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Introduction
Current institution
Publications
Publications (77)
Purpose: This study aimed to estimate the prevalence of perinatal depression in rural Kakamega, Kenya while exploring risk and protective factors in the context of the COVID-19 pandemic.
Methods: The mixed method approach employed i) quantitative data collected in a longitudinal maternal health evaluation conducted from October 2019 to May 2021 and...
In Sub-Saharan Africa, female entrepreneurs are well-represented in the healthcare sector but face significant challenges in accessing financial services. Digital financing technologies have the potential to close this gender-gap. This study aimed to assess the readiness, perspectives and gender disparities in (digital) loan characteristics among K...
In Sub-Saharan Africa, female entrepreneurs are well-represented in healthcare but struggle to access financial services. Digital financing technologies could help close this gap. This study assessed the readiness, perspectives and gender disparities in (digital) loan characteristics among Kenyan health Small and Medium Enterprises (SMEs). We inter...
Background
In low- and middle-income countries (LMICs), maternal mental health (MMH) during and after pregnancy is often neglected despite ongoing global efforts to reduce maternal mortality and morbidity. The complex nature of MMH problems and their stigmatization require a thorough understanding from the perspective of the different parties invol...
Purpose
Understanding the technical efficiency of health facilities is essential for an optimal allocation of scarce resources to primary health sectors. The COVID-19 pandemic may have further undermined levels of efficiency in low-resource settings. This study takes advantage of 2019 and 2020 data on characteristics of health facilities, health se...
The National Hospital Insurance Fund (NHIF) of Kenya was upgraded to improve access to healthcare for impoverished households, expand universal health coverage (UHC), and boost the uptake of essential reproductive, maternal, newborn and child health (RMNCH) services. However, premiums may be unaffordable for the poorest households. The Innovative P...
Self-care refers to the ability of people to promote their own health, prevent disease, maintain health, and cope with illness and disability, with or without the support of a health or care worker. Self-care interventions are tools that support self-care as additional options to facility-based care. Recognizing laypersons as active agents in their...
Background:
Epidemics can cause significant disruptions of essential health care services. This was evident in West-Africa during the 2014-2016 Ebola outbreak, raising concerns that COVID-19 would have similar devastating consequences for the continent. Indeed, official facility-based records show a reduction in health care visits after the onset...
Objective: This study evaluates how a subsidized, mobile phone-based health insurance program affected insurance uptake, healthcare utilization and health expenditures for low-income women and their family members in Western Kenya. The program, targeting pregnant women and mothers of children below age four, addressed both demand- and supply-side c...
Background
The Coronavirus Disease 2019 (COVID-19) pandemic and associated mitigation policies created a global economic and health crisis of unprecedented depth and scale, raising the estimated prevalence of depression by more than a quarter in high-income countries. Low- and middle-income countries (LMICs) suffered the negative effects on living...
Every year an estimated 5 to 8 million people die in low- and middle-income countries (LMICs) due to poor-quality care. Although quality improvements in healthcare facilities in LMICs are well-possible with tailored implementation plans, costs are often mentioned as a prohibiting factor. However, if quality improvements increase trust among patient...
Abstract Background Out- of-pocket health expenditures (OOPs) constitute a significant proportion of total health expenditures in many low- and middle-income countries (LMICs), leading to an increased likelihood of exposure to financial catastrophe in the event of illness. Health insurance has the potential to reduce catastrophic health expenditure...
The COVID-19 pandemic has painfully exposed the constraints of fragile health systems in low- and middle-income countries, where global containment measures largely set by high-income countries resulted in disproportionate collateral damage. In Africa, a shift is urgently needed from emergency response to structural health systems strengthening eff...
Maternal and neonatal mortality rates in many low- and middle-income countries (LMICs) are still far above the targets of the United Nations Sustainable Development Goal 3. Value-based healthcare (VBHC) has the potential to outperform traditional supply-driven approaches in changing this dismal situation, and significantly improve maternal, neonata...
