An Implementation Research Approach to Evaluating Health Insurance Programs: Insights from India

One of the distinguishing features of implementation research is the importance given to involve implementers in all aspects of research, and as users of research. We report on a recent implementation research effort in India, in which researchers worked together with program implementers from one of the longest serving government funded insurance schemes in India, the Rajiv Aarogyasri Scheme (RAS) in the state of undivided Andhra Pradesh, that covers around 70 million people. This paper aims to both inform on the process of the collaborative research, as well as, how the nature of questions that emerged out of the collaborative exercise differed in scope from those typically asked of insurance program evaluations. Starting in 2012, and over the course of a year, staff from the Aarogyasri Health Care Trust (AHCT), and researchers held a series of meetings to identify research questions that could serve as a guide for an evaluation of the RAS. The research questions were derived from the application of a Logical Framework Approach (“log frame”) to the RAS. The types of questions that emerged from this collaborative effort were compared with those seen in the published literature on evaluations of insurance programs in low- and middle-income countries (LMICs). In the published literature, 60% of the questions pertained to output/outcome of the program and the remaining 40%, relate to processes and inputs. In contrast, questions generated from the RAS participatory research process between implementers and researchers had a remarkably different distribution – 81% of questions looked at program input/ processes, and 19% on outputs and outcomes. An implementation research approach can lead to a substantively different emphasis of research questions. While there are several challenges in collaborative research between implementers and researchers, an implementation research approach can lead to incorporating tacit knowledge of program implementers into the research process, research questions that are more relevant to the research needs of policy-makers, and greater knowledge translation of the research findings

Sexual Violence against Children in Rwanda: Prevalence and Associated Factors

Background Information and data on the burden and factors associated with violence against children are critical in designing and implementing preventive strategies and interventions. This study aimed to examine patterns of the prevalence of sexual violence (SV) against children in Rwanda and investigate associated factors to contribute to the knowledge about violence against children in Rwanda. Methods A sample of 1,110 children aged 13-17 years from a cross-sectional national survey done in Rwanda in 2015 was analysed. Weighted descriptive statistics were applied to describe the prevalence of SV against children, and weighted logistic regression allowed us to investigate factors associated with it. Results Over eight percent (8.4%) of all children, including about three percent (2.8%) of male children and around five percent (5.6%) of female children, reported having experienced SV within the last twelve months. Being a female child, having a romantic partner, and not attending school were some factors associated with SV against children in Rwanda. Conclusion Female children reported more SV than male children. Factors associated with sexual violence pertained to the child’s characteristics, family or household background characteristics, and community relations. The study findings call for an urgent need to prevent SV against children through awareness raising about it amongst children and the general public. Rwanda J Med Health Sci 2022;5(3):302-31

Fonctions d’utilité dépendantes des états de la nature, choix en incertitude et perception des risques

Numéro de référence interne originel : a1.3 g 8

Analyse temporelle et spectrale de l'indice du prix mondial du café

L'analyse des séries chronologiques (ou temporelles) et des séries économiques en particulier, se divise en deux grandes parties: -L'analyse temporelle, -L'analyse fréquentiste dite aussi spectrale. L'analyse temporelle d'une série cherche à établir des relations existant entre les observations de cette série à des instants différents et d'en dégager un modèle pour la série. L'outil principal de cette analyse est la fonction d'autocorrélation (ou d'autocovariance) qui mesure la capacité de mémoire d'une série. Quant à l'analyse spectrale d'une série, elle n'intéresse aux composantes cycliques de cette série, i.e. à son contenu fréquentiste. Elle se base donc sur les propriétés de la série. Son outil principal est la fonction de densité spectrale normalisée mettant en relation chaque fréquence et sa puissance. Ainsi, utilisant la même information mais l'exploitant ou la traitant différemment, les deux analyses ont été longtemps considérées comme concurrentielles

Analyse temporelle et spectrale de l'indice du prix mondial du café

L'analyse des séries chronologiques (ou temporelles) et des séries économiques en particulier, se divise en deux grandes parties: -L'analyse temporelle, -L'analyse fréquentiste dite aussi spectrale. L'analyse temporelle d'une série cherche à établir des relations existant entre les observations de cette série à des instants différents et d'en dégager un modèle pour la série. L'outil principal de cette analyse est la fonction d'autocorrélation (ou d'autocovariance) qui mesure la capacité de mémoire d'une série. Quant à l'analyse spectrale d'une série, elle n'intéresse aux composantes cycliques de cette série, i.e. à son contenu fréquentiste. Elle se base donc sur les propriétés de la série. Son outil principal est la fonction de densité spectrale normalisée mettant en relation chaque fréquence et sa puissance. Ainsi, utilisant la même information mais l'exploitant ou la traitant différemment, les deux analyses ont été longtemps considérées comme concurrentielles

