%0 Journal Article %J Bulletin of the World Health Organization %D Forthcoming %T Next generation health system evaluation: options, opportunities, limits %A Kevin Croke %A Edwine Barasa %A Margaret E. Kruk %B Bulletin of the World Health Organization %G eng %0 Journal Article %J International Journal of Clinical Trials %D 2024 %T Evaluation of Estonia’s enhanced care management program: protocol for a cluster randomized trial %A Benjamin Daniels %A Rogger, Daniel %A Meyhar Mohammed %A Katre Vaarsi %A Kevin Croke %X

Background: Estonia’s aging population faces an increasing burden of non-communicable diseases (NCDs) and a growing population suffers with multiple chronic conditions. These changes have reduced well-being and quality of life for many older Estonians, while increasing the use of high cost specialist and emergency care. In response, the Estonia Health Insurance Fund (EHIF) is working to support primary care physicians to improve care for complex patients with multiple chronic conditions. A new EHIF program, Enhanced Care Management (ECM), trains family physicians to identify complex patients, co-develop proactive care plans with them, and conduct more active outreach and management of these patients.

Methods: In this protocol we describe a randomized controlled trial, developed in partnership with EHIF, to evaluate the impact of ECM training for physicians. The RCT enrolled a randomly selected 97 family physicians out of the 786 family physicians practicing in Estonia. Among those physicians’ 6,739 ECM-eligible patients, 2,389 patients were randomly selected for enrolment into the ECM program.

Results: Using administrative records, we evaluated the effects of ECM enrolment on: (1) health care utilization; (2) provider management of tracer conditions; and (3) markers of quality of care such as hospital admission for primary health care-sensitive conditions.

Conclusions: This protocol presents a pre-specified analysis plan for this evaluation of Estonia’s ECM  program.

Trial registration: First registered with the American Economics Association, AEARCTR-0003661. Registered May 1, 2019. Retrospective secondary registration with www.clinicaltrials.gov P169891. Registered April 26, 2023.

%B International Journal of Clinical Trials %V 11 %G eng %U https://www.ijclinicaltrials.com/index.php/ijct/article/view/725 %N 1 %0 Journal Article %J British Medical Journal %D 2023 %T The politics of health system quality: how to ignite demand %A Kevin Croke %A Thapa, Gagan K %A Aryal, Amit %A Pokhrel, Sudip %A Kruk, Margaret E %B British Medical Journal %V 383 %P e076792 %G eng %U https://www.bmj.com/content/383/bmj-2023-076792 %0 Journal Article %J Health Policy and Planning %D 2023 %T Health reform in Nigeria: the politics of primary health care and universal health coverage %A Kevin Croke %A Osondu Ogbuoji %X Over the past decade, Nigeria has seen major attempts to strengthen primary health care, through the Saving One Million Lives (SOML) initiative, and to move towards universal health care, through the National Health Act. Both initiatives were successfully adopted, but faced political and institutional challenges in implementation and sustainability. We analyse these programmes from a political economy perspective, examining barriers to and facilitators of adoption and implementation throughout the policy cycle, and drawing on political settlement analysis (PSA) to identify structural challenges which both programmes faced. The SOML began in 2012 and was expanded in 2015. However, the programme’s champion left government in 2013, a key funding source was eliminated in 2015, and the programme did not continue after external funding elapsed in 2021. The National Health Act passed in 2014 after over a decade of advocacy by proponents. However, the Act’s governance reforms led to confict between health sector agencies, about both reform content and process. Nine years after the Act’s passage, disbursements have been sporadic, and implementation remains incomplete. Both programmes show the promise of major health reforms in Nigeria, but also the political and institutional challenges they face. In both cases, health leaders crafted evidence-based policies and managed stakeholders to achieve policy adoption. Yet political and institutional challenges hindered implementation. Institutionally, horizontal and vertical fragmentation of authority within the sector impeded coordination. Politically, electoral cycles led to frequent turnover of sectoral leadership, while senior politicians did not intervene to support fundamental institutional reforms. Using PSA, we identify these as features of a ‘competitive clientelist’ political settlement, in which attempts to shift from clientelist to programmatic policies generate powerful opposition. Nonetheless, we highlight that some policy %B Health Policy and Planning %G eng %U https://academic.oup.com/heapol/advance-article/doi/10.1093/heapol/czad107/7426850 %0 Journal Article %J Lancet Global Health %D 2023 %T Primary health care in practice: Usual source of care and health system performance across 14 countries %A Kevin Croke %A Moshabela, Mosa %A Kapoor, Neena R. %A Svetlana V. Doubouva %A Ezequiel Garcia-Elorrio %A Mariam, Damen Haile %A Todd P. Lewis %A Gloria Nompumelelo Mfeka-Nkabinde %A Sailesh Mohan %A Peter Mugo %A Jacinta Nzinga %A Prabhakaran, Dorairaj %A Ashenif Tadele %A Katherine D. Wright %A Margaret E. Kruk %B Lancet Global Health %V 12 %P e134-e144 %G eng %U https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(23)00513-2/fulltext %N 1 %0 Journal Article %J Lancet Global Health %D 2023 %T Population confidence in the health system in 15 countries: results from the first round of People’s Voice Survey. %A Margaret E. Kruk %A Neena R Kapoor %A Todd P Lewis %A Arsenault, Catherine %A Eleni C Boutsikari %A Joao Breda %A Susanne Carai %A Kevin Croke %A Rashmi Dayalu %A Gunther Fink %A Patricia J Garcia %A Munir Kassa %A Mohan Sailesh %A Moshabela Mosa %A Jacinta Nzinga %A Oh, Juhwan %A Okiro, Emelda A %A Prabhakaran, Dorairaj %A SteelFisher, Gillian K %A Tarricone, Rosanna %A Ezequiel Garcia-Elorrio %B Lancet Global Health %V 12 %P e100-e111 %G eng %U https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(23)00499-0/fulltext %N 1 %0 Journal Article %J PLOS Medicine %D 2023 %T Measuring people’s views on health system performance: Design and development of the people’s voice survey %A Lewis, TP %A Kapoor, NR %A Aryal, A %A Bazua-Lobato, R %A Carai, S %A Clarke-Deelder, E %A Croke, K %A Dayalu, R %A Espinoza-Pajuelo, L %A G Fink %A Garcia, PJ %A Garcia- Elorrio, E %A Getachew, T %A Jarhyan, P %A Kassa, M %A Ae Kim, S %A Mazzoni, A %A Medina-Ranilla, J %A Mohan, S %A Molla, G %A Moshabela, M %A Naidoo, I %A Nzinga, J %A Oh, J. %A Okiro, EA %A Prabhakaran, D %A Roberti, J %A SteelFisher, G %A Taddele, T %A Tadele, A %A X. Wang %A Xu, R %A Leslie, HH %A Kruk, ME %B PLOS Medicine %V 20 %P e1004294 %G eng %U https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004294 %N 10 %0 Journal Article %J Lancet Regional Health - Southeast Asia %D 2023 %T Adverse Birth Outcomes Among Women with ‘Low-Risk’ Pregnancies in India: Findings from the Fifth National Family Health Survey, 2019-21 %A Ajay Tandon %A Roder-DeWan, Sanam %A Chopra, Mickey %A Sheena Chhabra %A Kevin Croke %A Marion Cros %A Hasan, Rifat %A Guru Rajesh Jammy %A Navneet Manchanda %A Amith Nagaraj %A Rahul Pandey %A Pradhan, Elina %A Andrew Sunil Rajkumar %A Michael A. Peters %A Margaret Elizabeth Kruk %X

