ENT
Annuaire
ConnexionRoom 313 - Pascal
PhD defence. Healthcare systems assessment in developing countries: case of ECOWAS countries
Kossivi Akoetey
CERDI, Université Clermont Auvergne
Healthcare systems assessment in developing countries: case of ECOWAS countries
Examiners
Bity Diene, CERDI, Université Clermont Auvergne, PhD supervisor
Awa Traore, Université Cheikh Anta Diop, Examiner
Sandy Tubeuf, Université catholique de Louvain, Examiner
Christine Le Clainche, LEM, Université de Lille, Examiner
Florent Bresson, CERDI, Université Clermont Auvergne, Examiner
Mbaye Diene, FASEG, Université Cheikh Anta Diop, PhD supervisor
Anne Viallefont, CERDI, Université Clermont Auvergne, Guest
Abstract
Health systems provide access to healthcare that enables better health status. They are thus indispensable in today's world and serve as a lever on which other domains can be impacted.
In developing countries, the low level of development of health systems, along with health crises, wars, insecurity, and climate change, have delayed health systems in achieving their goals, leading to avoidable loss of lives. This thesis is developed in this context. The objective is to evaluate the health systems of West African countries to identify weaknesses as well as strengths, and to determine the various channels that allow a change in course for better healthcare provision. To achieve this, the thesis is structured around five chapters.
The first chapter aims to evaluate the efficiency of health systems to determine efficiency scores, make comparisons between them, and identify factors impacting the provision of healthcare. In this first part, we used World Bank data from West African countries from 2000 to 2018, which we supplemented with a multiple imputation method based on a nearest neighbor approach, on M = 9 datasets. Next, we used the parametric "Stochastic Frontier Analysis" method with a fixed "country" effect by Kumbhakar et al. (2014), which eliminates exogenous factors and unobserved heterogeneity to determine efficiency scores and their determinants. The results from the combination of the M datasets showed that the average overall efficiency of health systems in West African countries is low (below 75%). Health systems face more permanent inefficiency issues than temporal ones. Only Niger has no permanent inefficiency. Nigeria has the largest gap between permanent inefficiency and temporal inefficiency, while Burkina Faso has the smallest. Côte d'Ivoire, Ghana, Cape Verde, and Sierra Leone have the lowest permanent efficiency (below 80%). The temporal efficiency of Sierra Leone, Mali, Guinea, Gambia, and Côte d'Ivoire has increased over time, while that of other countries has remained stable over the studied period. Moreover, the results showed that health expenditure per capita, GDP per capita, literacy rate, and governance quality are significantly associated with the efficiency of these countries' health systems.
In Chapter 2, we examine geographical disparities in access to maternal healthcare. To do this, we used combined data from 43 DHS surveys conducted between 2001 and 2021, covering a total of 291,056 respondents in West African countries. We then used the method by Wagstaff et al. (2003) and the concentration and Atkinson indices to determine the disparities and their decomposition. The results showed that Niger made the most progress in the number of prenatal visits during the studied period. However, during the studied period, access to maternal care is lower in Mali, Nigeria, and Niger compared to other countries. Generally, coastal countries have relatively better access than Sahelian countries. Additionally, the results showed that inequalities are stronger between countries than within regions of the same country.
Chapter 3 presents disparities in access to healthcare in other forms, particularly polarization in access to maternal healthcare in Togo. In this chapter, we used the Foster- Wolfson and Duclos, Esteban and Ray polarization indices applied to DHS survey data from 1998 and 2013 for Togo. The results showed that disparities in access to maternal healthcare tend to decrease over time with the emergence of a middle class in healthcare access.
Chapter 4 explores the relationship between populations' trust in their leaders or health authorities and their willingness to get vaccinated against Covid-19. In this chapter, we utilized data from the 8th wave of Afrobarometer surveys conducted between 2019 and 2021 for West African countries. We also used generalized ordered logit models, specifically "the partial proportional odds model". The results showed a significant impact of populations' trust on their willingness to receive the Covid-19 vaccine. Moreover, the results also showed that education, religion, access to information, and place of residence are significant covariates impacting the desire of the sub-region's populations to receive the Covid-19 vaccine.
Finally, in Chapter 5, we analyze the impact of preventive measures taken during the Covid-19 pandemic on access to perinatal healthcare in Senegal. The objective is to determine the potential harmful effects of Covid-19 preventive measures on healthcare access. We used the Probit model applied to data from the latest malaria indicators survey 2020-2021 in Senegal. The results showed a downward trend in intermittent preventive treatment with Sulfadoxine-Pyrimethamine during the periods of preventive measures, although not significant. Education level, household size, geographic area, head of household's gender, and wealth are indicators that significantly impact intermittent preventive treatment with Sulfadoxine-Pyrimethamine during the Covid-19 period in Senegal.
Keywords
assessment, health system, developing countries, health care access, inequality, ECOWAS.