Manuela De Allegri
Biographic Data
| ID | 132792 |
|---|---|
| NAME | Manuela De Allegri |
| GIVEN NAMES | Manuela |
| FAMILY NAME | De Allegri |
| SIGNATURE | DE ALLEGRI M |
| AFFILIATIONS | Heidelberg University |
| ORCID | 0000-0002-8677-1337 |
| VERIFIED | Yes |
| TOTAL WORKS | 83 |
| TOTAL CITATIONS | 107 |
| AUTHOR COUNT | 83 |
| EDITOR COUNT | 0 |
| FIRST PUBLICATION YEAR | 2006 |
| LATEST PUBLICATION YEAR | 2026 |
| H-INDEX | 7 |
Water against stone
Examining the effect of nearby armed conflict on access to maternal and child health services in Burkina Faso’s primary healthcare facilities
BACKGROUND: Armed conflict is increasing in sub-Saharan Africa, impacting access to vital health services. However, scant evidence exists on the effects of the recently escalated conflict in Burkina Faso, a country severely affected by rising violence. METHODS: We conducted a longitudinal study, aligning conflict event data from the Uppsala Conflict Data Program with Burkina Faso's Health Management Information System data spanning from 2013 to 2…
Making health insurance responsive to citizens
BACKGROUND: Many low-income and middle-income countries have introduced public health insurance systems, whereby, thanks to government subsidies, selected groups are entitled to receive insurance coverage even if not paying direct contributions into the system. These efforts towards achieving universal health coverage were often undermined by difficulties in enrolment and registration, barriers to health service utilisation or complicated rules a…
An extended cost-effectiveness analysis of decentralised TB diagnostic testing with Molbio Truenat MTB/RIF versus hub-and-spoke GeneXpert MTB/RIF in Mozambique and Tanzania
BACKGROUND: In low- and middle-income countries (LMICs), tuberculosis (TB) regained its status as the leading cause of death from a single infectious agent in 2023, surpassing COVID-19. Rapid and accurate diagnosis is critical, with decentralised diagnostic strategies offering a promising solution. Although decentralised diagnostic strategies have been proven cost-effective, further evidence is needed on affordability and equity in high-burden se…
Community-based mobile tuberculosis clinics in rural Madagascar
INTRODUCTION: Tuberculosis (TB) remains an important public health challenge globally. Madagascar faces a substantial TB burden despite enhanced efforts from its national TB control programme. This necessitates innovative and context-specific TB prevention and care interventions that are both impactful and cost-effective. We evaluated the effectiveness and cost-effectiveness of a community-based mobile TB clinic intervention in a remote rural are…
Stronger together
Box Global health research partnerships face persistent inequities, including funding imbalances, unbalanced recognition and inequitable recognition of low-and middle-income country (LMIC) researchers and their overall capacities
What factors shape an individual’s probability to be enrolled in a professionally-managed community-based health insurance? Results from a cross-sectional case-control study in two districts in Mali
Across West Africa, countries are promoting new models of community-based health insurance (CBHI) to overcome the challenges faced by existing schemes. We investigated factors associated with an individual’s probability to be enrolled in one of two professionally-managed CBHI in Mali. We carried out a case-control methodology and used multi-stage sampling to select CBHI members and non-members. The primary outcome variable was being enrolled or n…
Evolution of the nutritional status and factors associated with undernutrition in children under five of age between 2014 and 2017 in 24 health districts of Burkina Faso
The prevalences of undernutrition in children under five years of age appeared to decrease over the last decade in Burkina Faso. However, the country is now facing new health and security challenges that could threaten this progress. Therefore, it is essential to monitor the evolution of the situation within this specific context. We aimed to assess trends in undernutrition among children under 5 years of age, as well as the factors associated wi…
High coverage and equitable distribution of Covid-19 vaccine uptake in two vulnerable areas in Bangladesh
Bangladesh completed a primary series of COVID-19 vaccinations for about 86 individuals per 100 population as of 5 July 2023. However, ensuring higher coverage in vulnerable areas is challenging. We report on the COVID-19 vaccine uptake and associated factors among adults in two vulnerable areas in Bangladesh. We conducted a cross-sectional study between August and September 2022 in Duaripara, a slum in northeast Dhaka (in-migration site), and Ta…
Determinants of outpatient healthcare-seeking behaviors among the rural poor affected by chronic conditions in India
BACKGROUND: A rising burden of chronic non-communicable diseases (CNCDs) increases demand for outpatient healthcare. Yet, evidence on preferences and barriers to healthcare services for India's most disadvantaged population, the target of India's largest public health insurance scheme (PM-JAY), is lacking. OBJECTIVE: We explore determinants of outpatient healthcare-seeking behavior among PM-JAY eligible individuals with CNCDs in rural areas of se…