Seeking Ethics Approval in Colombia: A Health Systems Research Case Study

There is no single institution responsible for research ethics in health sciences in Colombia and there is no specific procedure for securing research ethics approval in the country. However, the Ministry of Health and Social Protection's resolution on health research provides guidance on key ethical considerations in health research and indicates which institutions in Colombia could provide ethics approval. Ethics approval has to be provided either by the researcher's institution of affiliation, the institution in which the research will be conducted, or the health authority responsible for the communities participating in the project. Despite this guidance, our experience with a health systems research project showed that the implementation and practice of research ethics vary between institutions. Attention should be given to ensuring effective implementation of the ethics approval process.En Colombie, il n'existe aucune institution responsable de l'éthique de la recherche en sciences de la santé et il n'existe pas de procédures spécifiques pour obtenir une approbation éthique pour un projet de recherche. Cependant, la résolution sur la recherche en santé du Ministère de la Santé et de la Protection sociale fournit des conseils sur les principales considérations éthiques de la recherche sur la santé et indique quelles institutions en Colombie pourraient fournir une approbation éthique. L'approbation éthique doit être fournie soit par l'institution d'affiliation du chercheur, l'établissement dans lequel la recherche sera menée, soit par l'autorité de santé responsable des communautés participant au projet. Malgré ces indications, notre expérience dans le cadre d'un projet de recherche sur les systèmes de santé a montré que la mise en œuvre et la pratique de l'éthique de la recherche varient d'une institution à l'autre. Une attention particulière devrait être accordée pour assurer la mise en œuvre efficace du processus d'approbation éthique

Diffidence Theorem, State-Dependent Preferences, and DARA*

C. Gollier (The Economics of Risk and Time. Cambridge: MIT Press, 2001) has developed a standard technique based on the diffidence theorem. This theorem provides a very simple instrument to solve relatively sophisticated problems when preferences are state-independent. The object of this article is to show that the theorem is also very useful to derive significant results with state-dependent preferences. Using the reference set notion and an extension of the diffidence theorem, we establish formally necessary and sufficient conditions on the reference set, in order to obtain prudence and decreasing absolute risk aversion. Examples of DARA utility functions compatible with non-linear reference sets are presented in the Appendix. The Geneva Papers on Risk and Insurance Theory (2001) 26, 139–154. doi:10.1023/A:1014334614157

Contracting non-state providers for universal health coverage: learnings from Africa, Asia, and Eastern Europe

Abstract Background Formal engagement with non-state providers (NSP) is an important strategy in many low-and-middle-income countries for extending coverage of publicly financed health services. The series of country studies reviewed in this paper - from Afghanistan, Bangladesh, Bosnia & Herzegovina, Ghana, South Africa, Tanzania and Uganda – provide a unique opportunity to understand the dynamics of NSP engagement in different contexts. Methods A standard template was developed and used to summarize the main findings from the country studies. The summaries were then organized according to emergent themes and a narrative built around these themes. Results Governments contracted NSPs for a variety of reasons – limited public sector capacity, inability of public sector services to reach certain populations or geographic areas, and the widespread presence of NSPs in the health sector. Underlying these reasons was a recognition that purchasing services from NSPs was necessary to increase coverage of health services. Yet, institutional NSPs faced many service delivery challenges. Like the public sector, institutional NSPs faced challenges in recruiting and retaining health workers, and ensuring service quality. Properly managing relationships between all actors involved was critical to contracting success and the role of NSPs as strategic partners in achieving national health goals. Further, the relationship between the central and lower administrative levels in contract management, as well as government stewardship capacity for monitoring contractual performance were vital for NSP performance. Conclusion For countries with a sizeable NSP sector, making full use of the available human and other resources by contracting NSPs and appropriately managing them, offers an important way for expanding coverage of publicly financed health services and moving towards universal health coverage

Moving towards universal health coverage: engaging non-state providers

Abstract This editorial provides an overview of the special issue “Moving towards UHC: engaging non-state providers”. It begins by describing the rationale underlying the Alliance’s choice of a research program addressing issues of non-state providers and briefly discusses the research process this entailed. This is followed by a summary of the findings and key messages of each of the eight articles included in the issue. The editorial concludes with a series of reflections regarding lessons learnt about the engagement of non-state providers, methodological challenges, areas for future research as well as the contribution of the research program towards efforts to build capacity and strengthen health systems towards universal health coverage