Magnus Lindelow

• BSc, MPhil, DPhil
• Manager at World Bank

Sub-Saharan Africa has fewer medical workers per capita than any region of the world, and that shortage has been highlighted consistently as a critical constraint to improving health outcomes in the region. This paper draws on newly available, systematic, comparable data from ten countries in the region to explore the dimensions of this shortage. W...

Sub-Saharan Africa has fewer medical workers per capita than any region of the world, and that shortage has been highlighted consistently as a critical constraint to improving health outcomes in the region. This paper draws on newly available, systematic, comparable data from ten countries in the region to explore the dimensions of this shortage. W...

Prior to the Sustainable Development Goals (SDG) era, considerable progress was made toward the Millennium Development Goals (MDGs) health indicators. Despite these achievements, many countries failed to meet the MDG target levels, between-country inequalities in health outcomes did not improve, and many countries making progress in average indicat...

Some of Adam Wagstsaff’s colleagues and research collaborators submitted short reflections about the different ways Adam made a difference through his amazing research output to health equity and health systems as well as a leader and mentor. The Guest Editors of this Special Issue selected a set of six essays related to dimensions of Adam’s contri...

Objective Assess the quality of healthcare across African countries based on health providers’ clinical knowledge, their clinic attendance and drug availability, with a focus on seven conditions accounting for a large share of child and maternal mortality in sub-Saharan Africa: malaria, tuberculosis, diarrhoea, pneumonia, diabetes, neonatal asphyxi...

Background: Health is recognized as a fundamental right in Brazil's constitution. In the absence of a clearly defined benefit packages of healthcare services that are financed under the Unified Health System (Sistema Único de Saúde, SUS), courts have become important in adjudicating coverage decisions. Empirical assessments of equity and the right...

Since 2013, the government of Malawi has been pursuing a number of health reforms, which include plans to increase domestic financing for health through "innovative financing." As part of these reforms, Malawi has sought to raise additional tax revenue through existing and new sources with a view to earmarking the revenue generated to the health se...

Progress towards UHC in Africa will require sustained increases in public spending on health and reduced reliance on out-of-pocket financing. This paper reviews trends and patterns of government spending in the East and Southern Africa region, and points out methodological challenges with interpreting data from the WHO global health expenditure dat...

Since 2013, the Government of Malawi has been pursuing a number of health reforms which includes plans to increase domestic financing for health through “innovative financing.” As part of these reforms, Malawi has sought to raise additional tax revenue through existing and new sources with a view of earmarking the revenue generated to the health se...

China was a pioneer in primary care and the prevention and control of infectious diseases, and more recently in universal insurance coverage. The introduction of barefoot doctors, urban and rural social health insurance schemes and ambitious public health campaigns combined with higher incomes, lower poverty and better living standards for both urb...

As avaliações do movimento rumo à cobertura universal de saúde tendem a enfocar a utilização dos serviços de saúde, benefício formal ou elegibilidade para acessar os serviços, bem como as medidas de proteção financeira. Entretanto, se nossa preocupação é avaliar até que ponto todas as pessoas conseguem obter os serviços de saúde que precisam, sem i...

Background: Brazil has experienced difficulties in attracting health professionals (especially doctors and nurses) to practice at the primary health care (PHC) level and in rural and remote areas. This study presents two case studies, each a current initiative in contracting for primary health services in Brazil: one for the state of Bahia and the...

Objective Reform of the health care system in urban areas of China has prompted concerns about the utilization of Community Health Centers (CHC). This study examined which of the dominant primary care delivery models, i.e., the public CHC model, the ‘gate-keeper’ CHC model, or the hospital-owned CHC models, was most effective in enhancing access to...

Objective This study examined the impact of an Integrated Care Delivery intervention on health care seeking and outcomes for chronically-ill patients in Henan province, China. Methods A case-control study was carried out in six health care organizations from two counties in Henan province, China. 371 patients aged 50 years or over with hypertensio...