Introduction
Inadequate, inefficient and slow processing of claims are major contributors to the cost of health insurance schemes, and therefore undermining their sustainability. This study uses the Technology, Organisation and Environment (TOE) framework to examine the preparedness of health facilities of the Christian Health Association of Ghana...
In Kenya, early coronavirus disease (COVID-19) modeling studies predicted that disruptions in antenatal care and hospital services could increase indirect maternal and neonatal deaths and stillbirths. As the Kenyan government enforced lockdowns and a curfew, many mothers-to-be were unable to safely reach hospital facilities, especially at night. Fe...
Health insurance enrollment in many Sub‐Saharan African countries is low, even with highly subsidized premiums and exemptions for vulnerable populations. One possible explanation is low service quality, which results in a low valuation of health insurance. Using a randomized control trial in 64 primary health care facilities in Ghana, this study as...
We track the effects of the COVID-19 pandemic on mental health in eight Low and Middle Income Countries (LMICs) in Asia, Africa, and South America utilizing repeated surveys of 21,162 individuals. Many respondents were interviewed over multiple rounds pre- and post-pandemic, allowing us to control for time trends and within-year seasonal variation...
Objectives
To examine the determinants of the continuum of maternal care from an integrated perspective, focusing on how key components of an adequate journey are interrelated.
Design
A facility-based prospective cohort study.
Setting
25 health facilities across three counties of Kenya: Nairobi, Kisumu and Kakamega.
Participants
A total of 5 879...
Introduction:
a subsidized community health insurance programme in Kwara State, Nigeria was temporarily suspended in 2016 in anticipation of the roll-out of a state-wide health insurance scheme. This article reports the adverse consequences of the scheme´s suspension on enrollees´ healthcare utilization.
Methods:
a mixed-methods study was carrie...
Background: Maternal and neonatal mortality rates in many low- and middle-income countries (LMICs) are still far above the targets of Sustainable Development Goal (SDG) 3. Value-based healthcare (VBHC) could potentially surpass traditional input-oriented approaches to create a high-quality health system and to improve maternal, newborn and child he...
Background
Universal Health Coverage ensures access to quality health services for all, with no financial hardship when accessing the needed services. Nevertheless, access to quality health services is marred by substantial resource shortages creating service delivery gaps in low-and middle-income countries, including Kenya. The Innovative Partners...
Women may face systematically greater benefits than men from adopting certain technologies, for example some health-improving technologies. Yet women often hold lower bargaining power, such that men’s preferences may constrain household adoption. Introducing a version of the technology that is less effective, but has lower perceived costs or higher...
Background
Globally, the possession of medicines stored at home is increasing. However, little is known about the determinants of possessing medicines, their usage according to clinical purpose, which we term ‘correct drug match’, and the role of health insurance.
Methods
This study uses data from a 2013 survey evaluating a health insurance progra...
Background: Social health insurance has been widely proposed as a key strategy to improve access to healthcare and provide financial protection. The Kwara Community Health Insurance Programme (KCHIP) in Nigeria was temporarily suspended in 2016 in anticipation of the roll-out of a state-wide health insurance scheme. This article reports the adverse...
This research assesses how low-income households in rural Kenya coped with the immediate economic consequences of the COVID-19 pandemic. It uses granular financial data from weekly household interviews covering six weeks before the first case was detected in Kenya to five weeks after during which various containment measures were implemented. Based...
Background: Universal Health Coverage (UHC) ensures access to quality health services for all, with no financial hardship when accessing the needed services. Nevertheless, access to quality health services is marred by substantial resource shortages creating service delivery gaps in low-and middle-income countries (LMICs), including Kenya. The Inno...
Health shocks (unpredictable illnesses and injuries) are an important source of risk for individuals in developing countries. In the absence of formal financial products such as health insurance or health savings accounts, unexpected illness or injury can have severe consequences. The burden of responding to health shocks often falls disproportiona...
In sub-Saharan Africa, accessibility to affordable quality care is often poor and health expenditures are mostly paid out of pocket. Health insurance, protecting individuals from out-of-pocket health expenses, has been put forward as a means of enhancing universal health coverage. We explored the utilization of different types of healthcare provide...