Background: Despite substantial progress in improving maternal and newborn health, India continues to experience high rates of newborn mortality and stillbirths. One reason may be that many births happen in health facilities that lack advanced services—such as Caesarean section, blood transfusion, or newborn intensive care. Stratification based on pregnancy risk factors is used to guide ‘high-risk’ women to advanced facilities. To assess the utility of risk stratification for guiding the choice of facility, we estimated the frequency of adverse newborn outcomes among women classified as ‘low risk’ in India.

Methods: We used the 2019–21 Fifth National Family Health Survey (NFHS-5)—India’s Demographic and Health Survey—which includes modules administered to women aged 15–49 years. In addition to pregnancy history and outcomes, the survey collected a range of risk factors, including biomarkers. We used national obstetric risk guidelines to classify women as ‘high risk’ versus ‘low risk’ and assessed the frequency of stillbirths, newborn deaths, and unplanned Caesarean sections for the respondent’s last pregnancy lasting 7 or more months in the past five years. We calculated the proportion of deliveries occurring at non-hospital facilities in all the Indian states.

Findings: Using data from nearly 176,699 recent pregnancies, we found that 46.6% of India’s newborn deaths and 56.3% of stillbirths were among women who were ‘low risk’ according to national guidelines. Women classified as ‘low risk’ had a Caesarean section rate of 8.4% (95% CI 8.1–8.7%), marginally lower than the national average of 10.0% (95% CI 9.8–10.3%). In India as a whole, 32.0% (95% CI 31.5–32.5%) of deliveries occurred in facilities that were likely to lack advanced services. There was substantial variation across the country, with less than 5% non- hospital public facility deliveries in Punjab, Kerala, and Delhi compared to more than 40% in Odisha, Madhya Pradesh, and Rajasthan. Newborn mortality tended to be lower in states with highest hospital delivery rates.

Interpretation: Individual risk stratification based on factors identified in pregnancy fails to accurately predict which women will have delivery complications and experience stillbirth and newborn death in India. Thus a determination of ‘low risk’ should not be used to guide women to health facilities lacking key life saving services, including Caesarean section, blood transfusion, and advanced newborn resuscitation and care.

%B Lancet Regional Health - Southeast Asia %G eng %U https://www.thelancet.com/journals/lansea/article/PIIS2772-3682(23)00113-0/fulltext %0 Journal Article %J Health Systems and Reform %D 2023 %T The Politics of Health Policy Agenda Setting in India: The Case of the PMJAY Program %A Anuska Kalita %A Kevin Croke %X In 2018, India’s Prime Minister announced a new health insurance program, Pradhan Mantri Jan Arogya Yojana (PMJAY), aiming to cover over 500 million people. This paper seeks to document and explain the emergence of PMJAY on India’s political and policy agendas. We analyze media, election manifestos, legislative debates, and health budgets to compare PMJAY’s presence on India’s policy agenda to previous health programs. We then apply Kingdon’s Multiple Streams Framework to explain the program’s emergence and adoption, validating our data and interpretations through consultations with Indian health policy experts. Comparing respective launch years, PMJAY was covered in national newspapers 37 to 212 times more than previous flagship health programs, although it was not more prominent in parliamentary debates or in the health budget. Events in the problem, politics, and policy streams converged to enable its prominence. Health policy elites who favored insurance as a policy to address out-of-pocket health expenditures gained influence after the 2014 election victory of the Bharatiya Janata Party (BJP). PMJAY’s naming and branding, scale, timing, implementation style, and design aligned with both the BJP’s ideology and political strategy. PMJAY represents the increased prominence of health programs in Indian politics, although primarily on the political and media agenda, rather than on the budgetary and legislative agenda during this period. The political forces that facilitated its emergence also shaped its design in ways that are likely to affect the Indian health system’s ability to provide comprehensive financial protection in the future. %B Health Systems and Reform %V 9 %G eng %U https://www.tandfonline.com/doi/full/10.1080/23288604.2023.2229062 %N 1 %0 Journal Article %J International Journal of Health Policy and Management %D 2023 %T Comment: Comparative Politics, Political Settlements, and the Political Economy of Health Financing Reform %A Kevin Croke %B International Journal of Health Policy and Management %G eng %0 Journal Article %J Economic Development and Cultural Change %D 2023 %T Up Before Dawn: Experimental Evidence from a Cross Border Trader Training at the Democratic Republic of Congo-Rwanda Border %A Kevin Croke %A Maria Elena Garcia-Mora %A Markus Goldstein %A Edouard Mensah %A Michael O'Sullivan %X Small-scale cross-border trade provides opportunities for economic gains in many developing countries. Yet cross-border traders—many of whom are women—face harassment and corruption which can undermine these potential gains. We present evidence from a randomized controlled trial that provided access to information on procedures, tariffs, and rights to small-scale traders to facilitate border crossings, lower corruption, and reduce gender-based violence along the DRC-Rwanda border. The training reduces bribe payment by 5 percentage points in the full sample and by 27.5 percentage points on average among compliers. The training also reduces the incidence of gender-based violence by 5.4 percentage points (30.5 p.p. among compliers). We assess competing explanations for the impacts using a game-theoretic model based on Hirschman’s Exit, Voice, and Loyalty framework. The effects are achieved through early border crossings at unofficial hours (exit) instead of traders’ use of voice mechanisms or reduced rent-seeking from border officials. These results highlight the need to improve governance and establish clear cross-border trade regulations, particularly on the DRC side of the border. %B Economic Development and Cultural Change %V 71 %G eng %U https://www.journals.uchicago.edu/doi/10.1086/718187 %N 3 %0 Journal Article %J PLOS Global Public Health %D 2022 %T Access to health services, food, and water during an active conflict: Evidence from Ethiopia %A Abay, Kibrom %A Abay, Mehari Hiluf %A Berhane, Guush %A Chamberlin, Jordan %A Kevin Croke %A Kibrom Tafere %X Civil conflict began in Ethiopia in November 2020 and has reportedly caused major disruptions in access to health services, food, and related critical services, in addition to the direct impacts of the conflict on health and well-being. However, the population-level impacts of the conflict have not yet been systematically quantified. We analyze high frequency phone surveys conducted by the World Bank, which included measures of access to basic services, to estimate the impact of the first phase of the war (November 2020 to May 2021) on households in Tigray. After controlling for sample selection, a difference-in-differences approach is used to estimate causal effects of the conflict on population access to health services, food, and water and sanitation. Inverse probability weighting is used to adjust for sample attrition. The conflict has increased the share of respondents who report that they were unable to access needed health services by 35 percentage points (95% CI: 14–55 pp) and medicine by 8 pp (95% CI:2–15 pp). It has also increased the share of households unable to purchase staple foods by 26 pp (95% CI:7–45 pp). The share of households unable to access water did not increase, although the percentage able to purchase soap declined by 17 pp (95% CI: 1–32 pp). We document significant heterogeneity across population groups, with disproportionate effects on the poor, on rural populations, on households with undernourished children, and those living in communities without health facilities. These significant disruptions in access to basic services likely underestimate the true burden of conflict in the affected population, given that the conflict has continued beyond the survey period, and that worse-affected households may have higher rates of non-response. Documented spatial and household-level heterogeneity in the impact of the conflict may help guide rapid post-conflict responses. %B PLOS Global Public Health %V 2 %P e0001015 %8 2022 %G eng %U https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0001015 %N 11 %0 Journal Article %J BMC Public Health %D 2022 %T Service delivery reform for maternal and newborn health in Kakamega County, Kenya: study protocol for a prospective impact evaluation and implementation science study %A Kevin Croke %A Gage, Anna %A Isabel Fulcher %A Kennedy Opondo %A Jacinta Nzinga %A Benjamin Tsofa %A Sebastien Haneuse %A Kruk, Margaret %X

