Global Health research

Africa

Researchers: Elisabetta De Cao, Department of Health Policy and Giulia La Mattina, Assistant Professor of Economics in the Department of Economics at the University of South Florida.
Date: 2019
Region: Africa, Nigeria
Publication details: American Economic Association
LSE Department: Department of Health Policy
Keywords: Female genital cutting (FGC)

Female genital cutting (FGC) affects more than 200 million women globally. Education is often depicted as an effective instrument for abandoning the practice, but causal evidence is scant. This paper uses the introduction of the Universal Primary Education program in Nigeria as a natural experiment to identify the causal effect of mothers’ education on the probability that their daughters are cut. Household survey data indicate no statistically significant impact of the reform on the probability that daughters undergo FGC, which may be explained by an insignificant effect of the reform on maternal support for the practice.

Researchers: Simon Gregson, Owen Mugurungi, Jeffrey Eaton, Albert Takaruza, Rebecca Rhead, Rufurwokuda Maswera, Junior Mutsvangwa, Justin Mayini, Morten Skovdal, Robin Schaefer, Timothy Hallett, Lorraine Sherr, Shungu Munyati, Peter Mason, Catherine Campbell, Geoffrey P Garnett and Constance Anesu Nyamukapa
Date: 2017
Region: Africa
Publication details: Health BMJ Open 7 (10) ISSN 2044-6055
LSE department: Department of Psychological and Behavioural Sciences & LSE Health
Keywords: HIV, preventative care, treatment, coverage

Purpose

The Manicaland cohort was established to provide robust scientific data on HIV prevalence and incidence, patterns of sexual risk behaviour and the demographic impact of HIV in a sub-Saharan African population subject to a generalised HIV epidemic. The aims were later broadened to include provision of data on the coverage and effectiveness of national HIV control programmes including antiretroviral therapy (ART).

Participants

General population open cohort located in 12 sites in Manicaland, east Zimbabwe, representing 4 major socioeconomic strata (small towns, agricultural estates, roadside settlements and subsistence farming areas). 9,109 of 11,453 (79.5%) eligible adults (men 17-54 years; women 15–44 years) were recruited in a phased household census between July 1998 and January 2000. Five rounds of follow-up of the prospective household census and the open cohort were conducted at 2-year or 3-year intervals between July 2001 and November 2013. Follow-up rates among surviving residents ranged between 77.0% (over 3 years) and 96.4% (2 years).

Findings to date

HIV prevalence was 25.1% at baseline and had a substantial demographic impact with 10-fold higher mortality in HIV-infected adults than in uninfected adults and a reduction in the growth rate in the worst affected areas (towns) from 2.9% to 1.0%pa. HIV infection rates have been highest in young adults with earlier commencement of sexual activity and in those with older sexual partners and larger numbers of lifetime partners. HIV prevalence has since fallen to 15.8% and HIV incidence has also declined from 2.1% (1998-2003) to 0.63% (2009-2013) largely due to reduced sexual risk behaviour. HIV-associated mortality fell substantially after 2009 with increased availability of ART.

Future plans

It is planned to extend the cohort to measure the effects on the epidemic of current and future HIV prevention and treatment programmes. Proposals for access to these data and for collaboration are welcome.

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Reasearchers: Dr. Clare Wenham & Dr. Justin Parkhurst
Date:2018
Region: Africa
LSE Department/Centre: Department of Health Policy
Keywords: Africa, Health Sciences, Health Systems Research, CARI

LSE Health researchers have been commissioned by the Wellcome Trust to lead a project to understand and improve investment mechanisms for health sciences research in Africa. Significant investment in health sciences research across the continent remains low, and this project will investigate a range of case studies to identify good practice and local challenges to improve health research outputs in Africa. The aim is to draw lessons of how to develop health sciences research effectively, such as: how best to implement initial investments (for example whether to focus on infrastructure, human resource development, or other priorities); or how to incentivise greater investment in health sciences research. It will further explore conditions in place in a range of country cases that appear to facilitate the development of health science research. Finally, to build capacity itself, and achieve greater local ownership, the project will engage with leading policymakers to facilitate peer learning for achieving institutional change for improving health sciences research at the national level in selected countries.

