The document discusses India's efforts to improve sanitation and reduce mortality from diseases transmitted through feces like rotaviruses. It summarizes India's "Total Sanitation Campaign" and "Swachh Bharat Abhiyan" programs which aim to eliminate open defecation by building toilets. The author develops a model to analyze the impact of these programs on diarrhea deaths. The model uses a non-linear state-fixed effects regression to relate toilet construction and other factors like literacy, GDP, and water facilities to reported diarrhea cases and deaths in 3 Indian states from 2010-2014.
Analysing the Effectiveness of Government Spending on Health across Countrieeurosigdoc acm
This document outlines a study analyzing the effectiveness of government spending on health across countries. It discusses collecting health spending and outcome data for 217 countries from 1990-2019. The data was prepared by addressing missing values and converting to numeric format. Regression, cluster, and geographical analyses were then used to model relationships. Regression showed health spending significantly increases life expectancy and decreases infant mortality. Clustering grouped countries with similar health profiles. Geographical plots visually depicted relationships between spending and outcomes. The study concluded that higher spending on health generally leads to better outcomes.
The document summarizes the status of civil registration systems, sample registration systems, and annual health surveys in India for monitoring vital statistics and health indicators. It discusses that a complete civil registration system can provide reliable fertility and mortality statistics on a real-time basis for evidence-based planning. While registration levels in India have improved, many births and deaths remain unregistered. Sample registration systems and annual health surveys have helped provide estimates but a complete civil registration system is still needed. The annual health survey in particular provides district-level data on 161 health indicators across eight states to help identify high priority districts.
Impact of increased district-level insecticide-treated net (ITN) distribution...MEASURE Evaluation
This study examined the impact of increased insecticide-treated mosquito net (ITN) distribution on child mortality in Malawi between 2004-2010. Using national survey and ITN distribution data at the district level, the researchers conducted a statistical analysis controlling for socioeconomic factors. They found that higher levels of ITN distribution were significantly associated with lower under-five mortality. Specifically, districts with over 0.25 ITNs per person experienced an 11% reduction in child deaths compared to districts with lower ITN levels. This suggests increased ITN coverage contributed meaningfully to the overall decline in under-five mortality in Malawi during this period.
Exploring the use of routinely-available, retrospective data to study the ass...HFG Project
Country-level evidence on the impact of malaria control on micro-economic outcomes is vital for mobilizing domestic and donor resources for malaria control. Using routinely available survey data could facilitate this investigation in a cost-efficient way. The authors of this study used Malaria Indicator Surveys (MIS) and Living Conditions Monitoring Survey (LCMS) data from 2006 to 2010 for all 72 districts in Zambia to relate malaria control scale-up with household food spending (proxy for household well-being), educational attainment and agricultural production.
The authors used two quasi-experimental designs: (1) a generalized propensity score for a continuous treatment variable (defined as coverage from owning insecticide-treated bed nets and/or receipt of indoor residual spraying); and, (2) a district fixed effects model to assess changes in the outcome relative to changes in treatment pre-post scale-up. The unit of analysis was at district level. The authors also conducted simulations post-analysis to assess statistical power.
MRC/HIVAN KZN AIDS Forum - 30/10/12 - Challenges and Opportunities for HIV/AI...info4africa
This presentation was given on 30/10/12 at the MRC/HIVAN KZN AIDS Forum.
Co-presented by Kwazi Mbatha (CEGAA Researcher/Trainer) and Mlungisi Vila kasi (TAC Community Mobiliser - uMgungundlovu), this talk was facilitated by Judith King (CEGAA Communications and Advocacy Manager).
For more information on CEGAA please visit their website: http://www.cegaa.org/
Pension systems and reforms are critically influenced by demographic developments that are increasingly compared across countries to identify common issues and trends. For demographic projections researchers across the world rely on those produced by the United Nations; for Europe the demographic projections by Eurostat form the basis of the periodic aging report by the EU Commission. While these projections are technically well done the underlying assumptions for the demographic drivers – fertility, mortality and migration – in the central variants are limited and are largely flawed. Worse, they risk offering a wrong picture about the likely future developments and the relevant alternatives. This paper investigates the assumptions of the demographic drivers by UN and Eurostat, compares it with those by national projections in Portugal and Spain, and offers a review of alternative, recent and cutting edge approaches to project demographic drivers that go beyond the use of past demographic developments. They suggest that economic and other socio-economic developments have a main bearing on future trends in fertility, mortality and migration. And they support the assessment that the UN/Eurostat projected re-increase in fertility rates may not take place, that the increase in life expectancy may be much larger, that the future flows of net migrants to EU countries may be much higher and rising. The resulting overall underestimation of population aging has a bearing on the financial sustainability of the pension systems and reform choices, a topic to be explored in the next papers.
Predictive analysis WHO's life expectancy dataset using Tableau data visualis...Tarun Swarup
This document discusses a statistical analysis of factors influencing life expectancy using data from the World Health Organization and United Nations. It describes the dataset, variables considered, and objectives of analyzing relationships between life expectancy and factors like immunization rates, mortality rates, economics, and demographics. Four dashboards are proposed to analyze trends in adult mortality rates, compare life expectancy and infant death rates in populated countries, forecast adult mortality and hepatitis rates in Brazil, and compare GDP in developed and developing countries.
Analysing the Effectiveness of Government Spending on Health across Countrieeurosigdoc acm
This document outlines a study analyzing the effectiveness of government spending on health across countries. It discusses collecting health spending and outcome data for 217 countries from 1990-2019. The data was prepared by addressing missing values and converting to numeric format. Regression, cluster, and geographical analyses were then used to model relationships. Regression showed health spending significantly increases life expectancy and decreases infant mortality. Clustering grouped countries with similar health profiles. Geographical plots visually depicted relationships between spending and outcomes. The study concluded that higher spending on health generally leads to better outcomes.
The document summarizes the status of civil registration systems, sample registration systems, and annual health surveys in India for monitoring vital statistics and health indicators. It discusses that a complete civil registration system can provide reliable fertility and mortality statistics on a real-time basis for evidence-based planning. While registration levels in India have improved, many births and deaths remain unregistered. Sample registration systems and annual health surveys have helped provide estimates but a complete civil registration system is still needed. The annual health survey in particular provides district-level data on 161 health indicators across eight states to help identify high priority districts.
Impact of increased district-level insecticide-treated net (ITN) distribution...MEASURE Evaluation
This study examined the impact of increased insecticide-treated mosquito net (ITN) distribution on child mortality in Malawi between 2004-2010. Using national survey and ITN distribution data at the district level, the researchers conducted a statistical analysis controlling for socioeconomic factors. They found that higher levels of ITN distribution were significantly associated with lower under-five mortality. Specifically, districts with over 0.25 ITNs per person experienced an 11% reduction in child deaths compared to districts with lower ITN levels. This suggests increased ITN coverage contributed meaningfully to the overall decline in under-five mortality in Malawi during this period.
Exploring the use of routinely-available, retrospective data to study the ass...HFG Project
Country-level evidence on the impact of malaria control on micro-economic outcomes is vital for mobilizing domestic and donor resources for malaria control. Using routinely available survey data could facilitate this investigation in a cost-efficient way. The authors of this study used Malaria Indicator Surveys (MIS) and Living Conditions Monitoring Survey (LCMS) data from 2006 to 2010 for all 72 districts in Zambia to relate malaria control scale-up with household food spending (proxy for household well-being), educational attainment and agricultural production.
The authors used two quasi-experimental designs: (1) a generalized propensity score for a continuous treatment variable (defined as coverage from owning insecticide-treated bed nets and/or receipt of indoor residual spraying); and, (2) a district fixed effects model to assess changes in the outcome relative to changes in treatment pre-post scale-up. The unit of analysis was at district level. The authors also conducted simulations post-analysis to assess statistical power.
MRC/HIVAN KZN AIDS Forum - 30/10/12 - Challenges and Opportunities for HIV/AI...info4africa
This presentation was given on 30/10/12 at the MRC/HIVAN KZN AIDS Forum.
Co-presented by Kwazi Mbatha (CEGAA Researcher/Trainer) and Mlungisi Vila kasi (TAC Community Mobiliser - uMgungundlovu), this talk was facilitated by Judith King (CEGAA Communications and Advocacy Manager).
