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GDN FUNDED PAPERS
An Impact Evaluation of the Safe Motherhood Program in China
Project :
Author : Xinglin Feng; Guang Shi; Yan Wang; Ling Xu; Hao Luo; Juan Shen; Hui Yin; Yan Guo
Date : May 2009
Description : Using 11 years of county level panel data, fixed effect models are estimated to evaluate the impact of the Safe Motherhood Program in China. Propensity score matching is used to select comparable factual and counterfactual counties. Out of 2013 counties in China, 283 are selected for the treatment group and 1052 for the control group. The results support the dose response relationship between the program and its targeted outcomes: 7 years’ treatment of the program increases hospital delivery rate by 3.992 per 100 live births and decreases Maternal Mortality Ratio(MMR) due to hemorrhage by 10.229 per 100 live births. Further modeling supports the conclusion that the program reduces MMR by enhancing MCH care. With an average annual incremental unit cost for the program of about 318.0 thousand RMB(39.8 thousand USD) per county, we conclude that the Safe Motherhood Program is effective in reducing MMR through the enhancement of hospital delivery.
Impacts Of A Government Social Franchise Model On Perceptions Of Service Quality And Client Satisfaction At Commune Health Stations In Vietnam
Project :
Author : Anh Ngo; Ha Phan; Van Pham; Thang Trinh; Khoa Truong
Date : August 2009
Description : This study evaluates behavioral outcomes associated with a new approach - the Government Social Franchise (GSF) model - developed to improve reproductive health and family planning (RHFP) service quality and capacity in Vietnam's commune health stations (CHSs). A quasi-experimental design with a matched control group assessed GSF model effects on client perceptions of serviced quality and satisfaction. Survey data from 1181 users and potential users were collected at baseline, six months and 12 months after implementation of the franchise network. Regression analyses controlled for baseline differences between intervention and control groups. CHS franchise membership was significantly associated with improvement of community perceptions of service quality and client satisfaction as well as their likeliness to return and recommend low cost, community-based RHFP services to others. This study provides preliminary evidence regarding the ability of the GSF model to increase client satisfaction with RHFP services in primary public health care clinics.
The Potential of Provider-Initiated Voluntary Hiv Counseling And Testing At Health Care Settings In Thailand
Project :
Author : Yot Teerawattananon; Yuwadee Leelukhanaveera; Piya Hanvoravongchai; Montarat Thavorncharoensap; Lily Ingsrisawang; Sripen Tantivess; Usa Chaikledkaew; Narin Hiransuthikul; Chewanan Leartpiriyasuwat;
Date : June 2009
Description : WHO and UNAIDS advocated healthcare providers to consider provider-initiated HIV counseling and testing for clients attending healthcare facilities. However, there is a lack of evidence, concerning the effectiveness of such interventions in Thailand and other settings with large outbreaks of the HIV epidemic, needed to support policy decisions. A cluster-randomization trial with pre-post test design was conducted to assess the effectiveness of provider-initiated voluntary HIV counseling and testing compared with the current practice in which HIV testing is provided upon the client’s request. Sixteen district hospitals (clusters) with high- and low-HIV prevalence were randomly assigned to either receiving the new intervention or the current practice with a 1:1 allocation ratio. Patients aged between 13-64 years, receiving ambulatory care in the participating hospitals, were eligible. The main outcome measures were the acceptance rate of HIV testing and the HIV detection rate. During the first 8-week baseline period, there was no significant difference between the control and experimental clusters on the acceptance rate and HIV detection. However, after the 8-week intervention period, the acceptance rate and HIV detection rate in the experimental clusters was significantly higher than those of the control clusters. The results from the generalised estimating equations and multilevel modeling also confirmed the findings. Economic appraisal alongside this study suggested that the intervention is very cost-effective under the Thai health care setting. Classification codes: C93 (Field Experiments) and I18 (Government Policy; Regulation; Public Health) Keywords: HIV/AIDS, HIV counseling and testing, provider-initiated HIV counseling and testing, cluster-randomised trial, Thailand
Evaluating Interventions To Reduce Maternal Mortality: Evidence From Parsalud Program In Peru
