Browsing by Subject "Access"

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Open Access
Energy Access as a Driver of Gender Equality: What is the Evidence?
(2020-05-22) Robinette, Forrest
Executive Summary Introduction Policy Problem. Worldwide, 2.7 billion people rely on traditional fuels such as wood, charcoal, agricultural residue, and animal dung for their cooking and heating needs (Mulugetta et al., 2019). Meanwhile, 1.4 billion do not have access to electricity (Gould et al., 2018). Lack of energy access negatively impacts outcomes as varied as health, time savings, economic empowerment, and education. Solid fuel use leads to household air pollution (HAP) exposure, causing chronic obstructive pulmonary disease (COPD), pulmonary tuberculosis, pneumonia, lung cancer, and acute respiratory infection (ARI). Primitive cookstoves can cause burns and fires in the home. The act of collecting solid fuels can also cause back pain and be extremely time-consuming, thereby restricting time for other activities. The absence of electricity, meanwhile, can increase the time spent on chores, restrict educational opportunities, and pose a safety concern (due to low lighting in dangerous areas). For each of these outcomes, evidence suggests that women are more severely impacted than men. Policy Question. “Does energy access contribute to increased gender equality?” This project seeks to understand the extent to which energy access, namely clean cooking access and electrification, benefits women through improvements in outcomes that can include health, time savings, education, and economic empowerment. This project defines interventions contributing to increased gender equality as those that benefit women relative to men. This includes interventions that benefit women but do not benefit men and those that benefit women more than men. Studies that find a positive impact of a given intervention on women—but do not study the impact on men—cannot be used as evidence of gender empowerment. Methodology The Sustainable Energy Transitions Initiative (SETI) conducted an ambitious systematic review in which the researchers examined nearly 80,000 peer-reviewed articles related to energy and development (Jeuland et al. 2019; Pattanayak et al., 2018). The team identified 3,183 quantitative studies on affordable and clean energy, which they then categorized according to the 17 Sustainable Development Goals (Jeuland et al. 2019; Pattanayak et al., 2018). Of these studies, 67 demonstrate the effect of energy access on gender equality. This project examines the studies in this sample that find a statistically significant relationship between energy access and gender equality. As the SETI study concluded in 2017, this project also collects and presents studies relating to energy access and gender equality written in the past three years. Results Evidence strongly supports that health benefits resulting from energy access contribute to gender equality. By far, health is the most well-supported pathway for gender equality in peer-reviewed studies that examine the impact of energy access on women. Organizations undertaking development work can credibly claim that energy access and clean cooking solutions benefit the health of women. Evidence moderately supports that time savings, education, and economic empowerment from energy access contribute to gender equality. The evidence for each of these pathways is limited to a handful of studies, even though these studies often find a sizable impact of energy access on any one of these three outcomes. Recommendations 1. Evidence strongly supports that health benefits from energy access contribute to gender equality. 2. Evidence moderately supports that time savings, education, and economic empowerment from energy access contribute to gender equality. 3. More studies need to be undertaken that examine women’s benefits of energy access relative to men.
Open Access
Enrollment Growth and Equity of Access: A Critical Analysis of the University of North Carolina's Strategic Plan
(2019-03-25) Levitt, Jessica
The University of North Carolina System’s strategic plan contains initiatives to increase access for low-income and rural students, improve student outcomes, and close achievement gaps. A complete assessment of UNC’s strategic plan will consider increased enrollment against the demand of the state’s economy, the cost of education, and institutional resources. Enrollment growth carries the risks of lowering academic standard or oversaturating North Carolina’s economy with college-educated workers. However, the low educational attainment of the state’s underserved populations supports expanding access. A more detailed investigation of demographics at each of the campuses is necessary to understand the scope of underrepresentation within the system. The resulting calculations show that in addition to underrepresentation, there is also unequal distribution of minority, low-income, and rural students across UNC institutions. While the system has identified a number of programs and methods for achieving its priorities, it is also worth examining other models that may have application in North Carolina. In its current form, UNC’s strategic plan is insufficient to drive state-wide improvements. The aims produce only minimal gains, overlook important gaps, and lack the coordination between campuses necessary to best utilize system resources. There is unmet need and significant opportunity for innovation in North Carolina’s public institutions, but more ambitious goals will have to be implemented to result in any meaningful impact.