In the last decade, almost every low- or middle-income country in the world has expressed support for universal health coverage (UHC). While at the beginning of the UHC movement, country strategies focused on increasing access to the formal sector as the first step of UHC, there is now consensus that countries should cover the entire population, wi...

Assessments of the movement toward universal health coverage tend to focus on the utilization of health services, formal entitlement or eligibility to access services, and measures of financial protection. However, if our concern is to assess to what extent all persons can obtain the health care they need without financial hardship, indicators in t...

This study presents two case studies, each on a current initiative of contracting for primary health services in Brazil, one for the state of Bahia, the other for the city of Rio de Janeiro. The two initiatives are not linked and their implementation has independently sprung from a search for more effective ways of delivering public primary health...

Using primary data from Laos, we compare a broad range of different types of shocks in terms of their incidence, distribution between the poor and the better off, idiosyncrasy, costs, coping responses, and self-reported impacts on well-being. Health shocks are more common than most other shocks, more concentrated among the poor, more idiosyncratic,...

Household coping strategies during maternal and child health shocks in Lao People's Democratic Republic (PDR) are analysed in this paper. Vulnerability was the consequence of high and immediate medical costs, which forced households to borrow money or sell off assets, and also of poor access to health care as a result of these costs. This, in turn,...

A pilot eliminating user fees associated with delivery at the point of services was introduced in two districts of Laos in March 2009. Following two years of implementation, an evaluation was conducted to assess the pilot impact, as well as to document the pilot design and implementation challenges. Study results show that, even in the presence of...

The Government of Lao Peoples' Democratic Republic (Lao PDR) has embarked on a path to achieve universal health coverage (UHC) through implementation of four risk-protection schemes. One of these schemes is community-based health insurance (CBHI) - a voluntary scheme that targets roughly half the population. However, after 12 years of implementatio...

Community-based health insurance in Lao People's Democratic Republic targets the informal workforce. Estimates of the program's impact on utilization and out-of-pocket expenditures (OOPs) were obtained using a case-comparison study of 3000 households (14 804 individuals) in urban and semi-urban areas. We used propensity score matching to control fo...

This paper sheds light on the inter-generational changes in pregnancy and childbirth practices in remote areas of Lao PDR over a period of 30 years. The study consisted of focus group discussions with pregnant women aged 14-30, mothers and fathers of small children, and older women aged 40+ in six rural communities in two districts. Childbirth prac...

Background Uncertainty is regarded as a central dimension in the experience of illness and in the processes of alleviating it. Few studies from resource-poor settings have investigated this and how it interacts with other factors. This study aims to shed light on how healthcare-seeking develops in the context of multiple medical alternatives and to...

Discusses the extent to which reforms have transformed the health system, focusing on the expansion and reorganization of service delivery, financing of health services, and governance and accountability arrangements of the Brazilian Unified Health System (Sistema Único de Saúde, SUS). The reforms envisaged a fundamental transformation, with univer...

More than 20 years have passed since the Brazilian Sistema Único de Saúde (Unified Health System or SUS) was formally established by the 1988 Constitution. The SUS reforms established health as a fundamental right and duty of the state and started a process of fundamentally transforming Brazil’s health system to achieve this goal. Twenty Years of...

This paper sheds light on the inter-generational changes in pregnancy and childbirth practices in remote areas of Lao PDR over a period of 30 years. The study consisted of focus group discussions with pregnant women aged 14–30, mothers and fathers of small children, and older women aged 40+ in six rural communities in two districts. Childbirth prac...

Background There are profound social meanings attached to bearing children that affect the experience of losing a child, which is akin to the loss of a mother in the household. The objective of this study is to comprehend the broader processes that shape household healthcare-seeking during fatal illness episodes or reproductive health emergencies i...

