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Health as a common good is of paramount importance for the world, especially in developing countries. This paper contributes to the literature by analysing the effect of climate vulnerability on child health outcomes in a sample of 107 developing countries over the period 2000–2020. We also analyse the mediating role of women's political empowerment and women's education in the relationship between climate vulnerability and child health outcomes. Using the method of generalised moments in a two-stage system and linear regression absorbing several levels of fixed effects, we found robust evidence that climate vulnerability worsens child health outcomes. We also found that women's political empowerment (WPE) and women's education mitigate the negative effect of climate vulnerability on child health outcomes. These results remain robust against several alternative tests and therefore highlight the need to better examine how the health consequences of climate vulnerability are structured by gender in developing countries. Given the importance of women as agents of change, it would be more beneficial for policymakers to include them in the decision-making process. • We use a dataset covering 107 developing countries over 21 years. • Child health outcomes: IMR, NMR, under-5 mortality rate, and vaccination coverage. • Linear regression absorbing multi-levels of fixed effects, and S-GMM are used. • Climate vulnerability leads to worse child health outcomes. • WPE and female education mitigate the effects of vulnerability on child health. [ABSTRACT FROM AUTHOR]

Health insurance is one of the main financing mechanisms currently being used in low and middle-income countries to improve access to quality services. Tanzania has been running its National Health Insurance Fund (NHIF) since 2001 and has recently undergone significant reforms. However, there is limited attention to the causal mechanisms through which NHIF improves service coverage and quality of care. This paper aims to use a system dynamics (qualitative) approach to understand NHIF causal pathways and feedback loops for improving service coverage and quality of care at the primary healthcare level in Tanzania. We used qualitative interviews with 32 stakeholders from national, regional, district, and health facility levels conducted between May to July 2021. Based on the main findings and themes generated from the interviews, causal mechanisms, and feedback loops were created. The majority of feedback loops in the CLDs were reinforcing cycles for improving service coverage among beneficiaries and the quality of care by providers, with different external factors affecting these two actions. Our main feedback loop shows that the NHIF plays a crucial role in providing additional financial resources to facilities to purchase essential medical commodities to deliver care. However, this cycle is often interrupted by reimbursement delays. Additionally, beneficiaries' perception that lower-level facilities have poorer quality of care has reinforced care seeking at higher-levels. This has decreased lower level facilities' ability to benefit from the insurance and improve their capacity to deliver quality care. Another key finding was that the NHIF funding has resulted in better services for insured populations compared to the uninsured. To increase quality of care, the NHIF may benefit from improving its reimbursement administrative processes, increasing the capacity of lower levels of care to benefit from the insurance and appropriately incentivizing providers for continuity of care. • The NHIF influences service coverage and quality in complex ways. • NHIF reimbursement is crucial for facilities and its delay affects inputs for quality. • Lower levels of care benefit less from NHIF. • Need to improve reimbursement process to enhance quality of care. [ABSTRACT FROM AUTHOR]

Global health research partnerships are increasingly taking the form of consortia that conduct programs of research in low and middle-income countries (LMICs). An ethical framework has been developed that describes how the governance of consortia comprised of institutions from high-income countries and LMICs should be structured to promote health equity. It encompasses initial guidance for sharing sovereignty in consortia decision-making and sharing consortia resources. This paper describes a first effort to examine whether and how consortia can uphold that guidance. Case study research was undertaken with the Future Health Systems consortium, performs research to improve health service delivery for the poor in Bangladesh, China, India, and Uganda. Data were thematically analysed and revealed that proposed ethical requirements for sharing sovereignty and sharing resources are largely upheld by Future Health Systems. Facilitating factors included having a decentralised governance model, LMIC partners with good research capacity, and firm budgets. Higher labour costs in the US and UK and the funder's policy of allocating funds to consortia on a reimbursement basis prevented full alignment with guidance on sharing resources. The lessons described in this paper can assist other consortia to more systematically link their governance policy and practice to the promotion of health equity. [ABSTRACT FROM AUTHOR]

Good health is crucial for human and economic development. In particular poor health in childhood is of utmost concern since it causes irreversible damage and has implications later in life. Recent research suggests globalization is a strong force affecting adult and child health outcomes. Yet, there is much unexplained variation with respect to the globalization effect on child health, in particular in low- and middle-income countries. One factor that could explain such variation across countries is the quality of democracy. Using panel data for 70 developing countries between 1970 and 2009 this paper disentangles the relationship between globalization, democracy, and child health. Specifically the paper examines how globalization and a country's democratic status and historical experience with democracy, respectively, affect infant mortality. In line with previous research, results suggest that globalization reduces infant mortality and that the level of democracy in a country generally improves child health outcomes. Additionally, democracy matters for the size of the globalization effect on child health. If for example Côte d’Ivoire had been a democracy in the 2000–2009 period, this effect would translate into 1200 fewer infant deaths in an average year compared to the situation without democracy. We also find that nutrition is the most important mediator in the relationship. To conclude, globalization and democracy together associate with better child health in developing countries. [ABSTRACT FROM AUTHOR]

Abstract: Health worker migration is an issue of first order concern in global health policy circles and continues to be the subject of much policy debate. In this paper, we contribute to the discussion by studying the impact of economic conditions on the migration of physicians from developing countries. To our knowledge, this is one of the first papers to do so. A major contribution of this paper is the introduction of a new panel dataset on migration to the US and the UK from 31 sub-Saharan Africa countries. The data spans the period 1975–2004. Using this data, we estimate the impact of changes in economic conditions on physician migration. In our preferred specification that allows for country-specific time trends, we find that a temporary one percentage point decline in GDP per capita increases physician migration in the next period by approximately. 3 percent. In our IV models a one percentage point decline in GDP per capita increases physician migration in the next period by between 3.4 and 3.6 percent. Overall, our results suggest a significant effect of developing country economic conditions on physician migration. [Copyright &y& Elsevier]

Abstract: Point-of-use water treatment (i.e., water purification at the point of consumption) has proven effective in preventing diarrhea in developing countries. However, widespread adoption has not occurred, suggesting that implementation strategies have not motivated sustained behavior change. We conducted a systematic literature review of published behavioral research on factors influencing adoption of point-of-use water treatment in countries categorized as low- to medium-development on the United Nations Development Programme Human Development Index. We used 22 key words to search peer-reviewed literature from 1950 to 2010 from OVID Medline, CINAHL, and PsycINFO. Twenty-six (1.7%) of 1551 papers met our four inclusion criteria: 1) implemented a point-of-use water treatment intervention, 2) applied a behavioral intervention, 3) evaluated behavior change as the outcome, and 4) occurred in a low- or medium-development country. We reviewed these 26 publications for detailed descriptions of the water treatment intervention, theoretical rationales for the behavioral intervention, and descriptions of the evaluation. In 5 (19%) papers, details of the behavioral intervention were fully specified. Seven (27%) papers reported using a behavioral theory in the design of the intervention and evaluation of its impact. Ten (38%) studies used a comparison or control group; 5 provided detailed descriptions. Seven (27%) papers reported high sustained use of point-of-use water treatment with rates >50% at the last recorded follow-up. Despite documented health benefits of point-of-use water treatment interventions in reducing diarrheal diseases, we found limited peer-reviewed behavioral research on the topic. In addition, we found the existing literature often lacked detailed descriptions of the intervention for replication, seldom described the theoretical and empirical rationale for the implementation and evaluation of the intervention, and often had limitations in the evaluation methodology. The scarcity of papers on behavior change with respect to point-of-use water treatment technologies suggests that this field is underdeveloped. [Copyright &y& Elsevier]

