Taryn Vian

Taryn Vian
University of San Francisco | USFCA · School of Nursing and Health Professions

SM, PhD
Currently working on a scoping review of whistleblowing for anti-corruption in the health sector.

About

91
Publications
46,076
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Introduction
My research is focused on anti-corruption, transparency, and accountability in the health sector, and the evaluation of community-based health programs and health systems strengthening. I apply qualitative methods for empirical analysis. I am currently working on a scoping review of whistleblowing as an anti-corruption approach in health and pharmaceutical organizations in low- and middle-income countries.
Additional affiliations
September 1999 - present
Boston University School of Public Health
Position
  • Associate Chair for Education, Associate Professor of Global Health

Publications

Publications (91)
Article
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Background: Maternity waiting homes (MWH) allow pregnant women to stay in a residential facility close to a health center while awaiting delivery. This approach can improve health outcomes for women and children. Health planners need to consider many factors in deciding the number of beds needed for an MWH. Objective: The objective of the study is...
Article
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Background Weak governance over public sector pharmaceutical policy and practice limits access to essential medicines, inflates pharmaceutical prices, and wastes scarce health system resources. Pharmaceutical systems are technically complex and involve extensive interactions between the private and public sectors. For members of public sector pharm...
Article
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Introduction Maternity waiting homes (MWHs) aim to increase access to maternity and emergency obstetric care by allowing women to stay near a health centre before delivery. An improved MWH model was developed with community input and included infrastructure, policies and linkages to health centres. We hypothesised this MWH model would increase heal...
Article
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Objective: To report on the effectiveness of a standardised core Maternity Waiting Home (MWH) model to increase facility deliveries among women living >10 km from a health facility. Design: Quasi-experimental design with partial randomisation at the cluster level. Setting: Seven rural districts in Zambia. Population: Women delivering at 40 h...
Article
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Objectives Corruption is a widely acknowledged problem in the health sector of low- and middle-income countries (LMICs). Yet, little is known about the types of corruption that affect the delivery of pathology and laboratory medicine (PALM) services. This review is a first step at examining corruption risks in PALM. Methods We performed a critical...
Article
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Background: Utilizing maternity waiting homes (MWHs) is a strategy to improve access to skilled obstetric care in rural Zambia. However, out-of-pocket (OOP) expenses remain a barrier for many women. We assessed delivery-related expenditure for women who used MWHs and those who did not who delivered at a rural health facility. Methods: During the...
Article
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Context: Ownership is an important construct of sustainability for community-based health programming, though it is often not clearly defined or measured. We implemented and evaluated a community-driven maternity waiting home (MWH) model in rural Zambia. We engaged stakeholders at all levels and provided intensive mentorship to an MWH governance c...
Article
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Background: Community-led governance can ensure that leaders are accountable to the populations they serve and strengthen health systems for maternal care. A key aspect of democratic accountability is electing respective governance bodies, in this case community boards, and holding public meetings to inform community members about actions taken on...
Article
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This paper provides a systematic and bibliometric review of 80 research articles on corruption in healthcare published in peer-reviewed journals between 2006 and 2017. Findings suggest that the number of studies has increased over time with a focus on low- and middle-income countries; academic researchers have published papers in a large variety of...
Article
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Background: In low-income countries such as Zambia, where maternal mortality rates are persistently high, maternity waiting homes (MWHs) represent one potential strategy to improve access to safe delivery, especially for women living in remote areas. The Maternity Homes Access in Zambia project (MAHMAZ) is evaluating the impact of a MWH model on w...
Article
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Background: As called for by the Sustainable Development Goals, governments, development partners and civil society are working on anti-corruption, transparency and accountability approaches to control corruption and advance Universal Health Coverage. Objectives: The objective of this review is to summarize concepts, frameworks, and approaches used...
Article
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Background: In 2014, Vietnam was the first Southeast Asian country to commit to achieving the World Health Organization's 90-90-90 global HIV targets (90% know their HIV status, 90% on sustained treatment, and 90% virally suppressed) by 2020. This pledge represented further confirmation of Vietnam's efforts to respond to the HIV epidemic, one feat...