For more information on CEGAA please visit their website: http://www.cegaa.org/
Pension systems and reforms are critically influenced by demographic developments that are increasingly compared across countries to identify common issues and trends. For demographic projections researchers across the world rely on those produced by the United Nations; for Europe the demographic projections by Eurostat form the basis of the periodic aging report by the EU Commission. While these projections are technically well done the underlying assumptions for the demographic drivers – fertility, mortality and migration – in the central variants are limited and are largely flawed. Worse, they risk offering a wrong picture about the likely future developments and the relevant alternatives. This paper investigates the assumptions of the demographic drivers by UN and Eurostat, compares it with those by national projections in Portugal and Spain, and offers a review of alternative, recent and cutting edge approaches to project demographic drivers that go beyond the use of past demographic developments. They suggest that economic and other socio-economic developments have a main bearing on future trends in fertility, mortality and migration. And they support the assessment that the UN/Eurostat projected re-increase in fertility rates may not take place, that the increase in life expectancy may be much larger, that the future flows of net migrants to EU countries may be much higher and rising. The resulting overall underestimation of population aging has a bearing on the financial sustainability of the pension systems and reform choices, a topic to be explored in the next papers.
Predictive analysis WHO's life expectancy dataset using Tableau data visualis...Tarun Swarup
This document discusses a statistical analysis of factors influencing life expectancy using data from the World Health Organization and United Nations. It describes the dataset, variables considered, and objectives of analyzing relationships between life expectancy and factors like immunization rates, mortality rates, economics, and demographics. Four dashboards are proposed to analyze trends in adult mortality rates, compare life expectancy and infant death rates in populated countries, forecast adult mortality and hepatitis rates in Brazil, and compare GDP in developed and developing countries.
There are numerous changes taking place in South Africa, in the economy, politics and health. All these are interdependent and embedded in a social milieu which brings a number of pressures on health services and systems. The major event in the medium to long term is the impact of the National Health Insurance. Other contextual factors of importance include the range of social determinants of health and disease, with the provision of water, sanitation, electricity and housing being the key services. South Africa will also be influenced in the future by the major diseases it harbours at present. This seminar provided some insight into how these factors will impact on the South African Health Services.
The impact of the global financial crisis on reproductive and maternal health...UN Global Pulse
Executive summary of the United Nations Population Fund (UNFPA) research: “The Impact of the Global Financial Crisis on Reproductive and Maternal Health in Jordan,” conducted as part of UN Global Pulse’s Rapid Impact and Vulnerability Assessment Fund (RIVAF). For more information: http://www.unglobalpulse.org/projects/rapid-impact-and-vulnerability-analysis-fund-rivaf
Trends in future health financing and coverage: future health spending and un...Henar Rebollo Rodrigo
This document summarizes projections of global health spending from 2015 to 2040 under different scenarios. The main findings are:
1) Global health spending is projected to increase from $10 trillion in 2015 to $20 trillion in 2040 under the reference scenario.
2) Per capita health spending is projected to increase the fastest in upper-middle-income countries, followed by lower-middle-income and low-income countries.
3) Despite overall growth, per capita health spending in 2040 is projected to range from only $40-$413 in low-income countries and $140-$1699 in lower-middle-income countries.
4) The share of health spending covered by pooled resources (government
Supplementary Actuarial Analysis of HIV/AIDS in Lagos State, NigeriaHFG Project
This document provides a supplementary actuarial analysis of including HIV/AIDS coverage in the Lagos State Health Scheme benefit package in Nigeria. It estimates the total additional medical cost to cover HIV/AIDS services would be 209.40 Naira per person per year, broken down into costs for HIV testing and counseling (13.60), antiretroviral therapy (133.05), and preventing mother-to-child transmission (15.96). The analysis is based on HIV service data from 2012-2016 and projected population and drug cost data from the Lagos State Ministry of Health. It assumes a 90% continuation and conversion rate for antiretroviral therapy and a 6.5% annual medical cost trend.
The document summarizes HIV and AIDS response efforts in Lagos, Nigeria led by the Lagos State Agency for the Control of AIDS (LSACA). Key points include:
- LSACA's vision is a stigma-free Lagos with low HIV incidence, and its mission is to coordinate HIV control activities, reduce incidence, and mitigate impacts.
- HIV prevalence in Lagos has declined from 6.8% in 1991 to 1.4% in 2014 due to testing and treatment programs. Over 100,000 people are currently on antiretroviral therapy.
- Priority interventions include achieving UNAIDS 95-95-95 targets by 2025, scaling up prevention of mother-to-child transmission, and
Minnesota’s accountable communities for health soder145
The document summarizes Minnesota's Accountable Communities for Health (ACH) grant program and lessons from its first year. It provides context on the federal State Innovation Model initiative and Minnesota's Accountable Health Model. It then describes the ACH program, which funds 15 community collaboratives to coordinate care and implement prevention strategies. It outlines ACH experiences and highlights data sources for the state's multi-year evaluation, including interviews that identified accomplishments, barriers, and lessons learned from grantees in the program's first year.
Impact and cost effectivene of rotavirus vaccine introduction in afghanistanNajibullah Safi
This document provides a summary of a cost-effectiveness analysis of introducing rotavirus vaccination in Afghanistan. The analysis finds that vaccination would be highly cost-effective compared to no vaccination. It estimates that over 10 years, vaccination could avert over 1 million cases, 661,000 outpatient visits, 49,000 hospitalizations and nearly 12,000 deaths. The incremental cost per disability-adjusted life year averted is estimated to be $103-$59 depending on perspective, below Afghanistan's GDP per capita threshold for cost-effectiveness. Sensitivity analysis showed results were robust to varying parameters like disease burden and vaccine price. The document discusses limitations and next steps to support government adoption of vaccination.
Kazal 6e data sources, uses and limitationsSizwan Ahammed
The document discusses various data sources available for analyzing food security in Bangladesh, including household surveys, nutrition surveys, and agricultural statistics. It describes the domains and indicators covered by each data source, as well as limitations related to their coverage, availability, and validity. Understanding these data sources is important for research, monitoring, evaluation, and informing policy decisions around food security.
Minnesota Accountable Health Model Continuum of Accountability Assessment: Ev...soder145
The document discusses Minnesota's Accountable Health Model and its Continuum of Accountability Assessment tool. It provides an overview of the tool, which assesses organizations on their capabilities and functions across 7 categories. It presents preliminary findings from completed assessment tools, including higher and lower average scores. It also compares scores between grant programs and urban vs. rural organizations. Evaluation of the tool will continue to track progress along the continuum over time.
Kano State has a population of over 9 million people, most of whom live rurally. The state has high rates of HIV, tuberculosis, maternal mortality, and child mortality. USAID/HFG has worked in Kano State to establish a Technical Working Group on tuberculosis funding and advocate for the inclusion of TB services in the state's contributory health insurance scheme. Key accomplishments include establishing a functional TWG, conducting an analysis of TB burden and funding gaps, and building stakeholder capacity in health financing. Challenges include untimely release of funds and limitations of the project's duration. Continued advocacy and establishing follow-on support are recommended.
Implementation of bphsphc afghanistan experience august 2019Najibullah Safi
The document discusses Afghanistan's experience implementing the Basic Package of Health Services (BPHS) and Essential Package of Hospital Services (EPHS) through contracting non-governmental organizations (NGOs) since 2003. Key points include:
1) NGOs deliver health services in 31 of 34 provinces through competitive bidding managed by the Ministry of Public Health. Services are financed through international donors.
2) The BPHS defines 7 elements of primary health care including maternal and newborn care, child health and immunization, public nutrition, communicable disease treatment and control, mental health, disability and rehabilitation, and essential drug supply.
3) Health indicators like immunization rates and access to maternal health
IOSR Journal of Pharmacy (IOSRPHR), www.iosrphr.org, call for paper, research...iosrphr_editor
The document discusses alternative sustainable financing options for primary health care services in Kenya. It notes that while the Kenyan government is committed to providing quality primary health care, budgetary allocations to health care have declined and out-of-pocket spending is high. User fees intended to increase cost recovery have negatively impacted access to care. The study examines alternative financing mechanisms that could help mitigate these trends, such as pooling funds to protect the poor from catastrophic costs, establishing taxes specifically for health care, and issuing bonds for health infrastructure. However, identifying the poor and providing safety nets like waivers will be important for the success of any new mechanisms.
