Dina Balabanova
Datos Biográficos
| ID | 247113 |
|---|---|
| NOMBRE | Dina Balabanova |
| NOMBRES | Dina |
| APELLIDO | Balabanova |
| FIRMA | BALABANOVA D |
| AFILIACIONES | London School of Hygiene & Tropical Medicine |
| ORCID | 0000-0001-7163-3428 |
| VERIFICADO | Sí |
| TOTAL DE OBRAS | 74 |
| TOTAL DE CITAS | 89 |
| TOTAL COMO AUTOR | 74 |
| TOTAL COMO EDITOR | 0 |
| PRIMER AÑO DE PUBLICACIÓN | 1998 |
| AÑO MÁS RECIENTE DE PUBLICACIÓN | 2026 |
| ÍNDICE H | 6 |
Measuring and assessing corruption in public health systems in low- and middle-income countries
Corruption in health systems has serious implications for health outcomes and equitable care. Although various methods exist to measure it, their application, purpose, effectiveness, and context have not yet been systematically consolidated to enable learning. We conducted a scoping review to identify empirical approaches used to measure health-sector corruption globally, with a focus on low- and middle-income countries. We examined the opportuni…
Contribution and influence of social capital on corruption in the health sector
BACKGROUND: The interplay between social capital and health system corruption in healthcare systems is underexplored, yet vital, a major barrier to advancing universal health coverage is underexplored. While social capital can support anticorruption by enabling collective action, it may also perpetuate corruption when networks are used to bypass procedures or access care unfairly. This study explores how social capital contributes to corrupt prac…
Barriers and facilitators of primary care management of type II diabetes mellitus in the West African sub-region
The prevalence of diabetes is rising rapidly across West Africa, posing a significant public health challenge. Effective diabetes management through accessible and quality primary healthcare is crucial, yet multiple barriers persist. This review aimed to synthesise the available evidence on factors influencing access, utilisation, and quality of diabetes primary care in West Africa. Following Arksey and O’Malley’s framework and PRISMA-ScR guideli…
Study on health seeking behaviour and determinants of undiagnosed hypertension in poor households in the Philippines, part of the Respond study (SHARP-Respond)
Hypertension is one of the leading preventable causes of premature death. Although it can be effectively managed with relatively simple interventions, up to 50% of individuals with hypertension in low- and middle-income countries (LMICs) remain undiagnosed. Key factors influencing the health-seeking behaviour of patients with hypertension include household wealth, knowledge about hypertension, perceptions of treatment effectiveness, and access to…
Corruption and the emergence of a healthcare 'marketplace' in Nigeria's primary health centres
Corruption in the health systems of low- and middle-income countries (LMICs) is fuelled by many factors, including health system failures, practical norms, informal rules, and social networks. Researchers have historically scrutinized these factors in isolation, often failing to grasp the intricate interconnections and the combined manner in which they manifest. In this ethnographic study, we present evidence from Nigeria's healthcare system, whe…
Who is absent and why? Factors affecting doctor absenteeism in Bangladesh
Absenteeism by doctors in public healthcare facilities in rural Bangladesh is a form of chronic rule-breaking and is recognised as a critical problem by the government. We explored the factors underlying this phenomenon from doctors’ perspectives. We conducted a facility-based cross-sectional survey in four government hospitals in Dhaka, Bangladesh. Junior doctors with experience in rural postings were interviewed to collect data on socio-demogra…
Predictors of unmet needs among people with diabetes mellitus type 2 in Gampaha district of Sri Lanka
Diabetes mellitus is a significant contributor to the disease burden in Sri Lanka. Despite government efforts to improve access to care for those with chronic illness, major gaps remain. We assessed the prevalence and correlates of unmet needs among persons with diabetes mellitus type 2 to inform policies on improving healthcare access in a predominantly tax-funded public healthcare system. A descriptive cross-sectional study identified 401 perso…
Did aid to the Ebola crisis divert aid for reproductive, maternal, and newborn health? An analysis of donor-reported data in Sierra Leone
Modest changes to RMNH donor aid patterns are insufficient to explain the severe decline in RMNH indicators recorded during the outbreak. Our findings therefore suggest the need for substantial increases in routine aid to ensure that basic RMNH services and infrastructure are strong before an epidemic occurs, as well as increased aid for RMNH during epidemics like Ebola and Covid-19, if reproductive, maternal and newborn healthcare is to be maint…
Enmity then empathy
In the autumn of 2014, with the 2013–16 West Africa Ebola epidemic spiralling out of control, the United Kingdom announced a bespoke military mission to support—and in some ways lead—numerous Ebola response functions in Sierra Leone. This study examines the nature and effect of the civil‐military relationships that subsequently developed between civilian and military Ebola response workers (ERWs). In total, 110 interviews were conducted with key …
Determinants of government spending on primary healthcare