Article
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Purpose: Out-of-pocket expenses associated with facility-based deliveries are a well-known barrier to health care access. However, there is extremely limited contemporary information on delivery-related household out-of-pocket expenditure in sub-Saharan Africa. We assess the financial burden of delivery for the most remote Zambian women and compare...
Article
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Reluctance to talk about corruption is an important barrier to action. Yet the stakes of not addressing corruption in the health sector are higher than ever. Corruption includes wrongdoing by individuals, but it is also a problem of weak institutions captured by political interests, and underfunded, unreliable administrative systems and healthcare...
Article
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Background Building financial management capacity is increasingly important in low‐ and middle‐income countries to help communities take ownership of development activities. Yet, many community members lack financial knowledge and skills. Methods We designed and conducted financial management trainings for 83 members from 10 community groups in ru...
Article
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Access to safe, effective, quality medicines is often compromised in the absence of mechanisms for good pharmaceutical system governance. The complex mix of actors and responsibilities make the pharmaceutical system particularly vulnerable to inefficiencies and losses from corruption. Strengthening transparency and accountability is therefore criti...
Article
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Corruption is diverse in its forms and embedded in health systems worldwide. Health-sector corruption directly impedes progress towards universal health coverage by inhibiting people's access to quality health services and to safe and effective medicines, and undermining systems for financial risk protection. Corruption is also a cross-cutting them...
Article
Background: Estimates of hypertension prevalence in Kenya range from 12.3% to 50.1% nationally. Of those diagnosed, only 1 in 5 were taking medication. Objectives: This study aims to describe the access to antihypertensive medicines at the household level in 8 counties of Kenya, including factors associated with the location of purchase. Method...
Article
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In Kenya, noncommunicable diseases (NCDs) account for 27% of all deaths. Adult Kenyans have an 18% chance of dying prematurely from cancers, diabetes, cardiovascular diseases or chronic respiratory diseases. A Novartis Access Initiative is making medicines available to treat cardiovascular diseases, diabetes, chronic respiratory diseases, and breas...
Article
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Introduction: Maternity waiting homes (MWHs) aim to improve access to facility delivery in rural areas. However, there is limited rigorous evidence of their effectiveness. Using formative research, we developed an MWH intervention model with three components: infrastructure, management and linkage to services. This protocol describes a study to me...
Article
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We discuss how corruption affects access to antiretroviral therapies (ARVs) globally. Recent cases of theft of ARVs, collusion, and manipulation in procurement found in countries such as Central African Republic, Bangladesh, Malawi, and Guinea, show there is still much work to be done to reduce the risk of corruption. This includes addressing the s...
Article
Background: It is estimated that about 4 million Kenyans, i.e., 10% of the country's population, have asthma. We aimed to evaluate access to asthma medicines at the household level in eight counties of Kenya, including factors associated with location of purchase. Methods: Individuals with a diagnosis and prescription of asthma medicines were as...
Article
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Background The WHO recommends maternity waiting homes (MWH) as one intervention to improve maternal and newborn health. However, persistent structural, cultural and financial barriers in their design and implementation have resulted in mixed success in both their uptake and utilization. Guidance is needed on how to design a MWH intervention that is...
Data
Conceptual framework for sustainability of public health programs. This conceptual framework was used to guide the development of this study [1]. (PDF)
Data
Free Listing study instruments. These are the instruments used for the Free Listing and household survey for women, men, and elders, in English and the local language of Tonga. (PDF)
Data
Key informant interview guide. This is the study instrument used for the key informant interviews, in English and the local language of Tonga. (PDF)
Data
Free list dataset. This is the dataset containing the aggregate pile sorting totals for women, men, and elders who responded to the three free list questions. (XLSX)
Data
Focus group discussion guide. This is the study instrument used for the focus group discussions with women, men, TBAs/SMAGs, and mothers-in-law, in English and the local language of Tonga. (PDF)
Data
Maternity waiting home costing tool. This is the tool used for analyzing the fixed and variable costs of a maternity waiting home. (XLSX)
Article
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Background Few Antiretroviral Therapy (ART) adherence trials investigate the reasons for intervention success or failure among HIV-positive individuals. Objectives To conduct qualitative research to explore the reasons for effectiveness of a 6-month mHealth (mobile health) trial that improved adherence among ART patients in China. The intervention...