Project :
Author : Juan José Díaz; Miguel Jaramillo
Date : May 2009
Description : This paper evaluates the impact of an intervention oriented to reduce maternal mortality in Peru. We take advantage of both spatial and longitudinal variation in the implementation of the program to identify its effects. Results suggest a positive impact of the training provided by the program on number of deliveries, deliveries using oxytocin, cesarean deliveries, and complicated deliveries, but ambiguous effects of infrastructure investments. Also, different types of training had different impacts, internships on perinatal technologies having the most positive impacts. No effects are found on obstetric complications, but positive effects on number of complicated deliveries attended. As far as cost effectiveness, we find that averting a case of postpartum hemorrhage is about US$ 3,328; compared with the present discounted value of the per capita GDP over a lifespan of 45 extra years of live—about US$ 36,700. JEL Codes: I12, I18, C23 Keywords: maternal mortality, impact evaluation, fixed-effects models
The Parsalud Program In Peru: Evaluating Its Impact On Quality Of Maternal Care
Project :
Author : Juan José Díaz ; Miguel Jaramillo
Date : June 2009
Description : In this paper we ask whether PARSALUD was effective in inducing positive change in the quality of care Peruvian mothers receive. We propose three sets of indicators, related to: medical peri-natal procedures, implementation of a cultural adequacy protocol and mother’s perception of quality of care. Our evidence points to few impacts of the Program on quality of care indicators. However, results suggest that PARSalud had impacts on reducing postpartum hemorrhage, both in urban and rural areas, with stronger effects in rural areas. These results suggest that the program still has plenty of scope to improve, in terms of the medical procedures, the implementation of culturally adequate protocols, and the overall quality of care in order to increase the use of modern maternal health care. Keywords: maternal health, health care quality, impact evaluation, Andean region.
Evaluation of the Impact of the Mother and Infant Health Project in Ukraine
Project :
Author : Olena Y. Nizalova; Maria Vyshnya
Date : April 2009
Description : This paper exploits a unique opportunity to evaluate the impact of improvement in the quality of prenatal care and labor and delivery services on maternal and infant mortality and morbidity. Since basic medical care has been universally available in Ukraine, implementation of the Mother and Infant Health Project allows addressing quality rather than quantity effect of medical care. Employing program evaluation methods we find that the administrative units (rayons) participating in the Project have exhibited greater improvements in both maternal and infant health compared to the control rayons. Among the infant health characteristics, the MIHP impact is most pronounced for stillbirths and infant mortality and morbidity resulted from deviations in perinatal period and congenital anomalies. As for the maternal health, the MIHP is the most effective at combating anemia, maladies of blood circulation, veins, and urinary-genital complications, as well as late toxicosis. The analysis suggests that the effects are due to early attendance of antenatal clinics, lower share of C-sections, and greater share of normal deliveries.
Do HIV-AIDS Teacher Training Programs Work in Africa? Evidence from the Cameroon
Project :
Author : Jean-Louis A; Eric Djimeu W
Date : June 2009
Description : We assess the impact on student knowledge, attitudes and behavior of a typical HIV-AIDS teacher training program, funded by the African Development Bank and implemented with technical assistance from UNESCO in the Cameroon. Applying an identification strategy based on instrumental variables that controls for teacher self selection into the training program, we find that exposure to a trained teacher increases the apprehension of 12 to 13 year olds concerning HIV-AIDS, by rendering them less likely to be willing to buy from an HIV-positive shopkeeper, and more likely to wish to remain sexually abstinent during adolescence. No effect is found either on their knowledge or on their behavior. For 16 to 17 year olds, on the other hand, exposure to a trained teacher increases the likelihood that students are willing to discuss HIV-AIDS issues within their families. More importantly, older students who are exposed to a trained teacher are 29% more likely to have used a condom during their last sexual intercourse, and are 27% more likely to have carried out an HIV test. Key words: teacher training, HIV-AIDS, Cameroon.