Findings from the project will support the establishment of the Coalition for African Research and Innovation (CARI), an initiative under the auspices of the Alliance for Accelerating Excellence in Science in Africa (AESA). CARI aims to accelerate scientific breakthroughs through the creation of a platform within Africa from which stakeholders can catalyze a highly coordinated, well-funded, innovative African R&D community together.

The project will be led by Dr Justin Parkhurst and Dr Clare Wenham in LSE’s Department of Health Policy,

For more information, please contact Clare Wenham (c.wenham@lse.ac.uk)

Reasearchers: Divya Parmar, Tiziana Leone, Ernestina Coast, Susan Fairley Murray, Eleanor Hukin & Bellington Vwalika
Date: 2017
Region: Africa
Publication details: Global Public Health, 12 (2). pp. 236-249. ISSN
LSE Department/Centre: Department for International Development
Keywords: abortion, termination of pregnancy, Zambia, cost, health system

Unsafe abortion is a significant but preventable cause of maternal mortality. Although induced abortion has been legal in Zambia since 1972, many women still face logistical, financial, social, and legal obstacles to access safe abortion services, and undergo unsafe abortion instead. This study provides the first estimates of costs of post abortion care (PAC) after an unsafe abortion and the cost of safe abortion in Zambia. In the absence of routinely collected data on abortions, we used multiple data sources: key informant interviews, medical records and hospital logbooks.

We estimated the costs of providing safe abortion and PAC services at the University Teaching Hospital, Lusaka and then projected these costs to generate indicative cost estimates for Zambia. Due to unavailability of data on the actual number of safe abortions and PAC cases in Zambia, we used estimates from previous studies and from other similar countries, and checked the robustness of our estimates with sensitivity analyses. We found that PAC following an unsafe abortion can cost 2.5 times more than safe abortion care. The Zambian health system could save as much as US$0.4 million annually if those women currently treated for an unsafe abortion instead had a safe abortion.

Reasearchers: Tim Allen and Melissa Parker
Date: 2016
Region: Africa, Global
Publication details: Africa at LSE Blog
LSE department: Firoz Lalaji Centre for Africa
Keywords: neglected tropical diseases, deworming, health policy, West Africa

The term Neglected Tropical Diseases (NTDs) was introduced around 15 years ago and has helped in concentrating attention on largely-ignored infections. Indeed, it has resulted in what has been hailed as the largest public health programme ever undertaken. However, the success of the term has created problems, which we have analysed in detail in our paper Neglected Tropical Diseases in Biosocial Perspective.

One issue is that the term makes no biological sense. It refers to a wide range of diseases that are very different to one another, and which often require very different kinds of treatment. To use the term as some sort of homogeneous category can therefore be misleading. Also, the fact that ‘neglect’ arises from social priorities, social relations and social behaviour is commonly set aside. It is neglected people who are typically infected with these diseases; and that kind of neglect has political and economic connotations that cannot be wished away.

Reasearchers: Catherine Campbell, Kerry Scott, Zivai Mupambireyi, Mercy Nhamo, Constance Nyamukapa, Morten Skovdal, and Simon Gregson
Date: 2014
Region: Africa
Publication details: BMC Health Services Research, 14 (1). ISSN 1472-6963.
LSE Department/Centre: Department of Psychological and Behavioural Sciences
Keywords: HIV/AIDS intervention, Programme evaluation, Africa, Community mobilisation, Commercial sex work

This paper presents community perceptions of a state-of-the-art peer education programme in Manicaland, Zimbabwe. While the intervention succeeded in increasing HIV knowledge among men and condom acceptability among women, and reduced HIV incidence and rates of unprotected sex among men who attended education events, it did not succeed in reducing population-level HIV incidence. To understand the possible reasons for this disappointing result, we conducted a qualitative study of local perspectives of the intervention.

