Health Equity: 02/27/12

Monday, February 27, 2012

[EQ] Paying for performance to improve the delivery of health interventions in low- and middle-income countries

Paying for performance to improve the delivery of health interventions
in low- and middle-income countries (Review)

Sophie Witter1, Atle Fretheim2,5, Flora L Kessy3, Anne Karin Lindahl4

1Immpact, University of Aberdeen, Aberdeen, UK. 2Global Health Unit, Norwegian Knowledge Centre for the Health Services, Oslo, Norway. 3Ifakara Health Institute (IHI), Dar es Salaam, Tanzania. 4Norwegian Knowledge Centre for the Health Services, Oslo, Norway. 5Institute of Health and Society, University of Oslo, Oslo, Norway

Cochrane Database of Systematic Reviews 2012, Issue 2. Art. No.: CD007899

Available online PDF [83p.] at: http://bit.ly/wAk4Gf

“…..There is a growing interest in paying for performance as a means to align the incentives of health workers and health providers with public health goals. However, there is currently a lack of rigorous evidence on the effectiveness of these strategies in improving health care and health, particularly in low- and middle-income countries. Moreover, paying for performance is a complex intervention with uncertain benefits and potential harms.
A review of evidence on effectiveness is therefore timely, especially as this is an area of growing interest for funders and governments.

Objectives

To assess the current evidence for the effects of paying for performance on the provision of health care and health outcomes in low and middle-income countries.

Search methods

We searched more than 15 databases in 2009, including the Cochrane Effective Practice and Organisation of Care Group Specialised Register (searched 3March 2009), CENTRAL (2009, Issue 1) (searched 3March 2009),MEDLINE, Ovid (1948 to present) (searched 24 June 2011), EMBASE, Ovid (1980 to 2009Week 09) (searched 2March 2009), EconLit, Ovid (1969 to February 2009) (searched 5 March 2009), as well as the Social Sciences Citation Index, ISI Web of Science (1975 to present) (searched 8 September 2010). We also searched the websites and online resources of numerous international agencies, organisations and universities to find relevant grey literature and contacted experts in the field. We carried out an updated search on the Results-Based Financing website in April 2011, and re-ran the MEDLINE search in June 2011.

Selection criteria

Pay for performance refers to the transfer of money or material goods conditional on taking a measurable action or achieving a predetermined performance target. To be included, a study had to report at least one of the following outcomes: changes in targeted measures of provider performance, such as the delivery or utilisation of healthcare services, or patient outcomes, unintended effects and/or changes in resource use. Studies also needed to use one of the following study designs: randomised trial, non-randomised trial ….”

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[EQ] Social Inequalities in Health in Montreal

Social Inequalities in Health in Montréal

2011 Report of the Director of Public Health

Direction de santé publique - Agence de la santé et des services sociaux de Montréal -Canada

Available online at: http://bit.ly/wjwf4K

“……Social inequalities in health in Montréal, like elsewhere, are due in large part to income gaps among individuals. The increase in income inequality between wealthy and less wealthy people in Canada has come to the attention of the Organisation for Economic Co-operation and Development (OECD); it has noted that over the past few years, Canadian rates of poverty and inequality have risen more than the average for member countries. In particular, since the end of the 1990s, mechanisms for income redistribution no longer suffice to correct the increase in income inequalities among Canadian households. All age groups are not equally affected since the low-income rate for seniors is about 6% while that for children hovers around 15%.

Policies and incentives to work implemented in Québec in the past few years have focused on improving families’ living conditions. Compared with other provinces,

Québec has been more successful in reducing social inequalities, as can be seen in after-tax income….”

Thank you.

[EQ] Social determinants of health: the environmental dimension

Social determinants of health: the environmental dimension

The Lancet, Volume 379, Issue 9817, Page 686, 25 February 2012

Website: http://bit.ly/xfxoNk

“……The concept of environmental health might typically conjure up images of people living in smog-filled cities, or by contaminated rivers or overflowing landfill sites. However, it also concerns the spaces in which people most frequently inhabit: their homes and workplaces.

Furthermore, the conditions in which people live and work can vary according to factors such as income, occupation, education, and ethnicity, and lead to inequalities in exposure to environmental risks and related diseases…..”

Environmental health inequalities in Europe
Assessment report

WHO European Centre for Environment and Health, Bonn Office
WHO Regional Office for Europe, 2012

Available online PDF [212p.] at: http://bit.ly/xA9tmV

“…..Recent debate on the social determinants of health has indicated that the unequal distribution of health and well-being in national populations is a major challenge for public health governance. This is equally true for environmental health conditions and for exposure to environmental risk, which varies strongly by a range of sociodemographic determinants and thus causes inequalities in exposure to – and potentially in disease resulting from – environmental conditions.

Interventions tackling such environmental health inequalities need to be based on an assessment of their magnitude and on the identification of population groups that are most exposed or most vulnerable to environmental risks. However, data to quantify the environmental health inequality situation are not abundant, making comprehensive assessments difficult at both national and international levels.

WHO Regional Office for Europe has carried out a baseline assessment of the magnitude of environmental health inequality in the European Region based on a core set of 14 inequality indicators. The main findings of the assessment report indicate that socioeconomic and demographic inequalities in risk exposure are present in all countries and need to be tackled throughout the Region. However, the report also demonstrates that each country has a specific portfolio of inequalities, documenting the need for country-specific inequality assessments and tailored interventions on the national priorities….”

CONTENT

Executive summary

Introduction

Chapter 1. The concept of environmental health inequalities

A historic perspective

Inequality and inequity

Identification and assessment of inequalities and inequities

Environmental health inequality: hazard and risk

Sociodemographic factors, exposure and vulnerability

The psychosocial dimension in environmental health inequality

Framing the problem

Chapter 2. Housing-related inequalities

Data and methods

Inequalities in inadequate water supply

Inequalities in lack of a flush toilet in the dwelling

Inequalities in lack of a bath or shower in the dwelling

Inequalities in overcrowding

Inequalities in dampness in the home

Inequalities in keeping the home adequately warm

Inequalities in keeping the home adequately cool

Chapter 3. Injury-related inequalities

Inequalities in work-related injuries

Inequalities in fatal road traffic injuries (RTIs)

Inequalities in fatal poisoning

Inequalities in fatal falls

Chapter 4. Environment-related inequalities

Inequalities in noise exposure at home

Inequalities in lack of access to recreational or green areas

Inequalities in second-hand smoke exposure at home

Inequalities in second-hand smoke exposure at work

Chapter 5. Gaps in evidence and restrictions on assessing environmental health inequalities

Missing data

Limited stratification by sociodemographic determinants

Data quality

Consistency and comparability

Access to data

Cumulative and multiple exposures

Country priorities

Data gaps and relevance for public health

Chapter 6. Priorities for action on environmental health inequalities

Suggested subregional priorities for action

Suggested priorities for national action

Conclusion

Annex 1. National environmental health inequality fact sheets

Annex 2. Examples of national practices in analysis and presentation of environmental health inequalities

Annex 3. Assessment of priority areas for national action

Thank you.