What strategies are cost-effective in improving health care for women and their newborns?

Findings from a systematic review, conducted by Dr Lindsay Mangham-Jefferies and colleagues for the IDEAS project at the London School of Hygiene & Tropical Medicine. Funded by the Bill & Melinda Gates Foundation. Key messages: •Cost-effective strategies are needed to improve the use and provision of maternal and newborn health care, and increase the coverage of maternal and newborn health interventions. •Demand and supply-side strategies can be cost-effective, and there is strong evidence in certain contexts. •Questions remain about the extent to which both costs and effects vary by implementation, context and scale. •Evidence is limited by the number of studies on different types of demand and supply strategies and the lack of high quality studies using comparable cost-effectiveness measures. •More attention should be given to the design and reporting of cost-effectiveness studies

Evidence to improve maternal and newborn health in Ethiopia, North East Nigeria and Uttar Pradesh, India

IDEAS aims to improve the health and survival of mothers and babies through generating evidence to inform policy and practice. IDEAS uses measurement, learning and evaluation to find out what works, why and how in maternal and newborn health. IDEAS is funded between 2010 and 2015 by a grant from the Bill & Melinda Gates Foundation to the London School of Hygiene & Tropical Medicine. One research question is"Do enhanced interactions lead to increased coverage of interventions?

Who Benefits from public spending on health care in Malawi? An application of Benefit Incidence Analysis to the Health Sector

A principal objective of the Malawi government is to provide public health services that reach poor men and women. This paper assesses to what extent the Government has been successful in achieving this. Malawi was also found to be more successful than other countries in Africa at providing health services that reach the poor. The analysis of benefit incidence finds that the distribution of benefits across socio-economic groups is largely explained by differences in the utilization of health services and the lower reported incidence of illness among the poor, rather than the distribution of the health subsidy. Malawi Medical Journal Vol. 18 (2) 2006: pp. 60-6

More cost-effectiveness studies are needed across the continuum of care

There is limited evidence that SUPPLY and DEMAND side strategies to help improve the health of mothers and babies are cost-effective. Of the few cost-effectiveness studies reported, most focus on pregnancy care and community-based strategies. A systematic review identified a range of strategies implemented at different levels of the health system and targeted different aspects of the continuum of care illustrated in this infographic

Economic evaluation of a cluster randomized trial of interventions to improve health workers' practice in diagnosing and treating uncomplicated malaria in Cameroon.

BACKGROUND: Malaria rapid diagnostic tests (RDTs) are a valid alternative to malaria testing with microscopy and are recommended for the testing of febrile patients before prescribing an antimalarial. There is a need for interventions to support the uptake of RDTs by health workers. OBJECTIVE: To evaluate the cost-effectiveness of introducing RDTs with basic or enhanced training in health facilities in which microscopy was available, compared with current practice. METHODS: A three-arm cluster randomized trial was conducted in 46 facilities in central and northwest Cameroon. Basic training had a practical session on RDTs and lectures on malaria treatment guidelines. Enhanced training included small-group activities designed to change health workers' practice and reduce the consumption of antimalarials among test-negative patients. The primary outcome was the proportion of febrile patients correctly treated: febrile patients should be tested for malaria, artemisinin combination therapy should be prescribed for confirmed cases, and no antimalarial should be prescribed for patients who are test-negative. Individual patient data were obtained from facility records and an exit survey. Costs were estimated from a societal perspective using project reports and patient exit data. The analysis used bivariate multilevel modeling and adjusted for imbalance in baseline covariates. RESULTS: Incremental cost per febrile patient correctly treated was $8.40 for the basic arm and$3.71 for the enhanced arm. On scale-up, it was estimated that RDTs with enhanced training would save $0.75 per additional febrile patient correctly treated. CONCLUSIONS: Introducing RDTs with enhanced training was more cost-effective than RDTs with basic training when each was compared with current practice

Preferences and skills of Indian public sector teachers

With a sample of 700 future public sector primary teachers in India, a Discrete Choice Experiment is used to measure job preferences, particularly regarding location. General skills are also tested. Urban origin teachers and women are more averse to remote locations than rural origin teachers and men respectively. Women would require a 26-73 percent increase in salary for moving to a remote location. The results suggest that existing caste and gender quotas can be detrimental for hiring skilled teachers willing to work in remote locations. The most preferred location is home, which supports decentralised hiring, although this could compromise skills

Physisorption controls the conformation and density of states of an adsorbed porphyrin

Conformational changes caused by adsorption can dramatically affect a molecule’s properties. Despite extensive study, however, the exact mechanisms underpinning conformational switching are often unclear. Here we show that the conformation of a prototypical flexible molecule, the freebase tetra(4-bromophenyl) porphyrin, adsorbed on Cu(111), depends critically on its precise adsorption site and that, remarkably, large conformational changes are dominated by van der Waals interactions between the molecule and the substrate surface. A combination of scanning probe microscopy, single-molecule manipulation, DFT with dispersion density functional theory, and molecular dynamics simulations show that van der Waals forces drive significant distortions of the molecular architecture so that the porphyrin can adopt one of two low-energy conformations. We find that adsorption driven by van der Waals forces alone is capable of causing large shifts in the molecular density of states, despite the apparent absence of chemical interactions. These findings highlight the essential role that van der Waals forces play in determining key molecular properties

Re-Imagining Images of Organization: A Conversation With Gareth Morgan

In this article, we review the metaphors presented by Morgan in Images of Organization and highlight how they simultaneously act as “relatively static reflections” (i.e., they provide a history of organization theory) and “relatively dynamic projections” (i.e., stimulating the formulation of further organizational images). We also discuss the potential for new organizational metaphors and consider two specific metaphors (i.e., the “global brain” and “organization as media”). We also challenge the established punctuated metaphorical process (i.e., a transfer from a metaphorical source domain to an organizational target domain), propose a dynamic perspective of interchange (i.e., source domain to target domain to source domain and so on), and develop the notion of multidirectionality (i.e., two-way projections between target and source domains)