Catastrophic payments for health care in Asia

Out-of-pocket (OOP) payments are the principal means of financing health care throughout much of Asia. We estimate the magnitude and distribution of OOP payments for health care in fourteen countries and territories accounting for 81% of the Asian population. We focus on payments that are catastrophic, in the sense of severely disrupting household living standards, and approximate such payments by those absorbing a large fraction of household resources. Bangladesh, China, India, Nepal and Vietnam rely most heavily on OOP financing and have the highest incidence of catastrophic payments. Sri Lanka, Thailand and Malaysia stand out as low to middle income countries that have constrained both the OOP share of health financing and the catastrophic impact of direct payments. In most low/middle-income countries, the better-off are more likely to spend a large fraction of total household resources on health care. This may reflect the inability of the poorest of the poor to divert resources from other basic needs and possibly the protection of the poor from user charges offered in some countries. But in China, Kyrgyz and Vietnam, where there are no exemptions of the poor from charges, they are as, or even more, likely to incur catastrophic payments

Pathways to change: improving the quality of education in Timor-Leste

After more than 400 years of Portuguese colonization and a 24-year period of Indonesian occupation, Timor-Leste became a fully independent state on May 20, 2012. Independence followed a period of extreme violence caused by the Indonesians, who destroyed homes, livelihoods and infrastructure and devastated schools before leaving the country. Since 2012, the country has resorted to international aid to reconstruct the country and rebuild its education system. Following the restructuring of the basic education, the country has recently implemented a new general secondary education curriculum, through international cooperation with Portuguese institutions. This article presents the new curriculum developed and puts forward some of the challenges regarding its implementation. Based on interviews conducted with several policy makers, findings suggest challenges related with the use of Portuguese language, the scientific and pedagogical training of teachers and the pedagogical and administrative management capacity in most secondary school

Essays on farm household credit constraint, productivity and consumption inequality in Malawi

Credit has proven to be a necessary tool for economic development affecting positively the welfare of households and individuals. However, one major area in which rural households lack is access to financial markets including credit. The studies included in this thesis contribute to the access to credit literature and the credit constraint/unconstraint impact on some welfare outcomes. The first empirical study examined farm households' access to credit in rural Malawi. Unlike previous empirical studies, particular attention is given to discouraged borrowers who are mostly ignored in such studies. Using the 2010/2011 household survey data from Malawi the study determines the demographic and socio-economic characteristics that distinguish farm households who need credit, who are the discouraged borrowers and who are rejected applicants. A three-step sequential estimation model following a trivariate probit model with double sample selection was adopted. The findings revealed that there were over 7 times more discouraged borrowers than denied applicants. Women were more likely to be discouraged from applying for credit but, if they applied, they were more likely to be successful in obtaining credit than males. This shows that when examining farm households' access to credit discouraged borrowers should be given special consideration. Capturing discouraged borrowers as also credit constrained, the second empirical study employed a switching model to estimate the impact of credit constraint status on farm productivity for each credit constraint regime. The study further compared the expected production under actual and counterfactual conditions for a household being credit constrained or unconstrained. The findings suggest that a household that is constrained is less productive than a randomly selected household from the sample would but that for the unconstrained household is inconclusive, however, the counterfactual arguments as seen from the analysis shows that being credit unconstrained was beneficial to the increase in productivity. Studies have shown that undeveloped financial markets have been a major contributing factor increasing inequality, especially in developing countries. The third empirical study examined the impact of household credit constraint on the consumption inequality of rural households in Malawi. Factors that explain the within and between credit constrained and unconstrained status of consumption inequality were examined. The General Entropy (GE) Index and the Regression-Based Inequality Decomposition Methods, Field's (2003) and Blinder-Oaxaca Decomposition were employed. The findings show that inequality was more prominent within the groups than between them. Also, the size of households and the value of assets were the major contributors to the within-group inequalities for credit constrained and unconstrained households. Further, only the endowment component was important in explaining the consumption inequality gap between the credit constrained and unconstrained households. Adjusting the level of endowments of constrained households to that of the unconstrained households increased their welfare by 15.7 percent

The Sustainable Development Oxymoron: Quantifying and Modelling the Incompatibility of Sustainable Development Goals

In 2015, the UN adopted a new set of Sustainable Development Goals (SDGs) to eradicate poverty, establish socioeconomic inclusion and protect the environment. Critical voices such as the International Council for Science, however, have expressed concerns about the potential incompatibility of the SDGs, specifically the incompatibility of socio-economic development and environmental sustainability. In this paper we test, quantify and model the alleged inconsistency of SDGs. Our analyses show which SDGs are consistent and which are conflicting. We measure the extent of inconsistency and conclude that the SDG agenda will fail as a whole if we continue with business as usual. We further explore the nature of the inconsistencies using dynamical systems models, which reveal that the focus on economic growth and consumption as a means for development underlies the inconsistency. Our models also show that there are factors which can contribute to development (health programs, government investment in education) on the one hand and ecological sustainability (renewable energy) on the other, without triggering the conflict between incompatible SDGs

