Policy analysis of iron micronutrient programs at USAID: The FANTA program in East Africa and the micronutrient initiative in Bihar region of India, using comparative cost effective and cost benefit analysis

It is the aim of this paper to examine iron supplementation programs which receive funding from United States Agency for International Development (USAID) but approach combating iron deficiency anemia in two vastly different ways. A brief literature review and background information on iron deficiencies and the differences between supplementation programs and micronutrient fortification were reviewed. Two non-governmental organizations (NGO's) were examined for this paper: the Food and Nutrition Technical Assistance II (FANTA) and the MicroNutrient Initiative. The FANTA program included an educational component to their supplementation program while the MicroNutrient Initiative solely used supplementation of micronutrients to their population. Methods used were cost-benefit analysis and cost-effectiveness analysis to determine the overall effectiveness of each program in reducing iron deficiency anemia in each population, if the added costs of the incentives in the FANTA program changed the cost-effectiveness of the program compared to the MicroNutrient Initiative program and to determine which program imparted the greatest benefit to each population by reducing the disease burden in Disability Adjusted Life Years (DALY). Results showed that the unit cost of the FANTA program per person was higher than the MicroNutrient Initiative program due to the educational component. The FANTA program reduced iron deficiency anemia less overall but cost less for each percentage point of anemia decreased in their respective populations. The MicroNutrient Initiative program had a better benefit cost ratio for the populations it served. The MicroNutrient Initiative's large scale program imparted many advantages by reducing unit cost per person and decreasing iron deficiency anemia. The FANTA program was more effective at decreasing iron deficiency anemia with less money: $5,660 per 1% decrease in iron deficiency anemia versus $18,450 per 1% decrease in iron deficiency anemia for the MicroNutrient Initiative program. ^ In conclusion, economic analysis cannot measure all of the benefits associated with programs that contain an educational component or large scale supplementation. More information needs to be gathered by NGOs and reported to USAID, such as detailed prevalence rates of iron deficiency anemia among the populations served. Further research is needed to determine the effects an educational supplementation program has on compliance rates of participants and motivation to participate in supplementation programs whose aim is to decrease iron deficiency anemia in a targeted population.^

Understanding mental illness in Nigeria: Bringing culture and traditional medicine into mental health policy

One of the major challenges in treating mental illness in Nigeria is that the health care facilities and mental health care professionals are not enough in number or well equipped to handle the burden of mental illness. There are several barriers to treatment for individual Nigerians which include the following: such as the lack of understanding of the root causes of mental illness, lack of financial support to get mental treatment, lack of social support (family, friends, neighbors), the fear of stigmatization concerning being labeled as mentally ill or being in association with the mentally ill, and the consultation of traditional native healers who may be unknowingly prolonging illness, rather than addressing and treating them due to lack of formal education and standardization of their treatments. Another barrier is the non-health nature of the mental health services in Nigeria. Traditional healers are essentially the mental health system. The elderly, women, and children are the most vulnerable groups in times of strife and hardships. Their mental well-being must be taken into account as well as their special needs in times of personal or societal crisis. ^ Nigerian mental health policy is geared toward forming a mental health system, but in actuality only a mental illness care system is the observed result of the policy. The government of Nigeria has drafted a mental health policy, yet its actual implementation into the Nigerian health infrastructure and society waits to be materialized. The limited health legislation or policy implementations tend to favor those who have access to these urban areas and the facilities' health services. Nigerians living in rural areas are at a disadvantage; many of them may not even be aware of services available to help them understand and treat mental illness. Perhaps, government driven health interventions geared toward mental illness in rural areas would reach an underserved Nigerians and Africans in general. Issues with political instability and limited infrastructure often hinder crucial financial resources and legislation from reaching the people that are truly in need of governmental leadership in regards to mental health policy.^ Traditional healers are a severely untapped resource in the treatment of mental illness within the Nigerian population. They are abundant within Nigerian communities and are meeting a real need for the mentally ill. However, much can be done to remove the barriers that prevent the integration of traditional healers within the mental health system and improve the quality of care they administer within the population. Mental illness is almost exclusively coped with through traditional medicine practices. Mobilization and education from each strata of Nigerian society and government as well as input from the medical community can improve how traditional medicine is utilized as a treatment for clinical illness and help alleviate the heavy burden of mental illness in Nigeria. Currently, there is no existing policy making structure for a working mental health system in Nigeria, and traditional healers are not taken into account in any formulation of mental health policy. Advocacy for mental illness is severely inadequate due to fear of stigmatization, with no formally recognized national of regional mental health association.^

A comparative state policy analysis of the adoption of birth defects surveillance legislation