Impact Evaluation of the Ethiopian Health Services Extension Program: A Non-experimental Approach
Project :
Author : Assefa Admassiea; Degnet Abebawa; Andinet D. Woldemichaelb;
Date : August 2009
Description : Ethiopia has launched a pro-poor health services extension program since 2003 to deliver preventive and basic curative health services to its inhabitants. Despite the massive support and recognition the program has received, there has not been proper evaluation of its impact. This study has applied propensity score matching and regression adjustment techniques to evaluate the short- and intermediate-term impacts of the program on child and maternal health indicators in the program villages. Empirical data for the study were collected from 3095 households from both program and non-program villages in rural Ethiopia. The estimated results indicate that the program has significantly increased the proportion of children fully and individually vaccinated against tuberculosis, polio, diphtheria-pertussis-tetanus, and measles. We find heterogeneity in childhood immunization coverage as a result of differences in terms of the number of health extension workers, in the quality of health posts and in terms of the educational achievement of mothers across program villages. The proportions of children and women using insecticide treated bednets for malaria protection are significantly larger in program villages than in non-program villages. The effect on preventive maternal care is rather limited. Whereas women in the program villages appeared to make their first contact with skilled health service provider significantly earlier during pregnancy, very little effect is detected on other prenatal and postnatal care services. Moreover, the program has not reduced the incidence and duration of diarrhea and cough diseases among under-five children. Keywords: impact evaluation; health services extension; propensity scores; regression adjustment; Ethiopia
Family Planning and Rural Fertility Decline in Iran: A Study in Program Evaluation
Project :
Author : Djavad Salehi-Isfahani; M. Jalal Abbasi-Shavazi; Meimanat Hosseini-Chavoshi
Date : May 2009
Description : During the first few years of the Islamic Revolution Iranian fertility was on the rise, in part because of the revolutionary government's pro-natal policies. In a policy reversal, in 1989 the government launched an ambitious and innovative family planning program specially aimed at rural families. By 2005, the program had covered more than 90 percent of the rural population and the average number of births per rural woman had declined to replacement level from about 8 birth in the mid-1980s. In this paper we ask to what extent this decline was the result of a particular design feature of the family planning program, namely rural health houses. We use the timing of establishment of rural health houses to identify their effect on village-level fertility. Our results attribute about 7-18 percent of the fertility decline during 1986-96 to health houses. We discuss the role of other aspects of Iran's family planning program, such as its elective media campaign that took advantage of the revolutionary government's credibility with the rural poor, as well as the effect of other policies that increased the cost of high parity children and increased the returns to education for the rural poor in persuading rural families to change their behavior from high fertility and low investment in child education to low fertility and high investment in children. JEL classfication: J13; J18; I12; I18; C31 Keywords: Iran, family planning, program evaluation, health houses
Evaluating the Impact of Community‐Based Health Interventions: Evidence from Brazil’s Family Health Program
Project :
Author : Romero Rocha; Rodrigo R. Soares
Date : June 2009
Description : This paper analyzes the direct and indirect impacts of Brazil’s Family Health Program. We estimate the effects of the program on mortality and on household behavior related to child labor and schooling, employment of adults, and fertility. We find consistent effects of the program on reductions in mortality throughout the age distribution, but mainly at earlier ages. Municipalities in the poorest regions of the country benefit particularly from the program. For these regions, implementation of the program is also robustly associated with increased labor supply of adults, reduced fertility, and increased schooling. Evidence suggests that the Family Health Program is a highly cost‐effective tool for improving health in poor areas. Keywords: family health program, mortality, household behavior, impact evaluation, Brazil
 
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