Dinâmicas comunitárias em deslocados e não deslocados residentes em áreas de exclusão social em Barranquilla (Colômbia)

El sentido de comunidad, la participación y el empoderamiento permiten comprender el proceso de desplazamiento y reasentamiento en el contexto de recepción, así como las consecuencias derivadas de ambos fenómenos. Los objetivos de la investigación son a) evaluar los tres constructos mencionados, b) analizar la sinergia que existe entre estos y c) proponer estrategias para aumentar su capacidad de influencia en los procesos de toma de decisiones. Llevamos a cabo una investigación exploratoria y transversal con población desplazada (n=30) y no desplazada (n=32) en dos localidades de bajos ingresos en Barranquilla (Colombia). Existe retroalimentación positiva entre los procesos evaluados, aunque no se observan diferencias significativas entre el grupo de desplazados y el de no desplazados. La dimensión Pertenencia (sentido de comunidad) es la que mejor explica la varianza del empoderamiento y de la participación en ambos grupos. Presentamos iniciativas para reforzar el sentido de comunidad y facilitar el acceso a los recursos socio-comunitarios en población desplazada.The sense of community, participation and empowerment enable us to understand the process of displacement and resettlement in the context of reception, as well as the consequences of both phenomena. Our objectives are a) to assess the three constructs mentioned above, b) to analyze the synergy existing among them and c) to propose strategies for increasing their capacity to influence the decision-making processes. We carried out a cross-sectional exploratory study with displaced (n=30) and non-displaced (n=32) people in two low-income districts of Barranquilla (Colombia). There is positive feedback between the processes evaluated, although no significant differences are observed between the displaced and the non-displaced groups. The dimension of belonging (sense of community) is the one that best explains the variance of empowerment and participation in both groups. Finally, we present a set of initiatives to reinforce the sense of community and to facilitate access to the community’s social resources for the displaced population.O sentido de comunidade, a participação e o empoderamento permitem compreender o processo de deslocamento e reassentamento no contexto de recepção bem como as consequências derivadas de ambos os fenômenos. Os objetivos desta pesquisa são: a) avaliar os três construtos mencionados; b) analisar a sinergia que existe entre estes e c) propor estratégias para aumentar sua capacidade de influência nos processos de tomada de decisões. Realizamos uma pesquisa exploratória e transversal com população deslocada (n=30) e não deslocada (n=32) em duas localidades de baixa renda em Barranquilla (Colômbia). Existe retroalimentação positiva entre os processos avaliados, embora não se observem diferenças significativas entre o grupo de deslocados e o de não deslocados. A dimensão Pertencimento (sentido de comunidade) é a que melhor explica a variância do empoderamento e da participação em ambos os grupos. Apresentamos iniciativas para reforçar o sentido de comunidade e facilitar o acesso aos recursos sociocomunitários em população deslocada

Assessing health facility performance in Indonesia using the Pabón-Lasso model and unit cost analysis of health services

Total health care costs have dramatically increased in Indonesia, and health facilities consume the largest share of health resources. This study aims to provide a better understanding of the characteristics of the best-performing health facilities. We use 4 national Indonesian datasets for 2011 and analysed 200 hospitals and 95 health centres. We first apply the Pabón-Lasso model to assess the relative performance of health facilities in terms of bed occupancy rate and the number of admissions per bed; the model gathers together health facilities into 4 sectors representing different levels of productivity. We then use a step-down costing method to estimate the cost per outpatient visit, inpatient, and bed days in hospitals and health centres. We combined both ratio analysis and applied bivariate and multivariate analyses to identify the predictors of the best-performing health facility; 37% of hospitals and 33% of health centres were located in the high-performing sector of the Pabón-Lasso model. The wide variation in unit costs across health facilities presented a basis for benchmarking and identifying relatively efficient units. Combining the unit cost analysis and Pabón-Lasso model, we find that health facility performance is affected by both internal (size and capacity, financing, type of patients, ownership, accreditation status, and staff availability) and external factors (economic status, population education level, location, and population density). Our study demonstrates that it is feasible to identify the best-performing health facilities and provides information about how to improve efficiency using simplistic methods

Human rights, health and the state in Bangladesh

BACKGROUND: This paper broadly discusses the role of the State of Bangladesh in the context of the health system and human rights. The interrelation between human rights, health and development are well documented. The recognition of health as a fundamental right by WHO and subsequent approval of health as an instrument of welfare by the Universal Declaration of Human Rights (UDHR) and the International Covenant on Social, Economic and Cultural Rights (ICSECR) further enhances the idea. Moreover, human rights are also recognized as an expedient of human development. The state is entrusted to realize the rights enunciated in the ICSECR. DISCUSSION: In exploring the relationship of the human rights and health situation in Bangladesh, it is argued, in this paper, that the constitution and major policy documents of the Bangladesh government have recognized the health rights and development. Bangladesh has ratified most of the international treaties and covenants including ICCPR, ICESCR; and a signatory of international declarations including Alma-Ata, ICPD, Beijing declarations, and Millennium Development Goals. However the implementation of government policies and plans in the development of health institutions, human resources, accessibility and availability, resource distribution, rural-urban disparity, the male-female gap has put the health system in a dismal state. Neither the right to health nor the right to development has been established in the development of health system or in providing health care. SUMMARY: The development and service pattern of the health system have negative correlation with human rights and contributed to the underdevelopment of Bangladesh. The government should take comprehensive approach in prioritizing the health rights of the citizens and progressive realization of these rights