Birth defects are the leading cause of infant mortality in the United States and are a major cause of lifetime disability. However, efforts to understand their causes have been hampered by a lack of population-specific data. During 1990–2004, 22 state legislatures responded to this need by proposing birth defects surveillance legislation (BDSL). The contrast between these states and those that did not pass BDSL provides an opportunity to better understand conditions associated with US public health policy diffusion. ^ This study identifies key state-specific determinants that predict: (1) the introduction of birth defects surveillance legislation (BDSL) onto states' formal legislative agenda, and (2) the successful adoption of these laws. Secondary aims were to interpret these findings in a theoretically sound framework and to incorporate evidence from three analytical approaches. ^ The study begins with a comparative case study of Texas and Oregon (states with divergent BDSL outcomes), including a review of historical documentation and content analysis of key informant interviews. After selecting and operationalizing explanatory variables suggested by the case study, Qualitative Comparative Analysis (QCA) was applied to publically available data to describe important patterns of variation among 37 states. Results from logistic regression were compared to determine whether the two methods produced consistent findings. ^ Themes emerging from the comparative case study included differing budgetary conditions and the significance of relationships within policy issue networks. However, the QCA and statistical analysis pointed to the importance of political parties and contrasting societal contexts. Notably, state policies that allow greater access to citizen-driven ballot initiatives were consistently associated with lower likelihood of introducing BDSL. ^ Methodologically, these results indicate that a case study approach, while important for eliciting valuable context-specific detail, may fail to detect the influence of overarching, systemic variables, such as party competition. However, QCA and statistical analyses were limited by a lack of existing data to operationalize policy issue networks, and thus may have downplayed the impact of personal interactions. ^ This study contributes to the field of health policy studies in three ways. First, it emphasizes the importance of collegial and consistent relationships among policy issue network members. Second, it calls attention to political party systems in predicting policy outcomes. Finally, a novel approach to interpreting state data in a theoretically significant manner (QCA) has been demonstrated.^

Policy analysis of shifting to the state-run Texas women's health program

During the 82nd Texas legislature, state leaders passed a provision stating that healthcare providers, who perform, promote, or affiliate with providers who perform or promote elective abortion services may not be eligible to participate in the Texas Medicaid Women's Health Program (WHP). The federal government reacted to this new provision by vowing to eliminate its 90% share of program support on the grounds that the provision violated a patient's freedom to choose a provider; a right protected by the Social Security Act. Texas leaders stated that the Women's Health Program would continue without federal support, financed exclusively with state funds.^ The following policy analysis compares the projected impact of the current Medicaid Women's Health Program to the proposed state-run program using the criteria-alternative matrix framework. The criteria used to evaluate the program alternatives include population affected, unintended pregnancy and abortion impact, impact on cervical cancer rate, and state-level government expenditures. Each criterion was defined by selected measures. The population affected was measured by the number of women served in the programs. Government expenditures were measured in terms of payments for program costs, Medicaid delivery costs, and cervical cancer diagnostic costs. Unintended pregnancy impact was measured by the number of projected unplanned pregnancies and abortions under each alternative. The impact on cervical cancer was projected in terms of the number of new cervical cancer cases under each alternative. Differences in the projections with respect to each criterion were compared to assess the impact of shifting to the state-only policy.^ After examining program alternatives, it is highly recommended that Texas retain the Medicaid WHP. If the state does decide to move forward with the state-run WHP, it is recommended that the program run at its previous capacity. Furthermore, for the purpose of addressing the relatively high cervical cancer incidence rate in Texas, incorporating HPV vaccination coverage for women ages 18-26 as part of the Women's Health Program is recommended.^

Integrated economic-hydrologic analysis of policy responses

Water is a vital resource, but also a critical limiting factor for economic and social development in many parts of the world. The recent rapid growth in human population and water use for social and economic development is increasing the pressure on water resources and the environment, as well as leading to growing conflicts among competing water use sectors (agriculture, urban, tourism, industry) and regions (Gleick et al., 2009; World Bank, 2006). In Spain, as in many other arid and semi-arid regions affected by drought and wide climate variability, irrigated agriculture is responsible for most consumptive water use and plays an important role in sustaining rural livelihoods (Varela-Ortega, 2007). Historically, the evolution of irrigation has been based on publicly-funded irrigation development plans that promoted economic growth and improved the socio-economic conditions of rural farmers in agrarian Spain, but increased environmental damage and led to excessive and inefficient exploitation of water resources (Garrido and Llamas, 2010; Varela-Ortega et al., 2010). Currently, water policies in Spain focus on rehabilitating and improving the efficiency of irrigation systems, and are moving from technocratic towards integrated water management strategies driven by the European Union (EU) Water Framework Directive (WFD).