Does health insurance coverage improve cardiometabolic risk factor levels? Quasi-experimental evidence from India
Background Chronic conditions cause notable health and economic burdens. While health insurance enables access to healthcare, its effects on chronic care outcomes remain under-explored.Objective To examine the association between health insurance coverage and cardiometabolic risk factors among people with chronic conditions in India.Methods Data from the Centre for Cardiometabolic Risk Reduction in South Asia (CARRS) and Solan studies, including …
The evolution of facility-based deliveries at primary healthcare centres during an insecurity and conflict crisis in Burkina Faso
This research provides crucial insights for strengthening Burkina Faso's health system resilience to conflict by spatially identifying how facility characteristics and geo-spatial determinants shape healthcare disruptions. Mapping these elements at a fine scale enables adaptive policy interventions and dynamic resource allocation based on evolving conflict dynamics, enhancing obstetric care during conflict. By integrating the applied geospatial m…
It is because we women do not have a voice to be heard” - perceptions of gender-based discrimination and its relevance to health
Gender-based discrimination (GBD) remains a pervasive determinant of health inequity for women globally, yet its systemic and culturally embedded forms in low- and middle-income countries are underexplored. This study explores women’s lived experiences of GBD in Burkina Faso, Ghana and Tanzania, highlighting how intersecting social and institutional norms influence access to health care, education, employment, financial resources and the resultin…
Do free healthcare policies play a role in expanding national health insurance enrollment among informal sector workers? The case of the Afya Care pilot program in Kenya
Several Sub-Saharan African countries have transitioned from fiscally unsustainable free healthcare policies to national health insurance schemes. These national schemes often expect informal sector workers to contribute directly to the scheme. Although enrollment in the national scheme is critical to achieving universal health coverage, informal sector workers’ inclusion remains challenging. In this paper, using the case of the Afya-Care free he…
Association between self-reported gender-based discrimination and maternal mortality rates
Sub-Saharan Africa suffers from the highest maternal mortality ratio (MMR) in the world, with 542 deaths per 100,000 live births in 2017, relative to a global ratio of 211. Reducing gender-based discrimination (GBD) and increasing the empowerment of women and girls have recently been recognized as prerequisites for improving maternal health. Previous studies have shown GBD to result in low utilization of maternal health services and poorer qualit…
Response to the letter ‘Impact of the free health care policies in Burkina Faso
Thit Thit Aye, Hoa Thi Nguyen, Laurène Petitfour, Valéry Ridde, Felix Amberg, Emmanuel Bonnet, Mariam Seynou, Joël Arthur Kiendrébéogo, Manuela De Allegri
Psychological constructs and preferences for a complementary inclusive health insurance
Many low- and middle-income countries are affected by catastrophic health expenditures due to overstretched public health financing, indicating need for complementary inclusive health insurance solutions. Promoting these solutions requires understanding drivers, including psychological determinants, of health insurance purchase. Yet, relevant evidence is lacking. We employed hybrid choice models to analyze discrete choice experiment data and exam…
Using a policy learning lens to understand health financing policy outcomes
INTRODUCTION: Achieving universal health coverage (UHC) through an effective health financing system is a challenge for many low-income countries. Learning is key to success due to many uncertainties and unknowns. Using the case of translating strategic health purchasing into policy and practice in Burkina Faso, our study seeks to understand how policy learning can shape policy processes and outcomes. METHODS: We used a qualitative case study des…
Preferences regarding Covid-19 vaccination among 12,000 adults in China
Understanding public preferences concerning vaccination is critical to inform pandemic response strategies. To investigate Chinese adults’ preferences regarding COVID-19 vaccine attributes, we conducted a cross-sectional online survey in 12,000 Chinese adults in June-July, 2021. Participants were requested to answer a series of discrete choice questions related to hypothetical COVID-19 vaccines. Using mixed logit models, our analysis revealed tha…
How do free healthcare policies impact utilization of maternal and child health services in fragile settings? Evidence from a controlled interrupted time series analysis in Burkina Faso
Burkina Faso has implemented a nationwide free healthcare policy (gratuité) for pregnant and lactating women and children under 5 years since April 2016. Studies have shown that free healthcare policies can increase healthcare service use. However, the emerging coronavirus disease 2019 pandemic, escalating insecurity and the political situation in recent years might have affected the implementation of such policies. No studies have looked at whet…