Methods

Eight focus group discussions and 11 interviews with 81 community members and local project staff were conducted. Transcripts were interrogated and analysed thematically.

Results

We identified three factors that may have contributed to the programme’s disappointing outcomes: (1) difficulties of implementing all elements of the programme, particularly the proposed income generation component in the wider context of economic strain; (2) a moralistic approach to commercial sex work by programme staff; and (3) limitations in the programme’s ability to engage with social realities facing community members.

Conclusions

We conclude that externally-imposed programmes that present new information without adequately engaging with local realities and constraints on action can be met by resistance to change.

Researchers: Dan Chisholm, Huseyin Naci, Adnan Ali Hyder, Nhan T Tran, and Margie Peden
Date: 2012
Region: Africa, Asia
Publication details: BMJ 2012;344:e612
LSE department: Department of Health Policy
Keywords: road traffic injuries, cost effectiveness, Africa, South East Asia

Objective

To identify and estimate the population costs and effects of a selected set of enforcement strategies for reducing the burden of road traffic injuries in developing countries.

Design

Cost effectiveness analysis based on an epidemiological model.

Setting

Two epidemiologically defined World Health Organization sub-regions of the world: countries in sub-Saharan Africa with very high adult and high child mortality (AfrE); and countries in South East Asia with high adult and high child mortality (SearD).

Interventions

Enforcement of speed limits via mobile speed cameras; drink-drive legislation and enforcement via breath testing campaigns; legislation and primary enforcement of seatbelt use in cars; legislation and enforcement of helmet use by motorcyclists; legislation and enforcement of helmet use by bicyclists.

Main outcome measures

Patterns of injury were fitted to a state transition model to determine the expected population level effects of intervention over a 10 year period, which were expressed in disability adjusted life years (DALYs) averted. Costs were expressed in international dollars ($Int) for the year 2005.

Results

The single most cost effective strategy varies by sub-region, but a combined intervention strategy that simultaneously enforces multiple road safety laws produces the most health gain for a given amount of investment. For example, the combined enforcement of speed limits, drink-driving laws, and motorcycle helmet use saves one DALY for a cost of $Int1000–3000 in the two sub-regions considered.

Conclusions

The potential impact of available road safety measures is inextricably bound by the underlying distribution of road traffic injuries across different road user groups and risk factors. Combined enforcement strategies are expected to represent the most efficient way to reduce the burden of road traffic injuries, because they benefit from considerable synergies on the cost side while generating greater overall health gains.

Researchers: Philipa Mladovsky and Maymouna Bâ
Date: 2017
Region: Africa
Publication details: Social Science and Medicine, 188. pp. 91-99. ISSN 0277-9536
LSE department: Department of International Development & LSE Health
Keywords: Healthservices, Affordability, Senegal, Health Inequity

Plan Sésame (PS) is a user fee exemption policy launched in 2006 to provide free access to health services to Senegalese citizens aged 60 and over. However, analysis of a household survey evaluating PS echoes findings of other studies showing that user fee removal can be highly inequitable. 34 semi-structured interviews and 19 focus group discussions with people aged 60 and over were conducted in four regions in Senegal (Dakar, Diourbel, Matam and Tambacounda) over a period of six months during 2012. They were analysed to identify underlying causes of exclusion from/inclusion in PS. These point to three steps at which exclusion occurs: (i) not being informed about PS; (ii) not perceiving a need to use health services under PS; and (iii) inability to access health services under PS, despite having the information and perceived need.

This study identifies lay explanations for exclusion at these different steps. Some lay explanations point to social exclusion, defined as unequal power relations; poor access to PS was seen to be caused by corruption, patronage, poverty, lack of social support, internalised discrimination and adverse incorporation. Other lay explanations do not point to social exclusion, for example: poor implementation; inadequate funding; high population demand; incompetent bureaucracy; and PS as a favour or moral obligation to friends or family. Within a critical realist paradigm, the study interprets these lay explanations as empirical evidence for the presence of the following hidden underlying causal mechanisms: lacking capabilities; mobilisation of institutional bias; and social closure. However, social constructionist perspectives leads the investigators to critique this paradigm by drawing attention to contested health, wellbeing and corruption discourses. These differences in interpretation lead to subsequent differential policy recommendations. This demonstrates the need for the adoption of a “multi-epistemological” perspective in studies of health inequity and social exclusion.