An Analysis of National Park Service Policy Regarding Management of White-Tailed Deer at Mammoth Cave National Park, Kentucky

The population of white-tailed deer (Odocoileus virginianus) occupying Mammoth Cave National Park, Kentucky is unknown. The population is uncontrolled, unmanaged, and suspected to be high. When uncontrolled, white-tailed deer tend to overpopulate and inflict negative impacts to vegetation through increased herbivory. The goal of this project is to demonstrate that the status of white-tailed deer at Mammoth Cave merits a policy formulation, and to provide suggestions as to what such a policy should contain. Three similar national parks have previously developed policies to manage white-tailed deer. These policies are analyzed, and common elements are identified that can transpose into a comparable policy at Mammoth Cave. Recommendations for a white-tailed deer management policy at Mammoth Cave National Park are given.

Changes in Access to Health Services of the Immigrant and Native-Born Population in Spain in the Context of Economic Crisis

Aim: To analyze changes in access to health care and its determinants in the immigrant and native-born populations in Spain, before and during the economic crisis. Methods: Comparative analysis of two iterations of the Spanish National Health Survey (2006 and 2012). Outcome variables were: unmet need and use of different healthcare levels; explanatory variables: need, predisposing and enabling factors. Multivariate models were performed (1) to compare outcome variables in each group between years, (2) to compare outcome variables between both groups within each year, and (3) to determine the factors associated with health service use for each group and year. Results: unmet healthcare needs decreased in 2012 compared to 2006; the use of health services remained constant, with some changes worth highlighting, such as the decline in general practitioner visits among autochthons and a narrowed gap in specialist visits between the two populations. The factors associated with health service use in 2006 remained constant in 2012. Conclusion: Access to healthcare did not worsen, possibly due to the fact that, until 2012, the national health system may have cushioned the deterioration of social determinants as a consequence of the financial crisis. Further studies are necessary to evaluate the effects of health policy responses to the crisis after 2012.

The Opportunity Costs of STEM Degrees and the Unmet Needs of the Low-Skilled: Two labour market problems explained. CEPS Policy Brief No. 295, 26 June 2013

There is general consensus that to achieve employment growth, especially for vulnerable groups, it is not sufficient to simply kick-start economic growth: skills among both the high- and low-skilled population need to be improved. In particular, we argue that if the lack of graduates in science, technology, engineering and mathematics (STEM) is a true problem, it needs to be tackled via incentives and not simply via public campaigns: students are not enrolling in ‘hard-science’ subjects because the opportunity cost is very high. As far as the low-skilled population is concerned, we encourage EU and national policy-makers to invest in a more comprehensive view of this phenomenon. The ‘low-skilled’ label can hide a number of different scenarios: labour market detachment, migration, and obsolete skills that are the result of macroeconomic structural changes. For this reason lifelong learning is necessary to keep up with new technology and to shield workers from the risk of skills obsolescence and detachment from the labour market.

The global race for talent: Europe's migration challenge. Bruegel Policy Brief 2014/02, March 2014

In an ageing world with demographic and economic imbalances, the number of international migrants is likely to rise during the twenty-first century. The geography of migration flows is changing, however. Mobile people will be increasingly attracted by faster-growing economies. Therefore, some traditional destinations in western Europe will face stronger competition for skilled labour-not least from countries like China where the working-age population will shrink after 2020. At the same time, the sentiment in many European receiving societies is turning against migration and intra-European Union mobility.

Helping Moldova stay on the EU course. Proposals for a real 'more for more' approach. EPC Policy Brief, 11 December 2013

At the Vilnius Eastern Partnership (EaP) Summit in November, Moldova initialled its Association Agreement including a Deep and Comprehensive Free Trade Area (DCFTA) with the EU and became the first EaP country to meet all the requirements of their Visa Liberalisation Action Plan. 2014 may prove to be a make or break year for Moldova, with Chisinau facing a number of serious challenges. From the EU’s point of view, it could also prove to be a make or break year for the Eastern Partnership. The period following Vilnius should be a soul-searching time for the EU. Of the three pillars (AA, DCFTA, visa regime) of the Eastern Partnership, two are now being openly challenged by Russia. While the EU should not engage in a populist competition with Russia, it does need to adapt its actions to the realities on the ground. In this Policy Brief, Cristian Ghinea, Amanda Paul and Victor Chirila argue that the EU should work for greater visibility, better public diplomacy and deliver visible, tangible benefits to the Moldovan population as rapidly as possible. Not only will this help counter Russian activities, but it will also help shore up support for pro-EU reformers in the country.

