Tim Ensor
Biographic Data
| ID | 1446383 |
|---|---|
| NAME | Tim Ensor |
| GIVEN NAMES | Tim |
| FAMILY NAME | Ensor |
| SIGNATURE | ENSOR T |
| AFFILIATIONS | University of Leeds |
| ORCID | 0000-0003-0279-9576 |
| VERIFIED | Yes |
| TOTAL WORKS | 34 |
| TOTAL CITATIONS | 154 |
| AUTHOR COUNT | 34 |
| EDITOR COUNT | 0 |
| FIRST PUBLICATION YEAR | 1991 |
| LATEST PUBLICATION YEAR | 2025 |
| H-INDEX | 4 |
School-based smoking prevention strategies for adolescents in a conservative LMIC context
Objective: Adolescent smoking is a critical form of psychoactive substance misuse, particularly in low- and middle-income countries like Egypt, where youth tobacco use remains a public health concern. This study explored current and potential school-based smoking prevention interventions in a conservative low- and middle-income country context, to identify strategies which enhance adolescents' capability, opportunity, and motivation to avoid smok…
Engaging rural communities in Bangladesh to address antimicrobial resistance via the community dialogue approach
Introduction: To effectively tackle antibiotic resistance (ABR) a One Health approach is required, focusing on the human, animal and environmental sectors together, and that public education and engagement programs must be part of the overall approach. However, there has been limited research on such programs in low-/middle-income countries (LMICs). Here we describe our plans to evaluate a community-engagement program, known as the community dial…
Health facility capacity and technical efficiency in the provision of adolescent sexual and reproductive health services in Niger
There is much room for improving the efficient use of financial and other resources in primary healthcare facilities that provide ASRH in Niger. Potential interventions include giving women more responsibility for these facilities and strengthening the ASRH production capacity of these facilities
Informal–Formal Healthcare Services Delivery Nexus in Nigeria’s Urban Slums
Urban slums are human habitats with poor habitation qualities that are vulnerable to infectious diseases and public health crises. Low coverage from formal healthcare services providers created opportunity for informal providers to thrive in urban slums. This study examined the nature of relationship between informal and formal healthcare services providers in urban slums and explored opportunities for strengthening collaborations between them. R…
The Role of the Private Sector in the Covid-19 Pandemic
As societies urbanize, their populations have become increasingly dependent on the private sector for essential services. The way the private sector responds to health emergencies such as the COVID-19 pandemic can determine the health and economic wellbeing of urban populations, an effect amplified for poorer communities. Here we present a qualitative document analysis of media reports and policy documents in four low resource settings-Bangladesh…
Powers, engagements and resultant influences over the design and implementation of medicine pricing policies in Ghana
INTRODUCTION: Universal availability and affordability of essential medicines are determined by effective design and implementation of relevant policies, typically involving multiple stakeholders. This paper examined stakeholder engagements, powers and resultant influences over design and implementation of four medicines pricing policies in Ghana: Health Commodity Supply Chain Master Plan, framework contracting for high demand medicines, Value Ad…
Role of trust in sustaining provision and uptake of maternal and child healthcare
Despite increasing attention to implementation research in global health, evidence from low- and middle-income countries (LMICs) using realist evaluations, in understanding how complex health programmes work remains limited. This paper contributes to bridging this knowledge gap by reporting how, why and in what circumstances, the implementation and subsequent termination of a maternal and child health programme affected the trust of service users…
Influence of Conditional Cash Transfers on the Uptake of Maternal and Child Health Services in Nigeria
Background: Increasing access to maternal and child health (MCH) services is crucial to achieving universal health coverage (UHC) among pregnant women and children under-five (CU5). The Nigerian government between 2012 and 2015 implemented an innovative MCH programme to reduce maternal and CU5 mortality by reducing financial barriers of access to essential health services. The study explores how the implementation of a financial incentive through…
Was the Maternal Health Cash Transfer Programme in Nigeria Sustainable and Cost-Effective
