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

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

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

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

Preferences and skills of Indian public sector teachers

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

You stab my back, I'll stab yours: Management experience and perceptions of organization political behaviour

This paper reports the findings of a survey of 250 British managers, exploring their experience and perceptions of organization politics. Political behaviour appeared to be common. Most managers viewed political behaviour as ethical and necessary, and aspects of organizational effectiveness, change, resourcing and reputation were attributed to political tactics, although 80% had no training in this area. Tactics experienced frequently included networking, using 'key players' to support initiatives, making friends with power brokers, bending the rules, and self-promotion. Tactics experienced as rare, but not unknown, included misinformation, spreading rumours, and keeping 'dirt files' for blackmail. A consistent pattern of responses concerning willingness to engage in politics, the need to act ruthlessly and the appropriateness of reciprocity when faced with political behaviour implies an attitude of 'you stab my back, I'll stab yours'. Findings are discussed using an 'antecedents–behaviours–consequences' framework of perceived organization politics to guide rese

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

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

Organization theory and military metaphor: time for a reappraisal?

A ‘conventional’ use of military metaphor would use it to convey attributes such as hierarchical organization, vertical communication and limited autonomy. This is often used in contrast to a looser form of organization based on the metaphor of the network. However, this article argues that military practice is more complex, with examples of considerable autonomy within the constraints of central direction. It is suggested that not only might this be a more useful metaphor for many contemporary organizations, but also that simplistic uses of military metaphor divert our attention away from the functions that management hierarchies play. The discussion is embedded within a critical realist account of metaphor, arguing for both its value and the need for its further development

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

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

An exploration of parents’ preferences for foot care in juvenile idiopathic arthritis: a possible role for the discrete choice experiment

Background: An increased awareness of patients’ and parents’ care preferences regarding foot care is desirable from a clinical perspective as such information may be utilised to optimise care delivery. The aim of this study was to examine parents’ preferences for, and valuations of foot care and foot-related outcomes in juvenile idiopathic arthritis (JIA).<p></p> Methods: A discrete choice experiment (DCE) incorporating willingness-to-pay (WTP) questions was conducted by surveying 42 parents of children with JIA who were enrolled in a randomised-controlled trial of multidisciplinary foot care at a single UK paediatric rheumatology outpatients department. Attributes explored were: levels of pain; mobility; ability to perform activities of daily living (ADL); waiting time; referral route; and footwear. The DCE was administered at trial baseline. DCE data were analysed using a multinomial-logit-regression model to estimate preferences and relative importance of attributes of foot care. A stated-preference WTP question was presented to estimate parents’ monetary valuation of health and service improvements.<p></p> Results: Every attribute in the DCE was statistically significant (p < 0.01) except that of cost (p = 0.118), suggesting that all attributes, except cost, have an impact on parents’ preferences for foot care for their child. The magnitudes of the coefficients indicate that the strength of preference for each attribute was (in descending order): improved ability to perform ADL, reductions in foot pain, improved mobility, improved ability to wear desired footwear, multidisciplinary foot care route, and reduced waiting time. Parents’ estimated mean annual WTP for a multidisciplinary foot care service was £1,119.05.<p></p> Conclusions: In terms of foot care service provision for children with JIA, parents appear to prefer improvements in health outcomes over non-health outcomes and service process attributes. Cost was relatively less important than other attributes suggesting that it does not appear to impact on parents’ preferences.<p></p&gt

Quality of care for the treatment for uncomplicated malaria in South-East Nigeria: how important is socioeconomic status?

Introduction: Ensuring equitable coverage of appropriate malaria treatment remains a high priority for the Nigerian government. This study examines the health seeking behaviour, patient-provider interaction and quality of care received by febrile patients of different socio-economic status (SES) groups. Methods: A total of 1642 febrile patients and caregivers exiting public health centres, pharmacies and patent medicine dealers were surveyed in Enugu state, South-East Nigeria to obtain information on treatment seeking behaviour, patient-provider interactions and treatment received. Socioeconomic status was estimated for each patient using exit survey data on household assets in combination with asset ownership data from the 2008 Nigeria Demographic and Health Survey. Results: Among the poorest SES group, 29% sought treatment at public health centres, 13% at pharmacies and 58% at patent medicine dealers (p < 0.01). Very few of those in the richest SES group used public health centres (4%) instead choosing to go to pharmacies (44%) and patent medicine dealers (52%, p < 0.001). During consultations with a healthcare provider, the poorest compared to the richest were significantly more likely to discuss symptoms with the provider, be physically examined and rely on providers for diagnosis and treatment rather than request a specific medicine. Those from the poorest SES group were however, least likely to request or to receive an antimalarial (p < 0.001). The use of artemisinin combination therapy (ACT), the recommended treatment for uncomplicated malaria, was low across all SES groups. Conclusions: The quality of malaria treatment is sub-optimal for all febrile patients. Having greater interaction with the provider also did not translate to better quality care for the poor. The poor face a number of significant barriers to accessing quality treatment especially in relation to treatment seeking behaviour and type of treatment received. Strategies to address these inequities are fundamental to achieving universal coverage of effective malaria treatment and ensuring that the most vulnerable people are not left behind