Asia

Researchers: Clare Wenham
Date: 2018
Region: Asia
Publication details: Contemporary Southeast Asia, 40 (1). pp.126-151. ISSN 0958-4935
LSE department: Department for Health Policy
Keywords: Thailand, governance, regional governance, hierarchy, disease control

Since the emergence of HIV/AIDS and SARS, Thailand has understood the security threat posed by disease and has responded by investing in the country's disease control infrastructure, such as through the development of the Field Epidemiology Training Program (FETP), improving pandemic preparedness, and collaborating with other states, international organizations, non-governmental organizations and private initiatives to ensure health security. This has led to the creation of a multi-stakeholder subregional governance network for disease control. However, underpinning this network is the individual transformation of Thailand, which, beyond acting as a norm entrepreneur, has scaled up its activities in disease control to become a would-be leader in disease control in mainland Southeast Asia. By using Lake's conceptions of hierarchy and Nolte's understanding of regional power, this article shows how Thailand has taken on this leadership role and has been able to dominate the normative processes of subregional disease control and in doing so has strengthened its own economic and national security. Moreover, this article draws conclusions for regional governance more broadly, through examining power dynamics between states within the arrangement.

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Researchers: Bhaven N. Sampat & Kenneth C. Shadlen
Date: 2018
Region: India
Publication details: PLoS ONE, 13 (4). https://doi.org/10.1371/journal.pone.0194714
LSE department: Department for International Development
Keywords: India, Pharmaceutical Patents, medical supplies, Medical Systems

India, like many developing countries, only recently began to grant pharmaceutical product patents. Indian patent law includes a provision, Section 3(d), which tries to limit grant of “secondary” pharmaceutical patents, i.e. patents on new forms of existing molecules and drugs. Previous research suggests the provision was rarely used against secondary applications in the years immediately following its enactment, and where it was, was redundant to other aspects of the patent law, raising concerns that 3(d) was being under-utilized by the Indian Patent Office. This paper uses a novel data source, the patent office’s first examination reports, to examine changes in the use of the provision. We find a sharp increase over time in the use of Section 3(d), including on the main claims of patent applications, though it continues to be used in conjunction with other types of objections to patentability. More surprisingly, see a sharp increase in the use of the provision against primary patent applications, contrary to its intent, raising concerns about potential over-utilization.

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Researchers: David Tordrup, Waqas Ahmed, Khalid Saeed Bukhari, Panos Kanavos
Date: 2013
Region: Asia
Publication details: The Lancet global health, 1 (1). e13-e14. ISSN 2214-109X
LSE department: Department for Health Policy
Keywords: natural disaster, Pakistan, medical supplies, aid, flooding

Access to essential medicines can be a formidable challenge in the wake of natural disasters where supply chains and health services might be severely affected. The devastating floods in Pakistan in 2010 affected most of the country from north to south, displacing more than 20 million people and damaging over 500 health facilities. This immense natural disaster, covering 2·4 million hectares of land at its highest, posed a substantial challenge to the provision of health services from the first rains in July until the flood waters receded in January the following year.

Reasearchers: Xuan-Wei Lu, Apurv Chauhan, Catherine CampbellDate: 2015
Region: Asia
Publication details: Journal of Community & Applied Social Psychology, 25 (5). pp. 384-399. ISSN 10529284
LSE department: Department of Psychological and Behavioural Science
Keywords: China; mental health; middle-aged men; Confucianism; stress

Little is understood by the ideas that urban Chinese population holds about mental health. Insufficient research and recognition of mental illnesses, and a dearth of social resources for mental health support and promotion limit understandings of how daily life stresses restrict the quality of life of China's urban population.Drawing on in-depth interviews with 15 middle-age urban men, we map out men's accounts of how they battle to cope with the demands of everyday social, political, and familial pressures.