Outreach services for vaccination present a useful vehicle to deliver maternal and child health (MCH) care to hard-to-reach women and children. In Laos, uptake of MCH services inversely correlates with distance from a health facility; hence, the concurrent delivery of MCH services during community vaccination outreach has been promoted. Here we ass...

In this paper, we address the issues of shortage and maldistribution of health personnel in southeast Asia in the context of the international trade in health services. Although there is no shortage of health workers in the region overall, when analysed separately, five low-income countries have some deficit. All countries in southeast Asia face pr...

In Laos health shocks are more common than most other shocks and more concentrated among the poor. They tend to be more idiosyncratic than non-health shocks, and are more costly, partly because they lead to high medical expenses, but also because they lead to income losses that are sizeable compared with the income losses associated with non-health...

To improve our understanding of corruption in service delivery, we use a newly designed game that allows us to investigate the effects of the institutional environment on the behavior of service providers and their monitors. We focus on the effect of four different factors: whether monitors are accountable to the service recipients, the degree of o...

This paper provides a survey of the recent empirical research on China's 'old' health system (i.e. prior to the spate of reforms beginning in 2003). It argues that this research has enhanced our understanding of the system prior to 2003, in some cases reinforcing conclusions (e.g. the demand-inducement associated with perverse incentives) while in...

This book began in 2003 during the initial formulations of China's 11th five-year plan, which covers the period 2006-10. During the entire period, the rural health Analytic and Advisory Activities (AAA) team analyzed the sector and debated reform options with government officials and scholars. It is helped the government in its extensive reform eff...

This article describes how health care has been and is currently financed, organized, and delivered in China, Hong Kong, and Taiwan. Each system's performance is assessed on the equity and efficiency axes in terms of how well it deals with important market failures. We conclude by drawing comparative lessons and showing how policymakers are trying...

In 2003, China launched a heavily subsidized voluntary health insurance program for rural residents. We combine differences-in-differences with matching methods to obtain impact estimates, using data collected from program administrators, health facilities and households. The scheme has increased outpatient and inpatient utilization, and has reduce...

We analyze the effect of insurance on the probability of an individual incurring 'high' annual health expenses using data from three household surveys. All come from China, a country where providers are paid fee-for-service according to a schedule that encourages the overprovision of high-tech care and who are only lightly regulated. We define annu...

This paper is concerned with the role of education as a determinant of health care choices. The central premise of the paper is that utilisation of health services is determined not solely by an individual's own education, but rather by a notion of effective education, which incorporates the educational attainment of other household members. The pa...

We report the results of a review of the Chinese- and English-language literatures on service delivery in China, asking how well China's health-care providers perform and what determines their performance. Although data and methodological limitations suggest caution in drawing conclusions, a critical reading of the available evidence suggests that...

This book shows how to implement a variety of analytic tools that allow health equity - along different dimensions and in different spheres - to be quantified. Questions that the techniques can help provide answers for include the following: Have gaps in health outcomes between the poor and the better-off grown in specific countries or in the devel...

Collective Volume Article

In many countries health services and/or health insurance are delivered but also partly financed by subnational entities that vary in their fiscal or financial capacity, e.g. local governments and social health insurance schemes. The central government typically mandates a specific (or at least minimum) level of benefit or expenditure per intended...

China's old rural Cooperative Medical Scheme (CMS) all but collapsed following the economic reforms of the early 1980s. In an effort to reduce financial risk and make health care more affordable, the Government of China recently began piloting of a new voluntary health insurance scheme for rural areas, commonly referred to as the New Cooperative Me...

Geographical imbalances in the health workforce have been a consistent feature of nearly all health systems, and especially in developing countries. In this paper we investigate the willingness to work in a rural area among final year nursing and medical students in Ethiopia. Analysing data obtained from contingent valuation questions for final yea...

Este informe presenta una selección de estudios sobre transparencia y corrupción que abarcan desde la relación de la corrupción con los fenómenos socioeconómicos hasta los vínculos entre implementación de políticas y cambios. El punto de partida es el análisis empírico de la corrupción que, en la actualidad, ha logrado una posición firme en un gran...