Background: Maternal and neonatal mortality remain elevated in low and middle income countries, and progress is slower than needed to achieve the Sustainable Development Goals. Existing strategies appear to be insufficient. One proposed alternative strategy, Service Delivery Redesign for Maternal and Neonatal Health (SDR), centers on strength- ening higher level health facilities to provide rapid, definitive care in case of delivery and post-natal complications, and then promoting delivery in these hospitals, rather than in primary care facilities. However to date, SDR has not been piloted or evaluated.

Methods: We will use a prospective, non-randomized stepped-wedge design to evaluate the effectiveness and implementation of Service Delivery Redesign for Maternal and Neonatal Health in Kakamega County, Kenya.

Discussion: This protocol describes a hybrid effectiveness/implementation evaluation study with an adaptive design. The impact evaluation (“effectiveness”) study focuses on maternal and newborn health outcomes, and will be accom- panied by an implementation evaluation focused on program reach, adoption, and fidelity.

%B BMC Public Health %V 22 %G eng %U https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-022-13578-y %N 1727 %0 Book Section %B Helminth Infections and their Impact on Global Public Health %D 2022 %T Epidemiology and Economics of Deworming %A Bundy, DAP %A Campbell, SJ %A Chami, GF %A Croke, K %A Schultz, L %A Turner, HC %B Helminth Infections and their Impact on Global Public Health %I Springer %G eng %U https://link.springer.com/chapter/10.1007/978-3-031-00303-5_1 %0 Journal Article %J Tropical Medicine and International Health %D 2022 %T Effects of a community-driven water, sanitation, and hygiene program on Covid-19 symptoms, vaccine acceptance, and non-Covid illnesses: A cluster-randomized controlled trial in rural Democratic Republic of Congo %A Kevin Croke %A Aidan Coville %A Eric Mvukiyehe %A Caleb Jeremie Dohou %A Jean-Paul Zibika %A Luca Stanus Ghib %A Michele Andreottola %A Yannick Bokasola Lokaya %A John Paul Quattrochi %X

Background: The government of the Democratic Republic of Congo responded to Covid-19 with policy measures, such as business and school closures and distribution of vaccines, which rely on citizen compliance. In other settings, prior experience with effective government programs has increased compliance with public health measures. We study the effect of a national water, sanitation, and hygiene program on compliance with COVID-19 policies.

Methods: Prior to the COVID-19 pandemic, 332 communities were randomly assigned to the Villages et Ecoles Assainis program or control. After COVID-19 reached DRC, individuals who owned phones (590/1312; 45%) were surveyed by phone three times between May 2020-August 2021. Primary outcomes were COVID symptoms, non- COVID illness symptoms, child health, psychological well-being, and vaccine acceptance. Secondary outcomes included COVID-19 preventive behavior and knowledge, and perceptions of governmental performance, including COVID response. All outcomes were self-reported. Outcomes are compared between treatment and control villages using linear models.

 

Results: The VEA program did not affect respondents’ COVID symptoms (-0.11, 95% CI -0.55, 0.33), non-COVID illnesses (-0.01, 95% CI -0.05, 0.03), child health (0.07, 95% CI -0.19, 0.33), psychological well-being (-0.05, 95% CI -0.35, 0.24), or vaccine acceptance (-0.04, 95% CI -0.19, 0.10). There was no effect on village-level COVID-19 preventive behavior (0.02, 95% CI -0.17, 0.22), COVID-19 knowledge (0.16, 95% CI - 0.08, 0.39), or trust in institutions.

Conclusions and relevance:
Although the VEA program increased access to improved water and sanitation, it did not increase trust in government. Accordingly, there was no evidence of increased compliance with COVID policies, and no reduction in illness.

