Research theme 1: protecting the poor against the impact of health-related shocks

Theme 1 seeks to understand how different types of health-related shocks affect households in terms of access to health services and impact on livelihoods, and how alternative institutional arrangements and financing mechanisms perform in helping the poor to cope with these shocks.

In Afghanistan, where maternal health care indicators are among the worst in the world, the research will assess the individual, household and community factors influencing the utilization of skilled care for routine maternal health needs and obstetric emergencies. Based on this analysis it will seek to identify programs or interventions that can influence these factors and increase appropriate maternal health care-seeking.

The Bangladesh proposal focuses on the potential role of informal providers in meeting the health needs of the poor. To address this issue it will look at the impact of ill-health on households at different socio-economic levels and the existing roles of various types of service providers in meeting the health needs of poor households.

The China team will be studying two recently introduced social support schemes. The New Cooperative Medical Scheme (NCMS) is a risk-pooling health insurance scheme intended to meet the needs of the majority of rural households, but the main focus of the research will be on poor counties where NCMS is heavily subsidised by central and provincial government. The Medical Assistance (MA) scheme is specifically targeted at the very poor and aimed at removing barriers to essential care through financial support mechanisms.

India intends to undertake broadly focused research on the links between health and poverty. It will consider how ill-health impacts on different types of households in three distinct socio-economic regions, addressing both direct and opportunity costs. In line with the overall objectives of theme 1, it intends to consider both the role of social and financial support schemes and the role of improved health services in addressing the needs of poorer households.

In Nigeria, the main emphasis will be on the establishment of effective mechanisms for the provision of essential malaria services to households in poor areas. The aim is to work in close collaboration with local communities in the design and implementation of these services. The initial phase of the research will involve the compilation of basic information and gaining an understanding of local circumstances, seeking advice from communities as to their needs and how these might best be met. The proposal also envisages additional support schemes for the very poor, which will allow them access to the implemented services.

Uganda will focus on the provision of services, especially by the public and PNFP sectors, to households in two poor districts. One, in Northern Uganda, has been severely affected by a long running conflict which has displaced large sections of the population and had a disrupted service provision. The other, in Eastern Uganda, has established a Demographic Surveillance System, which will allow longitudinal research on the links between poverty and heath. In both districts the team will consider how households cope with illness and related costs (including formal and informal support systems), and the roles of different types of providers in providing health care.