Measuring the harm of sugar sweetened beverages and internalities associated with it.

Introduction: Obesity, which is partly driven by the consumption of sugar-sweetened beverages (SSBs), significantly increases the risk of type-2 diabetes and cardiovascular diseases, leading to substantial health and economic burdens. Methods: This study aims to quantify the monetary value of health harms caused by SSB consumption, along with the associated internalities, through a contingent valuation survey. The results are crucial for determining the socially optimal tax rate. Results: We surveyed 293 residents of Wellington, New Zealand, to assess their willingness to pay (WTP) for reductions in the risks of diabetes, stroke, and heart disease associated with SSB intake. Logistic regression analysis revealed the marginal WTP for a 1% risk reduction in diabetes, stroke, and heart disease to be NZ$404.86, NZ$809.04, and NZ$1,236.84, respectively. Based on these values, we estimate the marginal harm from SSB consumption to be approximately NZ$17.37 per liter in New Zealand, with internalities amounting to NZ$6.43 per liter, suggesting an optimal tax rate of NZ$6.49 per liter. Discussion: Implementing such a tax is feasible and would likely double or triple the price of SSBs in New Zealand.

The economic impact of visceral leishmaniasis on rural households in one endemic district of Bihar, India.

OBJECTIVE: To estimate the economic burden of visceral leishmaniasis (VL) on the rural population of one VL endemic district of Bihar, the state with 85% of India's cases. METHODS: Using a survey of a stratified multistage sampling of 15 178 households with 214 individuals with VL in the previous 12 months, the study provides data on VL treatment expenditures, financing and days of work lost in the context of overall household expenditures, income sources and assets. RESULTS: Median household expenditures on VL treatment represent, on average, 11% of annual household expenditures and an estimated 7 months of an individual's income at the daily wage in rural Bihar. With 87% of households forced to take out loans to finance disease costs, VL can contribute to a spiral of increasing poverty. The current pattern of VL treatment, with multiple visits and treatments for a single episode of illness, significantly increases the economic burden on the household. CONCLUSION: India's National Elimination Program to make effective treatments accessible to the rural poor, if combined with expanded efforts to improve timely access to diagnosis by conducting rapid diagnostic tests closer to the community (and mobilizing the rural population to seek effective treatment earlier), can reduce VL's economic burden on India's rural households.

Effects of results-based financing of maternal and child health services on patient satisfaction in Afghanistan.

OBJECTIVE: To examine the impact of a results-based financing programme on patient satisfaction in Afghanistan. METHODS: We analysed data collected from over 3000 patients from a stratified sample of 112 health facilities (56 results-based financing and 56 non-results-based financing) in 11 out of the 34 provinces of Afghanistan over a three-year period. The 112 facilities were part of 442 primary care facilities that were stratified on facility type and randomly assigned to the results-based financing (intervention) and non-results-based financing (control) groups in the 11 provinces. Data were obtained from the National Health Service Performance Assessment, a baseline survey of patients conducted in 2010, and two follow-up surveys in 2011 and 2012. Measurement of patient satisfaction used a questionnaire comprising 11 questions concerning overall satisfaction, and satisfaction with specific aspects of care, from provider behaviour (e.g. respectfulness, communication) to cleanliness, opening hours and waiting times of facilities. We used a regression adjusted difference-in-differences estimator to investigate the treatment effect on patient satisfaction at facility level. RESULTS: There were some improvements in patient satisfaction in results-based financing facilities but these were not statistically significant. In 2011, 2 out of 11 aspects of satisfaction showed 5% improvement: satisfaction with the way health care providers explained the patient's condition and treatment. In 2012, patient satisfaction was higher for almost all aspects of care in results-based financing facilities, including the two aspects on health care provider respectfulness and facility opening hours, which had been 5% lower in results-based financing facilities than in non-results-based financing facilities in 2011. Overall satisfaction was almost 10% higher in results-based financing facilities than in non-results-based financing facilities in 2012. CONCLUSION: Even if not statistically significant, observed trends suggest some positive impacts of the results-based financing programme on patient satisfaction.

Microcredit, family planning programs, and contraceptive behavior: evidence from a field experiment in Ethiopia.

The impact of community-based family planning programs and access to credit on contraceptive use, fertility, and family size preferences has not been established conclusively in the literature. We provide additional evidence on the possible effect of such programs by describing the results of a randomized field experiment whose main purpose was to increase the use of contraceptive methods in rural areas of Ethiopia. In the experiment, administrative areas were randomly allocated to one of three intervention groups or to a fourth control group. In the first intervention group, both credit and family planning services were provided and the credit officers also provided information on family planning. Only credit or family planning services, but not both, were provided in the other two intervention groups, while areas in the control group received neither type of service. Using pre- and post-intervention surveys, we find that neither type of program, combined or in isolation, led to an increase in contraceptive use that is significantly greater than that observed in the control group. We conjecture that the lack of impact has much to do with the mismatch between women's preferred contraceptive method (injectibles) and the contraceptives provided by community-based agents (pills and condoms).