Open Access
Food Sovereignty and Conservation
(2023-04-28) Drici, Adam
This Master's Project examines the intersections between food sovereignty and conservation. Interviews and focus groups with community members and experts inform the recommendations. Equitable access to food, land, funding, and markets were the most pressing challenges detailed by community members. Several recommendations regarding policy, program, and approach were offered to the client, including equitable government conservation funding access policy reform and the development of a nationwide system of Indigenous protected areas based upon Indigenous traditional food and medicine species ranges. Conservation organizations must center community priorities in efforts to protect wild places to build resilient, inclusive strategies.
Open Access
Global Equity Challenges in COVID-19 Vaccine Purchasing
(2021-04-21) Raj, Aneesha
A rush to preemptively secure COVID-19 vaccines resulted in high income countries hoarding an excess supply while low- and middle-income countries are prevented from equitable access. Previous work on equity in vaccine purchasing has compared cases per million of COVID-19 to vaccination coverage but does not reflect urgent pressures placed on healthcare systems. This analysis investigates vaccination coverage against three measures of COVID-19 burden: deaths per 100,000 population, general hospital capacity reached, and ICU capacity reached, in order to identify the countries overburdened and underrepresented in vaccine purchasing. Publicly available data from the Duke Launch & Scale Speedometer, IHME COVID-19 projections, and Johns Hopkins COVID-19 mortality reports are used for this analysis. While non-high-income countries comprised 64% of this dataset, they represented 93% of countries in ICU crisis, 87% in general hospital capacity crisis, and 85% in a mortality crisis. This data provides evidence for the creation of a priority list for equitable global allocation of vaccines to low- and middle-income countries. High income countries can be incentivized to redistribute their excess vaccine supplies by reframing measures of pandemic progress away from nationalistic targets.
Open Access
Mixed-Method Analysis of Barriers to Surgical Care in Uganda
(2017) Incorvia, Joseph James
Background: Barriers to surgical care in low- and middle-income countries have basis in theoretical frameworks, but are often left undefined and understudied. Based on the Access Evaluation Framework and Healthcare Barrier Model, this study implemented two consumer decision tools and a qualitative interview to elucidate significant barriers to seeking surgical care in Uganda.
Methods: Participants were recruited from a convenience sample within the surgical wards of one national referral hospital and one regional referral hospital in Uganda. Individuals selected for the study answered a brief questionnaire and a ranking and rating exercise followed by an in-depth semi-structured interview. The questionnaire evaluated demographic, economic, transportation, and care-seeking characteristics, while the ranking and rating exercises assessed potential barriers to surgical care. Descriptive statistics were used to assess characteristics of the sample. Ranking and rating medians were compared between the two exercises for each barrier.
Results: Among the 214 participants, cost of surgery, distance to hospital, and transportation to hospital were identified as the most significant barriers to care. Language barrier, no control over decision making, and no caretaker available at the hospital were identified as the least significant barriers to care. Mulago National Referral Hospital had significantly greater costs and transportation times indicating larger scale barriers to care than Jinja Regional Referral Hospital even though top barriers were similar.
Conclusions: Both the ranking and rating exercises and interviews indicated that cost was the most significant barrier to surgical care among care-seekers in Uganda. Transportation to the hospital and distance from the hospital remain large barriers that need to be considered as well. These complementary analysis tools provide evidence that future policies and research need to consider mitigating cost, distance, and transportation issues for patients that need a surgical intervention. Next steps in determining more granular level differences between barriers will help understand how best to address these issues.