 

%B Tropical Medicine and International Health %V 27 %P 795-802 %G eng %U https://onlinelibrary.wiley.com/doi/abs/10.1111/tmi.13799 %N 9 %0 Journal Article %J Journal of African Economies %D 2022 %T The Role of Skills and Gender Norms in Sector Switches: Experimental Evidence from a Job Training Program in Nigeria %A Kevin Croke %A Markus Goldstein %A Alaka Holla %X

Industrialisation and structural change entails shifting workers from low-skill to high- skill occupations. In emerging economies, multiple constraints may impede sectoral switches among workers, including skill and spatial mismatches, and social norms related to gender in the workplace. This study uses a job training experiment across five cities in Nigeria to estimate the overall effect of training on sectoral switches into the information and communications technology and business process outsourcing sector and to examine the role of various factors that might constrain switching. After 2 years, the treatment group was 26% more likely to work in the information and communication technology (ICT)-enabled service sector, although they were no more likely to be employed than the control group. Sector switches were higher among those with sector-relevant skills, and training magnified the skills premium in switching. Switches were also higher in some cities, despite large improvements in skills in all cities. Women who were implicitly biassed against associating women with professional attributes were two times more likely to switch into ICT than unbiassed women, suggesting that training helped overcome internalised social norms among female applicants to the program. These results suggest that training can be an effective strategy for inducing sector switches and overcoming social norms that hamper female mobility in the labour market and that narrower targeting may make such sector-specific job training programs more effective.

%B Journal of African Economies %P ejac007 %G eng %U https://academic.oup.com/jae/advance-article-abstract/doi/10.1093/jae/ejac007/6571041 %0 Journal Article %J BMJ Global Health %D 2022 %T How are health workers paid and does it matter? Conceptualising the potential implications of digitising health worker payments %A Margaret McConnell %A Mahajan, Mansha %A Bauhoff, Sebastian %A Kevin Croke %A Stephane Verguet %A Castro, Marcia C %A Melo Furtado, Kheya %A Mehndiratta, Abha %A Farzana, Misha %A Faiz Rashid, Sabina %A Cash, Richard %B BMJ Global Health %V 7 %P e007344. %G eng %U https://gh.bmj.com/content/7/1/e007344 %0 Journal Article %J Injury Epidemiology %D 2022 %T Epidemiology of adult trauma injuries in Malawi: Results from a multi-site trauma registry %A Linda Chokotho %A Kevin Croke %A Meyhar Mohammed %A Wakisa Mulwafu %A Jonna Bertfelt %A Saahil Karpe %A Sveta Milusheva %X

Background: Large scale multi-site trauma registries with broad geographic coverage in low-income countries are rare. This lack of systematic trauma data impedes effective policy responses.

Methods: All patients presenting with trauma at 10 hospitals in Malawi from September 2018 to March 2020 were enrolled in a prospective registry. Using data from 49,241 cases, we analyze prevalence, causes, and distribution of trauma in adult patients, and timeliness of transport to health facilities and treatment.

Results: Falls were the most common mechanism of injury overall, but road traffic crashes (RTCs) were the most common mechanism of serious injury, accounting for (48%) of trauma admissions. This pattern was consistent across all central and district hospitals, with only one hospital recording <40% of admissions due to RTCs.  49% of RTC-linked trauma patients were not in motorized vehicles at the time of the crash. 84% of passengers of cars/trucks/buses and 48% of drivers of cars/trucks/buses from RTCs did not wear seatbelts, and 52% of motorcycle riders (driver and passenger) did not wear helmets. For all serious trauma cases (defined as requiring hospital admission), median time to hospital arrival is 5 hours 20 minutes (IQR: 1 hour 20 minutes, 24 hours). For serious trauma cases that presented on the same day that trauma occurred, median time to hospital arrival was 2 hours (IQR 1 hour, 11 hours). Significant predictors of hospital admission include being involved in an RTC, age >55, Glasgow Coma Score score <12, and presentation at hospital on a weekend.

Conclusions: RTCs make up almost half of hospitalized trauma cases in this setting, are equally common in referral and district hospitals, and are an important predictor of injury severity. Pedestrians and cyclists are just as affected as those in vehicles. Many of those injured in vehicles do not take adequate safety precautions. Most trauma patients, including those with serious injuries, do not receive prompt medical attention. Greater attention to safety for both motorized and especially non-motorized road users, and more timely, higher quality emergency medical services, are important policy priorities for Malawi and other developing countries with high burdens of RTC trauma.

%B Injury Epidemiology %V 9 %G eng %U https://injepijournal.biomedcentral.com/articles/10.1186/s40621-022-00379-5 %N 14 %0 Journal Article %J Journal of Health Policy, Politics, and Law %D 2021 %T Health insurance loss during COVID-19 increases support for universal health coverage %A Ashley M Fox %A Yongjin Choi %A Heather Lanthorn %A Kevin Croke %X

Context: The United States is the only high-income country that relies on employer-sponsored health coverage to insure a majority of its population. An estimated 15 to 27 million Americans have lost employer-sponsored health insurance during the COVID-19-induced economic downturn. We examine public opinion towards universal health coverage policies in this context.

Methods: Using data collected through an online survey of 1,211 Americans in June 2020, we examine the influence of health insurance loss on stated support for Medicare-for-All (M4A) in two ways. First, we examine the association of pandemic-related health insurance loss with M4A support. We consider this change in insurance status a ‘structural frame.’ Second, we make introduce a ‘situational frame,’ experimentally priming some respondents with a vignette of a sympathetic victim losing employer-sponsored health coverage during COVID-19. With this, we estimate the impacts of this ‘vicarious insurance loss’ on M4A support. In both cases, we examine how political party affiliation moderates the effect.

Findings: Nearly a quarter (22%) of respondents reported personal health insurance loss in the 6 months preceding the survey. We find that directly experiencing recent health insurance loss is strongly associated (10-15 pp, p<0.01) with greater M4A support. Experimental exposure to the vignette increases M4A support by 6 pp (p=0.05), largely by shifting respondents declaring they “don’t know” about their support into supporters. We find no moderating influence of political-party affiliation in the survey experiment. However, party identification does modify the association between insurance loss and M4A support; Republicans, who report much lower levels of baseline M4A support, are more likely than Democrats to have higher M4A approval if they have lost insurance recently.

Conclusions: In the context of the COVID-19 pandemic, situational framings can induce modest change in attitudes among individuals who do not have well-formed preferences about M4A. However, the effects of real world events such as job and health insurance loss are associated with larger changes, including among self-identified partisans. This suggests that the large scale loss of employer-based insurance offers the potential for new coalitions supportive of policies to expand health insurance coverage. %B Journal of Health Policy, Politics, and Law %G eng %U https://read.dukeupress.edu/jhppl/article-abstract/doi/10.1215/03616878-9417428/174075/Health-Insurance-Loss-during-COVID-19-Increases %0 Journal Article %J BMJ Global Health %D 2021 %T Effects of a community-driven water, sanitation, and hygiene intervention on water and sanitation infrastructure, access, behavior, and governance: a cluster-randomized controlled trial in rural Democratic Republic of Congo %A John P. Quattrochi %A Aidan Coville %A Eric Mvukiyehe %A Caleb Dohou %A Federica Esu %A Byron Cohen %A Yannick Lokaya %A Kevin Croke %X

Introduction Inadequate water and sanitation is a central challenge in global health. Since 2008, the Democratic Republic of Congo government has implemented a national programme, Healthy Villages and Schools (Villages et Ecoles Assainis (VEA), with support from UNICEF, financed by UK’s Foreign, Commonwealth and Development Office.

