Impact of the Georgia Charitable Care Network on Cost Savings From Lowering Blood Pressure and Decreasing Emergency Department Use

Background: The Georgia Charitable Care Network (GCCN) is a non-profit organization whose primary mission is to foster collaborative partnerships to deliver compassionate health care to low-income, uninsured individuals. Hypertension screening and management is a service provide by 90+ clinics in the GCCN statewide. Methods: With data from N=1661 patients who were screened and treated for hypertension at n=12 clinics in 2013, the impact of hypertension management on blood pressure levels, the incidence of coronary heart disease (CHD) and stroke, and utilization of emergency departments (EDs) were examined. The resulting changes in healthcare utilization were converted to changes in healthcare costs and compared to the expenditures for clinics providing screening and treatment services to the same population over a one-year period. Results: Patients with an initial diagnosis of hypertension or prehypertension experienced average reductions of 10.27 mmHg and 6.32 mmHg in systolic and diastolic blood pressure, respectively, during their follow-up visits. These changes were associated with 32.0% and 44.3% reductions in the relative risk of CHD and stroke, respectively. The savings from this reduction in blood pressure and avoided ED visits for 1661 hypertensive patients produced positive net benefits in 2013 US$, of more than$400,000, with a benefit-cost ratio of 1.6. Conclusions: For every dollar invested in GCCN clinics for hypertension screening and management, there is a benefit to the healthcare system through reduced costs of $1.60. GCCN clinics are a cost-saving delivery model for underserved communities with poor health status and high ED usage

Removing Systemic Barriers to Equity, Diversity, and Inclusion: Report of the 2019 Plant Science Research Network Workshop “Inclusivity in the Plant Sciences”

A future in which scientific discoveries are valued and trusted by the general public cannot be achieved without greater inclusion and participation of diverse communities. To envision a path towards this future, in January 2019 a diverse group of researchers, educators, students, and administrators gathered to hear and share personal perspectives on equity, diversity, and inclusion (EDI) in the plant sciences. From these broad perspectives, the group developed strategies and identified tactics to facilitate and support EDI within and beyond the plant science community. The workshop leveraged scenario planning and the richness of its participants to develop recommendations aimed at promoting systemic change at the institutional level through the actions of scientific societies, universities, and individuals and through new funding models to support research and training. While these initiatives were formulated specifically for the plant science community, they can also serve as a model to advance EDI in other disciplines. The proposed actions are thematically broad, integrating into discovery, applied and translational science, requiring and embracing multidisciplinarity, and giving voice to previously unheard perspectives. We offer a vision of barrier-free access to participation in science, and a plant science community that reflects the diversity of our rapidly changing nation, and supports and invests in the training and well-being of all its members. The relevance and robustness of our recommendations has been tested by dramatic and global events since the workshop. The time to act upon them is now

Women\u27s groups and COVID-19: An evidence review on savings groups in Africa

This paper presents emerging evidence from studies in diverse contexts in sub-Saharan Africa —with a deep dive into Nigeria and Uganda—on how COVID-19 has affected women’s groups and how these groups have helped mitigate the gendered effects of the pandemic’s and the associated policy responses’ consequences up until April 2021. The synthesis presents evidence that savings groups found ways to continue operating, provided leadership opportunities for women during the pandemic, and mitigated some of the negative economic consequences of COVID-19 on individual savings group members. Savings, credit, and group support from other members all likely contributed to the ability of groups to positively affect women’s group member’s resilience during COVID-19. However, savings groups themselves often faced financial challenges because of decreased savings, which sometimes resulted in the depletion of group assets. These findings are consistent with a recent evidence synthesis on how past covariate shocks affected women’s groups and their members. We conclude the paper by presenting various policy recommendations to enable savings groups to achieve improvements in women’s empowerment and economic outcomes and research recommendations to address some of the current evidence-gaps on how COVID-19 is affecting women’s groups and their members

Digital Technologies for Financial Inclusion: Three Papers on Innovative Mobile Money Regulation and Use in sub-Saharan Africa