Article
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Background: In 2016, an estimated 872,000 Kenyans were living with diabetes, a country average of 4%. The study objectives were (1) to describe the sociodemographic and geographic characteristics of the households with individuals diagnosed and on treatment for diabetes (2) to describe the medicines available at the household level, monthly househo...
Article
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Corruption is a critical challenge to global health efforts, and combating it requires international action, advocacy, and research.
Article
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Background Barriers to expanding access to medicines include weak pharmaceutical sector governance, lack of transparency and accountability, inadequate attention to social services on the political agenda, and financing challenges. Multi-stakeholder initiatives such as the Medicines Transparency Alliance (MeTA) may help overcome these barriers. Bet...
Article
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Background Residential accommodation for expectant mothers adjacent to health facilities, known as maternity waiting homes (MWH), is an intervention designed to improve access to skilled deliveries in low-income countries like Zambia where the maternal mortality ratio is estimated at 398 deaths per 100,000 live births. Our study aimed to assess the...
Article
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Access to affordable quality essential medicines is crucial if universal health coverage and the Sustainable Development Goals are to be achieved. Multistakeholder initiatives might help to overcome barriers to access such as weak pharmaceutical sector governance and lack of transparency and public accountability. The Medicines Transparency Allianc...
Article
Introduction: Health care sector corruption diverts resources that could otherwise be used to improve access to health services. Use of private-sector practices such as a public-private partnership (PPP) model for hospital governance and management may reduce corruption. In 2011, a government-run hospital in Lesotho was replaced by a PPP hospital,...
Data
Appendix S2. Focus Group Participants’ Opinions Regarding Payment Modes
Data
Appendix S1. Percent of Respondents Who are Willing to Pay 1–5, 6–9, and 10+ Zambian Kwacha for a Night's Stay in Maternity Waiting Home
Article
Introduction: Complications of pregnancy and childbirth can pose serious risks to the health of women, especially in resource-poor settings. Zambia has been implementing a program to improve access to emergency obstetric and neonatal care, including expansion of maternity waiting homes-residential facilities located near a qualified medical facili...
Article
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Introduction Novartis recently launched Novartis Access, an initiative to provide a basket of reduced price medicines for non-communicable diseases (NCDs) to be sold through the public and private non-profit sectors in programme countries. This study will evaluate the impact of Novartis Access on the availability and price of NCD medicines at healt...
Article
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Patient motivation is important in managing medication regimens such as antiretroviral treatment for HIV/AIDS. We tested whether self-determination theory could predict adherence behavior among 115 HIV-positive patients in the China Adherence through Technology Study, a randomized controlled trial of an intervention using text reminders and support...
Chapter
Health systems are intrinsically vulnerable to corruption due to the substantial resources and many actors who play a role in providing health services. Opportunities for corruption within the health system exist in governance, financing, human resources and pharmaceuticals management, and other opaque practices. When corruption is allowed to perme...
Article
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Corruption has been described as a disease. When corruption infiltrates global health, it can be particularly devastating, threatening hard gained improvements in human and economic development, international security, and population health. Yet, the multifaceted and complex nature of global health corruption makes it extremely difficult to tackle,...
Technical Report
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The Medicines Transparency Alliance (MeTA) initiative, implemented in seven countries (Ghana, Jordan, Kyrgyzstan, Peru, the Philippines, Uganda, and Zambia) from 2008 to 2015, sought to test the hypothesis that increasing transparency and accountability in the pharmaceutical sector would improve access to medicines by improving decision-making. Thi...
Article
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Universal Health Coverage seeks to assure that everyone can obtain the health services they need without financial hardship. Countries which rely heavily on out-of-pocket (OOP) payments, including informal payments (IP), to finance total health expenditures are not likely to achieve universal coverage. The Republic of Moldova is committed to promot...
Article
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Health care public-private partnerships (PPPs) between a government and the private sector are based on a business model that aims to leverage private-sector expertise to improve clinical performance in hospitals and other health facilities. Although the financial implications of such partnerships have been analyzed, few studies have examined the p...