In 2018 global leaders renewed their political commitment to primary healthcare (PHC) ratifying the Declaration of Astana emphasising the importance of building a sustainable PHC system based on accessible and affordable delivery models strengthened by community empowerment. Yet, PHC often remains underfunded, of poor quality, unreliable and not accountable to users which further deprives PHC of funding. This paper analyses the determinants of PH…
The role of Primary Health Care, primary care and hospitals in advancing Universal Health Coverage
Is it possible for drug shops to abide by the formal rules? The structural determinants of community medicine sales in Uganda
The medicines retail sector is an essential element of many health systems in Africa and Asia, but it is also well known for poor practice. In the literature, it is recognised that improvements in the sector can only be made if more effective forms of governance and regulation can be identified. Recent debate suggests that interventions responsive to structural constraints that shape and underpin poor practice is a useful way forward. This paper …
“I can’t kill myself”
Background: Absenteeism in the health sector is increasingly seen as a form of harmful rule-breaking, with health workers receiving a salary although they are not present to provide care. It is a barrier to achieving universal health coverage yet remains widespread in primary health centres (PHCs) in Nigeria and many other low-resource settings. Traditional approaches to combatting absenteeism have relied on anti-corruption measures such as promo…
Examining the militarised hierarchy of Sierra Leone’s Ebola response and implications for decision making during public health emergencies
BACKGROUND: In September, 2014, Médecins Sans Frontières (MSF) called for militarised assistance in response to the rapidly escalating West Africa Ebola Epidemic. Soon after, the United Kingdom deployed its military to Sierra Leone, which (among other contributions) helped to support the establishment of novel and military-led Ebola Virus Disease (Ebola) response centres throughout the country. To examine these civil-military structures and their…
We stay silent and keep it in our hearts’
A responsive health system must have mechanisms in place that ensure it is accountable to those it serves. Patients in Malawi have to overcome many barriers to obtain care. Many of these barriers reflect weak accountability. There are at least 30 mechanisms through which Malawian patients in the public sector can assert their rights, yet few function well and, as a consequence, they are underused. Our aim was to identify the various channels for …
The nature, drivers and equity consequences of informal payments for maternal and child health care in primary health centres in Enugu, Nigeria
In Nigeria, most basic maternal and child health services in public primary health-care facilities should be either free of charge or subsidized. In practice, additional informal payments made in cash or in kind are common. We examined the nature, drivers and equity consequences of informal payments in primary health centres (PHC) in Enugu State. We used three interlinked qualitative methods: participant observation in six PHC facilities and two …
The political economy of expedience
The 2013-2016 West Africa Ebola Epidemic is the largest outbreak of Ebola in history. By September, 2014 the outbreak was worsening significantly, and the international president of Médecins Sans Frontières called for military assistance. In Sierra Leone, the British and Sierra Leonean militaries intervened. They quickly established a National Ebola Response Centre and a constituent network of District Ebola Response Centres. Thereafter, these in…
Implementing and monitoring the right to health in breast cancer
We propose a set of indicators as a guide for health policy experts seeking to design national cancer plans that are based on a human rights-based approach to health, and for cancer specialists aiming to implement principles of the right to health in their practice. The 54 indicators selected may be used in High-Income Countries, or member states of the OECD who also have signed the International Covenant on Economic, Social and Cultural Rights t…
Policy space and pro-health equity national policymaking
Health equity is central to achieving sustainable development goals and COVID-19 has emphasized its importance. Ensuring health equity is prominent in policy discussions and decision-making is a critical challenge in all countries. Understanding the policy space for actors to promote health equity in the policy process may help to strengthen prioritization of equity in policy and programme discussions and decisions. Authors developed a conceptual…
Do Indian women know about and use the emergency contraceptive pill? An analysis of nationally representative data from 2005–06 and 2019–21
The emergency contraceptive pill (ECP) is a post-coital contraceptive method that prevents unintended pregnancy and is useful in specific circumstances. This study examined the awareness and use of the ECP in India, as there is scarce evidence in this area to guide policy development. This study used data from the 2005–06 (n = 124 385) and 2019–21 (n = 724 115) rounds of the National Family Health Survey of India. Bivariate analysis and multivari…
Designing feasible anti-corruption strategies in the Nigerian health system