Background Social health insurance has been widely proposed as a key strategy in moving towards universal health coverage. This paper reports on the transition of a community-based health insurance scheme in Kwara State, Nigeria, in 2016 to a state-wide social insurance program. Specifically, it analyses the consequences of the temporary suspension...
Health insurance can improve health-seeking behaviors and protect consumption from health shocks but may also crowd out informal insurance. This paper therefore examines whether impacts of health insurance depend on households’ access to informal insurance, as proxied for by mobile money usage. Based on high-frequency financial diaries data collect...
Using a carefully designed series of public goods games, we compare, across monogamous and polygynous households, the willingness of husbands and wives to cooperate to maximize household gains. Compared to monogamous husbands and wives, polygynous husbands and wives are less cooperative, one with another, and co-wives are least cooperative, one wit...
This study’s objective is to provide an alternative explanation for the low enrolment in health insurance in Ghana by analysing differences in perceptions between the insured and uninsured of the non-technical quality of healthcare. It further explores the association between insurance status and perception of healthcare quality to ascertain whethe...
Perceived quality data.
(DTA)
Baseline survey questionnaire.
(DOC)
Effect of currently insured status on perceived quality of healthcare.
(DOCX)
Association of never insured status on perceived quality of healthcare.
(DOCX)
Hyperbolic discounting is one potential reason why savings remain low among the poor. Most evidence of hyperbolic discounting is based on violations of either stationarity or time consistency. Stationarity is violated when intertemporal choices differ for trade-offs in the near versus the more distant future. Time consistency is violated if the opt...
Objectives
Better insights into health care utilization and out-of-pocket expenditures for non-communicable chronic diseases (NCCD) are needed to develop accessible health care and limit the increasing financial burden of NCCDs in Sub-Saharan Africa.
Methods
A household survey was conducted in rural Kwara State, Nigeria, among 5,761 individuals. D...
Minimal dataset for reproduction of results.
Dataset containing variables used for analysis, in Stata format (version 13).
(ZIP)
Types of self-reported NCCDs.
Incidence of the different NCCDs in the sample: overall, by sex, and by asset-based wealth quintile. All numbers are row percentages, test statistics are based on Pearson’s χ2 test.
(DOCX)
We present qualitative data from a study in Ghana (2011), where the National Health Insurance Scheme (NHIS) was introduced to improve access to health care. In 2011 membership enrolment and retention in the scheme was stalling. To obtain better insights into socio-cultural factors that influence utilization of healthcare services and the NHIS this...
Health shocks are among the most important unprotected risks for microfinance clients, but take-up of micro health insurance remains low. A framed field experiment with credit groups in Tanzania, eliciting demand for group versus individual insurance, attributes this to a social dilemma. In a context of joint liability, insurance is a public good b...
BACKGROUND:Quality care in health facilities is critical for a sustainable health insurance system because of its influence on clients' decisions to participate in health insurance and utilize health services. Exploration of the different dimensions of healthcare quality and their associations will help determine more effective quality improvement...
Many community-based development programmes are based on collective action and awareness raising. However, evaluations of such development interventions often do not take into account the potential spillovers on other community members due to the increased social capital within the village. This paper provides an evaluation of the Mahila Samakhya w...
Context:
Usage rates of female condoms are low throughout Sub-Saharan Africa. Programs have traditionally presented female condoms as a means of women's empowerment. However, prevailing gender norms in Sub-Saharan Africa assign sexual decision making to men, suggesting that male acceptance is imperative for increased use.
Methods:
In 2011, data...
In 2007, UNAIDS corrected estimates of global HIV prevalence downward from 40 million to 33 million based on a methodological shift from sentinel surveillance to population-based surveys. Since then, population-based surveys are considered the gold standard for estimating HIV prevalence. However, prevalence rates based on representative surveys may...
This paper provides a short-term impact evaluation of a home-visiting Early Child Development (ECD) program in the Caribbean aimed at vulnerable children from birth to three years. The analysis is based on a quasi-experimental research design including approximately four hundred children in treatment and comparable control communities. The differen...