Un/met
Social health protection policies can contribute to advancing UHC for primary care. However, in our setting, enhancing communication and outreach, addressing gender and age disparities, and improving quality of care and health infrastructure are necessary to fully meet the needs of the poorest populations
Cultural landscape transformations in the "Prosecco hills of Conegliano and Valdobbiadene" Unesco World Heritage Site in the context of terrain morphology
The "Prosecco Hills of Conegliano and Valdobbiadene" has been inscribed in the UNESCO World Heritage List since 2019 under the category “cultural landscapes”. The study analysed land use and landscape changes in the last six decades through spatial analyses and landscape metrics, identifying main changes and comparing similarities and differences between the Core and the Buffer Zone. The main aims were to identify the main drivers that contribute…
Medical treatment loans and their effects on health care utilization and out-of-pocket expenditure
Nutritional status of children under five years and associated factors in 24 districts of Burkina Faso
Malnutrition in children is a serious health problem, especially in Sub-Saharan Africa, with heavy socioeconomic burdens. The prevalence of stunting remains high in Burkina Faso. There is a need to further investigate undernutrition and identify the major factors contributing to its persistence. We aimed to assess the nutritional status of children aged under five years and the associated factors of undernutrition in Burkina Faso. We conducted a …
Awareness of India’s national health insurance scheme (PM-JAY)
The literature suggests that a first barrier towards accessing benefits of health insurance in low- and middle-income countries is lack of awareness of one’s benefits. Yet, across settings and emerging schemes, limited scientific evidence is available on levels of awareness and their determinants. To fill this gap, we assessed socio-demographic and economic determinants of beneficiaries’ awareness of the Pradhan Mantri Jan Arogya Yojana (PM-JAY),…
To enrol or not to enrol
Crowding out or no crowding out? A Self-Determination Theory approach to health worker motivation in performance-based financing
How do diffusion entrepreneurs spread policies? Insights from performance-based financing in Sub-Saharan Africa
Immediate and sustained effects of user fee exemption on healthcare utilization among children under five in Burkina Faso
The money can be a motivator, to me a little, but mostly PBF just helps me to do better in my job.’ An exploration of the motivational mechanisms of performance-based financing for health workers in M…
Performance-based financing (PBF) is assumed to improve health care delivery by motivating health workers to enhance their work performance. However, the exact motivational mechanisms through which PBF is assumed to produce such changes are poorly understood to date. Although PBF is increasingly recognized as a complex health systems intervention, its motivational effect for individual health workers is still often reduced to financial 'carrots a…
How does performance-based financing affect health workers' intrinsic motivation? A Self-Determination Theory-based mixed-methods study in Malawi
Do community-based health insurance schemes fulfil the promise of equity? A study from Burkina Faso
OBJECTIVE: To examine whether the community-based health insurance (CBHI) scheme in Burkina Faso has been effective in providing equitable healthcare access to poor individuals, women, children and those living far from health facilities. METHODS: We used the Nouna Health District Household Survey to collect panel data on 990 households during 2004-08. By applying a series of random effects regressions and using concentration curves, we first stu…
Eliciting community preferences for complementary micro health insurance
The unintended consequences of community verifications for performance-based financing in Burkina Faso
Performance-based financing (PBF) is being widely implemented to improve healthcare services in Africa. An essential component of PBF involves conducting community verifications, wherein investigators from local associations attempt to trace samples of patients. Community surveys are administered to patients to verify whether healthcare workers reported fictitious services to increase their revenue. At the same time, client satisfaction surveys a…
Preferences for long-term care insurance in China
Rapid population aging has led countries to consider the introduction of long-term care insurance (LTCI) as an essential component of a comprehensive social health protection package. Limited evidence, however, exists on people's preferences for such insurance products, especially in countries where their availability is still restricted. Using a discrete choice experiment (DCE), we investigated preferences, willingness to pay, and heterogeneity …
Illness reporting and demand for medical care in rural Burkina Faso
Why did performance-based financing in Burkina Faso fail to achieve the intended equity effects? A process tracing study