Abstract: The dynamics of childhood vaccination uptake in developing countries are unclear. Numerous studies document the relationship between vaccination coverage and access, socio economic and demographic factors. However, there is less knowledge about the relationship between vaccination coverage and carers'' motivation and willingness to seek childhood vaccinations. The aim of this paper is to introduce a framework for studying demand for childhood vaccination and to examine the coherence between theoretical predictions and empirical findings in a rural area in Malawi. We interviewed 635 carers with children aged 18–59 months. About 96 percent of the respondents reported to have fully vaccinated their youngest eligible child for all routine vaccinations scheduled in the Expanded Program on Immunization. This paper concludes that easy access to vaccination services cannot explain why demand is high. Many carers had to travel long distances to reach vaccination delivery points and a considerable share of the respondents scored waiting and travelling time as long. Results from the present study, in combination with theoretical predictions, suggest that a high level of trust in distributors of information and vaccines may be an essential explanatory factor for why carers seek immunization for their children, even in the presence of considerable costs. Trust may be an important explanatory factor as it can be seen to generate positive perceived benefits. [Copyright &y& Elsevier]

The nutrition transition hypothesis poses that as low-and-middle-income countries (LMICs) become wealthier and more urbanised, they experience a shift in dietary consumption towards 'Western' diets high in sugars, fats, animal-source foods, processed and packaged products. This paper uses panel data covering a period of 23 years to examine how changes in the urban environment relate to food expenditures, dietary diversity and traditional practices (food self-production and sharing) in Indonesia, a country that has experienced rapid economic growth and urbanisation over the last few decades. We first examine trends separately for urban and rural areas, and then use fixed effect models to examine whether change in urban residence is associated with changes in food expenditures, traditional practices, and overall dietary diversity. Results show that, despite some increases in acquisitions of animal-source foods and of packaged and ready-made foods, budget allocations for other food groups has remained constant, and that changes have largely occurred in parallel across urban and rural areas. In turn, traditional diets high in cereal and plant products, as well as traditional food practices continue to be dominant in both rural and urban areas, despite the context of rapid socio-economic change and urbanisation. Fixed effect regression suggests that transition from rural to urban residence is not significantly associated with changes in food expenditures for any of the outcomes examined. On the other hand, there is some evidence that moving specifically to Jakarta is associated with some change towards 'Western' food preferences. • Limited evidence of shift to "Western" dietary patterns for 13 Indonesian provinces (1993–2015). • Little or no change in expenditures for foods associated with the local traditional diet. • Urban residence not associated with "Western" dietary patterns except for Jakarta. • Pace of change similar in urban and rural areas; faster in rural areas for some foods. • Traditional food practices (self-production, transfers) retained in both urban and rural areas. [ABSTRACT FROM AUTHOR]

Abstract The development of human capabilities for many disadvantaged children around the world depends on growth recovery ('catch-up growth'). Here we develop a novel framework that allows different types of catch-up growth to be classified and estimated. We distinguish between catch-up in the mean of a group toward that of a healthy reference population versus catch-up within the group. We show these different growth types can be tested in a unified setting using a latent growth framework. We apply the results to four developing countries, using longitudinal data on 7641 children collected over the period 2002–2013. The results show catch-up growth rates are generally modest but vary significantly between countries, and that local environmental factors are material to variation in child growth trajectories. The paper discusses the benefits of the new framework versus current methods, shows that the method is feasible, and suggests they call for intervention designs that are sensitive to community and country contexts. Highlights • We distinguish between two forms of catch-up growth (within vs between). • A latent growth framework is used to estimate the two types of catch-up together. • We apply the empirical approach to the four Young Lives countries. • We find evidence of between- and within-country heterogeneity in catch-up. [ABSTRACT FROM AUTHOR]

Abstract: The high rate of maternal mortality in Timor-Leste is a persistent problem which has been exacerbated by the long history of military occupation and ongoing political crises since independence in 1999. It is similar to other developing countries where there have been slow declines in maternal mortality despite 20 years of Safe Motherhood interventions. The national Ministry of Health, United Nations (UN) agencies and non-government organisations (NGOs) have attempted to reduce maternal mortality by enacting policies and interventions to increase the number of births in health centres and hospitals. Despite considerable effort in promoting facility-based delivery, most Timorese women birth at home and the lack of midwives means few women have access to a skilled birth attendant. This paper investigates factors influencing access to and use of maternal health services in rural areas of Timor-Leste. It draws on 21 interviews and 11 group discussions with Timorese women and their families collected over two periods of fieldwork, one month in September 2006 and five months from July to December 2007. Theoretical concepts from anthropology and health social science are used to explore individual, social, political and health system issues which affect the way in which maternal health services are utilised. In drawing together a range of theories this paper aims to extend explanations around access to maternal health services in developing countries. An empirically informed framework is proposed which illustrates the complex factors that influence women’s birth choices. This framework can be used by policy-makers, practitioners, donors and researchers to think critically about policy decisions and where investments can have the most impact for improving maternal health in Timor-Leste and elsewhere. [Copyright &y& Elsevier]

Recent research and policy discourse commonly view the limited autonomy of women in developing countries as a key barrier to improvements in their reproductive health. Rarely, however, is the notion of women's autonomy interrogated for its conceptual adequacy or usefulness for understanding the determinants of women's reproductive health, effective policy formulation or program design. Using ethnographic data from 2001, including social mapping exercises, observation of daily life, interviews, case studies and focus group discussions, this paper draws attention to the incongruities between the concept of women's autonomy and the gendered social, cultural, economic and political realities of women's lives in rural Punjab, Pakistan. These inadequacies include: the concept's undue emphasis on women's independent, autonomous action; a lack of attention to men and masculinities; a disregard for the multi-sited constitution of gender relations and gender inequality; an erroneous assumption that uptake of reproductive health services is an indicator of autonomy; and a failure to explore the interplay of other axes of disadvantage such as caste, class or socio-economic position. This paper calls for alternative, more nuanced, theoretical approaches for conceptualizing gender inequalities in order to enhance our understanding of women's reproductive wellbeing in Pakistan. The extent to which our arguments may be relevant to the wider South Asian context, and women's lives in other parts of the world, is also discussed. [Copyright &y& Elsevier]

