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Title: A capability approach to understanding the efficient conversion of health resources into health outcomes : piloting a mixed-methods methodology in northern Vietnam
Author: Radin, Elizabeth
Awarding Body: University of Oxford
Current Institution: University of Oxford
Date of Award: 2013
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Achieving efficiency, or maximizing the outputs achieved per unit of resource invested, is of great interest to governments, donors and other stakeholders in the health sector. Many studies consider efficiency in public health using Cost Effectiveness Analyses which estimate the health outcomes achieved per unit of cost. Others employ Technical Efficiency Analysis to understand which health system units, usually hospitals, provide the most health services per unit of resource. However, very little is known about demand-side efficiency or how efficiently individuals convert available health resources into health outcomes. To address this gap, I developed and piloted a two-stage methodology using Amartya Sen's Capability Approach as a theoretical framework mapping the process by which individuals convert resources into outcomes. The first stage estimates conversion efficiency using Order-m Efficiency Analysis then identifies the social groups most likely to be efficient using regression analysis. The second stage undertakes focus group discussions and semi-structured interviews to investigate how and why the social groups identified in the quantitative stage were more likely to be efficient. I conducted my analysis in Ba Vi district, northern Vietnam looking specifically at how efficiently pregnant women converted maternal health resources—including health facilities and human resources for health—into both appropriate care and healthy pregnancy and delivery. I found that ethnic minorities and women in non-mountainous areas were more likely to be efficient at achieving appropriate care while ethnic minorities and less educated women are more likely to be efficient at achieving healthy pregnancy and delivery outcomes. Through qualitative feedback, women who were ethnic majorities, better educated and generally more affluent expressed stronger technology preference, greater use of the private sector, less continuity of care, tendencies towards overnutrition, less focus on mental and emotional health and more varied sources of health information including advertising and the internet. Evidence links each of these themes to adverse care and/or health outcomes. Consequently, the more affluent populations, who also have a greater endowment of public health resources, may be less likely to achieve good outcomes—explaining at least in part why they are found to be less efficient. My findings highlight that the development process and attendant epidemiological and nutrition transitions give rise to a new set of challenges not solely for public health, but also for the efficiency with which it is achieved using existing health system resources.
Supervisor: Ariana, Proochista Sponsor: John Fell Fund
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: Health and health policy ; Asia ; Human development ; Public Health ; Maternal and Child Health ; Demand-side ; Efficiency ; Capability Approach ; Mixed Methods ; Technical Efficiency Analysis ; Qualitative Research ; Health Transitions ; Vietnam