In recent years, performance-based financing (PBF) has attracted attention as a means of reforming provider payment mechanisms in low- and middle-income countries. Particularly in combination with demand-side interventions, PBF has been assumed to benefit also the most vulnerable and disadvantaged groups. However, impact evaluations have often found this not to be the case. In Burkina Faso, PBF was coupled with specific equity measures to enhance…
The impact of reducing and eliminating user fees on facility-based delivery
User fee reduction and removal policies have been the object of extensive research, but little rigorous evidence exists on their sustained effects in relation to use of delivery care services, and no evidence exists on the effects of partial reduction compared with full removal of user fees. We aimed to fill these knowledge gaps by assessing sustained effects of both partial reduction and complete removal of user fees on utilization of facility-b…
Health seeking behaviour and the related household out-of-pocket expenditure for chronic non-communicable diseases in rural Malawi
Malawi is facing a rising chronic non-communicable disease (CNCD) epidemic. This study explored health seeking behaviour and related expenditure on CNCDs in rural Malawi, with specific focus on detecting potential differences across population groups. We used data from the first round of a panel household health survey conducted in rural Malawi between August and October 2012 on a sample of 1199 households. Multinomial logistic regression was use…
What happens when performance-based financing meets free healthcare? Evidence from an interrupted time-series analysis
In spite of the wide attention performance-based financing (PBF) has received over the past decade, no evidence is available on its impacts on quantity and mix of service provision nor on its interaction with parallel health financing interventions. Our study aimed to examine the PBF impact on quantity and mix of service provision in Burkina Faso, while accounting for the parallel introduction of a free healthcare policy. We used Health Managemen…
No effects of pilot performance-based intervention implementation and withdrawal on the coverage of maternal and child health services in the Koulikoro region, Mali
Performance-based financing (PBF) has been promoted and increasingly implemented across low- and middle-income countries to increase the utilization and quality of primary health care. However, the evidence of the impact of PBF is mixed and varies substantially across settings. Thus, further rigorous investigation is needed to be able to draw broader conclusions about the effects of this health financing reform. We examined the effects of the imp…
From Amsterdam to Bamako
For the past 15 years, several donors have promoted performance-based financing (PBF) in Africa for improving health services provision. European and African experts known as ‘diffusion entrepreneurs’ (DEs) assist with PBF pilot testing. In Mali, after participating in a first pilot PBF in 2012–13, the Ministry of Health and Public Hygiene included PBF in its national strategic plan. It piloted this strategy again in 2016–17. We investigated the …
How does performance-based financing affect the availability of essential medicines in Cameroon? A qualitative study
Performance-based financing (PBF) is being implemented across low- and middle-income countries to improve the availability and quality of health services, including medicines. Although a few studies have examined the effects of PBF on the availability of essential medicines (EMs) in low- and middle-income countries, there is limited knowledge of the mechanisms underlying these effects. Our research aimed to explore how PBF in Cameroon influenced …
What factors drive heterogeneity of preferences for micro-health insurance in rural Malawi
Investigating the factors that drive differences in preferences for health insurance products among rural populations is a relevant policy issue that has so far received little attention. This study used a discrete choice experiment to explore heterogeneity of preferences for a prospective micro-health insurance (MHI) product in Malawi. Through an extensive qualitative study, six attributes, each associated with three levels, were derived and use…
Antenatal Care Services in Rural Uganda
Experience from countries that have achieved low maternal mortality suggests that access to good-quality maternity services is critical to improve maternal health. In this article we appraise the quality of antenatal care (ANC) services in a rural district of Uganda. We used a mixed methods approach, relying on a combination of semistructured interviews with both clients and providers, structured observations of provider-patient interactions, and…
Comparative cost analysis of insecticide-treated net delivery strategies
Insecticide-treated nets (ITNs) are effective in substantially reducing malaria transmission. Still, ITN coverage in sub-Saharan Africa (SSA) remains extremely low. Policy makers are concerned with identifying the most suitable delivery mechanism to achieve rapid yet sustainable increases in ITN coverage. Little is known, however, on the comparative costs of alternative ITN distribution strategies. This paper aimed to fill this gap in knowledge b…