Thesis (Ph.D.)--University of Washington, 2022Globally, about 24% of adults lack access to a basic account that can safely store and transfer money. The majority of these adults live in low and middle income countries; many are poor and many are women. Financial exclusion is especially widespread in sub-Saharan Africa, where nearly half of all adults do not have a bank account (Demirguc-Kunt et al., 2018). Advances in digital financial technology, especially through the proliferation of mobile money, offer a new way to extend financial services to populations who do not have access to the formal financial sector. Mobile money technology provides users with a convenient way to send and receive payments, such as domestic remittances, as well as a mechanism to safely and privately store money. Mobile money is accessible for anyone with a mobile phone and SMS network connectivity (smartphone and internet access are not required). Existing research reveals promising improvements in financial inclusion outcomes and welfare benefits (Jack & Suri, 2014; Nanda & Kaur, 2016; Bahia et al., 2020), but mobile money innovations currently outpace the academic literature. In Chapter 1, I examine one such innovation: a 2014 Bank of Tanzania policy mandating the distribution of interest to mobile wallet account balances. I exploit the differences in interest allocation methods of different mobile money providers in Tanzania to conduct a difference-in-differences analysis of the effect of a specific savings incentive on mobile savings behavior. I find a consistent and positive effect of the savings incentive; customers under this policy had an 11 percentage point increase in the probability of saving with their mobile wallet. I also show that the mobile savings incentive produced no negative repercussions for bank account ownership, directly addressing concerns from the banking sector that mobile interest is a threat to the formal financial sector. Such findings may be highly relevant to the current policy debates around leveraging mobile money interest provision to increase financial inclusion among the world’s poorest. In Chapter 2, I investigate another mobile money innovation: digital loan repayment for microfinance customers. Existing research is largely focused on the implications of digitization for loan repayment rates and operational efficiency, but this paper uniquely centers the overlooked perspectives of microfinance borrowers. I leverage a mixed-methods approach, including a quantitative discrete choice analysis and a qualitative content analysis of stated preferences, to explore the determinants of demand for a digital repayment option among a group of current microfinance clients in Uganda. I find that borrowers’ comfortability with mobile money, education level, and perceptions of the cost and convenience of digital repayment are important determinants of demand. However, qualitative data reveal heterogeneity in borrowers’ understanding of how digital repayment will impact the microfinance group structure and their future access to credit, which has substantial implications for the uptake of digital repayment. These findings can inform the design of digital microfinance innovations and also contribute to the broader literature around technology adoption by highlighting the importance of qualitative data and user-centered research. In Chapter 3, I focus on the diffusion of mobile money policies. Specifically, I examine the policy convergence around risk-based Know-Your-Customer (KYC) regulation over time in sub-Saharan Africa. Risk-based KYC policies lower barriers to both mobile money provision and access. I ask the research question: What are the internal determinants and external influences associated with the regulator’s decision to adopt internationally recommended KYC policies for mobile money? Using an event history approach, I investigate the relative importance of domestic banking concentration, foreign aid dependence, and participation in the international financial inclusion community on the time-to-implementation of risk-based KYC policies. While domestic pressures from highly concentrated banking sectors may marginally deter risk-based KYC adoption, I find the primary accelerator of risk-based KYC policy adoption to be regional diffusion. Insight into the mechanisms underlying mobile money policy convergence lays the groundwork for future research to facilitate the regulatory components of financial inclusion promotion

Women\u27s groups, covariate shocks, and resilience: An evidence synthesis of past shocks to inform a response to COVID-19

Background: Interventions with women’s groups are increasingly seen as an important strategy for advancing women’s empowerment, health, and economic outcomes in low- and middle-income countries, with the potential to increase the resiliency of members and their communities during widespread covariate shocks, such as coronavirus disease 2019 (COVID-19). Methods: This evidence synthesis compiles evidence from past shocks on women’s group activities and the extent to which women’s groups mitigate the effects of shocks on members and communities. We reviewed 90 documents from academic databases, organizational reports, and additional gray literature, and included literature diverse in geography, type of women’s group, and shock. Results: The literature suggests that covariate shocks tend to disrupt group activities and reduce group resources, but linkages to formal institutions can mitigate this impact by extending credit beyond the shock-affected resource pool. Evidence was largely supportive of women’s groups providing resilience to members and communities, though findings varied according to shock severity, group purpose and structure, and outcome measures. Further, actions to support individual resilience during a shock, such as increased payment flexibility, may run counter to group resilience. The findings of the evidence synthesis are largely consistent with emerging evidence about women’s groups and COVID-19 in South Asia and sub-Saharan Africa. Conclusions: We finalize the paper with a discussion on policy implications, including the importance of sustainable access to financial resources for women’s group members; equity considerations surrounding the distribution of group benefits and burdens; and the potential for meaningful partnerships between women’s groups and local governments and/or non-governmental organizations (NGOs) to enhance community response amidst crises

There’s no such thing as a free TB diagnosis: Catastrophic TB costs in Urban Uganda

