A decomposition analysis of inequalities in Low birth weight in Sri Lanka: findings from the Demographic and Health survey- 2016.

Birth weight is a crucial indicator of mothers and infants nutritional status. It determines a newborn's likelihood of survival, their growth and their psychological development. This study examines the socio-economic inequalities of low birth weight in Sri Lanka using the first island-wide Demographic and Health Survey (DHS) conducted in 2016. Nearly 17% of babies are reported as low birth weight (LBW) and the prevalence has stagnated for nearly two decades in Sri Lanka. LBW is indicative of inequalities in particular population subgroups. There is a lack of research on LBW inequalities and the contribution of different socio-economic determinants to these inequalities in Sri Lanka. A stepwise multivariate linear regression, health inequality measures and decomposition method are used to examine inequalities in LBW. Maternal body mass index (BMI), height, antenatal visits, birth interval, wealth and ethnicity are significantly associated with mean birth weight. Findings reveal that inequalities exist, where LBW is concentrated among the poorest households. The decomposition results highlight maternal BMI, education and ethnicity as major contributing factors for such inequalities. These findings suggest prioritising the nutritional needs of mothers and relevant interventions to address inequalities in birth weight to reduce the stagnated LBW in Sri Lanka.

Improving Health Care Coverage, Equity, And Financial Protection Through A Hybrid System: Malaysia's Experience.

Malaysia has made substantial progress in providing access to health care for its citizens and has been more successful than many other countries that are better known as models of universal health coverage. Malaysia's health care coverage and outcomes are now approaching levels achieved by member nations of the Organization for Economic Cooperation and Development. Malaysia's results are achieved through a mix of public services (funded by general revenues) and parallel private services (predominantly financed by out-of-pocket spending). We examined the distributional aspects of health financing and delivery and assessed financial protection in Malaysia's hybrid system. We found that this system has been effective for many decades in equalizing health care use and providing protection from financial risk, despite modest government spending. Our results also indicate that a high out-of-pocket share of total financing is not a consistent proxy for financial protection; greater attention is needed to the absolute level of out-of-pocket spending. Malaysia's hybrid health system presents continuing unresolved policy challenges, but the country's experience nonetheless provides lessons for other emerging economies that want to expand access to health care despite limited fiscal resources.

The quality of outpatient primary care in public and private sectors in Sri Lanka--how well do patient perceptions match reality and what are the implications?

OBJECTIVE: To compare the quality of clinical care and patient satisfaction in public and private outpatient primary care services in Sri Lanka. METHODS: A prospective, cross-sectional comparison was done by direct observation of patient encounters and exit interviews of outpatients in 10 public hospital general outpatient clinics and 66 private practitioner clinics in three districts of Sri Lanka. A total of 1027 public sector patients and 944 private sector patients were surveyed. Data were collected for 39 quality indicators covering diarrhoea, cough, hypertension, diabetes, asthma, upper respiratory tract infections (URTI) and five other conditions, along with prescribing indicators. The exit interviews collected data for 10 patient satisfaction indicators. RESULTS: The public sector performed better for some conditions (diarrhoea, cough and asthma) and the private sector performed better for others (hypertension, diabetes, URTI and tonsillitis). Overall quality was similar between the sectors in the domains of history taking, examination and investigations and management, but the private sector performed much better on patient education (57 vs 12%). Overall patient satisfaction was high in both sectors (98%), although the private sector performed much better in interpersonal satisfaction (94 vs 84%) and system-related indicators (95 vs 84%). Comparisons with studies from other countries suggest that both sectors perform considerably better than India, and similarly in many indicators to high-income countries. CONCLUSIONS: Quality of outpatient primary care in Sri Lanka is generally high for a lower-middle income developing country. The public and private sectors perform similarly, except that private sector patients have longer consultations, are more likely to receive education and advice, and obtain better interpersonal satisfaction. The public system, with its limited funding, is able to deliver care in diagnosis and management that is similar to the private sector, while private sector patients, who spend more on their healthcare receive better quality care in non-clinical areas.