This paper analyzes the redistributive effect and progressivity associated with the current health care financing schemes in the Occupied Palestinian Territory, using data from the first Palestinian Household Health Expenditure Survey conducted in 2004. The paper goes beyond the commonly used “aggregate summary index approach” to apply a more detailed “disaggregate approach”. Such an approach is borrowed from the general economic literature on taxation, and examines redistributive and vertical effects over specific parts of the income distribution, using the dominance criterion. In addition, the paper employs a bootstrap method to test for the statistical significance of the inequality measures. While both the aggregate and disaggregate approaches confirm the pro-rich and regressive character of out-of-pocket payments, the aggregate approach does not ascertain the potential progressive feature of any of the available insurance schemes. The disaggregate approach, however, significantly reveals a progressive aspect, for over half of the population, of the government health insurance scheme, and demonstrates that the regressivity of the out-of-pocket payments is most pronounced among the worst-off classes of the population. Recommendations are advanced to improve the performance of the government insurance schemes to enhance its capacity in limiting inequalities in health care financing in the Occupied Palestinian Territory. [Copyright &y& Elsevier]

Abstract: This paper is concerned with how poor populations can obtain access to trusted, competent knowledge and services in increasingly pluralistic health systems where unregulated markets for health knowledge and services dominate. The term “unregulated” here derives from the literature on the development of markets in low income countries and refers to the lack of state enforcement of formal laws and regulations. We approach this question of access through the changing roles and fortunes of community health workers over the last few decades and ask what kind of role they can be expected to play in the future. Community based health agents have been used in many settings as a way of filling gaps in service provision where more skilled personnel are not available. They have also fulfilled a more transformative role in broad based community development. We explore the reasons for the decline of programmes from the 1980s onwards. Using the specific experience of Bangladesh, the paper considers what lessons can be learned from past successes and failures and what needs to change to meet the challenges of 21st century health systems. These challenges are those of establishing credibility and legitimacy in a pluralistic environment and creating a sustainable livelihood strategy. The article concludes with a discussion of four potential models of community based health agents which are not necessarily exclusive: a generic agent that is closely linked to a reputable supervisory agency; a specialist cadre working with particular health conditions; an expert advocate; and a mobiliser or facilitator who can mediate between users and health markets. [Copyright &y& Elsevier]

Abstract: This paper discusses the present and future role of the health professions in health services delivery systems in low-income countries. Unlike richer countries, most low-income countries do not have a tradition of labour market regulation and the capacity of the professions themselves to regulate the provision of health services by their members tends to be weak. The paper looks at the impact of professional monopolies on the performance of health services delivery systems, e.g. equity of access, effectiveness of services, efficiency in the use of scarce resources, responsiveness to users'' needs, including protection against the financial impact of utilising health services. It identifies issues which policy-makers face in relation to opening the health labour market while guaranteeing the safety and security of services provided by professionals. The suggestion is made that a “social contract”, granting privileges of practice in exchange of a commitment to actively maintain and enhance the quality of their services, may be a viable course of action. This would require that the actors in the policy process collaborate in strengthening the capacity of regulatory agencies to perform their role. [Copyright &y& Elsevier]

Abstract: Little research exists on health determinants among adults living in economically deprived regions despite the fact that these areas comprise a good part of the world. This paper examines the distribution of wealth then tests associations between wealth inequality and a variety of health outcomes, among older adults, in one of the world''s poorest regions—rural Cambodia. Data from the 2004 Survey of the Elderly in Cambodia are employed. Using a disablement framework to conceptualize health, associations between four health components and a wealth inequality measure are tested. The wealth inequality measure is based on an index that operationalizes wealth as ownership of household assets and household structural components. Results confirm difficult economic conditions in rural Cambodia. The lowest wealth quintile lives in households that own nothing, while the next quintiles are only slightly better off. Nevertheless, logistic regressions that adjust for other covariates indicate heterogeneity in health across quintiles that appear qualitatively similar, with the bottom quintiles reporting the most health problems. An exception is disability, which presents a U-shaped association. It is difficult to determine mechanisms behind the relationship using cross-sectional data, but the paper speculates on possible causal directions, both from wealth to health and vice-versa. The analysis suggests the ability to generalize the relationship between wealth inequality and health to extremely poor populations as a very small difference in wealth makes a relatively large difference with respect to health associations among those in meager surroundings. [Copyright &y& Elsevier]

Abstract: Since health research has become increasingly acknowledged as an important tool for development, many approaches have been undertaken to understand national health research from a systems perspective. This paper reviews 28 case studies that describe or analyse health research systems in 26 low- and middle-income countries. These case studies were sponsored either by the Council on Health Research for Development or the South-East Asia Regional Office of the World Health Organization. In reviewing these case studies, we identify several common challenges facing national health research systems. These challenges include the lack of coordination in research activities; the inadequate participation of stakeholders in research, policy and implementation processes; the lack of demand for research and the low accessibility of research findings. These obstacles are compounded by some fundamental systems constraints, such as the lack of financial resources, human capacities, infrastructure and data. By identifying from these case studies the common challenges of health research systems as well as approaches to overcome these, this paper highlights the potential for case studies to inform policies and strategies for strengthening health research systems, and presents recommendations for future case studies to increase this potential. [Copyright &y& Elsevier]

Participatory approaches are becoming increasingly important in the field of health, and many organizations, governments and donors have recognized the need to increase stakeholder involvement to ensure sustainable and real change. However, commitment to participation is often lacking and participatory processes, if applied, tend to be shortterm and discrete, especially in institutional settings. Rarely, for example, are stakeholders involved in long-term monitoring and evaluation activities, due the time-consuming nature of participation, and to perceptions on the part of donors and other decision-makers that participation lacks the rigor and objectivity of external evaluation. This paper describes the strategies used by an international reproductive health organization to collaborate with local stakeholders in a long-term participatory approach to quality improvement, focusing on defining quality of care, identifying problems in health facilities, setting goals and seeking solutions to those problems, tracking changes in quality over time, and feeding this monitoring and evaluation information back into the quality improvement process. The paper also illustrates how greater participation was achieved over time as local stakeholders moved away from traditional models and relationships and started working together to meet their quality improvement goals. The paper argues that participatory techniques are essential if the real needs of clients are to be met through sustained change and continuous quality improvement at the site level. [ABSTRACT FROM AUTHOR]

