TITLE

Health systems performance in sub-Saharan Africa: governance, outcome and equity

AUTHOR(S)
Olafsdottir, Anna E.; Reidpath, Daniel D.; Pokhrel, Subhash; Allotey, Pascale
PUB. DATE
January 2011
SOURCE
BMC Public Health;2011, Vol. 11 Issue 1, p237
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: The literature on health systems focuses largely on the performance of healthcare systems operationalised around indicators such as hospital beds, maternity care and immunisation coverage. A broader definition of health systems however, needs to include the wider determinants of health including, possibly, governance and its relationship to health and health equity. The aim of this study was to examine the relationship between health systems outcomes and equity, and governance as a part of a process to extend the range of indicators used to assess health systems performance. Methods: Using cross sectional data from 46 countries in the African region of the World Health Organization, an ecological analysis was conducted to examine the relationship between governance and health systems performance. The data were analysed using multiple linear regression and a standard progressive modelling procedure. The under-five mortality rate (U5MR) was used as the health outcome measure and the ratio of U5MR in the wealthiest and poorest quintiles was used as the measure of health equity. Governance was measured using two contextually relevant indices developed by the Mo Ibrahim Foundation. Results: Governance was strongly associated with U5MR and moderately associated with the U5MR quintile ratio. After controlling for possible confounding by healthcare, finance, education, and water and sanitation, governance remained significantly associated with U5MR. Governance was not, however, significantly associated with equity in U5MR outcomes. Conclusion: This study suggests that the quality of governance may be an important structural determinant of health systems performance, and could be an indicator to be monitored. The association suggests there might be a causal relationship. However, the cross-sectional design, the level of missing data, and the small sample size, forces tentative conclusions. Further research will be needed to assess the causal relationship, and its generalizability beyond U5MR as a health outcome measure, as well as the geographical generalizability of the results.
ACCESSION #
61027165

 

Related Articles

  • PRENATAL AND DELIVERY CARE AND CHILDHOOD IMMUNIZATION IN QUATEMALA: DO FAMILY AND COMMUNITY MATTER? Pebley, Anne R.; Goldman, Noreen; Rodríguez, Germán // Demography;May96, Vol. 33 Issue 2, p231 

    This article focuses on family choices about pregnancy-related care, and the use of childhood immunization in Guatemala. In Guatemala, as in many countries, the public and the private sectors developed alongside and generally in isolation from several other preexisting medical belief and...

  • Comprehensive Perinatal Centers in the Era of Managed Care. Hartline, John V // Journal of Perinatology;Jan1999, Vol. 19 Issue 1, p1 

    Discusses perinatal centers in the era of managed care. Name of the person who helped in implementing the concept of the perinatal center in programs; Components of the perinatal center; Reasons for hiring neonatologists by the medium sized hospitals; Activities demonstrated by the New...

  • Making Moms Part of the Team.  // AHA News;09/21/98, Vol. 34 Issue 37, p2 

    Discusses how families at Evergreen Hospital in Kirkland, Washington have worked with hospital staff to shape Evergreen's maternity program. Details on the participation of mothers in a volunteer program; Education program being offered by the hospital; Benefits of Evergreen's program.

  • Quality of Maternal Health Care: A Call for Papers for a Maternal Health Task Force--PLoS Collection. Lattof, Samantha R.; Wegner, Mary Nell; Langer, Ana; Barbour, Virginia; Clark, Jocalyn; Jones, Susan; Norton, Melissa; Simpson, Paul; Veitch, Emma // PLoS Medicine;Nov2011, Vol. 8 Issue 11, Special section p1 

    A call for papers on the quality of maternal health care is presented.

  • Perinatal health services: an immodest proposal. Chalmers, Lain; Oakley, Ann; Macfarlane, Aidan // British Medical Journal;3/22/1980, Vol. 280 Issue 6217, p842 

    Comments on the proposed perinatal health services. Criticism on the policies for active induction; Efficacy of the proposal in lowering perinatal mortality; Need to consider the size of hospitals.

  • Changing practice in maternity care. Keirse, Marc J N C // BMJ: British Medical Journal (International Edition);10/17/98, Vol. 317 Issue 7165, p1027 

    Editorial. Presents information on maternity care in Great Britain; Significance of assessing the effectiveness of clinical interventions; Details on the implementation of randomization, a process conducting a randomized trial among patients to determine the most effective medical intervention;...

  • The introduction of intrapartum and postnatal aromatherapy service. Jardine, Maggie; Wade, Susan // British Journal of Midwifery;Mar2002, Vol. 10 Issue 3, p155 

    Focuses on the emphasis of the national policy in placing quality health care in Great Britain. Provision of flexible responsive maternity service on women's needs; Increase in the demand for complementary approaches to care; Exclusion of pregnant women.

  • The State of Health in Pakistan: An Overview. Afzal, Uzma; Yusuf, Anam // Lahore Journal of Economics;Sep2013 Special Edition, Vol. 18, p233 

    Although the Millennium Development Goals provide countries with well-rounded objectives for achieving human development over a period of 25 years, Pakistan is not on track to achieving the health-related goals. With the eighth highest newborn death rate in the world, in 2001-07 one in every ten...

  • Estimation of the Immunization Coverage in Mayotte in 2010. Jean-Louis, Solet; Noemie, Baroux; Tinne, Lernout; Laurent, Filleul; Alice, Petit; de Montera, Anne-Marie; Fabienne, Mazeau; Florence, Folliot-Garou // Open Public Health Journal;2013, Vol. 6, p1 

    Objectives: A survey was carried out in 2010 in order to assess the immunization coverage among children and adolescents living in Mayotte, a French collectivity located in the South Indian Ocean. Methods: This is a transversal two-stage cluster survey. Data was collected for 676 randomly...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics