Suman Chakrabarti, Md Tajuddin Khan and Samuel Scott
Respiratory infections are the most common
chronic disease in children globally and a leading cause of death in developing
countries. This situation is exacerbated by air pollution.
Air pollution in northern India, mainly New Delhi and the neighbouring states, is exacting a toll on the health of residents, making global headlines and highlighting the severity and extent of this public health disaster in one of the world’s fastest-growing economies.
A contributory factor to air pollution in northern India is the harmful practice of crop residue burning — when farmers burn the crop residue to clear fields before sowing a new crop. Although banned by the Indian government in 2015, this practice remains prevalent in many parts of the northern Indian states of Punjab, Haryana and Uttar Pradesh.
From 2010 to 2012 a P4P programme in Afghanistan provided quarterly bonus payments to health-care providers for increases in the use of maternal and child health (MCH) services, adjusted by a quality of care score. Our study, a large-scale cluster randomized trial, demonstrates that the programme did not produce the intended results. There were no observable improvements in any of the five key MCH coverage indicators measuring contraceptive prevalence, skilled birth attendances, vaccinations, and antenatal and postnatal check-ups. No changes were observed in the equity of care. While the programme appeared to increase time spent with patients, resulting in more complete histories and physical examinations, and improved patient counselling, other measures of quality, such as availability of medicines and supplies, did not substantially change. Continue reading “Lessons from the recent trial of a pay-for-performance programme in Afghanistan”→