Rapidly growing cities face new and compounding health challenges, leading governments and donors... more Rapidly growing cities face new and compounding health challenges, leading governments and donors to seek innovative ways to support healthier, more resilient urban growth. One such approach is the systems mapping process developed by Engaging Inquiry (EI) for the USAID-funded Building Healthy Cities project (BHC) in four cities in Asia. This paper provides details on the theory and methods of the process. While systems mapping is not new, the approach detailed in this paper has been uniquely adapted to the purpose of municipal planning. Strategic stakeholder engagement, including participatory workshops with a diverse group of stakeholders, is at the core of this approach and led to deeper insights, greater buy-in, and shared understanding of the city’s unique opportunities and challenges. This innovative mapping process is a powerful tool for defining municipal priorities within growing cities across the globe, where the situation is rapidly evolving. It can be used to provide evi...
Reduction of inequalities in child mortality through maternal education: an individual-level anal... more Reduction of inequalities in child mortality through maternal education: an individual-level analysis M R Alvarado and others 6 Hungering for survival: trends and inequalities in global under-5 malnutrition K G Andrews and others 7 An innovative tool for linking routine health information system (RHIS) and health system performance A Aqil and others 8 Tracking global trends in contraceptive security: Contraceptive Security Index 2003-09 D Aronovich and others 9 Costs and effects of a multifaceted intervention to improve the quality of care of children in district hospitals in Kenya E W Barasa and others 10 Estimation of the burden of disease attributable to mental disorders A Baxter and others 11 Evaluation of the association between vector control coverage, climate variability, and the spatial distribution of malaria at three periods in Zambia A Bennett and others 12 Priority cost-effective lessons for systems strengthening in South Africa (PRICELESS-SA): an example of strengthening in-country collaborations and capacity M Y Bertram and others 13 Estimates of the regional burden of non-fatal injuries in sub-Saharan Africa based on local data sources and new methods K Bhalla and others 14 The global burden of malaria mortality J Blore and others 15 Strengthening of country capacity for reviews of health progress and performance in the context of monitoring and evaluation of national health strategies T Boerma and others 16 Make it happen 2015: validation of the maternal mortality ratio in Trinidad and Tobago for 2000-06 E V C Bolastig and others 17 Addressing bias in national estimates of insecticide-treated mosquito net coverage in countries with heterogeneous distribution of malaria transmission with household surveys and GPS data C R Burgert and others 18 How reliable are maternal mortality estimates for small country populations? B Butrón Riveros and others 19 Use of data for emergency obstetric care facilities, staff, and their geographical distribution to interpret data for maternal mortality
The RAND Corporation is a nonprofit research organization providing objective analysis and effect... more The RAND Corporation is a nonprofit research organization providing objective analysis and effective solutions that address the challenges facing the public and private sectors around the world. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors. R ® is a registered trademark.
Nepal’s Multi-sector Plan of Action for Nutrition 2013-2017 (MSNP) provides a unique opportunity ... more Nepal’s Multi-sector Plan of Action for Nutrition 2013-2017 (MSNP) provides a unique opportunity to understand how nutrition policy is translated into action. SPRING’s two-year Pathways to Better Nutrition study drew on qualitative and quantitative data to provide a 360-degree view of Nepal’s MSNP process including the policy.
Background: When looking to better understand the links between income and health, urban settings... more Background: When looking to better understand the links between income and health, urban settings add an additional dimension of structural inequity. Without proactive urban planning, some neighborhoods are deprived of essential services, while other neighborhoods enjoy easier access to services and providers. The case of Indore, India was used to explore differentials in available services, infrastructure, and access to goods and services relating to non-communicable disease risk when the data was disaggregated by neighborhood type (slum vs non-slum). Methods: The environmental data for this paper came from a city-wide multi-level survey conducted in 2018, which included a neighborhood environmental assessment tool adapted from pre-validated questionnaires. Wards were randomly selected using a probability proportional to size (PPS) method after stratification by presence of slums. Within each ward, three colonies were then selected by PPS. The environmental data were collected from...
