Three School Studies Published in June Health Policy and Planning

Three studies by researchers from the Department of International Health at the Johns Hopkins Bloomberg School of Public Health appear in the June 2003 issue of Health Policy and Planning.  

Road Safety in Uganda and Pakistan 

David Bishai, MD, PhD, MPH, an associate professor of Population and Family Health Sciences,  Adnan A. Hyder, MD, MPH, PhD, assistant professor of International Health, and Leon Robertson Faculty Development Chair, and Richard H. Morrow, MD, MPH, professor of International Health, studied the amount of public investment in road safety in Uganda and Pakistan, two of the poorest countries in the world. They concluded that if more of an investment was made by the government, the rate of road traffic mortality would decrease.

The article, “Rates of public investment for road safety in developing countries: case studies of Uganda and Pakistan,” states that the levels of government expenditure in Uganda and Pakistan are extremely low. The government and other donors in Uganda and Pakistan contribute $0.09 and $0.07 per capita, respectively. The researchers explained that if the level of spending does not increase in each country, the effectiveness of safety measures to combat road traffic injuries would never be more effective than they are currently. 

In completing their investigation, researchers reviewed traffic budgets, driver licensing documents, vehicle inspection budgets, road safety designs and upgrades, bilateral aid for road safety, and pre-hospital care of road traffic victims in both Uganda and Pakistan.

Indonesian Economic Crisis

Hugh Waters, PhD, assistant professor of International Health, was the lead author of an investigation into the effects of the 1997-98 East Asian economic crisis on health care use and health status in Indonesia. 

According to Dr. Waters and his co-authors, the decrease in value of Indonesian currency led to inflation and reduced public spending on health in Indonesia. Negative economic growth, which is also a side effect of a decrease in currency value, along with increased poverty, unemployment and, in some countries, famine, deteriorates the effects of health care. An increase in unemployment and inflation and a sharp reduction in household purchasing power caused malnutrition in some Indonesian people, who were also less likely to visit outpatient health centers. In addition, the quality of the public health facilities decreased as a result of less private funding and public supply of health services.

The researchers concluded that social protection programs play a critical role in protecting populations against the adverse effects that economic downturns have on health and health care. 

The study, entitled, “The impact of the 1997-98 East Asian economic crisis on health and health care in Indonesia,” is based on an examination of the Indonesia National Socioeconomic Survey, a nationally representative household survey conducted annually with a sample size of 870,000-880,000 individuals. The researchers also looked at reports issued by non-government organizations on the effects of the crisis on nutritional and educational outcomes.

Children’s Health

Dr. Waters, Laurel Hatt, an International Health graduate student, and David H. Peters, MD, DrPH, MPH, an assistant professor of International Health, found that governments in developing countries must not only work with non-government health providers to increase health care for children, but they need to also regulate the standards of care by these organizations.

In their article, entitled “Working with the private sector for child health,” the authors explain that, in many countries, private and non-governmental health providers are more commonly consulted for child health illnesses than public providers. Private services are generally perceived to be of higher quality than publicly provided health care. No matter the perception, the researchers found that private providers are unregulated and the technical quality of the services they provide is questionable.

In their article, the authors discuss working with private sector heath providers to better care for child illnesses and to expand the coverage of their services. They found that a child’s health, nutritional status, and survival is most influenced by conditions and actions at the household level.The authors found that private sector groups greatly impact children’s health by driving household decisions on health. These groups include formally trained health care workers, informally trained heath care providers, private employers who provide financing, non-governmental organizations, private voluntary organizations, and traditional healers. In addition, pharmaceutical companies who influence drug prices and availability, private pharmacies and drug vendors, food producers and shopkeepers, the media, private health insurance, and private suppliers of medical equipment also ultimately affect household behavior and children’s health.

The researchers concluded that the private sector plays a major role in child health care and governments need to find ways to harness their efforts. Although past experiences working with private sector heath care workers have been positive, they vary by community, and the success of a program depends on the capacity of the government and their partners to collaborate their efforts. In addition, the authors suggest that future interventions should be designed with careful assessment of the intervention design and the environment in which the programs are implemented.