The study reveals that the representations of mental health are shaped by notions of control over emotions, adherence to Confucian philosophy, familial obligations, and the need to demonstrate social obedience and conformity. Data also suggest that the participants represent stable family support along with healthy social interactions as important enabling factors of positive mental health, whereas pressures of modernity are regarded as significant disruptive factors in mental health. The theory of social representations guides the process as well as analytic interpretations of this research.

Reasearchers: Mihoko Yotsui, Catherine Campbell, Teruo Honma
Date: 2016
Region: Asia
Publication details: Ageing and Society, 36 (5). 1052-1082. ISSN 0144-686X
LSE department: Department of Psychological and Behavioural Science
Keywords: participation, older people, natural disasters, community support, social capital, health enabling communities, social identity

How can social participation by older people support their wellbeing? We explore the elder-focused community support system developed in Minamisanriku town after the Great East Japan Earthquake of 2011. Many elderly people lost all their material possessions and were moved from their devastated home communities to temporary housing.

We conducted semi-structured interviews with 17 participants including 14 community workers and three members in the Minamisanriku Council of Social Welfare (MCSW) in a programme framed by the MCSW's disaster-response model.

Thematic analysis highlighted how older people's involvement in the visiting programme of their temporary community, and conducting twice-daily visits to other vulnerable elders, enabled them to provide valued social support to isolated and homebound peers.

It also helped reconstruct their own social identities shattered by the dissolution of former communities, the shock of displacement and loss of possessions.This positive social participation was heavily influenced by strong bridges between their temporary community and MCSW support staff and infrastructure that promoted and supported their visits.

Our study highlights how strong and empowering relationships amongst older people can be facilitated by an active government-funded support agency that is immediately responsive to the needs and deeply respectful of the world-views of vulnerable groups.

Researchers: Elias Mossialos, Yanfeng Ge, Jia Hu and Liejun Wang
Date: 2016
Region: Asia
Publication details: © World Health Organization 2016, ISBN 978 92 890 5039 5
LSE department: Department of Health Policy
Keywords: China, pharmaceuticals, health policy

China’s pharmaceutical system will struggle to cope with the twin challenges of a rapidly aging population and increases in non-communicable diseases, such as diabetes and heart and lung disease. This is one of the findings from a report published by LSE Health and the State Council of China. Recognising the importance of a strong domestic pharmaceutical industry in order to meet China’s growing healthcare needs, the authors identify the country’s main challenges and propose a series of policy measures to help build a robust system that provides affordable and effective medicines to all.

Europe

Researchers: Anna Odone, Taavi Tillmann, Andreas Sandgren, Gemma Williams, Bernd Rechel, David Ingleby, Teymur Noori, Philipa Mladovsky and Martin Mckee
Date: 2015
Region: Europe
Publication details: The European Journal Of Public Health
LSE department: International Development
Keywords: tuberculosis, migration, European Union, infectious diseases

Background

Although tuberculosis (TB) incidence has been decreasing in the European Union/European Economic Area (EU/EEA) in the last decades, specific subgroups of the population, such as migrants, remain at high risk of TB. This study is based on the report ‘Key Infectious Diseases in Migrant Populations in the EU/EEA’ commissioned by The European Centre for Disease Prevention and Control.

Methods

We collected, critically appraised and summarized the available evidence on the TB burden in migrants in the EU/EEA. Data were collected through: (i) a comprehensive literature review; (ii) analysis of data from The European Surveillance System (TESSy) and (iii) evidence provided by TB experts during an infectious disease workshop in 2012.

Results

In 2010, of the 73 996 TB cases notified in the EU/EEA, 25% were of foreign origin. The overall decrease of TB cases observed in recent years has not been reflected in migrant populations. Foreign-born people with TB exhibit different socioeconomic and clinical characteristics than native sufferers.

