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Analysis of cross-country changes in health services

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This presentation was given in a session at the Global Symposium on Health Systems Research which was organised by the Future Health Systems Consortium. The author is Toru Matsubayashi from Johns Hopkins Bloomberg School of Public Health

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Analysis of cross-country changes in health services

  1. 1. 1 Analysis of cross-country changes in health services Toru Matsubayashi, MD MSc Johns Hopkins Bloomberg School of Public Health
  2. 2. Background for the study  MDGs and categorical programs 1.International targets for priority health services • 90% for DPT, 90% for SBA, 70% for TB detection, 85% for TB cure • Feasible benchmarks? 2.Associations between different health services indicators 3.Roles of country characteristics 2
  3. 3. Objectives of the study  By using longitudinal and multilevel analyses, 1. To illustrate cross-country trends in priority health services 2. To estimate the levels of achievable changes in priority health services 3. To explore country characteristics affecting changes in priority health services 3
  4. 4. Methods for the study 1. National panel data from publicly available sources were constructed 2. Health service variables in three distinct areas were examined 3. Variables indicative of country characteristics explored 4. Multilevel models were fitted for the analyses 4
  5. 5. Trends of DPT3 Immunization 5
  6. 6. Country-specific estimates by random coefficient model, DPT3 coverage 6
  7. 7. Trends of SBA 7
  8. 8. Country-specific estimates by random coefficient model, SBA coverage 8
  9. 9. Projected to reach the 2015 target  SBA: 92/159 countries (57%)  DPT: 94/154 countries (61%)  Measles: 92/154 countries (59%)  DOT Case Detection: 92/165 (56%)  DOT Successful Treatment: 99/162 (61%) 9
  10. 10. Country characteristics and health services 10 DPT3 SBA TB Dx TB Tx Governance 0.51* 0.47* 0.27* 0.04 U5MR -0.71* -0.74* -0.24* -0.30* Fertility -0.64* -0.72* -0.18* -0.27* Population -0.02 -0.06 -0.15* 0.12* Literacy rate 0.61* 0.79* 0.22* 0.24* GNI per capita 0.41* 0.56* 0.11* 0.11* Health Expenditure 0.36* 0.50* 0.18* 0.06 ODA 0.05* 0.13* 0.17* 0.16* Pairwise correlation coefficients * p<0.05
  11. 11. Key findings  Significant heterogeneity among different countries  Individual country differences more important than international averages or universal target  Less than two thirds of LMICs projected to reach the universal targets  Country context variables such as governance playing a major role in country-specific experiences 11
  12. 12. Application of the method  Longitudinal data set provides rich sources of analyses  Different countries have different starting point and inherent differences: multilevel analyses are useful to incorporate such factors  Applicable to the analysis of health services at national, regional, and facility levels 12
  13. 13. The End 13
  14. 14. SECTION BREAK SLIDE Text here 14
  15. 15. Trends of DOT TB detection 15
  16. 16. Trends of DOT TB detection (model based) 16
  17. 17. Trends of DOT TB successful treatment 17
  18. 18. Trends of DOT TB successful treatment (model based) 18
  19. 19. U5MR Model Based Estimates 19

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