Geographical imbalances in the health workforce have been a consistent feature of nearly all health systems, and especially in developing countries. In this paper we investigate the willingness to work in a rural area among final year nursing and medical students in Ethiopia. Analyzing data obtained from contingent valuation questions, we find that...

Insufficient attention has been paid to understanding what determines the performance of health workers. This paper reports on findings from focus group discussions with both health workers and users of health services in Ethiopia, a country with some of the poorest health outcomes in the world. We describe performance problems identified by both h...

In recent years, a large body of empirical work has focused on measuring and explaining socio-economic inequalities in health outcomes and health service use. In any effort to address these questions, analysts must confront the issue of how to measure socioeconomic status. In developing countries, socioeconomic status has typically been measured by...

Health shocks have been shown to have important economic consequences in industrial countries. Less is known about how health shocks affect income, consumption, labor market outcomes, and medical expenditures in middle- and low-income countries. The authors explore these issues in China. In addition to providing new evidence on the general impact o...

In Mozambique, easily treatable diseases such as malaria, diarrhoea and respiratory infections contribute to a heavy burden of disease. Notwithstanding efforts by the Mozambican government to promote access to healthcare, many who could benefit from simple, cost-effective healthcare services do not currently receive treatment. Moreover, it is known...

Evidence shows that real-effort investments can affect bilateral bargaining outcomes. This paper investigates whether similar investments can inhibit equilibrium convergence of experimental markets. In one treatment, sellers’ relative effort affects the allocation of production costs, but a random productivity shock ensures that the allocation is n...

It is well recognized that much of the world's medical care is in the hands of laypeople. In pluralistic medical settings, laypeople choose what to do first, second, third, and fourth from a variety of treatment options. In retrospect, laypeople's choices can be represented as an ordered series of health-related behaviors. A systematic analysis of...

Embezzlement of resources is hampering public service delivery throughout the developing world. Research on this issue is hindered by problems of measurement. To overcome these problems we use an economic experiment to investigate the determinants of corrupt behaviour. We focus on three aspects of behaviour: (i) embezzlement by public servants; (ii...

In this paper we review the available summary measures for the magnitude of socio-economic inequalities in health. Measures which have been used differ in a number of important respects, including (1) the measurement of "relative" or "absolute" differences; (2) the measurement of an "effect" of lower socio-economic status, or of the "total impact"...

This paper investigates how information affect voting behaviour. There exist a large literature suggesting that uninformed voters can use informational shortcuts or cues to vote as if they were informed. This paper tests this hypothesis using unique Swedish individual survey data on the preferences of both politicians and voters. I find that uninfo...

Utilization of health services are an important policy concern in most developing countries, reflecting both efforts to improve health outcomes and to meet international obligations to make health services broadly accessible. Although many policy and research initiatives have focused on the need to improve physical access, not enough is understood...

This report presents findings from a baseline survey of 155 primary health care facilities (dispensaries, with and without maternity units) that was carried out in Uganda in the latter part of 2000. By collecting data both from the dispensaries and from local governments, it was possible to validate the collected data and check for discrepancies in...

Health facility surveys come in various guises. One dimension in which they vary is their motivation. Some seek to understand better links between households and providers. Others seek to understand better provider behavior and performance. Still others seek to understand the interrelationships between providers, while yet others seek to shed light...

The primary aim of the paper is to place current methodological discussions in macroeconometric modeling contrasting the ‘theory first’ versus the ‘data first’ perspectives in the context of a broader methodological framework with a view to constructively appraise them. In particular, the paper focuses on Colander’s argument in his paper “Economist...

We identify adverse selection by exploiting a unique institutional feature of the Ethiopian physician labor market, which allocates some new doctors randomly to their …rst jobs through a lottery mechanism, while others seek employment through the market, which matches better graduates to better jobs. We …nd evidence of adverse selection among lotte...