District Layyah Budget Trends Analysis for Advocacy by LR 19042015DUNYA NEWS
The document analyzes the medicines budget for the district of Layyah, Punjab from 2010-2015. It finds that over this period, the budget demanded increased but the budget allocated, released, and utilized all decreased. Specifically, the medicines budget allocated for 2014-2015 was Rs. 58.06 million compared to Rs. 74.73 million in 2010-2011. This represents only a 35% allocation against the demand that year. The document also notes per capita health spending is very low in Layyah compared to international standards and recommends increasing budget allocations and ensuring full utilization to improve healthcare.
Post reform changes in health care access and affordability in MN soder145
This document summarizes a presentation on changes in health care access and affordability in Minnesota following health care reforms. It analyzes data from Minnesota health surveys from 2007-2015. Key findings include: most Minnesotans have a usual source of care, though the uninsured report less access; while access has improved for many, some face issues getting appointments or with provider acceptance; forgone care due to costs has decreased for routine and mental care but remains an issue for low-income residents; and the percentage of people with medical bill or basic needs payment problems has declined since 2013 reforms.
This impact brief outlines the ways in which SIAPS works with USAID Bangladesh & Ministry of Health and Family Welfare to improve access to contraceptives in Bangladesh by strengthening pharmaceutical and supply chain systems.
1) The Salud Mesoamérica 2015 Initiative (SM2015) is a public-private partnership aimed at reducing maternal and child health inequalities in Central America and Chiapas, Mexico through a results-based financing model.
2) The results-based financing model provides initial funding to implement evidence-based maternal and child health interventions for the poorest 20% of populations, and provides additional incentive funds if countries meet at least 80% of agreed-upon targets.
3) Surveys found that coverage of important interventions and health outcomes remained low for the poorest populations, revealing inequalities hidden by national averages. However, countries made advances in increasing availability of supplies and equipment, and coverage of certain
Effective implementation of national health strategy finalNajibullah Safi
The document outlines key actions for effective implementation of Afghanistan's national health strategy 2016-2020 to achieve universal health coverage. The actions include expanding health services coverage and packages, enhancing financial protection, improving coordination, strengthening accountability, increasing efficiency, and addressing cross-cutting issues such as capacity building and private sector regulation. The overall goal is to ensure all Afghans have access to needed health services without financial hardship.
This document provides an overview of health information systems and descriptive statistics. It defines a health information system as a mechanism for collecting, processing, analyzing, and transmitting health data required for operating health services. Key components of health information systems include demography, health status, health resources, and service utilization. Sources of health information include censuses, vital event registration, sample registration systems, disease notification, and hospital and health service records. Descriptive statistics are used to organize and present health data in tables and graphs. Measures of central tendency and dispersion are discussed for describing key characteristics of health data.
Este documento presenta una rúbrica de perfiles para evaluar el desempeño docente. La rúbrica contiene una serie de indicadores sobre las prácticas docentes y su nivel de cumplimiento, el cual puede ser "siempre", "casi siempre" o "nunca". Los indicadores se refieren a actividades como el diseño de situaciones didácticas, la organización de la enseñanza, el uso de estrategias pedagógicas y la evaluación del aprendizaje de los estudiantes.
Witlon PM is a full service construction and project management firm offering estimating, cost engineering, planning, and scheduling services. They have over 30 years of field experience in construction. They can provide experienced, certified personnel including project managers, schedulers, construction managers, estimators, engineers, inspectors, and safety officers. They also offer project controls implementation and construction support services to help drive success and keep projects on budget and on schedule.
There are numerous changes taking place in South Africa, in the economy, politics and health. All these are interdependent and embedded in a social milieu which brings a number of pressures on health services and systems. The major event in the medium to long term is the impact of the National Health Insurance. Other contextual factors of importance include the range of social determinants of health and disease, with the provision of water, sanitation, electricity and housing being the key services. South Africa will also be influenced in the future by the major diseases it harbours at present. This seminar provided some insight into how these factors will impact on the South African Health Services.
The impact of the global financial crisis on reproductive and maternal health...UN Global Pulse
Executive summary of the United Nations Population Fund (UNFPA) research: “The Impact of the Global Financial Crisis on Reproductive and Maternal Health in Jordan,” conducted as part of UN Global Pulse’s Rapid Impact and Vulnerability Assessment Fund (RIVAF). For more information: http://www.unglobalpulse.org/projects/rapid-impact-and-vulnerability-analysis-fund-rivaf
Trends in future health financing and coverage: future health spending and un...Henar Rebollo Rodrigo
This document summarizes projections of global health spending from 2015 to 2040 under different scenarios. The main findings are:
1) Global health spending is projected to increase from $10 trillion in 2015 to $20 trillion in 2040 under the reference scenario.
2) Per capita health spending is projected to increase the fastest in upper-middle-income countries, followed by lower-middle-income and low-income countries.
3) Despite overall growth, per capita health spending in 2040 is projected to range from only $40-$413 in low-income countries and $140-$1699 in lower-middle-income countries.
4) The share of health spending covered by pooled resources (government
Supplementary Actuarial Analysis of HIV/AIDS in Lagos State, NigeriaHFG Project
This document provides a supplementary actuarial analysis of including HIV/AIDS coverage in the Lagos State Health Scheme benefit package in Nigeria. It estimates the total additional medical cost to cover HIV/AIDS services would be 209.40 Naira per person per year, broken down into costs for HIV testing and counseling (13.60), antiretroviral therapy (133.05), and preventing mother-to-child transmission (15.96). The analysis is based on HIV service data from 2012-2016 and projected population and drug cost data from the Lagos State Ministry of Health. It assumes a 90% continuation and conversion rate for antiretroviral therapy and a 6.5% annual medical cost trend.
The document summarizes HIV and AIDS response efforts in Lagos, Nigeria led by the Lagos State Agency for the Control of AIDS (LSACA). Key points include:
- LSACA's vision is a stigma-free Lagos with low HIV incidence, and its mission is to coordinate HIV control activities, reduce incidence, and mitigate impacts.
- HIV prevalence in Lagos has declined from 6.8% in 1991 to 1.4% in 2014 due to testing and treatment programs. Over 100,000 people are currently on antiretroviral therapy.
- Priority interventions include achieving UNAIDS 95-95-95 targets by 2025, scaling up prevention of mother-to-child transmission, and
Minnesota’s accountable communities for health soder145
The document summarizes Minnesota's Accountable Communities for Health (ACH) grant program and lessons from its first year. It provides context on the federal State Innovation Model initiative and Minnesota's Accountable Health Model. It then describes the ACH program, which funds 15 community collaboratives to coordinate care and implement prevention strategies. It outlines ACH experiences and highlights data sources for the state's multi-year evaluation, including interviews that identified accomplishments, barriers, and lessons learned from grantees in the program's first year.
Impact and cost effectivene of rotavirus vaccine introduction in afghanistanNajibullah Safi
This document provides a summary of a cost-effectiveness analysis of introducing rotavirus vaccination in Afghanistan. The analysis finds that vaccination would be highly cost-effective compared to no vaccination. It estimates that over 10 years, vaccination could avert over 1 million cases, 661,000 outpatient visits, 49,000 hospitalizations and nearly 12,000 deaths. The incremental cost per disability-adjusted life year averted is estimated to be $103-$59 depending on perspective, below Afghanistan's GDP per capita threshold for cost-effectiveness. Sensitivity analysis showed results were robust to varying parameters like disease burden and vaccine price. The document discusses limitations and next steps to support government adoption of vaccination.
Kazal 6e data sources, uses and limitationsSizwan Ahammed
The document discusses various data sources available for analyzing food security in Bangladesh, including household surveys, nutrition surveys, and agricultural statistics. It describes the domains and indicators covered by each data source, as well as limitations related to their coverage, availability, and validity. Understanding these data sources is important for research, monitoring, evaluation, and informing policy decisions around food security.
Minnesota Accountable Health Model Continuum of Accountability Assessment: Ev...soder145
The document discusses Minnesota's Accountable Health Model and its Continuum of Accountability Assessment tool. It provides an overview of the tool, which assesses organizations on their capabilities and functions across 7 categories. It presents preliminary findings from completed assessment tools, including higher and lower average scores. It also compares scores between grant programs and urban vs. rural organizations. Evaluation of the tool will continue to track progress along the continuum over time.
