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Does Provider Effort Constrain Healthcare Quality?

In this paper, authors study the quality of care in maternal health using data from health facilities in five of the countries that have the highest maternal mortality ratio: DRC, Cameroon, Central African Republic, Nigeria, and the Republic of Congo. Poor outcomes may arise due to low clinical quality, which in turn may stem from at least three reasons: first, structural constraints may continue to bind. Second, inadequate training may result in doctors not knowing what they should do. Third, doctors may not put their knowledge to use in their clinical practice. In this paper, we document, for different components of ANC, the share of consultations in which the providers know that they should perform an action, have all the equipment and supplies needed, and yet do not perform the action. Results show that, despite considerable heterogeneity in contexts, sizeable effort gaps exist along all dimensions of antenatal care. At least ten percent and as much as 65 percent of non-compliance to ANC protocol can be explained by know-do gaps. Finally, the authors explore the characteristics of facilities, providers and patients that correlate with the different gaps in provision of high-quality care. The authors show that despite unusually rich data on potential correlates, no clear patterns emerge, suggesting that more work is needed to understand low effort provision in healthcare in developing country contexts. Light lunch will be served.

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Speakers

Eeshani Kandpal, Economist, World Bank

Eeshani Kandpal is an Economist in the Development Research Group of the World Bank. Her research agenda lies at the intersection of two themes. The first is that average treatment effects often mask the widely divergent impacts of development policy, like health interventions, cash transfers, and empowerment programs. Unintended consequences may bolster or undermine the intended goals of the policy, but economic theory and evidence can help us predict where such consequences may arise. A second theme of her research is that inequality in access to government services or social capital often varies by attributes like gender, wealth, and ethnicity or caste. She led the IE of the HRITF-funded PBF pilot in Nigeria.

Gil Shapira, Economist, Development Research Group

Gil Shapira is an Economist in the Human Development Team of the Development Research Group. He received his B.A. in Economics from Columbia University in 2005, and his Ph.D. in Economics from the University of Pennsylvania in 2011. His current research focuses on analyzing demographic and health issues in developing countries, with an emphasis on Sub-Saharan Africa. More specifically, in his current research he studies decision-making in the context of the HIV/AIDS epidemic, the transition from adolescence to adulthood in Malawi, and the impact of interventions to improve maternal and child health in different countries.

Chair

Ellen Van de Poel, Senior Health Specialist, Global Financing Facility

Ellen Van de Poel is a Senior Health Economist supporting countries in developing and implementing strategies to increase domestic resources for health and improve the efficiency of health spending. Before joining the GFF, Ellen was an associate professor of Health Economics at Erasmus University Rotterdam. Her research focused on evaluating health financing reforms and on the measurement of equity in health and has been published in leading journals. She received a master’s degree from the Free University of Brussels and the Catholic University of Leuven, Belgium and obtained a PhD in Economics from Erasmus University.

Discussant

Supriya Madhavan, Senior Health Specialist, World Bank

Supriya Madhavan is a Senior Health Specialist at the World Bank and technical advisor to the Secretariat of the Global Financing Facility. She works primarily on West and Central Africa and South Asia in the areas of demographic dividend, and sexual and reproductive health. She is currently the country focal point for the GFF for Pakistan and Mali. Supriya completed her doctoral work in demography at Johns Hopkins University.

Materials