The health transition and mortality decline: the impact of interventions and programmes

We examine the effect of health reform in 1995 in Taiwan on health transition among the elderly Taiwanese, including functioning, disability and death by employing a nationally representative longitudinal survey, the “Survey of Health and Living Status of the Middle Aged and Elderly in Taiwan” for analyses. This study ran hazard models over 3 to 4 years to analyze changes from no physical function problem to having difficulty in physical functioning, no ADL/IADL problem to disability, and alive to dead. We found the higher-education benefited from national health insurance (NHI) more than the lower-education to get better mortality outcome. Because the higher-education were more likely to know when the new technology/medicine were available and covered by NHI. As for disability and physical functioning, our study showed that NHI helped to eliminate the income gap by allowing the lower income groups to have better access to health care after health reform.

The Government of Ghana has instituted a National Poverty Reduction Program with an initiative known as the Community-based Health Planning and Services (CHPS) as its core health development strategy. Originally launched as an experimental project of the Navrongo Health Research Centre, CHPS is currently a national initiative for shifting the focus of primary health care from clinics to communities. Four contrasting strategies of community health care were tested. In response to early evidence that community nursing could impact on survival, CHPS was launched to scale up the Navrongo community health service delivery system. The program currently functions in over 1000 villages dispersed in all 172 districts of Ghana. This paper presents a longitudinal demographic survival histories of 17,967 under age five children who were observed over the July 1993 to December 2010 period. Analysis of trends show that placing nurses in CHPS communities was associated with more pronounced mortality declines than was observed in comparison communities. Differentials show that Navrongo study areas exhibit equity relationships that are often observed elsewhere in Africa: Children whose parents are uneducated and relatively poor experience significantly higher mortality than children of the educated and less poor. Time conditional We

Background
Risk factors, early diagnosis and treatment for colorectal cancer (CRC) vary, and results in differences in incidence and outcomes across societies. To assess the influence of early diagnosis, we compare survival after CRC in a screened vs an unscreened population.

Methods
Relative survival (RS) analyses were performed to assess differences in outcomes for all CRC patients diagnosed in US SEER (2004, N=9349) and Norway (2004-05, N=8318). 39% died within three years.

Results
Stage distributions at diagnosis were different in US vs Norway (42% vs 22% localized; 35% vs 48% regional; 19% vs 23% distant). No (13%), minor (16%) or large (71%) resection rates were similar, but age and stage dependent. Overall 3-year RS was 72% in US and 67% in Norway. In multivariate models of age, sex, stage, and treatment, a weak country-effect was observed (excess mortality ratio (EMR) 0.9, CI 0.9-1.0), indicating better survival in the US, but this was significant for the youngest patients only (EMR 0.9, CI 0.8-0.9) for whom screening is an option.

Conclusion
The advantageous RS observed for US patients, and particularly for patients <80 years, likely reflects the earlier stage distribution, perhaps explained by different CRC screening practices as the US recommends screening whereas Norway does not.

In Bangladesh, low use of facilities for maternal health services in rural areas has been a critical challenge to the health system in reducing maternal mortality. Health facilities in rural areas operate at less than their capacity due to shortage and sub-optimal performance of service providers. An operations research was conducted to test the feasibility of pay-for-performance (P4P) approach, through which financial incentive was provided to motivate the team of managers, direct and indirect providers, and administrative and support staff of a facility for achieving both quantity and quality targets on maternal health services set for the institution on quarterly basis. Performance of a facility was measured using service statistics and quality assessment reports. An external body with an obstetrician, an anesthesiologist and a pediatrician was formed to assess the facility performance every three months and subsequently incentive was paid to the eligible facility. Performance-based incentive motivated additional efforts which caused to increase service volume remarkably, and the facilities also succeeded in improving quality of services. Performance-based incentive is required until it significantly increases the rate of institutional delivery, a key requirement to reduce maternal mortality.