Empirical evidence suggests that parental preferences may be important in determining investment allocations among their children. However, there is mixed or no evidence on a number of important related questions. Do parents invest more in better-endowed children, thus reinforcing differentials among their children? Or do they invest more in less-endowed children to compensate for their smaller endowments and reduce inequalities among their children? Does higher maternal education affect the preferences underlying parental decisions in investing among their children? What difference might such intrafamilial investments among children make? And what is the nature of these considerations in the very different context of developing countries? This paper gives new empirical evidence related to these questions. We examine how parental investments affecting child education and health respond to initial endowment differences between twins within families, as represented by birth weight differences, and how parental preference tradeoffs and therefore parental investment strategies vary between families with different maternal education. Using the separable earnings-transfers model (Behrman et al., 1982), we first illustrate that preference differences may make a considerable difference in the ratios of health and learning differentials between siblings – up to 30% in the simulations that we provide. Using a sample of 2000 twins, collected in the 2012 wave of the Early Childhood Longitudinal Survey for Chile, we find that preferences are not at the extreme of pure compensatory investments to offset endowment inequalities among siblings nor at the extreme of pure reinforcement to favor the better-endowed child with no concern about inequality. Instead, they are neutral, so that parental investments do not change the inequality among children due to endowment differentials. We also find that there are not significant preference differences between families with low- and high-educated mothers. Our estimates are consistent with previous empirical evidence that finds that parents do not invest differentially within twins. [ABSTRACT FROM AUTHOR]

There is a growing concern that inequalities are hindering health outcomes. This paper's primary objective is to investigate the role of relative deprivation and inequality in explaining the daily spread of the Covid-19 pandemic. For this purpose, we use secondary cross-sectional data across 119 (developed and developing) countries from January 2020 – to April 2021. For the empirical analysis, we use a recent dynamic panel data modelling approach that allows us to identify the role of time-invariant variables such as degree of globalisation, political freedom and income inequality on the dynamics of the pandemic and fatality rates across countries. We find that new cases per million and fatality rates are highly persistent processes. After controlling for time-varying mobility statistics from the Google mobility database and region-specific dummy variables, the two significant factors that explain the severity of Covid-19 spread in a country are per-capita Gross Domestic Product (GDP) and Yitzhaki's relative income deprivation index. Lagged value of new cases per million significantly explains cross-country variations in the daily case fatality rates. A higher proportion of the older population and pollution increased fatality rates while better medical infrastructure reduced it. • Higher inequality led to a faster spread of Covid-19 cases. • Per-capita GDP has a positive and significant effect on Covid-19 cases. • Google mobility data is a good predictor of Covid-19 cases. • Faster spread of Covid-19 cases is associated with higher case fatality rates. • Pollution increased Covid-19 fatality rates. [ABSTRACT FROM AUTHOR]

Despite optimism about the end of AIDS, the HIV response requires sustained financing into the future. Given flat-lining international aid, countries' willingness and ability to shoulder this responsibility will be central to access to HIV care. This paper examines the potential to expand public HIV financing, and the extent to which governments have been utilising these options. We develop and compare a normative and empirical approach. First, with data from the 14 most HIV-affected countries in sub-Saharan Africa, we estimate the potential increase in public HIV financing from economic growth, increased general revenue generation, greater health and HIV prioritisation, as well as from more unconventional and innovative sources, including borrowing, health-earmarked resources, efficiency gains, and complementary non-HIV investments. We then adopt a novel empirical approach to explore which options are most likely to translate into tangible public financing, based on cross-sectional econometric analyses of 92 low and middle-income country governments' most recent HIV expenditure between 2008 and 2012. If all fiscal sources were simultaneously leveraged in the next five years, public HIV spending in these 14 countries could increase from US$3.04 to US$10.84 billion per year. This could cover resource requirements in South Africa, Botswana, Namibia, Kenya, Nigeria, Ethiopia, and Swaziland, but not even half the requirements in the remaining countries. Our empirical results suggest that, in reality, even less fiscal space could be created (a reduction by over half) and only from more conventional sources. International financing may also crowd in public financing. Most HIV-affected lower-income countries in sub-Saharan Africa will not be able to generate sufficient public resources for HIV in the medium-term, even if they take very bold measures. Considerable international financing will be required for years to come. HIV funders will need to engage with broader health and development financing to improve government revenue-raising and efficiencies. [ABSTRACT FROM AUTHOR]

Under what conditions do local political elites in new democracies promote citizen health? To address the question, this paper advances hypotheses grounded in prominent political science debates and assesses them against comprehensive, granular data from the most recent South African national census. The evidence rejects the hypotheses that relatively great partisan competition and relatively great popular participation boost local population health. The evidence provides conditional support for the hypotheses that local health outcomes are enhanced in municipalities where the national ruling party commands relatively great citizen backing and where hereditary chiefs are strong. In particular, where local strongholds of the national ruling party coincide with strong chiefly authority, the predicted probability of infant and under-five death over all households is reduced, as is the predicted probability of infant and under-five death among majority Black African households, holding other things equal. In these nuanced ways, the actors holding power at the local level matter for the survival of babies and children in South Africa. The paper contributes to scholarship on institutions in new democracies, chiefly authority, the conditions for infant and under-five survival, and the political determinants of health. In doing so, it demonstrates the value of drilling down to the local level to probe the political determinants of population health. • Weighs factors flagged in political science debates as affecting citizen wellbeing. • Analysis for South Africa uses granular census data, augmented by municipal data. • Under some conditions, the odds of infant and child death vary with local context. • Local context is municipal support for national ruling party and chiefly power. • The study shows the value of probing the local political determinants of health. [ABSTRACT FROM AUTHOR]

While the economic consequences of IMF programs have been extensively analyzed in the literature, much less is known about how key welfare indicators, including suicide-mortality rates, correlate with countries' participation in such programs. This paper examines the impact of IMF lending on suicide mortality, using data from 30 developing and transition countries that received non-concessionary IMF loans during 1991–2008. Our results support the hypothesis of a positive causal relationship between suicide mortality and participation in IMF programs but reveal no systematic suicide-increasing effect from the size of IMF loans. This holds after accounting for self-selection into programs, resulting from the endogeneity of a country's decision to resort to the IMF for funding, and after controlling for standard socio-economic influences on suicidal behaviour. In particular, we find a positive aggregate suicide-mortality differential due to IMF-program participation of between 4 and 14 percentage points. We also find that the positive association between suicides and program participation is stronger and more robust among males. Comparing age groups, individuals belonging to the age group 45-to-64 exhibit the highest increase in suicide due to program-participation, which amounts to over 18 percentage points. Overall, our results imply that when countries are exposed to IMF programs in an attempt to resolve their economic problems, social-safety nets need to be designed to protect the adversely-affected part of the population. [ABSTRACT FROM AUTHOR]

The aim of this paper is to investigate the impact of inward foreign direct investment (FDI) on population health. For this purpose, we rely on a new measure of health, which not only takes into account life expectancy, but also morbidity and allows us to evaluate both quality and length of life. We apply a new instrumental variable approach, based on the diffuse characteristic of globalization, to a panel of 143 countries over the period 1990–2019 and find an overall positive association of FDI with health. However, we also demonstrate that this positive relationship decreases with countries' per capita GDP. We reveal that developing economies have strongly benefited from inward FDI but, more developed economies less so. For the most-developed countries in our sample, the impact is even negative, but we demonstrate that higher employment protection, which is associated with a lower level of job insecurity, allows countries to decrease this pernicious effect. • FDI is differently associated with health according to the country income-level. • FDI is negatively linked with Health-Adjusted Life Expectancy in richer countries. • Employment protection decreases the negative association in richer countries. [ABSTRACT FROM AUTHOR]