Kano State has a population of over 9 million people, most of whom live rurally. The state has high rates of HIV, tuberculosis, maternal mortality, and child mortality. USAID/HFG has worked in Kano State to establish a Technical Working Group on tuberculosis funding and advocate for the inclusion of TB services in the state's contributory health insurance scheme. Key accomplishments include establishing a functional TWG, conducting an analysis of TB burden and funding gaps, and building stakeholder capacity in health financing. Challenges include untimely release of funds and limitations of the project's duration. Continued advocacy and establishing follow-on support are recommended.
Implementation of bphsphc afghanistan experience august 2019Najibullah Safi
The document discusses Afghanistan's experience implementing the Basic Package of Health Services (BPHS) and Essential Package of Hospital Services (EPHS) through contracting non-governmental organizations (NGOs) since 2003. Key points include:
1) NGOs deliver health services in 31 of 34 provinces through competitive bidding managed by the Ministry of Public Health. Services are financed through international donors.
2) The BPHS defines 7 elements of primary health care including maternal and newborn care, child health and immunization, public nutrition, communicable disease treatment and control, mental health, disability and rehabilitation, and essential drug supply.
3) Health indicators like immunization rates and access to maternal health
IOSR Journal of Pharmacy (IOSRPHR), www.iosrphr.org, call for paper, research...iosrphr_editor
The document discusses alternative sustainable financing options for primary health care services in Kenya. It notes that while the Kenyan government is committed to providing quality primary health care, budgetary allocations to health care have declined and out-of-pocket spending is high. User fees intended to increase cost recovery have negatively impacted access to care. The study examines alternative financing mechanisms that could help mitigate these trends, such as pooling funds to protect the poor from catastrophic costs, establishing taxes specifically for health care, and issuing bonds for health infrastructure. However, identifying the poor and providing safety nets like waivers will be important for the success of any new mechanisms.
District Layyah Budget Trends Analysis for Advocacy by LR 19042015DUNYA NEWS
The document analyzes the medicines budget for the district of Layyah, Punjab from 2010-2015. It finds that over this period, the budget demanded increased but the budget allocated, released, and utilized all decreased. Specifically, the medicines budget allocated for 2014-2015 was Rs. 58.06 million compared to Rs. 74.73 million in 2010-2011. This represents only a 35% allocation against the demand that year. The document also notes per capita health spending is very low in Layyah compared to international standards and recommends increasing budget allocations and ensuring full utilization to improve healthcare.
Post reform changes in health care access and affordability in MN soder145
This document summarizes a presentation on changes in health care access and affordability in Minnesota following health care reforms. It analyzes data from Minnesota health surveys from 2007-2015. Key findings include: most Minnesotans have a usual source of care, though the uninsured report less access; while access has improved for many, some face issues getting appointments or with provider acceptance; forgone care due to costs has decreased for routine and mental care but remains an issue for low-income residents; and the percentage of people with medical bill or basic needs payment problems has declined since 2013 reforms.
This impact brief outlines the ways in which SIAPS works with USAID Bangladesh & Ministry of Health and Family Welfare to improve access to contraceptives in Bangladesh by strengthening pharmaceutical and supply chain systems.
1) The Salud Mesoamérica 2015 Initiative (SM2015) is a public-private partnership aimed at reducing maternal and child health inequalities in Central America and Chiapas, Mexico through a results-based financing model.
2) The results-based financing model provides initial funding to implement evidence-based maternal and child health interventions for the poorest 20% of populations, and provides additional incentive funds if countries meet at least 80% of agreed-upon targets.
3) Surveys found that coverage of important interventions and health outcomes remained low for the poorest populations, revealing inequalities hidden by national averages. However, countries made advances in increasing availability of supplies and equipment, and coverage of certain
Effective implementation of national health strategy finalNajibullah Safi
The document outlines key actions for effective implementation of Afghanistan's national health strategy 2016-2020 to achieve universal health coverage. The actions include expanding health services coverage and packages, enhancing financial protection, improving coordination, strengthening accountability, increasing efficiency, and addressing cross-cutting issues such as capacity building and private sector regulation. The overall goal is to ensure all Afghans have access to needed health services without financial hardship.
This document provides an overview of health information systems and descriptive statistics. It defines a health information system as a mechanism for collecting, processing, analyzing, and transmitting health data required for operating health services. Key components of health information systems include demography, health status, health resources, and service utilization. Sources of health information include censuses, vital event registration, sample registration systems, disease notification, and hospital and health service records. Descriptive statistics are used to organize and present health data in tables and graphs. Measures of central tendency and dispersion are discussed for describing key characteristics of health data.
Este documento presenta una rúbrica de perfiles para evaluar el desempeño docente. La rúbrica contiene una serie de indicadores sobre las prácticas docentes y su nivel de cumplimiento, el cual puede ser "siempre", "casi siempre" o "nunca". Los indicadores se refieren a actividades como el diseño de situaciones didácticas, la organización de la enseñanza, el uso de estrategias pedagógicas y la evaluación del aprendizaje de los estudiantes.
Witlon PM is a full service construction and project management firm offering estimating, cost engineering, planning, and scheduling services. They have over 30 years of field experience in construction. They can provide experienced, certified personnel including project managers, schedulers, construction managers, estimators, engineers, inspectors, and safety officers. They also offer project controls implementation and construction support services to help drive success and keep projects on budget and on schedule.
El documento analiza los diferentes tipos de violencia que pueden sufrir los niños, incluyendo el maltrato emocional, el maltrato por negligencia institucional, la violencia física y la violencia sexual. Explora las causas, consecuencias y efectos en el comportamiento escolar de cada tipo de violencia. En general, la violencia contra los niños puede afectar negativamente su desarrollo físico, cognitivo y emocional, y generar problemas como baja autoestima, rendimiento escolar bajo y déficit de atención.
Reserve Trucking Inc. is a leading freight forwarding company located in Island Park, New York that offers a wide variety of freight transportation and logistics services in Long Island. The company specializes in courier services, bulk cargo import and export, and domestic distribution. Reserve Trucking consolidates land freight transport throughout Venezuela and aims to attract capable people to help ensure hard work and constant improvement. The company has created conditions to offer small and medium enterprises not only transportation services and logistics for goods, but also to serve as a hub to offer and fill their products. Reserve Trucking's mission is to provide the most efficient and reliable specialized transportation and general cargo services based on extensive experience to meet customer needs and contribute to sustainable development.
Este documento resume el discurso del Lehendakari durante un acto de entrega de documentación histórica del Instituto Aranzadi al Instituto Gogora. Se agradece a Aranzadi el trabajo realizado desde 2002 para investigar a personas desaparecidas durante la Guerra Civil española. La documentación entregada contiene información valiosa sobre víctimas y violaciones a los derechos humanos durante la guerra y la dictadura que ahora será gestionada y puesta a disposición del público por el Instituto Gogora.
This document discusses the design and operation of a satellite-based solar power system (SSPS). It describes how an SSPS would collect solar energy using photovoltaic cells, convert it to microwave power using a DC to microwave converter, and transmit the power to rectennas on Earth using a large transmitting antenna. It discusses the technical requirements and challenges of SSPS including high efficiency power transmission and conversion, deployment in space, and addressing problems like interference. SSPS could help meet increasing energy demand through a renewable source with uninterrupted 24/7 power generation and without pollution.
1. The document discusses poverty measurement in India, including definitions of poverty and key indicators used to measure poverty such as head count ratio, poverty gap index, and squared poverty index. It also discusses income and non-income indicators of poverty like the Human Development Index.
2. The Indian economy has undergone structural changes with a shift to a more market-oriented development strategy in the 1990s. This has led to a decline in the share of the primary sector (agriculture) and rising shares of the secondary (industry) and tertiary (services) sectors. Services have become the major driver of growth in India's economy.
3. Factors like the growth of IT and knowledge industries, and rising demand
SocialCops and UN Papua New Guinea: Presentation for Data Stocktaking WorkshopSocialCops
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Bad Effects of Urbanization and Lifestyles, Population Health Improvements us...IRJET Journal
This document discusses the effects of urbanization and modern lifestyles on population health. It notes that urban populations face increased risk of spreading infectious diseases due to population density. Lifestyles in urban areas have also become less physically active. However, urban populations may have better access to healthcare and immunizations. The document proposes using predictive analytics and machine learning on healthcare data to predict future population health trends based on current lifestyles and identify ways to improve health outcomes. It evaluates several classification algorithms on a diabetes dataset and finds that a Naive Bayes classifier achieved the best performance. Suggested countermeasures to improve urban population health include promoting sustainable urbanization and economic reinvestment in healthcare.
