Communities in Action


Book Description

In the United States, some populations suffer from far greater disparities in health than others. Those disparities are caused not only by fundamental differences in health status across segments of the population, but also because of inequities in factors that impact health status, so-called determinants of health. Only part of an individual's health status depends on his or her behavior and choice; community-wide problems like poverty, unemployment, poor education, inadequate housing, poor public transportation, interpersonal violence, and decaying neighborhoods also contribute to health inequities, as well as the historic and ongoing interplay of structures, policies, and norms that shape lives. When these factors are not optimal in a community, it does not mean they are intractable: such inequities can be mitigated by social policies that can shape health in powerful ways. Communities in Action: Pathways to Health Equity seeks to delineate the causes of and the solutions to health inequities in the United States. This report focuses on what communities can do to promote health equity, what actions are needed by the many and varied stakeholders that are part of communities or support them, as well as the root causes and structural barriers that need to be overcome.




The Impact of Alternative Input Subsidy Exit Strategies on Malawi’s Maize Commodity Market


Book Description

This study has been conducted in order to generate evidence of the visibility of exit from farm input subsidies in an African context. The study simulates the impact of alternative exit strategies from Malawi’s farm input subsidy program on maize markets. The simulation is conducted using a multiequation partial equilibrium model of the national maize market, which is sequentially linked via a price-linkage equation to local rural maize markets. The model accounts for market imperfections prevailing in the country that arise from government price interventions. Findings show that some alternative exit strategies have negative and sustained impacts on maize yields, production, and acreage allocated to maize over the simulation period. Market prices rise steadily as a result of the implementation of different exit strategies. Despite higher maize prices, domestic maize consumption remains fairly stable, with a slow but increasing trend over the simulation period. Results further suggest that exit strategies that are coupled with improvements in agricultural extension services have the potential to offset the negative impacts of the removal or scaling down of agricultural input subsidies. The study findings demonstrate the difficulty of feasibly removing farm input subsidies. Study recommendations are therefore relevant for policymakers and development partners debating removal or implementation of farm input subsidies.




Historical Perspectives on the State of Health and Health Systems in Africa, Volume II


Book Description

This book focuses on Africa’s challenges, achievements, and failures over the past several centuries using an interdisciplinary approach that combines theory and fact and evidence-based practices and interventions in public health, and argues that most of the health problems in Africa are not a result of scarce or lack of resources, but of the misconceived and misplaced priorities that have left the continent behind every other on the globe in terms of health, education, and equitable distribution of opportunities and access to (quality) health as agreed by the United Nations member states at Alma-Ata in 1978.




Privatizing Health Services in Africa


Book Description

Privatizing Health Services in Africa analyzes the disappearance of public health in the form of state services in Africa, and the growth of a private market in health care that will serve primarily an urban elite. Meredeth Turshen considers the implications of introducing private insurance in countries with growing unemployment, a shrinking formal job sector, and a lack of social security programs or other safety nets. She debates the pros and cons of shifting the delivery of health services to the nongovernmental sector in the context of new concepts of the role of the state. Many of the schemes to privatize the purchase and sale of pharmaceuticals reverse decades of United Nations work challenging the power of the multinational drug industry. Turshen weighs these policy changes in light of the World Bank's eclipse of the World Health Organization as the premier UN health policy agency. Until now, no book has disputed the World Bank's plans to privatize health care in Africa. This is the first book-length analysis of policy changes in light of monetarism and globalization. Throughout the book, Turshen examines the implications of privatization for gender equity. She also provides a case study of Zimbabwe and comparative material from Malawi, Mozambique, and Zambia. Her study makes a contribution to current debates on the impact of structural adjustment policies on health and the design of health services in the Third World.




An Ex Ante Analysis of the Impact and Cost-Effectiveness of Biofortified High-Provitamin A and High-Iron Banana in Uganda


Book Description

Uganda has made notable progress in reducing micronutrient deficiencies in recent years, but the prevalence of vitamin A deficiency (VAD) and anemia among children under 5 remain unacceptably high. According to World Health Organization criteria, VAD remains a public health problem in Uganda, and anemia is a severe problem. In this paper we explore the potential contribution to reducing both of these deficiencies using a genetically modified, high–provitamin A and high-iron banana (HPVAHIB) that is currently being developed. We present an ex ante analysis of the costs and nutritional benefits of HPVAHIB. Using the Ugandan National Household Survey of 2005/06, we analyzed the production and consumption patterns of highland cooking banana (nakinyika) and sweet banana (sukalindizi). Informed by the empirical findings, we developed geographically differentiated adoption, production, consumption, and diffusion patterns for several types of HPVAHIB. Based on households’ reported quantities of each type of banana currently consumed, we estimated the number of people consuming each banana and the quantities they consume, and then simulated the additional intakes of vitamin A and iron and estimated the number of disability-adjusted life years (DALYs) saved attributable to each. Combining the health impacts with the estimated costs of the project, three impact measures of the HPVAHIB are developed: the cost per DALY saved, the benefit–cost ratio, and the internal rate of return. Eighteen scenarios are estimated. The base scenario, which includes only the biofortification of cooking banana with provitamin A at a level equal to 400 percent its intrinsic provitamin A content, estimates that the net present cost per DALY saved of HPVAHIB is US$62, its benefit–cost ratio is 16, and its internal rate of return is 31 percent. According to criteria established by the World Health Organization and the World Bank, the HPVAHIB project is a “very cost-effective” health intervention.




