While overall national HIV prevalence in South Asian countries remains low, the size of the regional population means low prevalence translates into large absolute numbers of people living with HIV.
... See More + Low national prevalence also masks higher HIV prevalence and incidence rates in certain geographical areas and among key populations at higher risk. The majority of new HIV infections are concentrated among population groups at higher risk including people who inject drugs, female and male sex workers and their clients, men who have sex with men and transgender people. Key lessons include: (a) there is significant variability in the capacity of national civil society organizations across the region. As these are the organizations that are closest to - and often members of - population groups at higher risk of HIV infection, it is important to note they may not have much experience or skill in proposal or report writing or monitoring and evaluation; (b) stigma and discrimination remain important barriers to accessing treatment and services; (c) there are important cross-cutting areas and scope for inter-sector and interministerial collaboration; and (d) there is demand for south-south learning and collaboration within the region and with south-east Asia. It is still too early to assess impact in terms of outcomes of the activities supported under this task, and in some cases the work is still on-going.
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This report summarizes the findings of a long and meticulous journey of data gathering and analysis to quantify the health losses from road deaths and injuries worldwide, as part of the path-finding Global Burden of Disease (GBD) study.
... See More + It is important, first, to acknowledge the profound contribution made by the lead authors and global team of injury prevention professionals to estimate the disease burden of road trauma, before absorbing their findings and recommendations. Without their dedication and tenacity, the way forward would be less certain. The first GBD study, published nearly two decades ago, signaled an emerging road safety crisis in developing regions of the world. It triggered a remarkable program of global advocacy that culminated in the United Nations decade of action for road safety and global plan to bring road safety outcomes under control in these regions by 2020. However, limited investment has been mobilized so far to implement the UN initiative. The second GBD studies, and related analyses presented in this report, confirm the importance of road safety as a global development priority and the urgency with which it must be addressed. The report's findings highlight the growth in road deaths and injuries globally, and their substantial impacts on maternal and child health, despite sustained reductions over the last three to four decades in high-income countries. Combined with the deaths arising from vehicle pollution, the road transport death toll exceeds that of, for example, HIV/AIDS, tuberculosis, malaria, or diabetes. This statistic further reinforces the call for global action. Without these GBD estimates we would not have a clear picture of the true situation because official country data in the developing world vastly understate the scale of road transport health losses.
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Publication 86304 MAR 31, 2014
Bhalla, Kavi; Shotten, Marc; Cohen, Aaron; Brauer, Michael; Shahraz, Saeid; Burnett, Richard; Leach-Kemon, Katherine; Freedman, Greg; Murray, Christopher J. L.
The objective of the Accelerating Universal Access to Early and Effective Tuberculosis (TB) Care Project is to support the aims of India's national strategic plan for tuberculosis control to expand the provision and utilization of quality diagnosis and treatment services for people suffering from tuberculosis.
... See More + There are three components to the project, the first component being new strategies to reach more tuberculosis patients with earlier and more effective care in the public and private sectors. The second component is the scale-up and improves diagnosis and treatment of drug-resistant tuberculosis. Finally, the third component is to expand public tuberculosis services integrated with the primary health care system. This component will focus on expanding and improving public sector TB services increasingly integrated with the government primary health care system. The IDA credit will finance activities at the national level, including for technical assistance, diagnostics, anti-TB medicines and other eligible expenditures, contributing to the following.
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The First Phase of the Dasu Hydropower Project (DHP) for Pakistan seeks to modernize and expand the energy sector of the country, while shifting from thermal generated electricity to low cost and high reward, clean generation of hydropower.
... See More + Some of the negative impacts and mitigation measures includes: a) ensure that displaced persons without titles to land or any recognizable legal rights to land are eligible for resettlement assistance and compensation for loss of non-land assets; b) develop procedures in a transparent, consistent, and equitable manner if land acquisition is through negotiated settlement to ensure that those people who enter into negotiated settlements will maintain the same or better income and livelihood status; c) improve the standards of living of the displaced poor and other vulnerable groups, including women, to at least national minimum standards. In rural areas provide them with legal and affordable access to land and resources, and in urban areas provide them with appropriate income sources and legal and affordable access to adequate housing; d) pay compensation and provide other resettlement entitlements before physical or economic displacement; and e) monitor and assess resettlement outcomes, their impacts on the standards of living of displaced persons, and whether the objectives of the resettlement plan have been achieved by taking into account the baseline conditions and the results of resettlement monitoring. Disclose monitoring reports.