Cardiovascular disease (CVD) is the leading cause of adult mortality in low-income countries but data on the prevalence of cardiovascular risk factors such as hypertension are scarce, especially in sub-Saharan Africa (SSA). This study aims to assess the prevalence of hypertension and determinants of blood pressure in four SSA populations in rural N...
Multivariable prediction models for blood pressure. SBP = systolic blood pressure, DBP = diastolic blood pressure, CI = confidence interval, Robust CI in parentheses, NP = not performed. Age = per year older, BMI = per unit increase, waist = per cm increase, cholesterol = per mmol/L increase *Compared to Hb tertile 1, **Food and non food consumptio...
Blood pressure pattern per age group in respondents with untreated or inadequately treated hypertension, all countries combined. HT = Hypertension, Isolated systolic hypertension = systolic blood pressure ≥140 and diastolic blood pressure <90, Isolated diastolic hypertension = diastolic blood pressure ≥90 and systolic blood pressure <140.
(TIF)
Awareness, treatment and blood pressure control in patients with hypertension in Namibia: insured versus not insured. Definitions: Aware = respondents who self report to have hypertension, Treated = respondents who self report to have hypertension, and who indicate to take drug treatment for hypertension, Controlled = respondents who self report to...
Construction of the HIV Knowledge score.
(DOC)
To estimate HIV incidence and prevalence in Windhoek, Namibia and to analyze socio-economic factors related to HIV infection.
In 2006/7, baseline surveys were performed with 1,753 private households living in the greater Windhoek area; follow-up visits took place in 2008 and 2009. Face-to-face socio-economic questionnaires were administrated by tra...
Abstract Impact evaluations of development programs usually do not explicitly take into account externalities on non-participants. Based on a unique dataset we estimate the direct as well as the spillover effects of Mahila Samakhya, a women's empowerment program in India, on child immunization. The survey covers both participants and non-participan...
The AIDS pandemic in sub-Saharan Africa puts increasing pressure on the buffer capacity of low- and middle-income households without access to health insurance. This paper examines the relationship between health shocks, insurance status and health-seeking behaviour. It also investigates the possible mitigating effects of insurance on income loss a...
Investigating alternative mechanisms of health care provision is important for African countries, where the epidemics of HIV/AIDS, tuberculosis, and malaria increase the demands on the health care sector. This chapter, using a unique combination of household survey data and a biomedical survey with HIV test data from Greater Windhoek in Namibia, an...
The literature on social capital clearly shows the significant relationship between social capital and individual outcomes such as educational attainment. However, there is little evidence so far on outcomes of very young children. This report studies the role of social capital in enhancing child outcomes. It investigates two potential sources of s...
Impact evaluations of development programmes usually focus on a comparison of participants with a control group. However, if the programme generates externalities for non-participants such an approach will capture only part of the programme's impact. Based on a unique large-scale quantitative survey we estimate the direct as well as the spillover e...
Within Egypt's national framework for improving access to and quality of education, the government has announced the intention of enlarging compulsory basic education with 1 or 2 years of preschool. This report to the World Bank examines early childhood development (ECD) in Egypt from an economic and financial perspective. Following an executive su...
UNAIDS recently corrected global HIV prevalence estimates downwards from 40 million to 33 million. This is not due to a reversal in the HIV/AIDS-epidemic, but to methodological adjustments, in particular to the shift from sentinel surveillance to population-based surveys. The main emphasis of our paper is on possible bias in these population-based...
Community-based development (CBD) projects are often argued to set in motion a virtuous cycle of increasing trust, norms and cooperation. However , empirical evidence on the existence of such a cycle is scarce. This paper investigates the impa ct of a women's empowerment programme in India on the dynamics of trust, reciprocity and coo peration. It...
Impact evaluations of development programmes usually do not explicitly take into account externalities on non-participants. Based on a unique dataset we estimate the direct as well as the spillover effects of a women's empowerment programme in India on child immunization. The survey covers both participants and non-participants in programme village...