The document analyzes health care access in Bangladesh using data from a survey of 664 households. It investigates the determinants of illness, choice of health care provider, and household out-of-pocket health expenditures. The summary is:
- The study uses survey data from 664 Bangladeshi households to analyze factors that influence illness, choice of health care provider, and household health care spending.
- Independent variables include individual characteristics, illness conditions, health facility attributes, household characteristics, environment, and economic status. Dependent variables include illness, choice of provider, and out-of-pocket expenditures.
- Preliminary univariate analysis of the survey data shows that 59% of respondents were young adults
This systematic review analyzed 12 studies on open defecation-free slippage in Ethiopia. The estimated pooled rate of slippage, where households engaged in open defecation after being certified open defecation-free, was 15.9%. Main contributing factors for slippage included lack of technical support, financial constraints, low-quality building materials, improper program implementation, and lack of sanitation marketing. The increasing rate of slippage puts Ethiopia at risk of not achieving its goal of ensuring sanitation for all by 2030.
This policy paper proposes alternatives to improve India's oral health care system. The current system has high rates of oral diseases but lacks access in rural areas. Three alternatives are proposed: 1) Strengthen the dental workforce by training them to provide primary care in rural areas. 2) Develop epidemiological research to inform needs-based policies. 3) Maintain the status quo. The alternatives are evaluated based on improving health, cost-effectiveness, and cost of implementation. Strengthening the workforce and research score highest by improving health while research is most cost-effective.
An Empirical Study on the Change of Consumption Level of Chinese ResidentsDr. Amarjeet Singh
With the rapid development of Chinese economy since the reform and opening up, people's living standards have been improved, and people's consumption level has been gradually improved. Consumption plays an important role in stimulating economic growth. At present, China needs to adjust its economic structure and optimize its industrial structure. Therefore, it is very important to analyze the factors that affect the consumption level of Chinese residents and study the main factors for promoting the healthy and sustainable development of Chinese economy. Therefore, based on the statistical data from 1995 to 2018, this paper collects the variable data that affects the consumption level of residents, such as the freight volume of infrastructure railway and highway, the per capita disposable income of national residents, ordinary college students, the consumer price index of residents, the average real wage index and the gross domestic product. And through the establishment of multiple linear regression model and the stepwise regression, the paper also finds out the main factors influencing the consumption level of residents. Using R language and analyzing the results of the research, we can draw the conclusion that the national per capita disposable income, ordinary college students and consumer price index and GDP are the main factors that affect the consumption level of Chine.
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In short, countries need to make their limited health resources go a long way. It is a financing challenge as well as a governance one. Countries cannot manage what they cannot measure. Countries need to measure their health spending – know where the money comes from, how much is spent and where, and how it can be spent more efficiently and equitably.
Policymakers can influence public and private health spending to improve efficiency, quality, equity, and expand access to life-saving health services. To succeed, however, governments need evidence around their health financing landscape. More and more, policymakers are appreciating the value of health resource tracking –that is, a range of methods, data collection initiatives, and estimation tools aimed at measuring the flow of funds to and through the health system.
Follow the Money: Making the Most of Limited Health ResourcesHFG Project
Worldwide, health systems are being asked to do more with less. In many countries, donor funds have stagnated or are declining. This sharp decline could have broad implications for the health sector— particularly Namibia’s HIV and AIDS response which relies heavily on donor resources. New and emerging threats, such as Zika and Ebola, are also testing weak and fragile health systems, such as those in Guinea and Liberia. And costly noncommunicable diseases, like diabetes and cancers, are on the rise in low- and middle-income countries (LMICs).
With the end of the MDGs and start of the new SDGS, momentum is growing for countries around the world to pursue Universal Health Coverage (UHC) reforms and to expand affordable access to health care services, without risk of financial hardship, while facing real resource constraints in the aftermath of the global economic crisis.
In short, countries need to make their limited health resources go a long way. It is a financing challenge as well as a governance one. Countries cannot manage what they cannot measure. Countries need to measure their health spending – know where the money comes from, how much is spent and where, and how it can be spent more efficiently and equitably.
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3. Capital expenditure was found to have a full mediating role, where it indirectly mediated the effect of fiscal independence level on human development index.
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1. Strengthening existing public health infrastructure in cities by establishing Primary Urban Health Centers (PUHCs) to improve access and referrals.
2. Partnering with non-governmental providers to fill gaps in health services through models like public-private partnerships.
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Background: In 2007, the government of the republic of Tanzania has launched the Primary Health care services development programme as one of the renewed efforts to effectively engage the healthy sector in poverty reduction strategies. The study was dealing with evaluation on the factors that affects health services delivery to private hospital facilities Method: Data was collected from 169 patients who are customers of KMH and two sampling techniques were used, namely purposive sampling and random sampling. The study use questionnaire and interviews together with documentary review together information concerning the study objective. Quantities data were analyzed through SPPS data were coded ruined to observe to which percent the variables were significant or not significant towards research objectives. Results: The study finding that there are factors that are challenges towards delivering health services to patients including absence of good communication, customer care, shortage number of health professionals and most of patients are not attended on time, however on other hand study discover that there factors pull health services delivery including presence of social media, good infrastructures that support patients from far and presence of NHIF services to KMH. Recommendations: This study recommends that Private Public Partnership should be more emphasized and applied in health sector for the aim of improving health survives delivery to patients. Conclusion: The study concludes that although much has been done over many years to restructure the health care system and to improve the quality of care being rendered to patients, the literature reveals that a lot of people in Mwanza city still suffer from getting quality health services from health facilities including hospitals which are owned by private institutions.
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1) Developing area-specific 2-year health plans at the sub-district level to address priority health issues like malaria, with involvement from medical officers, staff, and community stakeholders.
2) Establishing incentives for community participation in health as well as career growth for medical professionals involved in implementing plans.
3) Mobilizing resources from various sources including government budgets, private partnerships, and financing institutions to strengthen infrastructure and ensure accessibility of healthcare for all.
The model aims to improve health outcomes through inter-sectoral coordination and making primary healthcare systems proactive and sustainable.
1. 1 |C h u
Justin Chu
11/9/15
ECON 171a
India’s Sanitation Push: Impact on Mortality
Introduction:
For the past two decades, the Indian government has made a strong push to eliminate
open defecation, especially in rural areas due to the prevalence of death through rotaviruses –
viruses transmitted through the fecal-oral route. These viruses cause nearly 334,000 deaths
among children out of the 2.3 million deaths in India each year – nearly 15% of all deaths.1
The
main cause for such prevalence of these diseases in India is a lack of sanitary toilets in many
village centers which causes many residents to resort to open defecation. Starting in 1992, the
Indian government launched a program called Nirmal Bharat Abhiyan (renamed the Total
Sanitation Campaign in 2012) to incentivize community-led total sanitation (CLTS). This CLTS
effort revolved around providing localized means of construction through toilet construction
subsidies and lump sums to villages marked as “open defecation free.”2
. After his election in
2014, Indian Prime Minister Narendra Modi launched Swachh Bharat Abhiyan (Clean India
Mission) which launched the biggest cleanliness drive in Indian history.3
The majority of this
program focuses on the construction of Individual Household Latrines (further known as
IHHLs), cluster, community, and school toilets in all Gram Panchayats (municipalities).4
Part of
this program brought the monitoring into the social media realm with the inception of an app
used to take pictures and track progress of each finished construction project in a central internet
database. This database is sorted by time, state, and construction type; by sorting this data with
1
“Rotavirus mortality in India: estimates based on a nationally representative survey of diarrhoeal deaths,” World
Health Organization, Bulletin of the World Health Organization, 2012; vol. 90: 720-727.
2
“Restructuring of the Nirmal Bharat Abhiyan into Swachh Bharat Mission,” Press Information Bureau,
Government of India, Sep 24 2014.
3
Ibid.
4
Ibid.
2. 2 |C h u
diagnosed deaths from diarrheal diseases, one can begin to regress the effects of the new toilet
implementation program on overall health.
Literature Review:
For the bulk of the data in terms of application of the program, the source will be the
SBM website which carries the completed construction data based on the number of unique
geotags placed by each district user. Unfortunately, access does not always equate to utilization
as many of the rural poor feel as though these new toilets are not beneficial or necessary to their
own lives.5
In addition, many of our human development numbers on an annual basis will come
from the Center Bureau for Health Intelligence as well as the Annual Status of Education Report
which is facilitated by Pratham. As was previously stated, these numbers may not truly reflect
the overall impact of these individual variables in India; however, they offer very comprehensive
health and education surveys respectively, especially on the state-level. By utilizing these more
focused studies, one can create a more satisfactory model.
