HEALTH SYSTEMS EFFICIENCY AND HEALTH STATUS

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HEALTH SYSTEMS EFFICIENCY AND HEALTH STATUS

• MS. MONIKA SAWHNEY
• DOCTORAL CANDIDATE
• Tulane University School of Public Health and
  Tropical Medicine

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Presentation outline

• Objectives
• Data
• Methods
• Major findings
• Results
• Recommendations

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Objectives

• Rank major Indian states in terms of their
  efficiency in producing health (measured by child
  health).
• Identify states for in-depth analysis.
• Study difference in determinants of health status
  across states.
• Propose policy measures to improve health status.

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Study levels

• Level 1 - STATE LEVEL.
• Level 2 - HOUSEHOLD LEVEL.

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Data

• Data from 25 major Indian states -
  cross-sectional units - state level analysis.
• Data from Demographic and Health Survey (DHS)
  household level analysis.
• Data was collected from various secondary
  sources census bureau, sample registration
  system, UNICEF and WHO.

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Methods measuring efficiency

• Dependent variable Infant mortality rate (IMR).
• Independent variables literature supported
  social, economic and health variables.

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Measuring efficiency

• World Health Organization (WHO) approach to
  measure efficiency.
• The maximum is the level of health output the
  most efficient state would produce at each
  observed combination of inputs.
• The state with the lowest IMR after controlling
  for inputs, is the most efficient.

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Measuring efficiency

• Efficiency of other states is measured with
  respect to the maximum.
• Inefficiencies might be from wastage or because
  the most cost effective set of programs or
  interventions are not used.

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Statistical model to measure efficiency

• Fixed effect model was used to measure the
  efficiency of 25 Indian states in producing child
  health.
• Fixed effect model
• IMRSt a ? DummyS ß1 (Z)st ß2 (Z)st
  ß3 (Z)st
• S states (1-24), t time (years).
• ? specific coefficients for each of the state
  dummies.
• Z potential determinants of child health.

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Efficiency score

• Calculate the predicted IMR
• IMRs a ? ß1 LRFs ß2 EPIs ß3NSDPs
• ? Minimum value of the fixed effect
  coefficients.
• Efficiency score (ESs) 1 IMRs - IMRs /
  Max (IMRs - IMRs)

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Measuring health status

• 2 relatively efficient states
• Kerala and Manipur
• 2 relatively inefficient states
• Madhya Pradesh and Orissa

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Measuring health status dependent variable
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Measuring health status Independent variables

• Fertility behavior
• Nutritional deficiency among children
• Nutritional status of mother
• Maternal and child health
• Environmental factors
• Socio-economic factors

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Statistical model to measure health status

• Y a1 ßX1 ßX2.. ßX10 µi
• Y Nutritional status of children (measured by
  three outcome variables stunting, wasting, and
  under-weight)
• X1 X10 independent variables/factors
  affecting child health

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Statistical model to measure health status

• Neij ae ßeXe µ
• Nieij aie ßieXie µ
• 1 model for efficient states
• 2 model for inefficient states.

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Efficiency ranking
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Efficient vs. inefficient states
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Significant determinants

• Childs age in months
• Age of mother at first birth
• Hemoglobin level of mother
• Educational status of mother
• Standard of living index (measure of income)

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Significant determinants

• Vaccination status
• Drinking pattern during diarrhea
• Fertility rate
• Appropriate health seeking behavior
• Place of child delivery

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Conclusions

• Large disparities across different states in
  India
• Especially among relatively efficient and
  inefficient states
• Social, economic and health determinants play a
  vital role in improving health status.
• To improve health status overall, India needs to
  pay attention to groups of inefficient states.

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Recommendations

• Efficient use of available resources.
• Pay attention to significant determinants.
• Fertility rate a significant determinant
  highlights the importance of family planning
  program.
• Vaccinations importance of getting population
  vaccinated.
• Improve educational status of women

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Recommendations

• Encourage use of antenatal care.
• More professionally assisted deliveries.
• Provide knowledge about basic health care
  services (care during diarrhea episodes).
• Replicating successful models in other
  parts/regions of the country.

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Implications

• Health care personnel.
• Identifying important determinants of health
  status.
• Allocation of resources towards significant
  determinants.
• Policy makers.
• Identifying efficiency status of the
  state/region/county.
• Designing and implementing appropriate health
  policies at different levels (country/state/region
  /county).

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Impact of this study

• Results from this study will be very helpful
  world wide especially in present times.
• It will help identify efficiency of different
  regions/countries in producing health.
• Study the determinants which have a greater
  impact on health.
• Encourage use of available resources in most
  efficient manner.

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THANK YOU FOR YOUR TIME AND ATTENTION
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• QUESTIONS?