Is Independence Possible in an Interdependent World? Scotland vs. the UK's Participation in the European Economy. Bruges European Economic Policy (BEEP) Briefing 30/2013

Many commentators have criticised the strategy used to finance regional governments such as the Scottish Parliament – both the block grant system and the limited amount of fiscal autonomy devised in the Scotland Act of 2012. This lecture sets out to identify what level of autonomy or independence would best suit a regional economy in a currency union, and also the institutional changes needed to sustain those arrangements. Our argument is developed along three lines. First, we set out the advantages of a fiscal federalism framework and the institutions needed to support it, but which the Euro-zone currently lacks. The second is to elaborate a model of fiscal federalism where comprehensive powers of taxation and spending are devolved (an independent Scotland and the UK remain constituent members of the EU and European economy). Third, we evaluate the main arguments for the breakup of nations or economic unions with Scotland and the UK as leading examples. We note that greater autonomy may not result in increases in long run economic growth rate, but it does imply that enhancing the fiscal competence and responsibility of regional governments would result in productivity gains and hence higher levels of GDP per head. That means the population is permanently richer than before, even if ultimately their incomes continue to grow at the same rate. It turns out that these improvements can be achieved through devolved tax powers, but not through devolved spending powers or shared taxes.

Perspectives in Resource Management and Climate Change Adaptation in the Southern and Eastern Mediterranean. MEDPRO Policy Paper No. 6, March 2013

This policy paper focuses on the sustainable management of some key natural resources in southern and eastern Mediterranean countries (SEMCs) under climate change and anthropogenic pressures. In a business-as-usual and even more so in a failed cooperation scenario, water resources, ecosystems and biodiversity in the region are under stress, with negative consequences for agriculture, food security, tourism and development. However, proper adaptation strategies are shown to be effective in reconciling resource conservation with GDP, trade and population growth. These need be implemented in different ways: technological, institutional, behavioural; and at different levels: regional, national and international. There is ample room for fruitful cooperation between the EU and SEMCs in this area, which can take the form of EU direct financial and technical support when resources in SEMCs are scarce, and of multilateral and bilateral cooperation programmes to improve resource efficiency. The EU could also take on the role of coordinating these different bilateral actions and, at the same time, support SEMCs to establish a structured programme focused on the communication and dissemination of emerging best practices.

Population Scenarios for South Mediterranean Countries 2010-2050. MEDPRO Report No. 2, August 2012

The European Neighbourhood Policy (ENP) and its follow-up, the Union for the Mediterranean (UfM), were created in 2004 and 2008 to strengthen the prosperity, stability and security of all countries and avoid the emergence of new dividing lines between the EU and 16 neighbouring countries, including south Mediterranean countries (SMCs). Demographic factors in both EU and neighbouring countries will influence this goal. This report describes four population growth scenarios for SMCs, obtained using the MEDPRO economic-political development framework on how indicators of fertility, mortality and international migration might change if people in SMCs were to live in different macroeconomic and political contexts. Qualitative scenarios were then operationalized leading to four different quantitative scenarios using assumptions about possible trends in indicators of fertility, mortality and international migration. The paper concludes by reflecting on the results in light of recent political developments in the region.

The Racial Equality Directive – from law to practice. IES Policy Brief Issue 2013/07/September 2013

The transposition of the Racial Equality Directive (2000/43/EC) has immensely enhanced legal protection against discrimination on the grounds of racial and ethnic origin throughout the EU. More than 10 years after its adoption, the main challenge identified in many Member States is the enforcement of anti-discrimination laws in practice, in particular with regard to access to justice. Ultimately it is up to the domestic courts to ensure effective implementation of anti-discrimination law. Polls regularly show that the discrepancy between the levels of discrimination experienced and discrimination reported by victims must be seriously addressed. Awareness is low not only among the public but also among the members of the legal professions, leading to under-reporting of discrimination cases. In addition, data that reflect the ethnic or racial composition of the population are scarce which makes it difficult to prove discrimination before the competent authorities. Moreover, certain procedural difficulties that affect access to justice and effective enforcement also stem from the short limitation periods foreseen in legislation, lengthy procedures, evidence, high costs and failures in the provision of legal aid, ineffective sanctions, as well as barriers in the form of language and issues relating to legal standing or legitimate interest. The law remains complex and remedies often inadequate.

Still together, but apart? Kyiv’s policy towards the Donbas. OSW Commentary No. 160, February 6 2015

From the Introduction. The peace deal agreed on 5 September 2014 concerning the ceasefire in the region covered by the conflict in the Donbas brought about a significant reduction in the scale of military clashes. However, in mid-January the separatist forces, supported by the Russian military, started an offensive along the entire front line. For example, they seized the airport in Donetsk and the village of Krasnyi Partyzan. About a third of the Donetsk and the Lugansk oblasts currently remain outside Kyiv’s control (see Map). Before the war, these areas were inhabited by 6.6 million residents, 15% of Ukraine’s total population. The process launched in September 2014 in Minsk, which was intended to regulate the conflict within the so-called trilateral contact group (Ukraine, Russia, the OSCE and representatives of the separatists), resulted in an exchange of some prisoners of war, although it failed to have any political effects. Attempts at regulating the political situation were additionally complicated by the illegal ‘elections’ of leaders of the two separatist regions, the so-called Donetsk and Lugansk People’s Republics (the DPR and LPR).