Background: Nepal has a long tradition of designing good multisectoral nutrition policy. However,... more Background: Nepal has a long tradition of designing good multisectoral nutrition policy. However, success of policy implementation has varied. More evidence on how to successfully carry out multisector nutrition policy is needed. Objective: We tracked the influence of Nepal’s multisectoral nutrition plan (MSNP) on the process of priority setting and budgeting from 2014 to 2016. Methods: This study used a mixed-method longitudinal design to track qualitative and budgetary changes related to MSNP processes nationally as well as in 3 districts. Qualitative changes in each study area were assessed through interviews, observation, news content, and meeting notes. Changes in allocations and expenditures were calculated based on budget documents, work plans, and validation interviews. Results: Improved understanding of the MSNP was documented nationally and in study districts but not in VDCs. Human resources, ownership, bottom-up planning, coordination, advocacy, and sustainable structures...
Over the past two decades, multilateral organizations have encouraged increased engagement with p... more Over the past two decades, multilateral organizations have encouraged increased engagement with private healthcare providers in developing countries. As these efforts progress, there are concerns regarding how private delivery care may effect maternal health outcomes. Currently available data do not allow for an in-depth study of the direct effect of increasing private sector use on maternal health across countries. As a first step, however, we use demographic and health surveys (DHS) data to (1) examine trends in growth of delivery care provided by private facilities and (2) describe who is using the private sector within the healthcare system. As Asia has shown strong increases in institutional coverage of delivery care in the last decade, we will examine trends in six Asian countries. We hypothesize that if the private sector competes for clients based on perceived quality, their clientele will be wealthier, more educated and live in an area where there are enough health faciliti...
This document and trademark(s) contained herein are protected by law as indicated in a notice app... more This document and trademark(s) contained herein are protected by law as indicated in a notice appearing later in this work. This electronic representation of RAND intellectual property is provided for non-commercial use only. Unauthorized posting of RAND PDFs to a non-RAND Web site is prohibited. RAND PDFs are protected under copyright law. Permission is required from RAND to reproduce, or reuse in another form, any of our research documents for commercial use. For information on reprint and linking permissions, please see RAND Permissions.
The American Journal of Tropical Medicine and Hygiene, 2012
To understand how supply chain factors affect product availability at the community level, the Im... more To understand how supply chain factors affect product availability at the community level, the Improving Supply Chains for Community Case Management of Pneumonia and Other Common Diseases of Childhood Project developed a theory of change (TOC) framework for gathering, organizing, and interpreting evidence about supply constraints to community case management (CCM). Baseline assessments in Ethiopia, Malawi, and Rwanda conducted in 2010 provided information on the strengths and weaknesses of existing CCM supply chains for five main products: antibiotics for pneumonia, oral rehydration solution, ready to use therapeutic food, zinc, and artemether/lumefantrine. The assessments tested the strength and validity of causal pathways identified in the TOC that were believed to influence availability of CCM products among community health workers (CHWs) for treating common childhood illnesses. Results of the assessments showed product availability to be weak in each country, with more than half of CHWs stocked out of at least one tracer product on the day of the assessment. This report will focus on the findings related to three key preconditions of the TOC and how these were used to inform the design of the CCM supply chain improvement strategy in each country. The three key preconditions include product availability at CHW resupply points, supply chain knowledge and capacity among CHWs and their supervisors, and availability of appropriate transportation. * Country-specific names for community health workers include health extension workers in Ethiopia, health surveillance assistants in Malawi, and community health workers in Rwanda. All are referred to as community health workers in the report. CAMERWA = Rwanda Drug, Consumables and Equipment Central Procurement Agency; MPDD = Medical Procurement and Distribution Division. * Respondents were able to choose more than one response in Ethiopia and only one response in Malawi and Rwanda. † In Ethiopia, this response includes multiple responses.
