Impact of the 'Seguro Médico Siglo XXI' medical insurance programme on neonatal and infant mortality in Mexico, 2006-14: an ecological approach to estimation

A realist synthesis to develop an explanatory model of how policy instruments impact child and maternal health outcomes

BACKGROUND

Child and maternal health, a key marker of overall health system performance, is a policy priority area by the World Health Organization and the United Nations, including the Sustainable Development Goals. Previous realist work has linked child and maternal health outcomes to globalization, political tradition, and the welfare state. It is important to explore the role of other key policy-related factors. This paper presents a realist synthesis, categorising policy instruments according to the established NATO model, to develop an explanatory model of how policy instruments impact child and maternal health outcomes.

METHODS

A systematic literature search was conducted to identify studies assessing the relationships between policy instruments and child and maternal health outcomes. Data were analysed using a realist framework. The first stage of the realist analysis process was to generate micro-theoretical initial programme theories for use in the theory adjudication process. Proposed theories were then adjudicated iteratively to produce a set of final programme theories.

FINDINGS

From a total of 43,415 unique records, 632 records proceeded to full-text screening and 138 papers were included in the review. Evidence from 132 studies was available to address this research question. Studies were published from 1995 to 2021; 76% assessed a single country, and 81% analysed data at the ecological level. Eighty-eight initial candidate programme theories were generated. Following theory adjudication, five final programme theories were supported. According to the NATO model, these were related to treasure, organisation, authority-treasure, and treasure-organisation instrument types.

CONCLUSIONS

This paper presents a realist synthesis to develop an explanatory model of how policy instruments impact child and maternal health outcomes from a large, systematically identified international body of evidence. Five final programme theories were supported, showing how policy instruments play an important yet context-dependent role in influencing child and maternal health outcomes.

Socio-economic factors affecting high infant and child mortality rates in selected African countries: does globalisation play any role?

Background

Despite the declining trends worldwide, infant and child mortality rates are still high in many African countries. These high rates are problematic; therefore, this study attempts to explore the contributing factors that cause high infant and child mortality rates in 14 African countries using panel data for the period of 2000–2018. In particular, the role globalisation is explored.

Methods

The panel corrected standard error (PCSE), the Feasible generalized least square (FGLS) models, and the pair-wise Granger causality test have been applied as methodological approaches.

Results

The public health expenditure, numbers of physicians, globalization, economic development, education, good governance, and HIV prevalence rate have been revealed as the determinants of infant and child mortality in these countries. All these variables except the HIV prevalence rate negatively affect the infant and child mortality rates, while the HIV prevalence rate is found to be positive. Bidirectional and unidirectional causal relationships between the variables are also attained.

Conclusions

Effective socio-economic policy priority with due consideration of globalization should be emphasized to reduce infant and child mortality rates in these countries.