Open Access
Priority Review Voucher: Policy Barriers and Opportunities to Increase Access to Voucher-Winning Medicines
(2018) Bandara, Shashika
Background: Access to medicines is a vital component of upholding the right to health. However, there is a gap in access to medicines, especially in resource poor settings, that leads to poor health outcomes. The priority review voucher (PRV) is a ‘pull’ incentivizing mechanism designed to encourage new drug development for otherwise neglected diseases. This mechanism also reduces the cost of the end-product via incentives provided after the product has been developed. This study aims to understand policy and implementation barriers related to access to the PRV-winning drug bedaquiline. Bedaquiline is the first drug approved for multi-drug resistant tuberculosis (MDR-TB) in over 40 years. Based on an understanding of access barriers to this new drug, the study also aims to suggest policy recommendations to improve access for PRV winning drugs for tropical diseases.
Methods: The study used semi-structured qualitative interviews with multiple stakeholders at the global level and at the country level in South Africa. These were combined with data from research literature and advocacy materials and analyzed using thematic analysis, organized using Kingdon’s three streams model. The model includes three streams: the problem stream, politics stream, and policy stream. The model also identifies policy entrepreneurs and policy windows. The data were further analyzed using Lewin’s forcefield analysis (FFA) identifying supporting and opposing forces related to increasing access to bedaquiline.
Results: Overcoming policy and implementation access barriers related to bedaquiline is the responsibility of multiple stakeholders. The main barriers to access for bedaquiline currently include (i) barriers to registration of the drug at the country level, (ii) lack of research data (especially phase III trial data), (iii) weak health systems, and (iv) the lack of a sustainable pricing model. The manufacturer has a significant role to play, and this role is common among other PRV winners for tropical diseases as well.
Conclusion: PRV as an incentivizing mechanism to develop drugs for otherwise neglected diseases should strongly consider including an access plan requirement as part of the application process. The plan should be made available to the public for evaluation.
Open Access
Research priorities for expanding access to methadone treatment for opioid use disorder in the United States: A National Institute on Drug Abuse Center for Clinical Trials Network Task Force report.
(Substance abuse, 2021-01) Joudrey, Paul J; Bart, Gavin; Brooner, Robert K; Brown, Lawrence; Dickson-Gomez, Julie; Gordon, Adam; Kawasaki, Sarah S; Liebschutz, Jane M; Nunes, Edward; McCarty, Dennis; Schwartz, Robert P; Szapocnik, José; Trivedi, Madhukar; Tsui, Judith I; Williams, Arthur; Wu, Li-Tzy; Fiellin, David A
In the US, methadone treatment can only be provided to patients with opioid use disorder (OUD) through federal and state-regulated opioid treatment programs (OTPs). There is a shortage of OTPs, and racial and geographic inequities exist in access to methadone treatment. The National Institute on Drug Abuse Center for Clinical Trials Network convened the Methadone Access Research Task Force to develop a research agenda to expand and create more equitable access to methadone treatment for OUD. This research agenda included mechanisms that are available within and outside the current regulations. The task force identified 6 areas where research is needed: (1) access to methadone in general medical and other outpatient settings; (2) the impact of methadone treatment setting on patient outcomes; (3) impact of treatment structure on outcomes in patients receiving methadone; (4) comparative effectiveness of different medications to treat OUD; (5) optimal educational and support structure for provision of methadone by medical providers; and (6) benefits and harms of expanded methadone access. In addition to outlining these research priorities, the task force identified important cross-cutting issues, including the impact of patient characteristics, treatment, and treatment system characteristics such as methadone formulation and dose, concurrent behavioral treatment, frequency of dispensing, urine or oral fluid testing, and methods of measuring clinical outcomes. Together, the research priorities and cross-cutting issues represent a compelling research agenda to expand access to methadone in the US.