The main area of focus for the research will be the states of Uttar Pradesh, Madhya
Pradesh, and Rajasthan which are all along the northern edge of India. These states were chosen
due to their BIMARU status which is an acronym of the state names which is coincidentally – or
not – very similar to the Hindi word bimar meaning "sick." Bihar was not chosen due to the lack
of reported data in terms of both the SBM/NBA and disease death related data. These BIMARU
states share geographical boundaries as well as the fact that they all lag behind the rest of India in
terms of overall development factors such as real GDP growth and human development goals.
By targeting these less-developed areas, the impact of the program itself as opposed to other state
5
“PM Modi fulfills promise of 80 lakh toilets but not many takers in rural India,” Sharma, Neetu: India Today, Aug
14, 2015. Web.
3. 3 |C h u
factors should be more distinct especially given their relatively similar low strata of each state
involved.
In terms of other studies referenced, press releases and other similar nongovernmental
organizations reflecting general conditions of water and sanitation within the borders; however,
the bulk of the literature will come from the data provided by the state level and the reflections
provided in the model. In addition, the Indonesian government started a similar program which
can serve part of understanding the challenges facing India. Since the program is still developing,
many of the studies and accompanying surveys that would address the SBM’s efficacy are not
completed; despite that, India, and especially the Indian government, utilized similar structures
in their push to mitigate air and water pollution which is analyzed in a paper by Michael
Greenstone and Rema Hanna called Environmental Regulations, Air and Water Pollution, and
Infant Mortality in India. While the aforementioned government programs are not perfect
representations of the SBM, they each serve as important proxy lessons to create an analytic
apparatus for the SBM. The model combined with third-party research and on-the-ground stories
in newspapers and magazines will serve as the basis of the policy conclusions by combining
empirical statistics and insider perspective to create the most accurate picture as many of the
numbers can be deceptive without utilizing the most pertinent information.
Model
The basis of the model is a non-linear state-fixed effects regression in which nearly all of
the variables are being measured with the natural logarithm transformation applied to them. The
natural logarithmic transformation on the dependent variable (Yjt), total instances of diarrhea or
diarrheal deaths, and the independent variables: total toilets constructed, GDP per capita, total
Model 1 - Nonlinear regression using income
4. 4 |C h u
sanitation facilities (for drinking water) constructed, boils down the analysis to the forms of
percentages. For example, a 10% increase of an independent variable will result in a 1.10*β (the
coefficient in front of the dependent variable) change in the dependent variable. By using a non-
linear approach, the implicit assumption is that toilet construction, while holding all other factors
constant, does not have a fixed impact on instances of disease and death regardless of existing
facilities. In addition, the state fixed effects are measured in the (n-1) model in which the first
state is dropped and measured through the constant and the other states are attributed to certain
state ids.
In the above equation, β1 represents overall toilets constructed. β2 is measured in level 1 –
a baseline test for literacy issued to children which serves as a proxy for parental education since
many of these illiterate children most likely come from illiterate households and vice versa –
rural literacy rates. β3 is the GDP per capita as measured by overall GDP produced by each state
divided by the population and measured in crores, and β4 is the annual state production of
covered water dispensaries to combat clean water problems in the area. In addition, µt represents
the fixed effects of each state (Uttar Pradesh, Madhya Pradesh, and Rajasthan). As is the case in
all regressions, these variables were chosen to address any omitted variables that may have an
impact on Yjt beyond toilet construction. Literacy and extended education as a result, income,
and construction of clean water projects all could have an impact on conception of an easily-
transmitted, yet easily-avoided malady like acute diarrhea. The observations take five years’
worth of data on the state-by-state annual statistics; therefore, with the five years from 2010-
2014 and the three states, there are 15 observations in the panel data model.
However, the model can be tweaked in a more focused way to understand how the SBM
and NBA affected people and consequently – the impact of the program on disease. For the
5. 5 |C h u
NBA, the program paid households subsidies to build the toilets in their own homes. The
government offered 4600 rupees to any homeowner, especially poor home owners, to construct
their own individual toilets.6
As a result, there exists an interaction factor between individual
toilet constructions because building a toilet has the cash incentive which may make the
homeowner more likely to begin construction of the toilet, consequently, impacting their disease
instances. Due to the multicollinearity of GDP per capita and the interaction term of the
continuous variable of GDP per capita and toilets constructed, the variable for GDP per capita is
dropped out and exchanged for the interaction term.
Model 2 - New regression with interaction term
Data
For the 15 panel observations, most of the data falls into a relatively reasonable range
when applying the natural logarithmic transformation; unfortunately, when trying to expand the
observations by increasing the time scale from annual to quarterly or monthly is not applicable as
many of the observations fluctuate in random patterns as the construction numbers are delayed in
their reporting. Subsequently, the same problem emerges when attempting to use district level
data as the other data such as cases of acute diarrhea or literacy rate are not accurately reported
for each year. Therefore, using the annual data is the only way to insure validity for the
measurements within the data. Unfortunately, when attempting to run the extended fixed effects
regression model, the increased number of independent variables minimized the observations in
favor of degrees of freedom used in the F-test which is a measure to illustrate the fit of a
regression model on the data.
6
“Restructuring of the Nirmal Bharat Abhiyan into Swachh Bharat Mission,” Press Information Bureau,
Government of India, Sep 24 2014.
6. 6 |C h u
Looking at Figure 5, while the absolute totals of the variables do suffer from
occasionally large variances and, consequently, high standard deviations, they still form only a
small fraction of the mean in most cases meaning the points do not differ too much as a
proportion of the mean. That point can be illustrated in examining the kurtosis of the tails which
indicate the amount of outliers within the observations; most of these points do not exceed the
“baseline” value of 3 implying the tails are not oversaturated with observations which would
hamper the OLS assumptions of the model. For the total values, especially for the construction
numbers, one must expect a rather large fluctuation between the points given the differences
between states which will be covered more in the model results.
Looking at Figure 6, one can see that the dependent variable (“lntotalcases”) does not
have a very large standard deviation which is indicative of the logarithmic transformation as the
natural logarithm requires rather large values to fluctuate in value; however, it is also indicative
that the percentages of those contracting these symptoms do not vary greatly from year to year.
The same can be said for the independent variables (“lntoilets”, “lnBPLtoilets”, “lnGDPPC”,
“lev1rurallit, lnsharespent”). In addition, the kurtosis and skewness of each variable except
“lnsharespent” reflects a relatively normal distribution of the points indicates there are no strong
outliers which show strength in the data.
Case Studies
The main analytic lens applied for overall success for these types of programs in a similar
situation will be the implementation of the toilet construction initiative in Indonesia; the crucial
paper is a working paper written by the World Bank entitled Impact Evaluation of a Large-Scale
Rural Sanitation Project in Indonesia written by Lisa Cameron, Manisha Shah, and Susan Olivia
(hereafter referred to as Cameron et al.) The writers studied eight rural districts in 160
7. 7 |C h u
communities in Indonesia attempting to study the Total Sanitation and Sanitation Market
(TSSM) project.7
While the toilet construction in the treated communities increased by three
percentage points and diarrhea prevalence was only 3.3 percent in the treated areas compared to
4.6 in those that were not, it did not impact sanitation habits such as washing hands, open
defecation, or using soap which also have a large impact on diarrhea conception.8
When
measuring certain baseline demographic descriptive statistics such as defecting in an improved
sanitation facility, in the open, washing hands after going to the toilet, and having soap, none of
the respective difference-in-difference p-values are statistically significant except for the
construction of toilet variable, for obvious reasons.9
Unfortunately, that means that the program’s
efficacy was not explicitly tied to toilet construction but the decreases in diarrhea in the control
area may be correlated to other factors outside of the scope of the TSSM. For the SBM, this
factor is important in attempting to discern the impact of toilets and knowledge of good
sanitation practices by itself.
The supplementary case study is the piece written by Greenstone and Hanna in which
they discuss the efficacy of the Indian government attempting to rein in air and water pollution:
the Supreme Court Action Plans and Mandated Catalytic Converters, as well as the National
River Conservation Plan.10
Through a Quandt likelihood ratio test, the researchers found that
there was almost no impact from the adoption of the National River Conservation Plan (NRCP)
but a definitive structural break from the air pollution policies from which very changes emerged
as an engaged public galvanized the additional push needed to execute the policy despite less
7
“Impact Evaluation of a Large-Scale Rural Sanitation Project in Indonesia,” Cameron et.al, The World Bank,
Water and Sanitation Program, Feb 2013.