Conclusion

This is one of the first studies to use multiple data sources, including the largest available European database on infectious disease notifications, to assess the burden and provide a comprehensive description and analysis of specific TB features in migrants in the EU/EEA. Strengthened information about health determinants and factors for migrants’ vulnerability is needed to plan, implement and evaluate targeted TB care and control interventions for migrants in the EU/EEA.

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Reasearchers: Rachel Jenkins, Stuart Lancashire, David McDaid, Yevgeniy Samyshkin, Samantha Green, Jonathan Watkins, Angelina Potasheva, Alexey Nikiforov, Zinaida Bobylova, Valery Gafurov, David Goldberg, Peter Huxley, Jo Lucas, Nick Purchase and Rifat Atun
Date: 2007
Region: Europe
Publication details: Bulletin of the World Health Organisation (WHO) 2007;85:858–866
LSE department: LSE Health
Keywords: Mental health, social inclusion, Russia, health policy

Objective

To facilitate mental health reform in one Russian oblast (region) using systematic approaches to policy design and implementation.

Methods

The authors undertook a three-year action-research programme across three pilot sites, comprising a multifaceted set of interventions combining situation appraisal to inform planning, sustained policy dialogue at federal and regional levels to catalyse change, introduction of multidisciplinary and intersectoral-working at all levels, skills-based training for professionals, and support for nongovernmental organizations (NGOs) to develop new care models.

Findings

Training programmes developed in this process have been adopted into routine curricula with measurable changes in staff skills. Approaches to care improved through multidisciplinary and multisectoral service delivery, with an increase in NGO activities, user involvement in care planning and delivery in all pilot sites. Hospital admissions at start and end of the study fell in two pilot sites, while the rate of readmissions in all three pilot sites by 2006 was below that for the region as a whole. Lessons learned have informed the development of regional and federal mental health policies.

Conclusion

A multifaceted and comprehensive programme can be effective in overcoming organizational barriers to the introduction of evidence-based multisectoral interventions in one Russian region. This can help facilitate significant and sustainable changes in policy and reduce institutionalization.

Latin America

Researchers: Alessandro Luciano and Alex Voorhoeve
Date: 2019
Region: Latin America
Publication details: Health and Human Rights Journal. ISSN 2150-4113
LSE department: Department of Philosophy
Keywords: Costa Rica, Right to health, Fair priority setting, Health reform

The experience of Costa Rica highlights the potential for conflicts between the right to health and fair priority setting. For example, one study found that most favorable rulings by the Costa Rican constitutional court concerning claims for medications under the right to health were either for experimental treatments or for medicines that should have low priority based on health gain per unit of expenditure and severity of disease. In order to better align rulings with priority setting criteria, in 2014, the court initiated a reform in its assessment of claims for medicine.

This paper assesses this reform’s impact on the fairness of resource allocation. It finds three effects: (1) a reduction in successful claims for experimental medication, which is beneficial; (2) an increase in the success rate of medication lawsuits, which is detrimental because most claims are for extremely cost-ineffective medications; and (3) a decline in the number of claims for medicine, which is beneficial because it forestalls such low-priority spending. This paper estimates that, taking all three effects into account, the reform has had a modest net positive impact on overall resource allocation. However, it also argues that there is a need for further reforms to lower the number of claims to low-priority medicines that are granted.

Researchers: Ivan Arroyave, Philipp Hessel, Alex Burdorf, Jesus Rodriguez-Garcia, Doris Cardona and Mauricio Avendaño
Date: 2015
Region: Latin America
Publication details: International Journal for Equity in Health, 14 (48). ISSN 1475-9276
LSE department: LSE Health
Keywords: Mortality, Economic recession, Colombia, Developing countries, Health insurance

Studies in high-income countries suggest that mortality is related to economic cycles, but few studies have examined how fluctuations in the economy influence mortality in low- and middle-income countries. We exploit regional variations in gross domestic product per capita (GDPpc) over the period 1980-2010 in Colombia to examine how changes in economic output relate to adult mortality.

