In this study, we investigated education inequalities in the receipt of maternal health care services in rural and urban areas separately, and we examined whether these inequalities decreased, increased, or remained unchanged.MethodsThe data for the study came from the 2011 and 2016 Ethiopia Demographic and Health Surveys. Using women's education as a dimension of inequality, we separately analyzed inequalities in maternal health care services in urban and rural settings. Inequalities were measured through the Erreygers concentration index, second differences, and Relative Index of Inequality (RII). Whether inequalities changed over time was analyzed by relative and absolute measures. An Oaxaca-type decomposition approach was applied to explain changes in absolute disparities over time.ResultsThere were glaring educational disparities in maternal health care services in urban and rural areas, where the services were more concentrated among women with better schooling. The disparities were more severe in urban than in rural areas. In urban areas, skilled birth service was the most unequal in both periods. Disparities in rural places were roughly similar for all services except that in 2011, postnatal care was the least unequal, and in 2016, skilled birth was the most unequal services. Trend analyses revealed that disparities significantly dropped in urban by absolute and relative measures. Conversely, in rural regions, the disparities grew by the concentration index measure for most services. The RII and second differences presented conflicting results regarding whether the gaps were increasing, shrinking, or remaining the same.ConclusionSubstantial disparities in maternal health care services remained and even increased, as in rural areas. Different and targeted strategies are needed for urban and rural places to close the observed educational inequalities in these areas