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The development objective of the Health Sector Reform : Improving Health System Quality and Efficiency Project for Romania is to improve access to, and quality and efficiency of public health services in Romania.
... See More + The project focuses on four components. The first component, hospital network rationalization will support the rationalization of the health care service delivery network by strengthening key hospitals that will become the backbone of the hospital networks. The second component, ambulatory care strengthening will support secondary ambulatory and primary care through following two sub-components: (i) implementing specialized secondary ambulatory care which aims at creating the conditions to increase secondary specialized services (higher volume-lower cost-greater quality) and reduce the admissions rate in hospitals for patients who can be treated in outpatient settings; and (ii) enhancing primary health care services at the community level which will support the scaling up of multifunctional health centers and the implementation of different types of long-term care currently being provided as regular hospital services. The third component aims to support health sector governance and stewardship improvements to bridge the gap between policy and practice and to increase the capacity for conducting and improving the quality of medical care services. The fourth component aims to support the project management unit (PMU) to provide day-today project management, including the fiduciary tasks of the project and monitoring, evaluation, and reporting through the provision of goods, non-consulting services, consultant services, training, auditing, and incremental operating costs.
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The spread of tuberculosis (TB) by migrant mineworkers in South Africa is a serious public health problem. The key messages in this brief include: 1) at 2,500-3,000 cases for every 100,000 people, TB incidence among mineworkers in South Africa is the highest among any working population in the world; 2) the World Bank is working with national health ministries, the Stop TB Partnership, mining companies, mineworkers and exmineworkers' associations and other partners to help resolve the 100-year-old problem of TB among mineworkers; 3) mineworkers are more susceptible to TB because many live with HIV and/or develop silicosis; 4) preliminary findings from a study commissioned by the World Bank on the economics of TB prevention and control in these four countries suggest that the cost of testing and treating all mineworkers is significant (about R330 million or US $33 million a year), but would result in considerable long-term benefits, as productivity increases and fewer people require treatment; and 5) the study will recommend a three-pronged approach to reduce TB among mineworkers: a) test and treat all gold mineworkers for TB over two years, followed by all mineworkers, b) set up a cross-border tracking and referral system to reach all former mineworkers, c) improve working/living conditions to reduce the risk of occupational lung disease.
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This paper formalizes the design of experiments intended specifically to study spillover effects. By first randomizing the intensity of treatment within clusters and then randomly assigning individual treatment conditional on this cluster-level intensity, a novel set of treatment effects can be identified.
... See More + The paper develops a formal framework for consistent estimation of these effects, provides explicit expressions for power calculations, and shows that the power to detect average treatment effects declines precisely with the quantity that identifies the novel treatment effects. A demonstration of the technique is provided using a cash transfer program in Malawi.
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Policy Research Working Paper WPS6824 MAR 01, 2014
Baird, Sarah; Bohren, Aislinn; McIntosh, Craig; Ozler, Berk
An extensive multi-disciplinary literature examines the effects of learning one's HIV status on subsequent risky sexual behaviors. However, many of these studies rely on non-experimental designs; use self-reported outcome measures, or both.
... See More + This study investigates the effects of a randomly assigned home based HIV testing and counseling (HTC) intervention on risky sexual behaviors and schooling investments among school-age females in Malawi. The study finds no overall effects on HIV, Herpes Simplex Virus (HSV-2), or achievement test scores at follow-up. However, among the small group of individuals who tested positive for HIV, a large increase in the probability of contracting HSV-2 is found, with this effect stronger among those surprised by their test results. Similarly, those surprised by HIV-negative test results see a significant improvement in achievement test scores, consistent with increased returns to investments in human capital. The finding of increased HSV-2 prevalence among HIV-positive individuals suggests that the conventional wisdom that those who learn they are HIV-positive will adopt safer sexual practices should be treated with caution.