Methods A cluster-level randomised controlled trial of VEA was implemented throughout 2019 across 332 rural villages, grouped into 50 treatment and 71 control clusters. Primary outcomes included time spent collecting water; quantity of water collected; prevalence of improved primary source of drinking water; and prevalence of improved primary defecation site. Secondary outcomes included child health, water governance, water satisfaction, handwashing practices, sanitation practices, financial cost of water, school attendance and water storage practices. All outcomes were self-reported. The primary analysis was on an intention-to-treat basis, using linear models. Outcomes were measured October–December 2019, median 5 months post-intervention.

Results The programme increased access to improved water sources by 33 percentage points (pp) (95% CI 22 to 45), to improved sanitation facilities by 26 pp (95% CI 14 to 37), and improved water governance by 1.3 SDs (95% CI 1.1 to 1.5), water satisfaction by 0.6 SD (95% CI 0.4 to 0.9), handwashing practices by 0.5 SD (95% CI 0.3 to 0.7) and sanitation practices by 0.3 SD (95% CI 0.1 to 0.4). There was no significant difference in financial cost of water, school attendance, child health or water storage practices.

Conclusion VEA produced large increases in access to and satisfaction with water and sanitation services, in self-reported hygiene and sanitation behaviour, and in measures of water governance.

%B BMJ Global Health %V 6 %P e005030 %G eng %U https://gh.bmj.com/content/6/5/e005030 %0 Journal Article %J Journal of Politics %D 2021 %T The Impact of Health Programs on Political Opinion: Evidence from Malaria Control in Tanzania %A Kevin Croke %X For elections to produce accountable government, citizens must reward politicians who deliver benefits. Yet there is relatively limited causal evidence of changes in public opinion in direct response to specific government programs. This question is examined in Tanzania, which has implemented large health programs targeting diseases such as HIV/AIDS and malaria. Tanzania’s 2010–11 antimalaria campaign took place concurrently with a national household survey. Exploiting discontinuities based on interview dates to estimate the effect of these programs on the popularity of local politicians, this article shows that a bed net distribution campaign resulted in large, statistically significant improvements in approval of political leaders, especially in malaria endemic areas. Effects were largest shortly after program implementation but persisted for up to six months. These findings suggest that citizens update their evaluation of politicians in response to programs, especially those that address important problems, and that the effects decay over time, but not completely. %B Journal of Politics %V 83 %P 340-353 %G eng %U https://www.journals.uchicago.edu/doi/pdfplus/10.1086/709670 %N 1 %0 Journal Article %J Health Systems and Reform %D 2020 %T Hybrid Organizations in Health Systems: The Case of Malaysia's National Heart Institute %A Amrit Virk %A Kevin Croke %A Mariana Mohd Yusoff %A Khairiah Mokhtaruddin %A Zalilah Abdullah %A Ainul Nadziha Mohd Hanafiah %A Emira Soleha Ramli, %A Nor Filzatun Borhan %A Yadira Almodovar-Diaz %A Yap Wei-Aun %A Rifat Atun %X Health system reforms across high- and middle-income countries often involve changes to public hospital governance. Corporatization is one such reform, in which public sector hospitals are granted greater functional independence while remaining publicly owned. In theory, this can improve public hospital efficiency, while retaining a public service ethos. However, the extent to which efficiency gains are realized and public purpose is maintained depends on policy choices about governance and payment systems. We present a case study of Malaysia’s National Heart Institute (IJN), which was created in 1992 by corporatization of one department in a large public hospital. The aim of the paper is to examine whether IJN has achieved the goals for which it was created, and if so, whether it provides a potential model for further reforms in Malaysia and other similar health systems. Using a combination of document analysis and key informant interviews, we examine key governance, health financing and payment, and equity issues. For governance, we highlight the choice to have IJN owned by and answerable to a Ministry of Finance (MOF) holding company and MOF-appointed board, rather than the Ministry of Health (MOH). On financing and payment, we analyze the implications of IJN’s combined role as fee-for-service provider to MOH as well as provider of care to private patients. For equity, we analyze the targeting of IJN care across publicly-referred and private patients. These issues demonstrate unresolved tensions between IJN’s objectives and public service goals. As an institutional innovation that has endured for 28 years and grown dramatically in size and revenue, IJN’s trajectory offers critical insights on the relevance of the hybrid public-private models for hospitals in Malaysia as well as in other middle-income countries. While IJN appears to have achieved its goal of establishing itself as a commercially viable, publicly owned center of clinical excellence in Malaysia, the value for money and equity of the services it provides to the Ministry of Health remain unclear. IJN is accountable to a small Ministry of Finance holding company, which means that detailed information required to evaluate these critical questions is not published. The case of IJN highlights that corporatization cannot achieve its stated goals of efficiency, innovation, and equity in isolation; rather it must be supported by broader reforms, including of health financing, payment, governance, and transparency, in order to ensure that autonomous hospitals improve quality and provide efficient care in an equitable way. %B Health Systems and Reform %V 6 %P e1833639 %G eng %U https://www.tandfonline.com/doi/full/10.1080/23288604.2020.1833639 %N 1 %0 Journal Article %J Health Policy and Planning %D 2020 %T The Origins of Ethiopia’s Primary Health Care Expansion: The politics of state building and health system strengthening %A Kevin Croke %X

Ethiopia’s expansion of primary health care over the past 15 years has been hailed as a model in sub-Saharan Africa. A leader closely associated with the programme, Tedros Adhanom Gebreyesus, is now Director-General of the World Health Organization, and the global movement for expansion of primary health care often cites Ethiopia as a model. Starting in 2004, over 30 000 Health Extension Workers were trained and deployed in Ethiopia and over 2500 health centres and 15 000 village-level health posts were constructed. Ethiopia’s reforms are widely attributed to strong leadership and ‘political will’, but underlying factors that enabled adoption of these policies and implementation at scale are rarely analysed. This article uses a political economy lens to iden- tify factors that enabled Ethiopia to surmount the challenges that have caused the failure of similar primary health programmes in other developing countries. The decision to focus on primary health care was rooted in the ruling party’s political strategy of prioritizing rural interests, which had enabled them to govern territory successfully as an insurgency. This wartime rural governance strategy included a primary healthcare programme, providing a model for the later national pro- gramme. After taking power, the ruling party created a centralized coalition of regional parties and prioritized extending state and party structures into rural areas. After a party split in 2001, Prime Minister Meles Zenawi consolidated power and implemented a ‘developmental state’ strategy. In the health sector, this included appointment of a series of dynamic Ministers of Health and the mo- bilization of significant resources for primary health care from donors. The ruling party’s ideology also emphasized mass participation in development activities, which became a central feature of health programmes. Attempts to translate this model to different circumstances should consider the distinctive features of the Ethiopian case, including both the benefits and costs of these strategies.