Rapidly growing cities face new and compounding health challenges, leading governments and donors... more Rapidly growing cities face new and compounding health challenges, leading governments and donors to seek innovative ways to support healthier, more resilient urban growth. One such approach is the systems mapping process developed by Engaging Inquiry (EI) for the USAID-funded Building Healthy Cities project (BHC) in four cities in Asia. This paper provides details on the theory and methods of the process. While systems mapping is not new, the approach detailed in this paper has been uniquely adapted to the purpose of municipal planning. Strategic stakeholder engagement, including participatory workshops with a diverse group of stakeholders, is at the core of this approach and led to deeper insights, greater buy-in, and shared understanding of the city’s unique opportunities and challenges. This innovative mapping process is a powerful tool for defining municipal priorities within growing cities across the globe, where the situation is rapidly evolving. It can be used to provide evi...
Reduction of inequalities in child mortality through maternal education: an individual-level anal... more Reduction of inequalities in child mortality through maternal education: an individual-level analysis M R Alvarado and others 6 Hungering for survival: trends and inequalities in global under-5 malnutrition K G Andrews and others 7 An innovative tool for linking routine health information system (RHIS) and health system performance A Aqil and others 8 Tracking global trends in contraceptive security: Contraceptive Security Index 2003-09 D Aronovich and others 9 Costs and effects of a multifaceted intervention to improve the quality of care of children in district hospitals in Kenya E W Barasa and others 10 Estimation of the burden of disease attributable to mental disorders A Baxter and others 11 Evaluation of the association between vector control coverage, climate variability, and the spatial distribution of malaria at three periods in Zambia A Bennett and others 12 Priority cost-effective lessons for systems strengthening in South Africa (PRICELESS-SA): an example of strengthening in-country collaborations and capacity M Y Bertram and others 13 Estimates of the regional burden of non-fatal injuries in sub-Saharan Africa based on local data sources and new methods K Bhalla and others 14 The global burden of malaria mortality J Blore and others 15 Strengthening of country capacity for reviews of health progress and performance in the context of monitoring and evaluation of national health strategies T Boerma and others 16 Make it happen 2015: validation of the maternal mortality ratio in Trinidad and Tobago for 2000-06 E V C Bolastig and others 17 Addressing bias in national estimates of insecticide-treated mosquito net coverage in countries with heterogeneous distribution of malaria transmission with household surveys and GPS data C R Burgert and others 18 How reliable are maternal mortality estimates for small country populations? B Butrón Riveros and others 19 Use of data for emergency obstetric care facilities, staff, and their geographical distribution to interpret data for maternal mortality
The RAND Corporation is a nonprofit research organization providing objective analysis and effect... more The RAND Corporation is a nonprofit research organization providing objective analysis and effective solutions that address the challenges facing the public and private sectors around the world. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors. R ® is a registered trademark.
Nepal’s Multi-sector Plan of Action for Nutrition 2013-2017 (MSNP) provides a unique opportunity ... more Nepal’s Multi-sector Plan of Action for Nutrition 2013-2017 (MSNP) provides a unique opportunity to understand how nutrition policy is translated into action. SPRING’s two-year Pathways to Better Nutrition study drew on qualitative and quantitative data to provide a 360-degree view of Nepal’s MSNP process including the policy.
Background: When looking to better understand the links between income and health, urban settings... more Background: When looking to better understand the links between income and health, urban settings add an additional dimension of structural inequity. Without proactive urban planning, some neighborhoods are deprived of essential services, while other neighborhoods enjoy easier access to services and providers. The case of Indore, India was used to explore differentials in available services, infrastructure, and access to goods and services relating to non-communicable disease risk when the data was disaggregated by neighborhood type (slum vs non-slum). Methods: The environmental data for this paper came from a city-wide multi-level survey conducted in 2018, which included a neighborhood environmental assessment tool adapted from pre-validated questionnaires. Wards were randomly selected using a probability proportional to size (PPS) method after stratification by presence of slums. Within each ward, three colonies were then selected by PPS. The environmental data were collected from...