Abstract: In recent years, there has been considerable interest in social capital theory in both research and policy arenas. Social capital has been associated with many aspects of improvements in health, environment and development. This paper assesses the theoretical support for a social capital based analysis of environment and health issues with a focus on the water-health nexus in low and middle income countries. We review conceptualisation of social capital by Pierre Bourdieu in relation to his concepts of “fields” and “habitus” as well as other conceptualisations of social capital by James Coleman and Robert Putnam. We integrate these authors' ideas with ecosocial analysis of social and geographical patterns of access to safe water, adequate sanitation and hygiene and the resulting health impacts. Further, we develop a conceptual framework for linking social capital and health through the water-health nexus. The framework focuses on the role of social capital in improving water-related knowledge, attitudes and practices as well as facilitating collective action towards improving access to water and sanitation. The proposed framework will facilitate critical engagement with the pathways through which social processes and interactions influence health within the context of access to water, sanitation and hygiene in low and middle income countries. [Copyright &y& Elsevier]

Abstract: Sector Wide Approaches (SWAp) emerged during the 1990s as a new policy mechanism for aid delivery. Eschewing many features of traditional project-based aid, SWAps give greater control of aid allocation to recipient countries. Some critics have questioned whether reducing a donor's level of influence over aid allocation might lead to a decrease in donor contributions. While some qualitative evaluations have described the level of fund pooling and donor participation in SWAps, no previous study has empirically examined this potential ‘donor-flight’ response to health SWAp implementation. This paper utilises a uniquely compiled dataset of 46 low-income countries over 1990–2009 and a variety of panel data regression models to estimate the impact of health SWAp implementation on levels of health aid. Results suggest that amongst 16 especially poor low-income countries, SWAp implementation is associated with significant decreases in health aid levels compared with non-implementers. This suggests donors are not indifferent to how their contributions are allocated by recipients, and that low-income countries considering a SWAp may need to weigh the benefits of greater control of aid allocations against the possibility of reduced aid income. [Copyright &y& Elsevier]

Abstract: Behaviour change communication is vital for increasing the enactment of particular behaviours known to promote health and growth. The techniques used to change behaviour are important for determining how successful the intervention is. In order to integrate findings from different interventions, we need to define and organize the techniques previously used and connect them to effectiveness data. This paper reviews 24 interventions and programs implemented to change four health behaviours related to child health in developing countries: the use of bed nets, hand washing, face washing and complementary feeding. The techniques employed are organized under six categories: information, performance, problem solving, social support, materials, and media. The most successful interventions use three or even four categories of techniques, engaging participants at the behavioural, social, sensory, and cognitive levels. We discuss the link between techniques and theories. We propose that program development would be more systematic if researchers considered a menu of technique categories appropriate for the targeted behaviour and audience when designing their studies. [Copyright &y& Elsevier]

Abstract: A substantial portion of the world’s population does not have ready access to safe water. Moreover, obtaining water may involve great expense of time and energy for those who have no water sources in or near home. From an historical perspective, with the invention of piped water, fetching water has only recently become largely irrelevant in many locales. In addition, in most instances, wells and clean surface water were so close by that fetching was not considered a problem. However, population growth, weather fluctuations and social upheavals have made the daily chore of carrying water highly problematic and a public health problem of great magnitude for many, especially women, in the poor regions and classes of the world. In this paper, we consider gender differences in water carrying and summarize data about water access and carrying from 44 countries that participated in the Multiple Indicator Cluster Survey (MICS) program. Women and children are the most common water carriers, and they spend considerable time (many trips take more than an hour) supplying water to their households. Time is but one measure of the cost of fetching water; caloric expenditures, particularly during droughts, and other measures that affect health and quality of life must be considered. The full costs of fetching water must be considered when measuring progress toward two Millennium Development Goals – increasing access to safe drinking water and seeking an end to poverty. [Copyright &y& Elsevier]

Abstract: Socioeconomic-related inequalities in healthcare delivery have been extensively studied in developed countries, using standard linear models of decomposition. This paper seeks to assess equity in healthcare delivery in the particular context of the occupied Palestinian territory: the West Bank and the Gaza Strip, using a new method of decomposition based on microsimulations. Besides avoiding the ‘unavoidable price’ of linearity restriction that is imposed by the standard methods of decomposition, the microsimulation-based decomposition enables to circumvent the potentially contentious role of heterogeneity in behaviours and to better disentangle the various sources driving inequality in healthcare utilisation. Results suggest that the worse-off do have a disproportinately greater need for all levels of care. However with the exception of primary-level, utilisation of all levels of care appears to be significantly higher for the better-off. The microsimulation method has made it possible to identify the contributions of factors driving such pro-rich patterns. While much of the inequality in utilisation appears to be caused by the prevailing socioeconomic inequalities, detailed analysis attributes a non-trivial part (circa 30% of inequalities) to heterogeneity in healthcare-seeking behaviours across socioeconomic groups of the population. Several policy recommendations for improving equity in healthcare delivery in the occupied Palestinian territory are proposed. [Copyright &y& Elsevier]

Abstract: In spite of high levels of poverty in low and middle income countries (LMIC), and the high burden posed by common mental disorders (CMD), it is only in the last two decades that research has emerged that empirically addresses the relationship between poverty and CMD in these countries. We conducted a systematic review of the epidemiological literature in LMIC, with the aim of examining this relationship. Of 115 studies that were reviewed, most reported positive associations between a range of poverty indicators and CMD. In community-based studies, 73% and 79% of studies reported positive associations between a variety of poverty measures and CMD, 19% and 15% reported null associations and 8% and 6% reported negative associations, using bivariate and multivariate analyses respectively. However, closer examination of specific poverty dimensions revealed a complex picture, in which there was substantial variation between these dimensions. While variables such as education, food insecurity, housing, social class, socio-economic status and financial stress exhibit a relatively consistent and strong association with CMD, others such as income, employment and particularly consumption are more equivocal. There are several measurement and population factors that may explain variation in the strength of the relationship between poverty and CMD. By presenting a systematic review of the literature, this paper attempts to shift the debate from questions about whether poverty is associated with CMD in LMIC, to questions about which particular dimensions of poverty carry the strongest (or weakest) association. The relatively consistent association between CMD and a variety of poverty dimensions in LMIC serves to strengthen the case for the inclusion of mental health on the agenda of development agencies and in international targets such as the millenium development goals. [Copyright &y& Elsevier]

