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Analysis of cross-country changes in health services

Toru Matsubayashi, MD MScJohns Hopkins Bloomberg School of Public Health

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Background for the study

MDGs and categorical programs1. International targets for priority health

services• 90% for DPT, 90% for SBA, 70% for TB

detection, 85% for TB cure• Feasible benchmarks?

2.Associations between different health services indicators

3.Roles of country characteristics

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Objectives of the study

By using longitudinal and multilevel analyses, 1. To illustrate cross-country trends in

priority health services2. To estimate the levels of achievable

changes in priority health services3. To explore country characteristics

affecting changes in priority health services

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Methods for the study

1. National panel data from publicly available sources were constructed

2. Health service variables in three distinct areas were examined

3. Variables indicative of country characteristics explored

4. Multilevel models were fitted for the analyses

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Trends of DPT3 Immunization

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Country-specific estimates by random coefficient model, DPT3 coverage

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Trends of SBA

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Country-specific estimates by random coefficient model, SBA coverage

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Projected to reach the 2015 target

SBA: 92/159 countries (57%) DPT: 94/154 countries (61%) Measles: 92/154 countries (59%) DOT Case Detection: 92/165 (56%) DOT Successful Treatment: 99/162

(61%)

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Country characteristics and health services

DPT3 SBA TB Dx TB TxGovernance 0.51* 0.47* 0.27* 0.04

U5MR -0.71* -0.74* -0.24* -0.30*

Fertility -0.64* -0.72* -0.18* -0.27*

Population -0.02 -0.06 -0.15* 0.12*

Literacy rate 0.61* 0.79* 0.22* 0.24*

GNI per capita 0.41* 0.56* 0.11* 0.11*Health Expenditure 0.36* 0.50* 0.18* 0.06

ODA 0.05* 0.13* 0.17* 0.16*Pairwise correlation coefficients

* p<0.05

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Key findings

Significant heterogeneity among different countries

Individual country differences more important than international averages or universal target

Less than two thirds of LMICs projected to reach the universal targets

Country context variables such as governance playing a major role in country-specific experiences

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Application of the method

Longitudinal data set provides rich sources of analyses

Different countries have different starting point and inherent differences: multilevel analyses are useful to incorporate such factors

Applicable to the analysis of health services at national, regional, and facility levels

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The End

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SECTION BREAK SLIDEText here

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Trends of DOT TB detection

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Trends of DOT TB detection (model based)

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Trends of DOT TB successful treatment

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Trends of DOT TB successful treatment (model based)

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U5MR Model Based Estimates