Investigating sex differences in the accuracy of dietary assessment methods to measure energy intake in adults:a systematic review and meta-analysis

BACKGROUND: To inform the interpretation of dietary data in the context of sex differences in diet-disease relations, it is important to understand whether there are any sex differences in accuracy of dietary reporting. OBJECTIVE: To quantify sex differences in self-reported total energy intake (TEI) compared with a reference measure of total energy expenditure (TEE). METHODS: Six electronic databases were systematically searched for published original research articles between 1980 and April 2020. Studies were included if they were conducted in adult populations with measures for both females and males of self-reported TEI and TEE from doubly labeled water (DLW). Studies were screened and quality assessed independently by 2 authors. Random-effects meta-analyses were conducted to pool the mean differences between TEI and TEE for, and between, females and males, by method of dietary assessment. RESULTS: From 1313 identified studies, 31 met the inclusion criteria. The studies collectively included information on 4518 individuals (54% females). Dietary assessment methods included 24-h recalls (n = 12, 2 with supplemental photos of food items consumed), estimated food records (EFRs; n = 11), FFQs (n = 10), weighed food records (WFRs, n = 5), and diet histories (n = 2). Meta-analyses identified underestimation of TEI by females and males, ranging from -1318 kJ/d (95% CI: -1967, -669) for FFQ to -2650 kJ/d (95% CI: -3492, -1807) for 24-h recalls for females, and from -1764 kJ/d (95% CI: -2285, -1242) for FFQ to -3438 kJ/d (95% CI: -5382, -1494) for WFR for males. There was no difference in the level of underestimation by sex, except when using EFR, for which males underestimated energy intake more than females (by 590 kJ/d, 95% CI: 35, 1,146). CONCLUSION: Substantial underestimation of TEI across a range of dietary assessment methods was identified, similar by sex. These underestimations should be considered when assessing TEI and interpreting diet-disease relations

Integrating hydrological modelling and ecosystem functioning for environmental flows in climate change scenarios in the Zambezi River (Zambezi Region, Namibia)

The Zambezi-Chobe wetlands in Namibia are of great international importance for trans-boundary water management because of their remarkable ecological characteristics and the variety and magnitude of the ecosystem services provided. The main objective of this study is to establish the hydro-ecological baseline for the application of environmental flow regimes (EFR). The specific objectives are: (i) the assessment of environmental flow components (EFC) in the current near-natural hydrological conditions; (ii) the generation of future scenarios for climatic and socioeconomic changes; (iii) the estimation of the area duration curves and estimated annual habitat during the inundation of the critical habitats for fisheries (mulapos), under the existing conditions and future scenarios; and (iv) to provide a framework for the future application of EFRs, based on hydrological and ecological processes. To make a sound analysis of the ecological implications, first we develop a conceptual framework of the linkages between the hydrological and biological processes concerning fish communities, because of the critical role of fisheries in the region. The EFCs in near-natural hydrological conditions provide the basis for developing interim EFRs in the region, within the framework of an adaptive management of water resources. The future scenarios indicate a mitigation of the flow variability; and, in the worst-case scenario, the reduction of the maximum flow and inundated area of the mulapos would result in a reduction of the estimated annual habitat of 22%. This means a reduction in the spawning habitats for quiet-water species, in the food resources for fry and juvenile fish and a consequent reduction in fish stocks. Furthermore, the habitat loss during low events is similar and greater under both scenarios, at ca. 35%. Here we corroborate that the EFCs and their variability may become the building blocks of flow-ecology models that lead to environmental flow recommendations, monitoring and research programmes and flow protection activities.This research was part of the research project CERPA (Certification of Protected Areas), funded by the German Federal Ministry of Education and Research (BMBF), and focused on the evaluation of new market-based instruments for biodiversity conservation and their socioeconomic implications. The authors also thank two anonymous reviewers who provided substantial input that improved the manuscript. The study has been partially funded by the national research project IMPADAPT (CGL2013-48424-C2-1-R), with MINECO (Spanish Ministry of Economy) and FEDER funds.Martinez-Capel, F.; García López, L.; Beyer, M. (2017). Integrating hydrological modelling and ecosystem functioning for environmental flows in climate change scenarios in the Zambezi River (Zambezi Region, Namibia). River Research and Applications. 33(2):258-275. https://doi.org/10.1002/rra.3058S25827533