Identifying and reducing TB-related costs is necessary for achieving the End TB Strategy’s goal that no family is burdened with catastrophic costs. This study explores costs during the pre-diagnosis period and assesses the potential for using coping costs as a proxy indicator for catastrophic costs when comprehensive surveys are not feasible. Detailed interviews about TB-related costs and productivity losses were conducted with 196 pulmonary TB patients in Kampala, Uganda. The threshold for catastrophic costs was defined as 20% of household income. Multivariable regression analyses were used to assess the influence of patient characteristics on economic burden, and the positive predictive value (PPV) of coping costs was estimated. Over 40% of patients experienced catastrophic costs, with average (median) pre-diagnosis costs making up 30.6% (14.1%) of household income. Low-income status (AOR = 2.91, 95% CI = 1.29, 6.72), hospitalisation (AOR = 8.66, 95% CI = 2.60; 39.54), and coping costs (AOR = 3.84, 95% CI = 1.81; 8.40) were significantly associated with the experience of catastrophic costs. The PPV of coping costs as an indicator for catastrophic costs was estimated to be 73% (95% CI = 58%, 84%). TB patients endure a substantial economic burden during the pre-diagnosis period, and identifying households that experience coping costs may be a useful proxy measure for identifying catastrophic costs

The impact of nursing students on the health-related quality of life and perceived social support of a rural population in Ecuador: effects of a service-based learning course

Abstract Background Students seeking degrees in healthcare in Ecuador participate in community improvement projects and provide free health services under the supervision of faculty health professionals. The aim of this study is to determine the impact of a community-based intervention delivered by nursing students on health-related quality of life (HRQoL) and perceived social support of a rural population in Ecuador. Methods A quasi-experimental non-equivalent control group design study was conducted in two rural communities in Tumbaco, Ecuador. Families from one rural community were invited to participate in the intervention, receiving 8 weekly home visits from nursing students. Families from a neighboring community were similarly recruited as wait-list controls. One member of each family was consented into the study; the final sample included 43 intervention participants and 55 control participants. HRQoL and perceived social support were assessed before and after the intervention in both groups. The SF-12 was used to measure HRQoL, including eight domain scores and two composite scores, and the Interpersonal Support Evaluation List was used as an indicator of perceived social support. Difference-in-differences (DD) analyses were conducted to mitigate the effects of any baseline differences in the non- equivalent control group design. Results When compared to the control group, the intervention group realized significant improvements in the physical component summary score of the SF-12 (4.20, p < 0.05) and the physical function domain of the SF-12 (4.92, p < 0.05). There were no statistically significant differences for any other components of the SF-12 or in the measure of perceived social support. Conclusions Nursing students completing their rural service rotation have the potential to improve the health-related quality of life of rural residents in Ecuador. Future research should continue to examine the impact of service-based learning on recipient populations

Safety and clinical activity of intratumoral MEDI9197 alone and in combination with durvalumab and/or palliative radiation therapy in patients with advanced solid tumors

Background MEDI9197 is an intratumorally administered toll-like receptor 7 and 8 agonist. In mice, MEDI9197 modulated antitumor immune responses, inhibited tumor growth and increased survival. This first-time-in-human, phase 1 study evaluated MEDI9197 with or without the programmed cell death ligand-1 (PD-L1) inhibitor durvalumab and/or palliative radiation therapy (RT) for advanced solid tumors.Patients and methods Eligible patients had at least one cutaneous, subcutaneous, or deep-seated lesion suitable for intratumoral (IT) injection. Dose escalation used a standard 3+3 design. Patients received IT MEDI9197 0.005–0.055 mg with or without RT (part 1), or IT MEDI9197 0.005 or 0.012 mg plus durvalumab 1500 mg intravenous with or without RT (part 3), in 4-week cycles. Primary endpoints were safety and tolerability. Secondary endpoints included pharmacokinetics, pharmacodynamics, and objective response based on Response Evaluation Criteria for Solid Tumors version 1.1. Exploratory endpoints included tumor and peripheral biomarkers that correlate with biological activity or predict response.Results From November 2015 to March 2018, part 1 enrolled 35 patients and part 3 enrolled 17 patients; five in part 1 and 2 in part 3 received RT. The maximum tolerated dose of MEDI9197 monotherapy was 0.037 mg, with dose-limiting toxicity (DLT) of cytokine release syndrome in two patients (one grade 3, one grade 4) and 0.012 mg in combination with durvalumab 1500 mg with DLT of MEDI9197-related hemorrhagic shock in one patient (grade 5) following liver metastasis rupture after two cycles of MEDI9197. Across parts 1 and 3, the most frequent MEDI9197-related adverse events (AEs) of any grade were fever (56%), fatigue (31%), and nausea (21%). The most frequent MEDI9197-related grade ≥3 events were decreased lymphocytes (15%), neutrophils (10%), and white cell counts (10%). MEDI9197 increased tumoral CD8+ and PD-L1+ cells, inducing type 1 and 2 interferons and Th1 response. There were no objective clinical responses; 10 patients in part 1 and 3 patients in part 3 had stable disease ≥8 weeks.Conclusion IT MEDI9197 was feasible for subcutaneous/cutaneous lesions but AEs precluded its use in deep-seated lesions. Although no patients responded, MEDI9197 induced systemic and intratumoral immune activation, indicating potential value in combination regimens in other patient populations.Trial registration number NCT02556463