Health worker absenteeism is a major form of corruption in the Nigerian health system, reducing the impact of healthcare investment and disproportionately affecting vulnerable communities. Top-down governance and accountability measures to improve attendance have had limited effect, potentially because they have not addressed underlying incentives driving health worker behaviour. To inform feasible interventions to reduce absenteeism, we sought t…
The Lancet Global Health Commission on financing primary health care
The COVID-19 pandemic has brought the need for well-functioning primary health care (PHC) into sharp focus. PHC is the best platform for providing basic health interventions (including effective management of non-communicable diseases) and essential public health functions. PHC is widely recognised as a key component of all high-performing health systems and is an essential foundation of universal health coverage. PHC was famously set as a global…
Absenteeism in primary health centres in Nigeria
BACKGROUND: Primary health centres (PHCs) in Nigeria suffer critical shortages of health workers, aggravated by chronic absenteeism that has been attributed to insufficient resources to govern the system and adequately meet their welfare needs. However, the political drivers of this phenomenon are rarely considered. We have asked how political power and networks influence absenteeism in the Nigerian health sector, information that can inform the …
Strong structuration analysis of patterns of adherence to hypertension medication
Achieving blood pressure control is among the highest priorities for reducing the burden of cardiovascular diseases globally. Control is poor in the Philippines, especially in socioeconomically marginalised communities. This paper explores long-term adherence to anti-hypertensive medication in these communities, identifying 4 distinct medication adherence patterns. We draw on Strong Structuration Theory to explore motivations of action for those …
Absenteeism among doctors in the Bangladesh health system
Despite considerable investment by the Bangladesh government in measures to strengthen accountability and transparency, absenteeism among doctors remains a barrier to the achievement of Universal Health Coverage. Recent innovations in anti-corruption theory point to the importance of acting on the structural drivers of absenteeism and argue for approaches that are better able to take local and national level context into account. In this qualitat…
Towards an understanding of resilience
The recent outbreak of Ebola Virus Disease (EVD) in West Africa has drawn attention to the role and responsiveness of health systems in the face of shock. It brought into sharp focus the idea that health systems need not only to be stronger but also more 'resilient'. In this article, we argue that responding to shocks is an important aspect of resilience, examining the health system behaviour in the face of four types of contemporary shocks: the …
Providers' constructions of the role of women in cervical cancer screening in Bulgaria and Romania
Democracy and growth in divided societies
Strengths and Weaknesses of Digital Diaries as a Means to Study Patient Pathways
The rise of digital mobile communications has made possible novel research methods that can provide a better understanding of patients' experience of non-communicable diseases. This study explores the opportunities and challenges in employing 'digital diaries' via mobile phones to track the lived experiences of people with hypertension in the Philippines. Following in-depth interviews, 40 hypertensive adults were invited to submit digital diaries…
I don't see gender
Academic experts share their ideas, as well as contribute to advancing health science by participating in publishing as an author, reviewer and editor. The academy shapes and is shaped by knowledge produced within it. As such, the production of scientific knowledge can be described as part of a socially constructed system. Like all socially constructed systems, scientific knowledge production is influenced by gender. This study investigated one l…
The persistence of irregular treatment of hypertension in the former Soviet Union
BACKGROUND: Hypertension is one of the leading causes of avoidable mortality in the former Soviet Union (fSU). In previous work, the authors described patterns of irregular hypertension treatment in eight countries of the fSU in 2001. This paper presents new data on changes in the use of hypertension treatment in the same countries. METHODS: Using household survey data from 18 420 (2001) and 17 914 (2010) respondents from Armenia, Azerbaijan (201…
Winners and Losers
Objectives. This study sought to describe the evolution of the Russian compulsory health insurance system and to identify factors associated with noncoverage. Methods. Data from successive waves of the Russian Longitudinal Monitoring Survey (1992–2000) were analyzed. Results. Insurance coverage grew rapidly throughout the 1990s, although 11.8% of the country’s citizens were still uninsured by 2000. Coverage initiation rates were greater at first …
(Re)arranging “systems of care” in the early Ebola response in Sierra Leone
Despite an expanding literature on Ebola-response, few studies detail or reflect on the responses of diverse systems of care. Little is known about how, why or in what ways, strategies of ill-health management were enacted locally, how health-systems power, authority and hierarchy were perceived and contested, or how other social systems, institutions and relationships shaped the response. This paper presents an interdisciplinary analysis of loca…