Background: Nepal has a long tradition of designing good multisectoral nutrition policy. However,... more Background: Nepal has a long tradition of designing good multisectoral nutrition policy. However, success of policy implementation has varied. More evidence on how to successfully carry out multisector nutrition policy is needed. Objective: We tracked the influence of Nepal’s multisectoral nutrition plan (MSNP) on the process of priority setting and budgeting from 2014 to 2016. Methods: This study used a mixed-method longitudinal design to track qualitative and budgetary changes related to MSNP processes nationally as well as in 3 districts. Qualitative changes in each study area were assessed through interviews, observation, news content, and meeting notes. Changes in allocations and expenditures were calculated based on budget documents, work plans, and validation interviews. Results: Improved understanding of the MSNP was documented nationally and in study districts but not in VDCs. Human resources, ownership, bottom-up planning, coordination, advocacy, and sustainable structures...
Over the past two decades, multilateral organizations have encouraged increased engagement with p... more Over the past two decades, multilateral organizations have encouraged increased engagement with private healthcare providers in developing countries. As these efforts progress, there are concerns regarding how private delivery care may effect maternal health outcomes. Currently available data do not allow for an in-depth study of the direct effect of increasing private sector use on maternal health across countries. As a first step, however, we use demographic and health surveys (DHS) data to (1) examine trends in growth of delivery care provided by private facilities and (2) describe who is using the private sector within the healthcare system. As Asia has shown strong increases in institutional coverage of delivery care in the last decade, we will examine trends in six Asian countries. We hypothesize that if the private sector competes for clients based on perceived quality, their clientele will be wealthier, more educated and live in an area where there are enough health faciliti...
This document and trademark(s) contained herein are protected by law as indicated in a notice app... more This document and trademark(s) contained herein are protected by law as indicated in a notice appearing later in this work. This electronic representation of RAND intellectual property is provided for non-commercial use only. Unauthorized posting of RAND PDFs to a non-RAND Web site is prohibited. RAND PDFs are protected under copyright law. Permission is required from RAND to reproduce, or reuse in another form, any of our research documents for commercial use. For information on reprint and linking permissions, please see RAND Permissions.
The American Journal of Tropical Medicine and Hygiene, 2012
To understand how supply chain factors affect product availability at the community level, the Im... more To understand how supply chain factors affect product availability at the community level, the Improving Supply Chains for Community Case Management of Pneumonia and Other Common Diseases of Childhood Project developed a theory of change (TOC) framework for gathering, organizing, and interpreting evidence about supply constraints to community case management (CCM). Baseline assessments in Ethiopia, Malawi, and Rwanda conducted in 2010 provided information on the strengths and weaknesses of existing CCM supply chains for five main products: antibiotics for pneumonia, oral rehydration solution, ready to use therapeutic food, zinc, and artemether/lumefantrine. The assessments tested the strength and validity of causal pathways identified in the TOC that were believed to influence availability of CCM products among community health workers (CHWs) for treating common childhood illnesses. Results of the assessments showed product availability to be weak in each country, with more than half of CHWs stocked out of at least one tracer product on the day of the assessment. This report will focus on the findings related to three key preconditions of the TOC and how these were used to inform the design of the CCM supply chain improvement strategy in each country. The three key preconditions include product availability at CHW resupply points, supply chain knowledge and capacity among CHWs and their supervisors, and availability of appropriate transportation. * Country-specific names for community health workers include health extension workers in Ethiopia, health surveillance assistants in Malawi, and community health workers in Rwanda. All are referred to as community health workers in the report. CAMERWA = Rwanda Drug, Consumables and Equipment Central Procurement Agency; MPDD = Medical Procurement and Distribution Division. * Respondents were able to choose more than one response in Ethiopia and only one response in Malawi and Rwanda. † In Ethiopia, this response includes multiple responses.
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