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Policy Research Working Paper WPS6823 MAR 01, 2014
Baird, Sarah; Gong, Erick; McIntosh, Craig; Ozler, Berk
For young adults living in countries with AIDS epidemics, getting an HIV test may influence near-term decisions, such as when to leave school, when to marry, and when to have a first child.
... See More + These behaviors, which define the transition from adolescence to adulthood, have long-term implications on well-being and directly affect a person's risk of contracting HIV. Using an experimental design embedded in a panel survey from Malawi, this study assesses the impact of voluntary counseling and testing of young adults for HIV on these decisions. The results show negligible intent-to-treat effect of HIV testing on behaviors. There is some suggestive evidence on differential response by wealth and by prior beliefs about one's status.
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Policy Research Working Paper WPS6825 MAR 01, 2014
This toolkit addresses the questions what and why, while focusing on the answer to how it can be done. The toolkit is pervaded by answers to the first question, while explaining the "how to": the process, the planning, the design, and the implementation of performance-based financing (PBF) schemes.
... See More + Even though the toolkit provides guidance based on experience, the experience itself is based on trial and error and constant testing, assessing, and reassessing. And this approach is why the toolkit is not meant as a final product. It attempts to capture the current state of affairs and best practices, while attempting to stay abreast by updating the methods, experiences, and tools used. This toolkit is conceived as an organized and structured collection of tools and documents to implement PBF approaches in low- and lower- middle- income countries. By using this toolkit, countries will be able to implement PBF approaches and to move rapidly in designing and implementing their schemes. This report is organized as follows: part one (chapters 1-8) deals with facility- level design issues. Part two (chapters 9-16) gives attention to design structures and issues relevant for implementation. Part three (chapter 17) addresses the current evidence on PBF schemes and contrasts the approaches in lower- and middle- income countries and organization for economic co- operation and development (OECD) countries.
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This paper investigates the effects of intermittent screening and treatment of malaria on the health and education of school children in an area of low-to-moderate malaria transmission.
... See More + A cluster randomized trial was implemented with 5,233 children in 101 government primary schools on the south coast of Kenya in 2010-12. The intervention was delivered to children randomly selected from classes 1 and 5 who were followed up twice across 24 months. Once during each school term, public health workers used malaria rapid diagnostic tests to screen the children. Children who tested positive were treated with a six-dose regimen of artemether-lumefantrine. Given the nature of the intervention, the trial was not blinded. The primary outcomes were anemia and sustained attention and the secondary outcomes were malaria parasitaemia and educational achievement. The data were analyzed on an intention-to-treat basis. Anemia in this setting in Kenya, intermittent screening and treatment, as implemented in this study, is not effective in improving the health or education of school children. Possible reasons for the absence of an impact are the marked geographical heterogeneity in transmission, the rapid rate of reinfection following artemether-lumefantrine treatment, the variable reliability of malaria rapid diagnostic tests, and the relative contribution of malaria to the etiology of anemia in this setting.
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Policy Research Working Paper WPS6791 FEB 01, 2014
Halliday, Katherine E.; Okello, George; Turner, Elizabeth L.; Njagi, Kiambo; Mcharo, Carlos; Kengo, Juddy; Allen, Elizabeth; Dubeck, Margaret M.; Jukes, Matthew C.H.; Brooker, Simon J.
In Lao People's Democratic Republic (PDR), 11 percent of deaths of children under 5 are due to diarrhea. Undernourished children have an increased risk of falling sick and greater severity of disease.
... See More + Undernourished children who fall sick are much more likely to die from illness than well-nourished children. Parasitic infestation diverts nutrients from the body and can cause blood loss and anemia. During the important transition period to a mix of mix of breast milk and solid food between six and nine months of age, nearly half (48 percent) of infants are not fed appropriately with both breast milk and other foods. The World Bank is supporting both nutrition sensitive and nutrition-specific interventions involving multiple sectors. At the policy-level, the World Bank recently collaborated with Food and Agriculture Organization (FAO) on the rice policy study (2012) and is financing a knowledge exchange activity between Lao PDR and Indonesia to facilitate high-level interactions among policymakers to improve the effectiveness of and to scale-up nutrition interventions.
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