Abstract: This paper presents findings on conditions of healthcare delivery in Afghanistan. There is an ongoing debate about barriers to healthcare in low-income as well as fragile states. In 2002, the Government of Afghanistan established a Basic Package of Health Services (BPHS), contracting primary healthcare delivery to non-state providers. The priority was to give access to the most vulnerable groups: women, children, disabled persons, and the poorest households. In 2005, we conducted a nationwide survey, and using a logistic regression model, investigated provider choice. We also measured associations between perceived availability and usefulness of healthcare providers. Our results indicate that the implementation of the package has partially reached its goal: to target the most vulnerable. The pattern of use of healthcare provider suggests that disabled people, female-headed households, and poorest households visited health centres more often (during the year preceding the survey interview). But these vulnerable groups faced more difficulties while using health centres, hospitals as well as private providers and their out-of-pocket expenditure was higher than other groups. In the model of provider choice, time to travel reduces the likelihood for all Afghans of choosing health centres and hospitals. We situate these findings in the larger context of current debates regarding healthcare delivery for vulnerable populations in fragile state environments. The ‘scaling-up process’ is faced with several issues that jeopardize the objective of equitable access: cost of care, coverage of remote areas, and competition from profit-orientated providers. To overcome these structural barriers, we suggest reinforcing processes of transparency, accountability and participation. [Copyright &y& Elsevier]

Abstract: The issue of illness reporting in modelling demand for health care in low- and middle-income countries can be handled according to either of two conceptually-different constructs: (a) considering illness reporting behaviour as endogenous to demand; or (b) considering demand itself as the outcome of a sample selection phenomenon. In this paper, we take the second viewpoint and estimate the demand for medical care with an estimator that uses Heckman-type. Empirical estimates based on household survey data from rural Burkina Faso suggest that there are some implications of illness reporting behaviour for modelling the demand for medical care. [Copyright &y& Elsevier]

Abstract: In developing countries, where health insurance is not a commonly purchased financial instrument, recent debates have revolved around extending health insurance coverage to a wider range of the population, primarily via compulsory insurance schemes. However, these debates rarely consider the competing demands placed on the family budget, which will influence the acceptability of the program by the populace. In this paper, we draw on data from the 2000 income and expenditure survey to examine treatment effects associated with household insurance status, providing a detailed examination of expenditure substitution patterns within South Africa. In agreement with economic theory, the expansion of health insurance coverage via compulsory schemes creates additional burdens for households, which households accommodate via expenditure substitution. The observed variation in the household''s ability to accommodate increased expenditure can and should be used in future to assess policy options and in the design of an optimal social health insurance program. [Copyright &y& Elsevier]

Abstract: In the past 15 or so years, the “evidence-based medicine” (EBM) framework has become increasingly institutionalized, facilitating its transfer across the globe. In the late 1990s, the basic principles of EBM began to have a marked influence in a number of non-clinical public policy arenas. Policy-makers working in these areas are now being urged to move away from developing policies according to political ideologies to a more legitimate approach based on “scientific fact,” a process termed “evidence-based policy-making” (EBPM). The conceptual diffusion of EBM to non-clinical arenas has exposed epistemologically destabilizing views regarding the definition of “science,” particularly as it relates to the demands of global versus national/sub-national policy-making. Using the maternal and neonatal subfield as an ethnographic case-study, this paper explores the effects of these divergences on EBPM in 5 developing countries (Bangladesh, Burkina Faso, Ghana, Malawi and Nepal). In doing so, our analysis aims to explain why EBPM has thus far had a limited impact in the area of context-specific programmatic policy-development and implementation at the national and sub-national levels. Results highlight that the political contexts in which EBPM is played out promote uniformity of methodological and policy approaches, despite the fact that disciplinary diversity is being called for repeatedly in the public health literature. Even in situations where national EBPM diverges from international priorities, national evidence-based policies are found to hold little weight in countering global policy interests, which some informants claim are themselves legitimated, rather than informed, by evidence. Informants also highlight the way interpretations of research findings are shaped by the broader political context within which donors set priorities and distribute limited resources – contexts that are driven by the need to provide generalisable research recommendations based on scientifically replicable methods. Added to this are clear rifts between senior and junior-level experts within countries that constrain national and sub-national research agendas from serving as tools for empowered knowledge production and problem-solving. We conclude by arguing for diverse forms of research that can more effectively address context-specific problems. While such diversity may render EBPM more conflict-ridden, debate is by no means an undesirable characteristic in any evolving system of knowledge, for it has the potential to foster critical insight and localized change. [Copyright &y& Elsevier]

Abstract: Governmental-contracting of non-governmental organizations (NGOs) is a central strategy of neoliberal health reforms in Central America. More than improving the equity, efficiency, and quality of health services, contracting presents a potential mechanism to redefine antagonistic relationships between the state and civil society, particularly in countries ravaged by political violence. In this paper I examine the process of heath reform in Guatemala through the implementation of the Sistema Integral de Atención en Salud (SIAS) in the municipality of San Martín Jilotepeque. Mandated in the 1996 Peace Accords, SIAS potentially facilitates decentralization and civil participation through governmental-contracting of NGOs to provide health services to underserved populations. Drawing on ethnographic interviews with NGO representatives, Ministry of Health (MOH) workers, and community health workers and midwives, I examine the contracting process and then address issues of equity, efficiency, and quality of services, as well as the process of decentralization. I argue that contracted NGOs are largely restricted to serve as administrators, removed from the delivery of services, and are heavily dependent upon the traditional MOH structure, which limits the ability of SIAS to improve health services or foster the processes of decentralization and democratization. [Copyright &y& Elsevier]

Caesarean section rates have risen dramatically in several developing countries, especially in Latin America and South Asia. This raises a range of concerns about the use of caesarean section for non-emergency cases, not least the progressive shift of resources to non-essential medical interventions in resource-poor settings and additional health risks to mothers and newborns following a caesarean section. There are only a few studies that have systematically examined the factors influencing the recent increase in caesarean rates. In particular, it is not clear whether high elective caesarean rates are driven by medical, institutional or individual and family decisions. Where a woman''s decisions predominate her interaction with peers and significant others have an impact on her caesarean section choices. Using random intercept logistic regression analyses, this paper analyses the institutional, socio-economic and community factors that influence caesarean section in six countries: Bangladesh, Colombia, Dominican Republic, Egypt, Morocco and Vietnam. The analyses, based on data from over 20,000 births, show that women of higher socio-economic background, who had better access to antenatal services are the most likely to undergo a caesarean section. Women who exchange reproductive health information with friends and family are less likely to experience a caesarean section than their counterparts. The study concludes that there is a need to pursue community-based approaches for curbing rising caesarean section rates in resource-poor settings. [Copyright &y& Elsevier]

Abstract: This paper examines how people account for health-seeking behaviour regarding infertility in developing countries, where infertility is a serious problem. Traditionally, studies of health related behaviours focus on how individuals'' decisions depend upon a combination of demographic and cognitive characteristics and practical inhibitors. However, there are calls for more social approaches to health behaviour which address the social context and an individual''s own rationale for their actions. Therefore, we use discursive psychology to examine how Malawian interviewees describe and explain actions (not) taken to solve their fertility problem, and the interpersonal functions (e.g., blaming and justifying) thereby served. We focus in particular on respondents'' descriptions of inaction since this is neglected in the literature, which emphasises instead intense health-seeking behaviour in response to infertility. We show how respondents attend to inaction as accountable, that is, as deviation from normative expectations and thus requiring explanation, and how they emphasise the reasonable and blameless character of their decisions and (in)action. The analysis highlights how explanations of health-seeking perform social functions rather than being neutral reflections of decision-making processes. Insofar as orientations to normative expectations inform people''s relentless search for a cure, this may be problematic for health care seekers and providers alike. [Copyright &y& Elsevier]