(De)constructing 'therapeutic itineraries' of hypertension care
Hypertension, a major risk factor for non-communicable diseases, remains poorly controlled in many countries. In the Philippines, it is still one of the leading causes of preventable deaths despite the accessibility and availability of essential technologies and medicine to detect and treat hypertension. This paper characterizes the 'therapeutic itineraries' of people with hypertension from poor communities in rural and urban settings in the Phil…
Participant Use of Digital Diaries in Qualitative Research
Lived experiences of chronic conditions are marked by fluidity and change, which should be considered if care is to be truly patient-centered. Seeking to capture this fluidity, we used digital diaries via mobile phones to communicate with hypertensive patients in the Philippines over approximately 12 months. This paper draws on Strong Structuration Theory to conceptualize the complex array of factors shaping participants' usage (and non-usage) of…
Equity in community health insurance schemes
INTRODUCTION: Community health insurance (CHI) schemes are growing in importance in low-income settings, where health systems based on user fees have resulted in significant barriers to care for the poorest members of communities. They increase revenue, access and financial protection, but concerns have been expressed about the equity of such schemes and their ability to reach the poorest. Few programmes routinely evaluate equity impacts, even th…
The desirability and feasibility of scaling up community health insurance in low-income settings-Lessons from Armenia
Drivers of health system strengthening
There is a growing understanding that strong health systems are crucial to sustain progress. Health systems, however, are complex and much of their success depends on factors operating at different levels and outside the health system, including broader governance and political commitment to health and social development priorities. Recognizing these complexities, this article offers a pragmatic approach to exploring the drivers of progress in ma…
Reforming health care financing in Bulgaria
Doing' hypertension
Patients' embodied experiences do not always correspond to the biomedical concepts of particular diseases. Drawing from year-long fieldwork in the Philippines that involved semi-structured interviews, focus group discussions and digital diaries, we examine how individuals 'do' hypertension through their embodied experiences and the knowledge and practice that emerge from them. Drawing inspiration from Annemarie Mol's work on the notion of 'multip…
Irregular treatment of hypertension in the former Soviet Union
BACKGROUND: The USSR failed to establish a modern pharmaceutical industry and lacked the capacity for reliable distribution of drugs. Patients were required to pay for outpatient drugs and the successor states have inherited this legacy, so that those requiring long-term treatment face considerable barriers in receiving it. It was hypothesised that citizens of former Soviet republics requiring treatment for hypertension may not be receiving regul…
Navigating the health system
BACKGROUND: Effective delivery of diabetes care requires integration across specialist teams delivering recognized interventions, a reliable pharmaceutical supply, and promoting self-management. Drawing on a framework incorporating physical, human, intellectual and social resources, the paper examines how these challenges are managed in diabetes care in Georgia. METHODS: The rapid appraisal study triangulated data from interviews with users, prov…
Designing feasible anti-corruption strategies in the Nigerian health system
Health worker absenteeism is a major form of corruption in the Nigerian health system, reducing the impact of healthcare investment and disproportionately affecting vulnerable communities. Top-down governance and accountability measures to improve attendance have had limited effect, potentially because they have not addressed underlying incentives driving health worker behaviour. To inform feasible interventions to reduce absenteeism, we sought t…
Health system reforms in China a half century apart
Patterns of smoking in Bulgaria
The observed pattern of smoking indicates the need for a robust policy to tackle smoking in Bulgaria, especially among the young in large cities, informed by a better understanding of why smoking rates vary among different groups
Understanding informal payments for health care
Russia
Background/Aims Vision impairment (VI) increases the risk of various comorbidities, including depression. However, the relationship between depression and VI is unclear, and existing findings are inconsistent. We therefore investigated the risk of depression in adults before and after their registration as visually impaired. Methods In this longitudinal, nationwide, retrospective cohort study, 131 434 patients (aged ≥18 years) with newly register…
Winners and Losers
Objectives. This study sought to describe the evolution of the Russian compulsory health insurance system and to identify factors associated with noncoverage. Methods. Data from successive waves of the Russian Longitudinal Monitoring Survey (1992–2000) were analyzed. Results. Insurance coverage grew rapidly throughout the 1990s, although 11.8% of the country’s citizens were still uninsured by 2000. Coverage initiation rates were greater at first …
Reforming health care financing in Bulgaria
To Retain or Remove User Fees?