Methods

Data on the number of annual deaths at ages 20 years and older (n=3,506,600) from mortality registries, disaggregated by age groups, sex and region, were linked to population counts for the period 1980–2010. We used region fixed effect models to examine whether changes in regional GDPpc were associated with changes in mortality. We carried out separate analyses for the periods 1980–1995 and 2000–2010 as well as by sex, distinguishing three age groups: 20-44 (predominantly young working adults), 45-64 (middle aged working adults), and 65+ (senior, predominantly retired individuals).

Results

The association between regional economic conditions and mortality varied by period and age. From 1980 to 1995, changes in GDPpc were unrelated to mortality in ages 20 to 64, but they were associated with reductions in mortality for senior men. By contrast, from 2000 to 2010, changes in GDPpc were not associated with old age mortality, while an increase in GDPpc was associated with a decline in mortality at ages 20-44 years. Analyses restricted to regions with high registration coverage yielded similar albeit less precise estimates for most sub-groups.

Conclusions

The relationship between business cycles and mortality varied by period and age in Colombia. Most notably, mortality shifted from being acyclical to being countercyclical for males aged 20-44, while it shifted from being countercyclical to being acyclical for males aged 65+.

Researcher: Joan Costa-Font
Date: 2015
Region: Latin America
Publication details: Journal of International Development, 286997-1005
LSE Department/Centre: Department of Health Policy
Keywords: Access to drugs, Deregulation, Peru, Information Asymmetries, Price regulation.

This paper provides an economic policy assessment of the effects of medicine deregulation drawing on the Peruvian experience between 1991 and 2006. As in other low-income countries, health insurance development is inadequate, drug expenditure is mostly paid out-of-pocket and approximately one third of the Peruvian population has limited access to ‘essential medicines’.

Market deregulation in this context can exert an impact on prices and hence reduce access to medicines. Based on this evidence, we find that product and price deregulation of the medicines market appears to have reduced consumer trust of locally produced medicines, which in turn incentivised a switch to branded and more expensive drugs. The latter resulted in a further decreased access to medicines.

Global

Researchers: Tiziana Leone
Date: 2019
LSE Department: Department of International Development

Mid-life ageing is a neglected stage of women’s lives, particularly in Low and Middle Income Countries (LMICs). Birth injuries, menopause, manual labour in particular for women in more deprived areas can cause health problems from mid-life onward. This study analyses the relationship between health deterioration and age in women across wealth groups in 6 countries - China, Ghana, Mexico, Russia, South Africa and India.

Read the article.

Researchers: Dr. Clare Wenham, Dr. Ernestina Coast, Dr. Tiziana Leone & Sonia Corrêa
Date:2018
Region: Global
LSE Department: Department of Health Policy
Keywords: Zika, Abortion, Regulation, Disease Control, Medical Abortion

An inter-disciplinary team from LSE have received funding from Wellcome Trust for a seed project to understand the impact of the Zika outbreak on how women access medical abortion, and how national regulation has impacted on women’s choices and abortion service provider’s activity during this health emergency.

This LSE Health research will be undertaken by Clare Wenham (Department of Health Policy), Ernestina Coast (Department of International Development), Tiziana Leone (Department of International Development) and Sonia Correa (LSE Gender Institute), and will analyse medical abortion (the use of mifepristone and misoprostol to terminate pregnancy) during the Zika outbreak, to consider the impact different regulatory environments had on women's reproductive health at a time of uncertainty.

The project will analyse the intersection of Zika, regulation and medical abortion through a comparative case study of Brazil, Colombia and El Salvador. Each of these states had Zika infected women (albeit with differing incidence) yet represent diverse regulatory environments for medical abortion, ranging from legalisation in Colombia to criminalisation in El Salvador to medical abortion drugs being on the list of prohibited smuggled drugs in Brazil.

In spite of regulation, however, it is believed that women have still been accessing medical abortion during the Zika epidemic, assumed through civil society groups, pharmacies and the black market. The research will assess women’s choices and provider activity in the case study locations, and in doing so, produce a conceptual framework for understanding the regulation of abortion during health emergencies.