Abstract: Increasing attention has been paid in recent years to efforts to strengthen the impact of research on policy in low- and middle-income countries. However, the processes by which such research might have policy impact remain a subject of debate. This paper presents an analysis of the research/policy interface, drawing on the experiences of two South African health policy and systems research (HPSR) units and one specific study which traced the development and implementation of three areas of health care financing policy change and debate between 1994 and 1999. The analysis is based primarily on the authors'' own experiences and has been developed through a deliberate process of reflection. It suggests, first, that it is important to acknowledge the conceptual and symbolic uses and impacts of research – perhaps, particularly in relation to the system-oriented work of HPSR groups. These uses may not be verifiable by specific changes in policy and practice but are important contributions to the policy environment and do filter into policy-makers'' understandings and actions. Second, achieving any form of impact on policy is linked to the attention researchers pay to the context in which the research is undertaken, the nature and credibility of the research; and the importance of nesting any single project in a broader programme of engagement with the policy environment that builds trust in the researchers. [Copyright &y& Elsevier]

Abstract: Individual informed consent is a key ethical obligation for clinical studies, but empirical studies show that key requirements are often not met. Common recommendations to strengthen consent in low income settings include seeking permission from community members through existing structures before approaching individuals, considering informed consent as a process rather than a single event, and assessing participant understanding using questionnaires. In this paper, we report on a qualitative study exploring community understanding and perceptions of a malaria vaccine trial (MVT) conducted in a rural setting on the Kenyan Coast. The MVT incorporated all of the above recommendations into its information-giving processes. The findings support the importance of community level information-giving and of giving information on several different occasions before seeking final individual consent. However, an emerging issue was that inter-personal interactions and relationships between researchers and community members, and within the community, play a critical role in participants'' perceptions of a study, their decisions to consent or withdraw, and their advice to researchers on study practicalities and information to feedback at the end of the trial. These relationships are based on and continually tested by information-giving processes, and by context specific concerns and interests that can be difficult to predict and are well beyond the timescale and reach of single research activities. On the basis of these findings, we suggest that the current move towards increasingly ambitious and stringent formal standards for information-giving to individuals be counter-balanced with greater attention to the diverse social relationships that are essential to the successful application of these procedures. This may be assisted by emphasising respecting communities as well as persons, and by recognising that current guidelines and regulations may be an inadequate response to the complex, often unpredictable and ever shifting ethical dilemmas facing research teams working ‘in the field’. [Copyright &y& Elsevier]

Although the subject of health services exports by developing countries has been much discussed, the phenomenon is still in its early stage, and its real implications are not yet clear. Given the rapid development in this area, little empirical data are available. This paper aims to fill this gap by providing reliable data on consumption of health services abroad (GATS mode 2 of international service supply). It starts by assessing the magnitude of the volume of international trade in health services. This is followed by an in-depth analysis of the case of Tunisia based on an original field research. Because of the high quality of its health sector and its proximity with Europe, Tunisia has the highest export potential for health services in the Middle-East and North Africa (MENA) Region. Health services exports may represent a quarter of Tunisia''s private health sector output and generate jobs for 5000 employees. If one takes into account tourism expenses by the incoming patient (and their relatives), these exports contribute to nearly 1% of the country''s total exports. Finally, this case study highlights the regional dimension of external demand for health services and the predominance of South–South trade. [Copyright &y& Elsevier]

Abstract: Much of the writing on health in developing countries focuses on the public sector rather than the private market, and on providers rather than on consumers. A more consumer-oriented perspective would regard the transactions by which most people in most poor countries buy healthcare as the norm, just one among many purchases of a personal service which all of us, as consumers, have to make. This paper contends that asymmetric information is not confined to health and medicine, but is a common problem for consumers whatever the GDP of the country they live in, and however rich and poor they may be. Understanding how consumers overcome these problems yields insights into the ways in which providers have to market their services, and into what, if anything, governments and donors can do to extend, improve or regulate the private healthcare market. [Copyright &y& Elsevier]

Abstract: There has been much discussion of the role that recent advances in information and communication technologies (ICTs) could play in improving health systems in developing countries, but limited independent analysis of existing applications. Combining a case study approach with a general discussion of the issues, this paper attempts to assess the potential benefits of a diverse range of ICT innovations and some of the constraints they will need to overcome. Four broad areas are considered: improvements in traditional health information systems; computer-aided diagnosis and treatment monitoring; a range of applications generically labelled ‘telemedicine’; and the use of ICT to inform general populations on health and healthcare. The final section speculates on the possible medium-term impacts of ICT in terms of improving the performance of existing systems, allowing scope for radical innovations, or even changing basic assumptions about the provider–patient relationship. [Copyright &y& Elsevier]

Abstract: In this paper, we used data from the 2004 Survey of Family Income & Expenditure of Taiwan to show that the problem of the crowding-out effects of tobacco and alcohol in a country with low expenditure can still be serious. Most studies that have investigated this issue have focused on developing countries with a high expenditure share on tobacco or alcohol, and have often overlooked the effects in countries with a low expenditure on such goods. After controlling for the endogeneity of tobacco and alcohol expenditure, and the possibility that households with a zero expenditure on tobacco and alcohol may result from a corner solution rather than abstention, we found that the lowest income households are still most vulnerable to tobacco and alcohol expenditures despite an overall low expenditure in Taiwan. Even higher income households may suffer a lower standard of living due to such expenditure. In addition, some goods and services may be perceived differently by households with different levels of income and this may be caused by the difference in composition across broad expenditure categories. Our results suggest that the government ought to tackle the problem of smoking and drinking outside the realm of health, since these expenditures may harm the country''s standard of living even when there is high income. [Copyright &y& Elsevier]

Abstract: Changes in measles immunization are commonly expressed in terms of a change in mean coverage rates but these mean changes may conceal substantial disparities within societies by poverty status. This paper analyzes trends in both the level and the socio-economic distribution of measles immunization coverage in the 1990s for 21 developing countries with two rounds of Demographic and Health Surveys available. We examine these trends using “achievement” indices that combine trends in means and in inequality. We propose and employ “achievement contours” to illustrate graphically how a greater degree of societal aversion to inequality may affect the ranking of countries in terms of achieved measles immunization coverage. The results indicate that most countries have experienced an improvement in their mean measles immunization rate but that this improvement was often unequally distributed across wealth groups, disfavouring the poor in all countries. Mean improvements were found to be associated with both increasing and decreasing inequality. When the trend in the mean and in the degree of inequality was opposite, the trend in the overall “achievement” score is determined by the assumed underlying degree of inequality aversion. As such, the achievement measure “penalizes” coverage improvements that leave the poor lagging behind. [Copyright &y& Elsevier]