Providers' constructions of the role of women in cervical cancer screening in Bulgaria and Romania
The desirability and feasibility of scaling up community health insurance in low-income settings-Lessons from Armenia
Navigating the health system
BACKGROUND: Effective delivery of diabetes care requires integration across specialist teams delivering recognized interventions, a reliable pharmaceutical supply, and promoting self-management. Drawing on a framework incorporating physical, human, intellectual and social resources, the paper examines how these challenges are managed in diabetes care in Georgia. METHODS: The rapid appraisal study triangulated data from interviews with users, prov…
Equity in community health insurance schemes
INTRODUCTION: Community health insurance (CHI) schemes are growing in importance in low-income settings, where health systems based on user fees have resulted in significant barriers to care for the poorest members of communities. They increase revenue, access and financial protection, but concerns have been expressed about the equity of such schemes and their ability to reach the poorest. Few programmes routinely evaluate equity impacts, even th…
Prescription for change
BACKGROUND Many Russians experienced difficulty in accessing prescription medication during the widespread health service disruption and rapid socio-economic transition of the 1990s. This paper examines trends and determinants of access in Russia during this period. METHODS Data were from nine rounds (1994-2004) of the Russia Longitudinal Monitoring Survey, a 38-centre household panel survey. Trends were measured in failing to access prescribed m…
Democracy and growth in divided societies
Good Health at Low Cost’
Updates a 1985 report and presents case studies of five developing countries' progress toward achieving well-functioning health systems. Examines common factors, including good governance, innovation, scaled-up workforce mobilization, and fair financing
The persistence of irregular treatment of hypertension in the former Soviet Union
BACKGROUND: Hypertension is one of the leading causes of avoidable mortality in the former Soviet Union (fSU). In previous work, the authors described patterns of irregular hypertension treatment in eight countries of the fSU in 2001. This paper presents new data on changes in the use of hypertension treatment in the same countries. METHODS: Using household survey data from 18 420 (2001) and 17 914 (2010) respondents from Armenia, Azerbaijan (201…
Irregular treatment of hypertension in the former Soviet Union
BACKGROUND: The USSR failed to establish a modern pharmaceutical industry and lacked the capacity for reliable distribution of drugs. Patients were required to pay for outpatient drugs and the successor states have inherited this legacy, so that those requiring long-term treatment face considerable barriers in receiving it. It was hypothesised that citizens of former Soviet republics requiring treatment for hypertension may not be receiving regul…
Good Health at Low Cost 25 years on
Measuring governance at health facility level
BACKGROUND: Governance has been cited as a key determinant of economic growth, social advancement and overall development. Achievement of millennium development goals is partly dependant on governance practices. In 2007, Health Systems 20/20 conducted an Internet-based survey on the practice of good governance. The survey posed a set of good practices related to health governance and asked respondents to indicate whether their experience confirme…
After the Global Fund
Peru has received around $70 million from Global Fund to fight AIDS, Tuberculosis and Malaria (Global Fund). Recent economic growth resulted in grant ineligibility, enabling greater government funding, yet doubts remain concerning programme continuity. This study examines the transition from Global Fund support to increasing national HIV/AIDS funding in Peru (2004-2012) by analysing actor roles, motivations and effects on policies, identifying re…
Wealth and cardiovascular health
Inequality in hypertension management outcomes decreased as countries became richer, but the considerable variation in patterns of wealth-related inequality - even among countries at similar levels of economic development - underscores the importance of health systems in improving hypertension management for all. These findings show that some, but not all, countries, including those with limited resources, have been able to achieve more equitable…
Extending access to essential services against constraints
China's 60 year experience in establishing a de-professionalized, community-based, health service delivery model that is economically feasible, institutionally and culturally appropriate mechanism can be useful to other low- and middle-income countries (LMICs) seeking to extend essential services. Lessons can be drawn from both reform content and from its implementation pathway, identifying the political, institutional and contextual factors shap…
Health systems facilitators and barriers to the integration of HIV and chronic disease services
Interventions and approaches to integrating HIV and mental health services
Drivers of health system strengthening
There is a growing understanding that strong health systems are crucial to sustain progress. Health systems, however, are complex and much of their success depends on factors operating at different levels and outside the health system, including broader governance and political commitment to health and social development priorities. Recognizing these complexities, this article offers a pragmatic approach to exploring the drivers of progress in ma…
Integrating cardiovascular diseases, hypertension, and diabetes with HIV services
Community health volunteers could help improve access to and use of essential health services by communities in LMICs
A number of primary studies and systematic reviews focused on the contribution of community health workers (CHWs) in the delivery of essential health services. In many countries, a cadre of informal health workers also provide services on a volunteer basis [community health volunteers (CHV)], but there has been no synthesis of studies investigating their role and potential contribution across a range of health conditions; most existing studies ar…
Medicine (48 obras) · Political science (40 obras) · Economics (35 obras) · Healthcare Systems and Reforms (34 obras) · Economic growth (32 obras) · Business (31 obras) · Health care (30 obras) · Global Maternal and Child Health (29 obras) · Nursing (23 obras) · Environmental health (20 obras)