%B Health Policy and Planning %V 35 %P 1318–1327 %G eng %U https://watermark.silverchair.com/czaa095.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAsAwggK8BgkqhkiG9w0BBwagggKtMIICqQIBADCCAqIGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMUqHuqP73giNMFzrTAgEQgIICc4UrEkuiYSVXL1dhfxQWxbwfVwgTef-0f7yLCsFiPjzQgCK %N 10 %0 Journal Article %J International Journal of Health Planning and Management %D 2020 %T Implementation of a multi-centre digital trauma registry: Experience in district and central hospitals in Malawi %A Kevin Croke %A Linda Chokotho %A Sveta Milusheva %A Jonna Bertfelt %A Saahil Karpe %A Meyhar Mohammed %A Wakisa Mulwafu %X

Background: Trauma is a rapidly growing component of the burden of disease in developing countries; yet systematic data collection about trauma in such contexts is relatively rare.

Methods: This paper describes the implementation of a trauma registry in 10 government-run hospitals in Malawi, with a focus on implementation logistics, stakeholder engagement strategies, and data quality procedures.
 

Results: 51 337 trauma cases were recorded over the first 14 months of registry operations. The number of cases per month, data accuracy, and the geographic coverage of the registry improved over time as data quality measures were implemented.

Conclusions: Multi-center digital trauma registries are feasible in low-resource settings. Stakeholder engagement, periodic in-person and frequent digital follow up with data teams, and regular channeling of findings back to data collection teams help to improve data quality and complete- ness over a 14month period. Financial and staffing constraints remain challenges for sustainability over time, but this experience demonstrates the feasibility of large-scale registry operations.

%B International Journal of Health Planning and Management %V 35 %P 1157-1172 %G eng %U https://onlinelibrary.wiley.com/doi/epdf/10.1002/hpm.3023 %N 5 %0 Journal Article %J BMJ Global Health %D 2020 %T The impact of a health facility construction campaign on health service utilization and outcomes: Analysis of spatially-linked survey and facility location data in Ethiopia %A Kevin Croke %A Andualem Telaye Mengistu %A Stephen O'Connell %A Kibrom Tafere %B BMJ Global Health %V 5 %P e002430. %8 August 27, 2020 %G eng %U https://gh.bmj.com/content/5/8/e002430.full %N 8 %0 Journal Article %J Health Policy and Planning %D 2019 %T The political economy of health financing reform in Malaysia %A Kevin Croke %A Mariana Mohd Yusoff %A Zalilah Abdullah %A Ainul Nadziha Mohd Hanafiah %A Khairiah Mokhtaruddin %A Emira Soleha Ramli, %A Nor Filzatun Borhan %A Yadira Almodovar-Diaz %A Rifat Atun %A Amrit Kaur Virk %X There is growing evidence that political economy factors are central to whether or not proposed health financing reforms are adopted, but there is little consensus about which political and institutional factors determine the fate of reform proposals. One set of scholars see the relative strength of interest groups in favour of and opposed to reform as the determining factor. An alternative literature identifies aspects of a country’s political institutions–specifically the number and strength of formal ‘veto gates’ in the political decision-making process—as a key predictor of reform’s prospects. A third group of scholars highlight path dependence and ‘policy feedback’ effects, stressing that the sequence in which health policies are implemented determines the set of feasible reform paths, since successive policy regimes bring into existence patterns of public opinion and interest group mobilization which can lock in the status quo. We examine these theories in the context of Malaysia, a successful health system which has experienced several instances of proposed, but ultimately blocked, health financing reforms. We argue that policy feedback effects on public opinion were the most important factor inhibiting changes to Malaysia’s health financing system. Interest group opposition was a closely related factor; this opposition was particularly powerful because political leaders perceived that it had strong public support. Institutional veto gates, by contrast, played a minimal role in preventing health financing reform in Malaysia. Malaysia’s dramatic early success at achieving near-universal access to public sector healthcare at low cost created public opinion resistant to any change which could threaten the status quo. We conclude by analysing the implications of these dynamics for future attempts at health financing reform in Malaysia. %B Health Policy and Planning %V 34 %P 732-739 %8 28 Sept 2019 %G eng %U https://academic.oup.com/heapol/advance-article/doi/10.1093/heapol/czz089/5575920 %N 10 %0 Journal Article %J Social Science and Medicine - Population Health %D 2019 %T Health service delivery and political trust in Nigeria %A Adanna Chukwuma %A Bossert, Thomas J. %A Kevin Croke %X Do improvements in health service delivery affect trust in political leaders in Africa? Citizens expect their government to provide social services. Intuitively, improvements in service delivery should lead to higher levels of trust in and support for political leaders. However, in contexts where inadequate services are the norm, and where political support is linked to ethnic or religious affiliation, there may be weak linkages between improvements in service delivery and changes in trust in political leaders. To examine this question empirically, we take advantage of a national intervention that improved health service delivery in 500 primary health care facilities in Nigeria, to estimate the impact of residence within 10 km of one or more of the intervention facilities on trust in the president, local councils, the ruling party, and opposition parties. Using difference-in-difference models, we show that proximity to the intervention led to increases in trust in the president and the ruling party. By contrast, we find no evidence of increased trust in the local council or opposition parties. Our study also examines the role of ethnicity and religious affiliation in mediating the observed increases in trust in the president. While there is a large literature suggesting that both the targeting of interventions, and the response of citizens to interventions is often mediated by ethnic, geographic or religious identity, by contrast, we find no evidence that the intervention was targeted at the president's ethnic group, zone, or state of origin. Moreover, there is suggestive evidence that the intervention increased trust in the president more among those who did not share these markers of identity with the president. This highlights the possibility that broad-based efforts to improve health services can increase trust in political leaders even in settings where political attitudes are often thought to be mediated by group identity. %B Social Science and Medicine - Population Health %V 7 %8 April 2019 %G eng %U https://www.sciencedirect.com/science/article/pii/S2352827318302982?via%3Dihub %0 Journal Article %J PLOS Neglected Tropical Diseases %D 2019 %T The Long Run Impact of Early Childhood Deworming on Numeracy and Literacy: Evidence from Uganda %A Kevin Croke %A Rifat Atun %B PLOS Neglected Tropical Diseases %V 13 %P e0007085 %G eng %U https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0007085 %N 1 %0 Journal Article %J The Lancet %D 2018 %T Investment in child and adolescent health and development: key messages from Disease Control Priorities, 3rd Edition %A Bundy, Donald AP %A Nilanthi de Silva %A Horton, Susan %A Patton, George C %A Schultz, Linda %A Dean T. Jamison %A DCP-3 Child and Adolescent Health Development Authors Group %B The Lancet %V 391 %P 687-699 %G eng %U http://dcp-3.org/sites/default/files/resources/DCP3%20Child%20Development%20Lancet%20Article.pdf?issu %N 10121 %0 Journal Article %J PLOS Neglected Tropical Diseases %D 2018 %T Health, financial, and education gains of investing in preventive chemotherapy for schistosomiasis, soil-transmitted helminthiases, and lymphatic filariasis in Madagascar: a modeling study %A Jan-Walter de Neve %A Rija Lalaina Andriantavison %A Kevin Croke %A Johannes Krisam %A Voahirana Hanitriniala Rajoela %A Rary Adria Rakotoarivony %A Valerie Rambeloson %A Linda Brooke Schultz %A Jumana Qamruddin %A Verguet, Stéphane %B PLOS Neglected Tropical Diseases %V 12 %P e0007002 %G eng %U https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0007002 %N 12 %0 Journal Article %J Advances in Parasitology %D 2018 %T 100 Years of Mass Deworming Programmes: A Policy Perspective From the World Bank's Disease Control Priorities Analyses %A Bundy, Donald A.P. %A Appleby, Laura J. %A Mark Bradley %A Kevin Croke %A T. Deirdre Hollingsworth %A Rachel Pullan %A Hugo C. Turner %A Nilanthi de Silva %B Advances in Parasitology %V 100 %P 127-154 %G eng %U https://www.sciencedirect.com/science/article/pii/S0065308X18300198 %0 Book Section %B Disease Control Priorities: Child and Adolescent Health and Development, Chapter 13 %D 2017 %T Deworming Programs in Middle Childhood and Adolescence %A Donald Bundy %A Laura Appleby %A Mark Bradley %A Kevin Croke %A T. Deirdre Hollingsworth %A Rachel Pullan %A Hugo C. Turner %A Nilanthi de Silva %B Disease Control Priorities: Child and Adolescent Health and Development, Chapter 13 %7 3 %I World Bank %C Washington DC %V 8 %P 165-182 %G eng %U http://dcp-3.org/chapter/2437/deworming %0 Journal Article %J BMC Infectious Diseases %D 2017 %T Relationships between sickle cell trait, malaria, and educational outcomes in Tanzania %A Kevin Croke %A Deus S. Ishengoma %A Filbert Francis %A Makani, Julie %A Mathias L. Kamugisha %A John Lusingu %A Martha Lemnge %A Horacio Larreguy %A Fink, , Günther %A Bruno P. Mmbando %X