Substantial healthcare expenses can impoverish households or push them further into poverty. In this paper, we examine the cost of obstetric care and the social and economic consequences associated with exposure to economic shocks up to a year following the end of pregnancy in Burkina Faso. Burkina Faso is a low-income country with poor health outcomes and a poorly functioning health system. We present an inter-disciplinary analysis of an ethnographic study of 82 women nested in a prospective cohort study of 1013 women. We compare the experiences of women who survived life-threatening obstetric complications (‘near-miss’ events) with women who delivered without complications in hospitals. The cost of emergency obstetric care was significantly higher than the cost of care for uncomplicated delivery. Compared with women who had uncomplicated deliveries, women who survived near-miss events experienced substantial difficulties meeting the costs of care, reflecting the high cost of emergency obstetric care and the low socioeconomic status of their households. They reported more frequent sale of assets, borrowing and slower repayment of debt in the year following the expenditure. Healthcare costs consumed a large part of households’ resources and women who survived near-miss events continued to spend significantly more on healthcare in the year following the event, while at the same time experiencing continued cost barriers to accessing healthcare. In-depth interviews confirm that the economic burden of emergency obstetric care contributed to severe and long-lasting consequences for women and their households. The necessity of meeting unexpectedly high costs challenged social expectations and patterns of reciprocity between husbands, wives and wider social networks, placed enormous strain on everyday survival and shaped physical, social and economic well-being in the year that followed the event. In conclusion, we consider the implications of our findings for financing mechanisms for maternity care in low-income settings. [Copyright &y& Elsevier]

Abstract: On average, child health outcomes are better in urban than in rural areas of developing countries. Understanding the nature and the causes of this rural–urban disparity is essential in contemplating the health consequences of the rapid urbanization taking place throughout the developing world and in targeting resources appropriately to raise population health. Using micro-data on child health taken from the most recent Demographic and Health Surveys for 47 developing countries, the purpose of this paper is threefold. First, we document the magnitude of rural–urban disparities in child nutritional status and under-5 mortality across all 47 developing countries. Second, we adjust these disparities for differences in population characteristics across urban and rural settings. Third, we examine rural–urban differences in the degree of socioeconomic inequality in these health outcomes. The results demonstrate that there are considerable rural–urban differences in mean child health outcomes in the entire developing world. The rural–urban gap in stunting does not entirely mirror the gap in under-5 mortality. The most striking difference between the two is in the Latin American and Caribbean region, where the gap in growth stunting is more than 1.5 times higher than that in mortality. On average, the rural–urban risk ratios of stunting and under-5 mortality fall by, respectively, 53% and 59% after controlling for household wealth. Controlling thereafter for socio-demographic factors reduces the risk ratios by another 22% and 25%. We confirm earlier findings of higher socioeconomic inequality in stunting in urban areas and demonstrate that this also holds for under-5 mortality. In a considerable number of countries, the urban poor actually have higher rates of stunting and mortality than their rural counterparts. The findings imply that there is a need for programs that target the urban poor, and that this is becoming more necessary as the size of the urban population grows. [Copyright &y& Elsevier]

Abstract: This paper proposes a framework for examining the process by which government consideration and adoption of new vaccines takes place, with specific reference to developing country settings. The cases of early Hepatitis B vaccine adoption in Taiwan and Thailand are used to explore the relevance of explanatory factors identified in the literature as well as the need to go beyond a variable-centric focus by highlighting the role of policy context and process in determining the pace and extent of adoption. The cases suggest the feasibility and importance of modeling ‘causal diversity’—the complex set of necessary and sufficient conditions leading to particular decisional outcomes—in a broad range of country contexts. A better understanding of the lenses through which government decision-makers filter information, and of the arenas in which critical decisions are shaped and taken, may assist both analysts (in predicting institutionalization of new vaccines) and advocates (in crafting targeted strategies to accelerate their diffusion). [Copyright &y& Elsevier]

Abstract: Developing countries that were early, enthusiastic adopters of primary health care often developed an extensive—but eventually dilapidated and under utilized—network of public clinics at the grassroots. As paradigms and investment patterns of health sector reform have shifted, the question of what role these public clinics can meaningfully play, and how best to revitalize them, has become important in a number of countries. This paper evaluates the strategy taken by, and outcomes of, a major attempt in Vietnam to revitalize the grassroots infrastructure of primary health care against the backdrop of the country''s economic transition. The project''s substantial supply-side investments in infrastructure led to marginal increases in utilization and the quality of preventive health services provided by the centers. But because the project failed to take adequate stock of broader, public sector-wide trends and reforms over the transition, the investments had little impact on the incentives, accountability patterns and capacities of clinic staff and the local authorities. Such institutional factors are heavily implicated, in Vietnam as elsewhere, in the substantial and often increasing disparities in service access and quality that continue to afflict transitional health sectors. [Copyright &y& Elsevier]

Abstract: The commitment of high-level government leaders is widely recognized as a key factor in curbing national AIDS epidemics. But where does such leadership come from? This paper presents a quantitative analysis of the determinants of AIDS leadership in 54 developing countries, using the 2003 AIDS Program Effort Index “political support” score as an indicator of political commitment. Explanatory variables include measures of political institutions as well as economic development and integration. Models developed in the analysis explain over half of the variation in commitment across the countries in the sample. In particular, press freedoms, income equality, and HIV prevalence stand out as determinants of political commitment. [Copyright &y& Elsevier]

Abstract: Current global economic trends in both developed and developing countries, including unregulated labor markets, trade competition and technological change, have greatly expanded a complex labor market situation characterised by many employees working under temporary work status, job insecurity, low social protection and low income level. Although the health of women is disproportionately affected by workplace flexibility, this has been largely ignored. The main purpose of this paper is to draw attention to this relevant but neglected topic. [Copyright &y& Elsevier]

Abstract: Global public–private health partnerships (GHPs) have become an established mechanism of global health governance. Sufficient evaluations have now been conducted to justify an assessment of their strengths and weaknesses. This paper outlines seven contributions made by GHPs to tackling diseases of poverty. It then identifies seven habits many GHPs practice that result in sub-optimal performance and negative externalities. These are skewing national priorities by imposing external ones; depriving specific stakeholders a voice in decision-making; inadequate governance practices; misguided assumptions of the efficiency of the public and private sectors; insufficient resources to implement partnership activities and pay for alliance costs; wasting resources through inadequate use of recipient country systems and poor harmonisation; and inappropriate incentives for staff engaging in partnerships. The analysis highlights areas where reforms are desirable and concludes by presenting seven actions that would assist GHPs to adopt better habits which, it is hoped, would make them highly effective and bring about better health in the developing world. [Copyright &y& Elsevier]