8
Ibid.
9
Ibid.
10
“Environmental Regulations, Air and Water Pollution, and Infant Mortality in India,” Greenstone et al,
Massachusetts Institute of Technology, Feb 2011.
8. 8 |C h u
than efficient government structures.11
The researchers concluded that this break emerged from a
factor of utility juxtaposed with more energized and efficient institutions (the Supreme Court)
that could effectively legislate and dole out proper regulations and create enforcement
mechanisms.12
In addition, the study showed that the efficacy of the program was tied to the
high avoidance costs for air pollution as people can only breathe air in a certain medium and
cannot buy imported air while water is more easily cleaned through boiling it.13
The main
conclusion from these points to the eventual success or failure or the SBM is that the government
policies can succeed when the populace stands behind the program and encourages their own
part of the policy. Another conclusion is that the program functions best when the avoidance
costs are high and people feel a definitive change in their avoidance of the pollutants, especially
in a comparison between water and air pollutants.
Results
While much of the program is rather new, the results gathered were a mixed affair in
terms of expectations. Before the experimentation with the model, many of the stories regarding
the efficacy of the SBM stated that many of those who had toilets constructed in their homes or
local townships felt too constrained to use the new toilets provided to them and still chose to
defecate in the open. Due to these untraceable biases, many of the independent variables lack the
statistical significance needed to assert their own validity as variables. While it is possible that
the lack of significance for some of these variables is due to the overall lack of observations,
looking at the graphs in Figure 2 clearly shows trends that would support the present hypothesis
that increased facilities and increased pressure to use them will decrease the instances of diarrhea
11
“Environmental Regulations, Air and Water Pollution, and Infant Mortality in India,” Greenstone et al,
Massachusetts Institute of Technology, Feb 2011.
12
Ibid.
13
Ibid.
9. 9 |C h u
in these poor states. For example, the regression results in Figure 3 using the robust standard
error assumption still show the same relative t-statistic which implies that these observations are
relatively consistent even if the statistical significance is rather small compared to the desired
level. However, with that being said, there is clearly some form of bias that is accounting for the
fluctuations in the total instances which is clearly encapsulated in the variables marking the state
id in both Figure 1 and Figure 3 as state id 2 (Madhya Pradesh) and state id 3 (Rajasthan) are
statistically significant to a reasonable degree. In addition, the variable for GDP per capita
measured a positive variable, meaning that increases in overall GDP per capita may be
detrimental to health; however, one must consider the impact of the subsidies on the toilet and
see if that extra incentive at all impacts the overall levels of diarrhea.
While looking at the other model comparing the interaction factor of GDP per capita and
total below poverty line toilets constructed in a logarithmic transformation in Figure 4, there is a
clear significance level of both the construction of toilets below the poverty line and the subsidy
put in place for that construction. Unfortunately, the signs for both variables are negative and
positive respectively meaning that the impact of the subsidy for each toilet built is negatively
increasing or time. Thus, the model implies that the impact of toilet building with the subsidy,
which is already built into the legislation, the toilets themselves are only effective to a certain
point in a case of diminishing margins of returns. While many of the independent variables in
this regression lack overall statistical significance, it is important to include them as they serve to
eliminate any omitted variable bias. Whether or not the overall independent variables are
statistically significant, the individual state levels must also be considered in order to gain the
full picture.
10. 10 |C h u
In analyzing both Model 1 and Model 2, there is a clear statistical significance in both
Madhya Pradesh (state 2) and Rajasthan (state 3) as opposed to Uttar Pradesh (constant).
Additionally, the signs on both of the states are negative which indicates that there are
underlying factors within each state that are not necessarily outlined in the model which help
lower the percentages of diarrhea occurrence. Therefore, there is some unknown factor or factors
in the model which shows that the states Madhya Pradesh and Rajasthan are healthier than Uttar
Pradesh beyond the variables stated in the two different regressions.
Conclusions and Policy
The program push for a “Clean India” is certainly not without its warts or inefficiencies;
however, the impact of toilets and toilet usage is still yet to be determined under the SBM and
NBA. Unfortunately, it is clear that toilets are not the only factor in overall health due to the fact
that they are not necessarily the biggest variable factor in the models; this news is of no real
surprise given the lessons provided in Indonesia with their TSSM program. While looking at the
stories surrounding the program itself, the reception has not been incredibly outstanding. In an
interview with Kartikay Mehrotra of Bloomberg Business, a woman named Sunita in Uttar
Pradesh stated that “only Dalits, the lowest Hindu caste, should be exposed to excrement in a
closed space.”14
That mentality is the main problem in the overall longevity of the program;
without people being willing to use the toilets, they are effectively useless in preventing
instances of diseases. As was the case in Indonesia, one can lead the program and build all the
sanitary conditions for toilets as necessary but they are not useful when left idle. As stated by
Archana Patkar, a program manager at the Water Supply & Sanitation Collaborative Council, “‘
the problem has gotten worse with the government thinking this is a supply driven problem. The
14
“India’s Toilet Race Failing as Villages Don’t Use Them,” Mehrotra, Kartikay, Bloomberg Business, Aug 4,
2014. Web.
11. 11 |C h u
problem is that germs are invisible, and so understanding the threat of open defecation is far
removed from reality.”15
Therefore, the next step is doing internal research on the mentality
surrounding toilet usage to enlighten people to the changes that clean defecation practices can
have in their lives. Without properly addressing the mentality around the usage of toilets as
something only meant for lower strata of society, there is only so much that can be accomplished
by building toilets without any education. For example, when the World Bank released their
study on Indonesia, surveys on good sanitary behavior were released to both the treatment and
control group on their understanding of these topics; these results showed that the changes in
construction of sanitary areas did not create a significant impact on beliefs around proper
sanitation.16
By educating people below the poverty line, as the caste is not necessarily tied to
economic status, there can be a real impact of using those toilets on diarrhea death and diseases;
however, as the old saying goes, you can lead a horse to a toilet but you cannot make it use the
toilet.
15
“India’s Toilet Race Failing as Villages Don’t Use Them,” Mehrotra, Kartikay, Bloomberg Business, Aug 4,
2014. Web.
16
“Impact Evaluation of a Large-Scale Rural Sanitation Project in Indonesia,” Cameron et.al, The World Bank,
Water and Sanitation Program, Feb 2013.
12. 12 |C h u
Figures:
Figure 1 – fixed effects regression using below poverty line household toilet construction
measurements.