Article
Real-time adherence monitoring is now possible through medication storage devices equipped with cellular technology. We assessed the effect of triggered cell phone reminders and counseling utilizing objective adherence data on antiretroviral (ART) adherence among Chinese HIV-infected patients. We provided ART patients in Nanning, China, with a medi...
Chapter
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The OECD Study on the Impact of Corruption on Economic Growth presented to the G20 in 2013 concluded that “while the direct link between corruption and GDP growth is difficult to assess, corruption does have significant negative effects on a host of key transmission channels, […] –which impact significantly on economic welfare and, in the case of t...
Technical Report
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The OECD Study on the Impact of Corruption on Economic Growth presented to the G20 in 2013 concluded that “while the direct link between corruption and GDP growth is difficult to assess, corruption does have significant negative effects on a host of key transmission channels, […] – which impact significantly on economic welfare and, in the case of...
Article
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Abstract—Public-private partnerships (PPPs) seek to expand access to quality health services in ways that best leverage the capacities and resources of both sectors. There are few examples of PPPs in the hospital sector in developing countries, and little is known about how the involvement of the private sector transforms the delivery of health ser...
Chapter
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According to the G20 2010 Anti-corruption Action Plan “corruption threatens the integrity of markets, undermines fair competition, distorts resource allocation, destroys public trust, and undermines the rule of law.” However, how much it undermines, distorts and destroys -- and in what sectors it threatens the integrity of markets the most -- is di...
Technical Report
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The purpose of this risk assessment was to support UNDP’s Support to Anti-Corruption Efforts in Kosovo (SAEK) program by conducting an exploratory mission to understand the types of risks in the health sector, and to propose risk mitigation strategies. The assessment included a literature review and interviews with 36 key informants representing di...
Article
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We conducted a synthesis of peer-reviewed literature to shed light on links between governance mechanisms and health outcomes in low- and middle-income countries. Our review yielded 30 studies, highlighting four key governance mechanisms by which governance may influence health outcomes in these settings: Health system decentralization that enables...
Technical Report
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The Government of the Republic of Moldova is committed to ensuring access to affordable high-quality health care for all citizens through health reforms which promote universal coverage, reduce inequities, improve efficiency and expand financial protection. There is concern that high out-of-pocket (OOP) payments and the presence of informal payment...
Conference Paper
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Performance-based budgeting (PBB) is a public finance reform meant to increase accountability, transparency, and effectiveness of government resource allocation. The purpose of this study is to describe and model the factors affecting progress of performance-based budgeting reform in hospitals in Lesotho. We analyzed four case studies each centered...
Article
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Industry partnerships can help leverage resources to advance HIV/AIDS vaccine research, service delivery, and policy advocacy goals. This often involves capacity building for international and local non-governmental organizations (NGOs). International volunteering is increasingly being used as a capacity building strategy, yet little is known about...
Article
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The GAVI Alliance – an alliance of the world's major players in global immunisation – uncovered massive misuse of its grants in Cameroon in 2011. GAVI's Transparency and Accountability Policy triggered an investigation into the financial management of Cameroon's Health Systems Strengthening grant. The investigation revealed that, of US$5.1 million...
Article
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Strategies to increase transparency and accountability often include complaints mechanisms by which organisations can respond to individual suspicions of corruption and other grievances. This Brief discusses how complaints mechanisms have been used by the vigilance director for health's office in Karantaka state, India, and by Partners in Health –...
Article
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Lesotho has been implementing financial management reforms, including performance-based budgeting (PBB) since 2005 in an effort to increase accountability, transparency and effectiveness in governance, yet little is known about how these efforts are affecting the health sector. Supported by several development partners and $24 million in external r...
Article
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We collected data on feasibility and acceptability of a real-time web-linked adherence monitoring container among HIV-positive injection drug users (IDU) in China. "Wisepill" uses wireless technology to track on-time medication dosing. Ten patients on antiretroviral therapy (ART) at the Guangxi CDC HIV clinic in Nanning, China, used Wisepill for on...