To enrol or not to enrol
A qualitative investigation into knowledge, beliefs, and practices surrounding mastitis in sub-Saharan Africa
Health problems related to breastfeeding are perceived to be very common in rural Burkina Faso. Further epidemiological research to assess the actual prevalence of such pathologies is urgently needed to inform the design of adequate control measures, especially given the impact of mastitis on HIV vertical transmission. Our investigation into local illness concepts and health care seeking behaviour is useful to ensure that such measures be cultura…
Comparative cost analysis of insecticide-treated net delivery strategies
Insecticide-treated nets (ITNs) are effective in substantially reducing malaria transmission. Still, ITN coverage in sub-Saharan Africa (SSA) remains extremely low. Policy makers are concerned with identifying the most suitable delivery mechanism to achieve rapid yet sustainable increases in ITN coverage. Little is known, however, on the comparative costs of alternative ITN distribution strategies. This paper aimed to fill this gap in knowledge b…
Illness reporting and demand for medical care in rural Burkina Faso
Antenatal Care Services in Rural Uganda
Experience from countries that have achieved low maternal mortality suggests that access to good-quality maternity services is critical to improve maternal health. In this article we appraise the quality of antenatal care (ANC) services in a rural district of Uganda. We used a mixed methods approach, relying on a combination of semistructured interviews with both clients and providers, structured observations of provider-patient interactions, and…
Effects of information, education, and communication campaign on a community-based health insurance scheme in Burkina Faso
OBJECTIVE: The study analysed the effect of Information, Education, and Communication (IEC) campaign activities on the adoption of a community-based health insurance (CHI) scheme in Nouna, Burkina Faso. It also identified the factors that enhanced or limited the campaign's effectiveness. DESIGN: Complementary data collection approaches were used. A survey was conducted with 250 randomly selected household heads, followed by in-depth interviews wi…
The Impact of Health Insurance Programs on Out-of-Pocket Expenditures in Indonesia
We used panel data from the Indonesian Family Life Survey to investigate the impact of health insurance programs on reducing out-of-pocket expenditures. We employed three linear panel data models, two of which accounted for endogeneity: pooled ordinary least squares (OLS), pooled two-stage least squares (2SLS) for instrumental variable (IV), and fixed effects (FE). The study revealed that two health insurance programs had a significantly negative…
Do community-based health insurance schemes fulfil the promise of equity? A study from Burkina Faso
OBJECTIVE: To examine whether the community-based health insurance (CBHI) scheme in Burkina Faso has been effective in providing equitable healthcare access to poor individuals, women, children and those living far from health facilities. METHODS: We used the Nouna Health District Household Survey to collect panel data on 990 households during 2004-08. By applying a series of random effects regressions and using concentration curves, we first stu…
Eliciting community preferences for complementary micro health insurance
Factors affecting adoption, implementation fidelity, and sustainability of the Redesigned Community Health Fund in Tanzania
BACKGROUND: Despite the implementation of various initiatives to address low enrollment in voluntary micro health insurance (MHI) schemes in sub-Saharan Africa, the problem of low enrollment remains unresolved. The lack of process evaluations of such interventions makes it difficult to ascertain whether their poor results are because of design failures or implementation weaknesses. OBJECTIVE: In this paper, we describe a process evaluation protoc…
Health insurance and child mortality in rural Burkina Faso
BACKGROUND: Micro health insurance schemes have been implemented across developing countries as a means of facilitating access to modern medical care, with the ultimate aim of improving health. This effect, however, has not been explored sufficiently. OBJECTIVE: We investigated the effect of enrolment into community-based health insurance on mortality in children under 5 years of age in a health and demographic surveillance system in Nouna, Burki…
Universal health coverage from multiple perspectives
BACKGROUND: There is an emerging global consensus on the importance of universal health coverage (UHC), but no unanimity on the conceptual definition and scope of UHC, whether UHC is achievable or not, how to move towards it, common indicators for measuring its progress, and its long-term sustainability. This has resulted in various interpretations of the concept, emanating from different disciplinary perspectives. This paper discusses the variou…
Insecticide-treated mosquito nets in rural Burkina Faso
Insecticide-treated mosquito nets (ITNs) are an essential tool of the Roll Back Malaria strategy. An increasing number of African countries have embarked on mass distribution campaigns of long-lasting insecticide-treated nets (LLINs) with the ultimate goal of universal coverage. Such a national campaign with the goal of one ITN for every two people has been conducted in Burkina Faso in 2010. Our aim was to assess the coverage and equity effect of…