Background

Sickle Cell Trait (SCT) has been shown to be protective against malaria. A growing literature suggests that malaria exposure can reduce educational attainment. This study assessed the relationship and interactions between malaria, SCT and educational attainment in north-eastern Tanzania.

Methods

Seven hundred sixty seven children were selected from a list of individuals screened for SCT. Febrile illness and malaria incidence were monitored from January 2006 to December 2013 by community health workers. Education outcomes were extracted from the Korogwe Health and Demographic Surveillance system in 2015. The primary independent variables were malaria and SCT. The association between SCT and the number of fever and malaria episodes from 2006 to 2013 was analyzed. Main outcomes of interest were school enrolment and educational attainment in 2015.

Results

SCT was not associated with school enrolment (adjusted OR 1.42, 95% CI [0.593,3.412]) or highest grade attained (adjusted grade difference 0.0597, 95% CI [−0.567, 0.686]). SCT was associated with a 29% reduction in malaria incidence (adjusted IRR 0.71, 95% CI [0.526, 0.959]) but not with fever incidence (adjusted IRR 0.905, 95% CI [0.709-1.154]). In subgroup analysis of individuals with SCT, malaria exposure was associated with reduced school enrollment (adjusted OR 0.431, 95% CI [0.212, 0.877]).

Conclusions

SCT appears to reduce incidence of malaria. Overall, children with SCT do not appear to attend more years of school; however children who get malaria despite SCT appear to have lower levels of enrolment in education than their peers.

%B BMC Infectious Diseases %V 17 %P 568 %G eng %U https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-017-2644-x %0 Journal Article %J PLOS Neglected Tropical Diseases %D 2017 %T Should the WHO withdraw support for mass deworming? %A Kevin Croke %A Joan Hamory Hicks %A Eric Hsu %A Michael Kremer %A Edward Miguel %B PLOS Neglected Tropical Diseases %V 11 %P e0005481 %8 June 8, 2017 %G eng %U http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0005481 %N 6 %0 Journal Article %J American Journal of Tropical Medicine and Hygiene %D 2017 %T More Evidence on the Effects of Deworming: What Lessons Can We Learn? %A Kevin Croke %A Eric Hsu %A Michael Kremer %B American Journal of Tropical Medicine and Hygiene %V 96 %P 1265-66 %G eng %U http://www.ajtmh.org/content/journals/10.4269/ajtmh.17-0161#html_fulltext %N 6 %0 Journal Article %J International Journal of Epidemiology %D 2017 %T Commentary: Exploiting randomized exposure to early childhood deworming programmes to study long-run effects: A research programme in progress %A Kevin Croke %B International Journal of Epidemiology %G eng %U https://doi.org/10.1093/ije/dyw344 %0 Journal Article %J Democratization %D 2017 %T Tools of Single Party Hegemony in Tanzania: Evidence from Surveys and Survey Experiments %A Kevin Croke %X

Political systems dominated by a single party are common in the developing world, including in countries that hold regular elections. Yet we lack knowledge about the strategies by which these regimes maintain political dominance. This article presents evidence from Tanzania, a paradigmatic dominant party regime, to demonstrate how party institutions are used instrumentally to ensure the regime's sustained control. First, I show that the ruling party maintains a large infrastructure of neighbourhood representatives, and that in the presence of these agents, citizens self-censor about their political views. Second, I provide estimates of the frequency with which politicians give goods to voters around elections, demonstrating that such gifts are more common in Tanzania than previous surveys suggest. Third, I use a survey experiment to test respondents’ reaction to information about corruption. Few voters change their preferences upon receipt of this information. Taken together, this article provides a detailed picture of ruling party activities at the micro-level in Tanzania. Citizens conceal opposition sympathies from ten cell leaders, either because they fear punishment or seek benefits. These party agents can monitor citizens’ political views, facilitating clientelist exchange. Finally, citizens’ relative insensitivity to clientelism helps explain why politicians are not punished for these strategies.