Figure 2 - Graphs showing the changes in total cases of diarrhea and other indicator
variables measured by state id (1- UP, 2 - Madhya Pradesh, 3- Rajasthan)
_cons 3.836265 6.993411 0.55 0.598 -12.29057 19.9631
_Istate_id_3 -1.325917 .5417518 -2.45 0.040 -2.575199 -.0766347
_Istate_id_2 -.4617604 .4158162 -1.11 0.299 -1.420634 .4971135
lnGDPPC 1.230642 .6481366 1.90 0.094 -.2639639 2.725248
lev1rurallit .0206392 .0965196 0.21 0.836 -.2019354 .2432137
lntotalsancov -.1230762 .090466 -1.36 0.211 -.3316911 .0855387
lnBPLtoilets -.19465 .1377828 -1.41 0.195 -.5123778 .1230778
lntotalcases Coef. Std. Err. t P>|t| [95% Conf. Interval]
Robust
Root MSE = .27938
R-squared = 0.7461
Prob > F = 0.0002
F(6, 8) = 21.29
Linear regression Number of obs = 15
i.state_id _Istate_id_1-3 (naturally coded; _Istate_id_1 omitted)
. xi: regress lntotalcases lnBPLtoilets lntotalsancov lev1rurallit lnGDPPC i.state_id, r
13. 13 |C h u
Figure 3 - Same regression as Figure 1 but with robust heteroskedastic errors
Figure 4- Same regression as Figures 1 and 3 but including a subsidy interaction term
(which drops out GDP variable)
_cons 1.40949 6.554861 0.22 0.835 -13.70605 16.52503
_Istate_id_3 -1.439068 .49245 -2.92 0.019 -2.57466 -.3034764
_Istate_id_2 -.5625891 .3866586 -1.46 0.184 -1.454226 .3290473
lnsharespent -.1044713 .0528974 -1.97 0.084 -.226453 .0175104
lnGDPPC 1.310905 .5904148 2.22 0.057 -.0505935 2.672404
lev1rurallit .0103106 .098293 0.10 0.919 -.2163535 .2369747
lnBPLtoilets -.1013052 .1005108 -1.01 0.343 -.3330836 .1304732
lntotalcases Coef. Std. Err. t P>|t| [95% Conf. Interval]
Robust
Root MSE = .26847
R-squared = 0.7656
Prob > F = 0.0004
F(6, 8) = 16.82
Linear regression Number of obs = 15
i.state_id _Istate_id_1-3 (naturally coded; _Istate_id_1 omitted)
. xi: regress lntotalcases lnBPLtoilets lev1rurallit lnGDPPC lnsharespent i.state_id, r
_cons 3.836247 6.993453 0.55 0.598 -12.29068 19.96318
_Istate_id_3 -1.325916 .5417537 -2.45 0.040 -2.575203 -.0766302
_Istate_id_2 -.461761 .4158177 -1.11 0.299 -1.420638 .4971164
lnGDPxBPLtoilets 1.230642 .6481394 1.90 0.094 -.26397 2.725254
lev1rurallit .0206393 .09652 0.21 0.836 -.2019362 .2432148
lntotalsancov -.1230756 .0904663 -1.36 0.211 -.3316912 .08554
lnBPLtoilets -1.425292 .7257946 -1.96 0.085 -3.098977 .2483936
lntotalcases Coef. Std. Err. t P>|t| [95% Conf. Interval]
Robust
Root MSE = .27938
R-squared = 0.7461
Prob > F = 0.0002
F(6, 8) = 21.29
Linear regression Number of obs = 15
i.state_id _Istate_id_1-3 (naturally coded; _Istate_id_1 omitted)
> ate_id, r
. xi: regress lntotalcases lnBPLtoilets lntotalsancov lev1rurallit lnGDPxBPLtoilets i.st
14. 14 |C h u
99% 660.3888 660.3888 Kurtosis 5.810532
95% 660.3888 373.6622 Skewness 1.712458
90% 373.6622 257.7996 Variance 26962.84
75% 256.8474 256.8474
Largest Std. Dev. 164.2036
50% 144.026 Mean 183.3494
25% 56.7074 56.7074 Sum of Wgt. 15
10% 43.5264 54.2441 Obs 15
5% 3.75 43.5264
1% 3.75 3.75
Percentiles Smallest
sharespent
99% 72391.2 72391.2 Kurtosis 2.136755
95% 72391.2 65658.42 Skewness .5419822
90% 65658.42 61480.77 Variance 1.94e+08
75% 58636.92 58636.92
Largest Std. Dev. 13943.92
50% 42496.59 Mean 45256.68
25% 33366.44 33366.44 Sum of Wgt. 15
10% 30038.24 32087.83 Obs 15
5% 26539.93 30038.24
1% 26539.93 26539.93
Percentiles Smallest
GDPPC
99% 2915407 2915407 Kurtosis 6.888059
95% 2915407 1613384 Skewness 2.03895
90% 1613384 1166016 Variance 4.74e+11
75% 900769 900769
Largest Std. Dev. 688177.2
50% 648792 Mean 818640.1
25% 515427 515427 Sum of Wgt. 15
10% 252800 266197 Obs 15
5% 134873 252800
1% 134873 134873
Percentiles Smallest
totaltoilets
99% 1042578 1042578 Kurtosis 4.097271
95% 1042578 711103 Skewness 1.377213
90% 711103 621743 Variance 7.53e+10
75% 472521 472521
Largest Std. Dev. 274358.4
50% 213312 Mean 328844.5
25% 158175 158175 Sum of Wgt. 15
10% 81700 102905 Obs 15
5% 45359 81700
1% 45359 45359
Percentiles Smallest
totalBPLtoilets
99% 826246 826246 Kurtosis 2.096739
95% 826246 768021 Skewness -.2490236
90% 768021 745457 Variance 3.66e+10
75% 740328 740328
Largest Std. Dev. 191327.5
50% 535012 Mean 539293.5
25% 431893 431893 Sum of Wgt. 15
10% 227571 290705 Obs 15
5% 223106 227571
1% 223106 223106
Percentiles Smallest
totalcases
Figure 5- Summary Statistics of all dependent and independent variables in absolute form
15. 15 |C h u
99% 6.492829 6.492829 Kurtosis 5.626488
95% 6.492829 5.923352 Skewness -1.469123
90% 5.923352 5.552183 Variance 1.445991
75% 5.548482 5.548482
Largest Std. Dev. 1.202494
50% 4.969994 Mean 4.76409
25% 4.037905 4.037905 Sum of Wgt. 15
10% 3.773368 3.993494 Obs 15
5% 1.321756 3.773368
1% 1.321756 1.321756
Percentiles Smallest
lnsharespent
99% 16.2 16.2 Kurtosis 2.161826
95% 16.2 15.9 Skewness .2154488
90% 15.9 15.1 Variance 2.265524
75% 15.1 15.1
Largest Std. Dev. 1.505166
50% 13.3 Mean 13.58667
25% 12.7 12.7 Sum of Wgt. 15
10% 11.4 12.4 Obs 15
5% 11.2 11.4
1% 11.2 11.2
Percentiles Smallest
lev1rurallit
99% 11.18984 11.18984 Kurtosis 1.938605
95% 11.18984 11.09222 Skewness .1607812
90% 11.09222 11.02648 Variance .0917857
75% 10.97912 10.97912
Largest Std. Dev. .3029615
50% 10.65718 Mean 10.67694
25% 10.41531 10.41531 Sum of Wgt. 15
10% 10.31023 10.37623 Obs 15
5% 10.18641 10.31023
1% 10.18641 10.18641
Percentiles Smallest
lnGDPPC
99% 13.85721 13.85721 Kurtosis 2.60935
95% 13.85721 13.47457 Skewness -.1402715
90% 13.47457 13.34028 Variance .700332
75% 13.06584 13.06584
Largest Std. Dev. .8368584
50% 12.27051 Mean 12.39531
25% 11.97146 11.97146 Sum of Wgt. 15
10% 11.31081 11.54156 Obs 15
5% 10.72236 11.31081
1% 10.72236 10.72236
Percentiles Smallest
lnBPLtoilets
99% 13.62465 13.62465 Kurtosis 2.629621
95% 13.62465 13.55157 Skewness -.8406101
90% 13.55157 13.52175 Variance .1756777
75% 13.51485 13.51485
Largest Std. Dev. .4191393
50% 13.19004 Mean 13.1254
25% 12.97593 12.97593 Sum of Wgt. 15
10% 12.33522 12.58006 Obs 15
5% 12.3154 12.33522
1% 12.3154 12.3154
Percentiles Smallest
lntotalcases
Figure 6- Summary Statistics of all dependent and independent variables in natural logarithm
form
16. 16 |C h u
References:
1. “ASER Yearly Reports”, Aser Centre, Pratham Education Foundation,
http://asercentre.org, Web.
2. “CHBI National Health Profiles”, Central Bureau of Health Intelligence,
http://cbhidghs.nic.in , Web.
3. “Environmental Regulations, Air and Water Pollution, and Infant Mortality in India,”
Greenstone et al, Massachusetts Institute of Technology, Feb 2011.
4. “Impact Evaluation of a Large-Scale Rural Sanitation Project in Indonesia,” Cameron
et.al, The World Bank, Water and Sanitation Program, Feb 2013.
5. “India’s Toilet Race Failing as Villages Don’t Use Them,” Mehrotra, Kartikay,
Bloomberg Business, Aug 4, 2014. Web.
6. “India’s Toilet Race Failing as Villages Don’t Use Them,” Mehrotra, Kartikay, Bloomberg
Business, Aug 4, 2014. Web.
7. “National Rural Drinking Water Programme”, Government of India,
http://indiawater.gov.in , Web.
8. “PM Modi fulfills promise of 80 lakh toilets but not many takers in rural India,”
Sharma, Neetu: India Today, Aug 14, 2015. Web.
9. “Restructuring of the Nirmal Bharat Abhiyan into Swachh Bharat Mission,” Press
Information Bureau, Government of India, Sep 24 2014.
10. “Swachh Bharat Mission”, Government of India, http://tsc.gov.in , Web.