Health seeking behaviour and the related household out-of-pocket expenditure for chronic non-communicable diseases in rural Malawi
Malawi is facing a rising chronic non-communicable disease (CNCD) epidemic. This study explored health seeking behaviour and related expenditure on CNCDs in rural Malawi, with specific focus on detecting potential differences across population groups. We used data from the first round of a panel household health survey conducted in rural Malawi between August and October 2012 on a sample of 1199 households. Multinomial logistic regression was use…
What factors drive heterogeneity of preferences for micro-health insurance in rural Malawi
Investigating the factors that drive differences in preferences for health insurance products among rural populations is a relevant policy issue that has so far received little attention. This study used a discrete choice experiment to explore heterogeneity of preferences for a prospective micro-health insurance (MHI) product in Malawi. Through an extensive qualitative study, six attributes, each associated with three levels, were derived and use…
Crowding out or no crowding out? A Self-Determination Theory approach to health worker motivation in performance-based financing
The unintended consequences of community verifications for performance-based financing in Burkina Faso
Performance-based financing (PBF) is being widely implemented to improve healthcare services in Africa. An essential component of PBF involves conducting community verifications, wherein investigators from local associations attempt to trace samples of patients. Community surveys are administered to patients to verify whether healthcare workers reported fictitious services to increase their revenue. At the same time, client satisfaction surveys a…
Immediate and sustained effects of user fee exemption on healthcare utilization among children under five in Burkina Faso
“I wanted a skeleton … they brought a prince”
While several evaluations have examined the extent to which performance based financing (PBF) programs induce changes in the quantity and quality of health services provided, less is known about the process of implementing PBF. We conducted a process evaluation of a PBF intervention in Malawi that focused on understanding moderators of program implementation. Informed by a seminal theory of implementation, we first created a timeline and taxonomy…
Street-level workers’ inadequate knowledge and application of exemption policies in Burkina Faso jeopardize the achievement of universal health coverage
This quantitative study confirmed earlier qualitative results on the importance of training and informing health workers and monitoring the measures targeting equity, to ensure compliance with government directives. The local context (e.g., hierarchy, health system, interventions) and the ideas that street-level workers have about the policy instruments can influence their effective implementation. Methods for remunerating health workers and heal…
Inequities and their determinants in coverage of maternal health services in Burkina Faso
Existing inequities in maternal health services in Burkina Faso are likely going to jeopardize the achievement of Universal Health Coverage. It is important that policy makers continue to strengthen and monitor the implementation of strategies that promote proportionate universalism and forge multi-sectoral approach in dealing with social determinants of inequities in maternal health services coverage
The unintended consequences of combining equity measures with performance-based financing in Burkina Faso
The severity of unintended consequences undermined the effectiveness and equity of the intervention. If the intervention is prolonged and expanded, decision-makers and implementers will have to address these unintended consequences to reduce inequities in accessing care
An Evaluation of Healthcare Use and Child Morbidity 4 Years After User Fee Removal in Rural Burkina Faso
Objectives Increasing financial access to healthcare is proposed to being essential for improving child health outcomes, but the available evidence on the relationship between increased access and health remains scarce. Four years after its launch, we evaluated the contextual effect of user fee removal intervention on the probability of an illness occurring and the likelihood of using health services among children under 5. We also explored the p…
How far is mixed methods research in the field of health policy and systems in Africa? A scoping review
Both the academic and the policy community are calling for wider application of mixed methods research, suggesting that combined use of quantitative and qualitative methods is most suitable to assess and understand the complexities of health interventions. In spite of recent growth in mixed methods studies, limited efforts have been directed towards appraising and synthetizing to what extent and how mixed methods have been applied specifically to…
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