%B Democratization %V 24 %P 189-208 %8 March 8, 2016 %G eng %U http://www.tandfonline.com/doi/pdf/10.1080/13510347.2016.1146696 %N 2 %0 Journal Article %J American Political Science Review %D 2016 %T Deliberate Disengagement: How Education Can Decrease Political Participation in Electoral Authoritarian Regimes %A Kevin Croke %A Guy Grossman %A Horacio A. Larreguy %A Marshall, John %X

A large literature examining advanced and consolidating democracies suggests that education increases political participation. However, in electoral authoritarian regimes, educated voters may instead deliberately disengage. If education increases critical capacities, political awareness, and support for democracy, educated citizens may believe that participation is futile or legitimizes autocrats. We test this argument in Zimbabwe—a paradigmatic electoral authoritarian regime—by exploiting cross-cohort variation in access to education following a major educational reform. We find that education decreases political participation, substantially reducing the likelihood that better-educated citizens vote, contact politicians, or attend community meetings. Consistent with deliberate disengagement, education’s negative effect on participation dissipated following 2008’s more competitive election, which (temporarily) initiated unprecedented power sharing. Supporting the mechanisms underpinning our hypothesis, educated citizens experience better economic outcomes, are more interested in politics, and are more supportive of democracy, but are also more likely to criticize the government and support opposition parties.

%B American Political Science Review %V 110 %P 579-600 %G eng %U https://www.cambridge.org/core/journals/american-political-science-review/article/deliberate-disengagement-how-education-can-decrease-political-participation-in-electoral-authoritarian-regimes/192AB48618B0E0450C93E97BE8321218 %N 3 %0 Journal Article %J Health Systems and Reform %D 2016 %T Influence of Organizational Structure and Administrative Processes on the Performance of State-Level Malaria Programs in Nigeria %A Ndukwe Kalu Udoha %A Kelechi Ohiri %A Charles Chikodili Chima %A Yewande Kofoworola Ogundeji %A Alero Rone %A Chike William Nwangwu %A Heather Lanthorn %A Kevin Croke %A Michael R. Reich %X

Studies have found links between organizational structure and performance of public organizations. Considering the wide variation in uptake of malaria interventions and outcomes across Nigeria, this exploratory study examined how differences in administrative location (a dimension of organizational structure), the effectiveness of administrative processes (earmarking and financial control, and communication), leadership (use of data in decision making, state ownership, political will, and resourcefulness), and external influences (donor influence) might explain variations in performance of state malaria programs in Nigeria. We hypothesized that states with malaria program administrative structures closer to state governors will have greater access to resources, greater political support, and greater administrative flexibility and will therefore perform better. To assess these relationships, we conducted semistructured interviews across three states with different program administrative locations: Akwa-Ibom, Cross River, and Niger. Sixty-five participants were identified through a snowballing approach. Data were analyzed using a thematic framework. State program performance was assessed across three malaria service delivery domains (prevention, diagnosis, and treatment) using indicators from Nigeria Demographic and Health Surveys conducted in 2008 and 2013. Cross River State was best performing based on 2013 prevention data (usage of insecticide-treated bednets), and Niger State ranked highest in diagnosis and treatment and showed the greatest improvement between 2008 and 2013. We found that organizational structure (administrative location) did not appear to be determinative of performance but rather that the effectiveness of administrative processes (earmarking and financial control), strong leadership (assertion of state ownership and resourcefulness of leaders in overcoming bottlenecks), and donor influences differed across the three assessed states and may explain the observed varying outcomes.

%B Health Systems and Reform %V 2 %P 331-356 %8 29 Sep 2016 %G eng %U http://www.tandfonline.com/doi/full/10.1080/23288604.2016.1234865 %N 4 %0 Journal Article %J Canadian Journal of Development Studies %D 2014 %T Collecting High Frequency Panel Data in Africa Using Mobile Phones %A Kevin Croke %A Andrew Dabalen %A Johannes Hoogeveen %A Gabriel Demombynes %A Marcelo Giugale %X As mobile phone ownership rates have risen in Africa, there is increased interest in using mobile telephony as a data collection platform. This paper draws on two pilot projects that use mobile phone interviews for data collection in Tanzania and South Sudan. In both cases, high frequency panel data have been collected on a wide range of topics in a manner that is cost effective, flexible and rapid. Attrition has been problematic in both surveys, but can be explained by the resource and organisational constraints that both surveys faced. We analyse the drivers of attrition to generate ideas for how to improve performance in future mobile phone surveys. %B Canadian Journal of Development Studies %V 35 %G eng %N 1 %0 Journal Article %J Studies in Comparative International Development %D 2012 %T Governance and Child Mortality Decline in Tanzania and Uganda, 1995-2007. %A Kevin Croke %X This article identifies political economy factors that help explain dramatic differences in the pace of child mortality reduction between Tanzania and Uganda from 1995 to 2007. The existing literature largely explains divergence in basic health outcomes with reference to economic variables such as GDP per capita. However, these factors cannot explain recent divergence across African countries with similar levels of GDP per capita, rates of economic growth, and levels of health funding. I argue that institutional and governance divergences between Tanzania and Uganda can be linked directly to differing coverage levels of key child health interventions (especially related to malaria control), and thus to differing child health outcomes. These institutional differences can be explained in part by historical factors, but more relevant causes can be found in recent political events. In Tanzania, there was an unusually effective project of institution building in the health sector, while in Uganda, by contrast, there was a negative political shock to the health system. This was driven by the repatrimonialization of the Ugandan state after President Yoweri Museveni’s decision to eliminate term limits in the 2001–2006 period. This repatrimonialization process reversed previous health sector institutional gains and had particularly negative effects on child health service delivery in Uganda over the period in question. %B Studies in Comparative International Development %V 47 %P 441-463 %G eng %N 4