The Child Health Implications of Privatizing Africa’s Urban Water Supply


Book Description

Identifying policies which can improve water sector management is critically important given the global burden of water-related disease. Each year, 1 in 10 child deaths—roughly 800,000 in total—is the direct result of diarrhea. Can private-sector participation (PSP) in the urban piped water sector improve child health? The author uses child-level data from 39 African countries during 1986–2010 to show that introducing PSP decreases diarrhea among urban dwelling children under five years of age by 5.6 percentage points, or 35 percent of its mean prevalence. PSP also leads to greater reliance on piped water. To attribute causality, the author exploits time variation in the private water market share controlled by African countries’ former colonizers. A placebo analysis reveals that PSP does not affect symptoms of respiratory illness in the same children, nor does it affect a rural control group unaffected by PSP.




Assessment of the Capacity, Incentives, and Performance of Agricultural Extension Agents in Western Democratic Republic of Congo


Book Description

Agricultural extension is critical for agricultural growth and food security, but making the extension system effective, demand driven, and responsive to the needs of a diverse set of producers remains a challenge. As part of the institutional reforms in the Democratic Republic of Congo (DRC), the extension system is being reviewed to identify strategies and practical actions to transform the system to better respond to the knowledge needs in a rapidly changing agriculture and food sector. This paper provides an in-depth review of the agricultural extension system of DRC including an analysis of its policies and legal framework, organization, and management; links to critical institutions; and capacity and incentive of different actors in the system. This review involved document analyses, interviews with key informants, and surveys of 107 extension organizations and 162 extension agents in 156 randomly selected villages in western DRC. This review suggests serious funding constraints, human resource management problems, no linkage and coordination within the extension system and with research and education systems, and a majority of underserved communities and farmers. This review also highlights a good opportunity given the huge human resources (more than 11,000 agents) deployed into the sectors and territories as part of the Ministry’s agricultural inspection system. However, their mandate is not clear and they currently focus on data collection (census) and checking what farmers do and limited in extension and advisory work. This review highlights the urgent need for human resource or civil service reform; public-sector commitment and funding; infrastructure rebuilding and skills upgrading in extension, education and training, and research organizations; and a unified policy or strategy with clear vision, mandate, targets, and performance-based incentive system.




Targeting Technology to Reduce Poverty and Conserve Resources


Book Description

Demand heterogeneity often makes it profitable for firms to price and promote goods and services differently in different market segments. When private consumption brings public benefits, this same heterogeneity can be used to target public subsidies. We explore the design of public–private targeting and segmentation strategies in the case of a resource-conserving agricultural technology in India. To understand farmers’ heterogeneous demand for laser land leveling (LLL), we conducted an experimental auction for LLL services with an integrated randomized controlled trial to estimate the private benefits of the technology. We use graphical and econometric approaches to characterize farmer demand for LLL. We then add detailed cost data from LLL providers to simulate and evaluate several potential targeted delivery strategies based on measures of (1) the cost-effectiveness of expanding LLL dissemination, (2) water savings, and (3) market surplus in a welfare framework. These simulations demonstrate inherent tradeoffs between increasing the amount of land that is leveled and expanding the number of farmers who adopt the technology, and between adoption and water savings. While segmenting and targeting are popular elements of many public–private partnerships to develop and disseminate agricultural technologies, formulating and implementing effective delivery strategies requires a rich understanding of costs, benefits, and demand. Our experimental approach generates such an understanding and may be relevant in other contexts.




Handbook of Global Urban Health


Book Description

Through interdisciplinary and multidisciplinary perspectives, and with an emphasis on exploring patterns as well as distinct and unique conditions across the globe, this collection examines advanced and cutting-edge theoretical and methodological approaches to the study of the health of urban populations. Despite the growing interest in global urban health, there are limited resources available that provide an extensive and advanced exploration into the health of urban populations in a transnational context. This volume offers a high-quality and comprehensive examination of global urban health issues by leading urban health scholars from around the world. The book brings together a multi-disciplinary perspective on urban health, with chapter contributions emphasizing disciplines in the social sciences, construction sciences and medical sciences. The co-editors of the collection come from a number of different disciplinary backgrounds that have been at the forefront of urban health research, including public health, epidemiology, geography, city planning and urban design. The book is intended to be a reference in global urban health for research libraries and faculty collections. It will also be appropriate as a text for university class adoption in upper-division under-graduate courses and above. The proposed volume is extensive and offers enough breadth and depth to enable it to be used for courses emphasizing a U.S., or wider Western perspective, as well as courses on urban health emphasizing a global context.




Reverse-Share-Tenancy and Marshallian Inefficiency


Book Description

While there are ample empirical studies that claim the potential disincentive effects of sharecropping arrangements, the existing literature is shallow in explaining why share tenancy contracts are prevalent and diffusing in many developing countries. Using a unique tenant-landlord matched dataset from the Tigray region of Ethiopia, we are able to show how the tenants’ strategic response to the varying economic and tenure-security status of the landlords can explain sharecroppers’ productivity differentials. To the best of our knowledge, this is the first study to use tenant–landlord matched data that accounts for both the supply (landlord) and demand (tenant) side characteristics in analyzing sharecroppers’ level of effort and productivity. The study reveals that sharecroppers’ yields are significantly lower on plots leased from landlords who are non-kin, who are female, who have lower income-generating opportunity, and who are tenure insecure than on plots leased from landlords with the opposite characteristics. While, on aggregate, the results show no significant efficiency loss on kin-operated sharecropped plots, more decomposed analyses indicate strong evidence of Marshallian inefficiency on kin-operated plots leased from landlords with weaker bargaining power and higher tenure insecurity. This study thus shows how failure to control for the heterogeneity of landowners’ characteristics can explain the lack of clarity in the existing empirical literature on the extent of moral hazard problems in sharecropping contracts.