Colombia - Dov Chernichovsky

Brechas regionales de la mortalidad infantil en Colombia Marta C. Jaramillo-Mejía, Dov Chernichovsky, José J. Jiménez-Moleón

ABSTRACT
Objectives. To study the variations in infant mortality rate (IMR) across Colombia’s 33 administrative departments over the period 2003-2009, examine persistency of variations across departments over time, and relate those variations to the impact of socio-economic conditions and availability of care on IMR. Materials and methods. Using vital statistics and related socio-economic data we establish three types of analysis according to: (a) the variation of the departmental IMR (2003- 2009), (b) the association between the departmental IMR and its key determinants over time, and (c) the lines of causality and relative impact of different factors, by using structural equations. Results. The 4.7 fold ratio between the highest and lowest departmental IMR (2009) may be underestimated considering underreporting, especially in low-income departments. There is a negative association between the departmental IMR with time and a set of highly correlated variables, such as the mother education, income per capita, health insurance level and access to services. Conclusions. The effect of better insurance, availability of private beds, and having doctors attending mothers, eclipse the impact of better socioeconomic conditions. The range of services does not appear to be influenced by a rational policy; resources are not allocated according to the need, but with the general development. Private beds are made available where there is better health insurance.

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  • Country: Colombia
  • # Pages: 53
  • Publication Year: 2012
  • Type of Media: Scientific Report

Abstract

This paper evaluates the Profamilia's outreach effort of 1986. Profamilia is an affiliate of the International Planned Parenthood Federation and provides more than 60 percent of Colombia's family planning services. This paper focuses around the question of Profamilia's ability to provide more protection with the same resources. The authors found that: (i) operations tend to be constrained by limited personnel and supplies; (ii) the labor costs and unit costs of contraception are lower in the outreach and clinical programs, which can be expanded with available infrastructure; (iii) the clinical and outreach program is the least cost-effective because of the higher cost of sterilization; (iv) more resources should be targeted to areas where there are proportionately more mothers and where people are better educated; (v) experienced and married workers sell more in the outreach program than their junior unmarried colleagues; and (vi) in both the clinical and surgical programs, output would increase if there were proportionately more nurses and fewer doctors.

  • Country: Colombia
  • # Pages: 113
  • Publication Year: 1991
  • Type of Media: Scientific Report

Abstract:

Traditional assessments of the impact and cost-effectiveness of various contraceptive methods, using couple-years of protection (CYPs) per dollar spent, do not accurately measure the level of protection offered by each method. An alternative measure--adjusted CYPs--that takes into account the relative risk of pregnancy among the users of each method is proposed here. Calculations show how cost recovery and reinvestment of the proceeds from family planning programs lead to the cross-subsidization of methods. In general, the more subsidized contraceptive methods are supported by the less subsidized methods. An examination of data from Colombia's Profamilia family planning program indicates that because of the differences in the relative risk of pregnancy of women of different ages, sterilization, the most effective contraceptive method, is not necessarily the most cost-effective method in terms of the number of CYPs it provides per unit cost.