The project will start in Summer 2018, and will begin with a research workshop with leading abortion and Zika academics and activists to determine pathways to understanding the impact of the outbreak on medical abortion, and suitable study sites.

For more information, please contact Clare Wenham c.wenham@lse.ac.uk

Researchers: Ernestina Coast, Allison H. Norris, Ann M. Moore and Emily Freeman
Date: 2018
Region: Global
Publication details: Social Science and Medicine, 200 pp. 199-210 ISSN 0277-9536
LSE department: Department of International Development & LSE Health
Keywords: Induced abortion, Conceptual framework, Systematic mapping

This study presents a new conceptual framework for studying trajectories to obtaining abortion-related care. It assembles for the first time all of the known factors influencing a trajectory and encourages readers to consider the ways these macro- and micro-level factors operate in multiple and sometimes conflicting ways. Based on presentation to and feedback from abortion experts (researchers, providers, funders, policymakers and advisors, advocates) (n = 325) between 03/06/2014 and 22/08/2015, and a systematic mapping of peer-reviewed literature (n = 424) published between 01/01/2011 and 30/10/2017, the framework synthesises the factors shaping abortion trajectories, grouped into three domains: abortion-specific experiences, individual contexts, and (inter)national and sub-national contexts

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Researchers: Ernestina Coast, Nathalie Kapp, Kelly Blanchard, Bella Ganatra, Jane Harries, Katharine Footman, Ann Moore, Onikepe Owolabi, Clementine Rossier, Kristen Shellenberg, Britt Wahlin and Cynthia Woodsong
Date: 2018
Region: Global
Publication details: Contraception, 97 (2) pp. 184-188 ISSN 0010-7824
LSE department: Department of International Development & LSE Health
Keywords: Medical abortion self-us, eearly medical abortion research gaps, non-prescription medical abortion

In December 2016, following the “Africa Regional Conference on Abortion: From Research to Policy,” a group of 20 global abortion researchers, representing nine different international organizations and universities, convened to discuss current and future research on medical abortion self-use. While recognizing the meaning of “self-use” to be evolving, we considered women's self-use of medical abortion as provision of drugs from pharmacies, drug sellers or through online services or other outlets, without a prescription from a clinician, followed by a woman's self-management of the abortion process, including care-seeking for any complications.

Research has not kept abreast of women's self-use of medical abortion, leaving many gaps in the scientific literature regarding the ideal conditions for safe and effective use. Therefore, our main objectives were to assess the research gaps highlighted during the conference, identify specific challenges to conducting research on medical abortion self-use and share promising research methodologies to advance this research. Although there are overlaps with the recommended and well-researched practice of women's self-management of the abortion process at home after receiving medical abortion medicines, screening and information from a clinician, our intent was focused on the emerging practice of self-use.

The challenges laid out in this document — a list of identified research gaps and methodologic considerations in addressing them — are intended to inform both ongoing and future research by the participants in this meeting; in sharing them, we hope to inform and validate not only our future work but also that of other researchers.

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Researchers: Trygve Ottersen, David B. Evans, Elias Mossialos & John-Arne Røttingen
Date: 2017
Region: Global
Publication details: Health Economics, Policy and Law 12 (2) pp. 105-111 ISSN 1744-1331
LSE department: Department of Health Policy
Keywords: Financing, long-term care, Global Health, 2030 Agenda, WHO

Universal health coverage and healthy lives for all are now widely shared goals and central to the 2030 Agenda for Sustainable Development. Despite significant progress over the last decades, the world is still far from reaching these goals. Billions of people lack basic coverage of health services, live with unnecessary pain and disability, or have their lives cut short by avoidable or treatable conditions (Jamison et al., 2013; Murray et al., 2015; World Health Organization, World Bank, 2015). At the same time, millions are pushed into poverty simply because they need to use health services and must pay for them out-of-pocket. Fundamental to this situation is the way health interventions and the health system are financed. Numerous countries spend less than is required to ensure even the most essential health services, scarce funds are wasted, out-of-pocket payments remain high and disadvantaged groups get the least public resources despite having the greatest needs

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