Background: The Subsidy Reinvestment and Empowerment Programme (SURE-P), Maternal and Child Health (MCH) was introduced by the Nigerian government to increase the use of skilled maternal health services and reduce maternal mortality. The programme, funded out of a reduction in the fuel subsidy, was implemented between October 2012 and April 2015 and incorporated a conditional cash transfer to women to encourage use of facility based maternal serv…
Which mechanisms explain the motivation of primary health workers? Insights from the realist evaluation of a maternal and child health programme in Nigeria
INTRODUCTION: Well-trained, adequately skilled and motivated primary healthcare (PHC) workers are essential for attaining universal health coverage (UHC). While there is abundant literature on the drivers of workforce motivation, published knowledge on the mechanisms of motivation within different contexts is limited, particularly in resource-limited countries. This paper contributes to health workforce literature by reporting on how motivation w…
We shouldn’t count chickens before they hatch
Results-based financing (RBF) is subject to fierce debate and the evidence-base on its cost effectiveness is scarce. To our knowledge, only one cost-effectiveness study of RBF in a lower-middle income country has been published in a peer reviewed journal. That study – in Zambia – concludes that RBF is cost-effective, which was then uncritically repeated in an editorial accompanying its release. Here we would like to warn against readily accepting…
Addressing Unintentional Exclusion of Vulnerable and Mobile Households in Traditional Surveys in Kathmandu, Dhaka, and Hanoi
The methods used in low- and middle-income countries' (LMICs) household surveys have not changed in four decades; however, LMIC societies have changed substantially and now face unprecedented rates of urbanization and urbanization of poverty. This mismatch may result in unintentional exclusion of vulnerable and mobile urban populations. We compare three survey method innovations with standard survey methods in Kathmandu, Dhaka, and Hanoi and summ…
Tracing theories in realist evaluations of large-scale health programmes in low- and middle-income countries
Realist evaluations (RE) are increasingly popular in assessing health programmes in low- and middle-income countries (LMICs). This article reflects on processes of gleaning, developing, testing, consolidating and refining two programme theories (PTs) from a longitudinal mixed-methods RE of a national maternal and child health programme in Nigeria. The two PTs, facility security and patient–provider trust, represent complex and diverse issues: tru…
Nutrition transition, overweight and obesity among rural-to-urban migrant women in Kenya
Objective: To assess the effect of rural-to-urban migration on nutrition transition and overweight/obesity risk among women in Kenya. Design: Secondary analysis of data from nationally representative cross-sectional samples. Outcome variables were women’s BMI and nutrition transition. Nutrition transition was based on fifteen different household food groups and was adjusted for socio-economic and demographic characteristics. Stepwise backward mul…
Changes in catastrophic health expenditure in post-conflict Sierra Leone
The findings support the need to continue expanding current demand-side policies in Sierra Leone to reduce the financial risk of exposure to ill health
Socio-economic inequalities in access to maternal and child healthcare in Nigeria
This article examines socioeconomic inequalities in maternal and child health care in Nigeria over an 18-year period. Studies demonstrate that maternal and child mortality is much higher amongst the poor in low-income countries, with access to health care concentrated among the wealthiest. Evidence suggests that in Nigeria inequalities in access to quality services continue to persist. We use data from two rounds of the Nigerian Demographic and H…
Impact of health financing policies in Cambodia
Improving financial access to services is an essential part of extending universal health coverage in low resource settings. In Cambodia, high out of pocket spending and low levels of utilisation have impeded the expansion of coverage and improvement in health outcomes. For twenty years a series of health financing policies have focused on mitigating costs to increase access particularly by vulnerable groups. Demand side financing policies includ…
How to (or not to) … measure performance against the Abuja target for public health expenditure
In 2001, African heads of state committed ‘to set a target of allocating at least 15% of our annual budget to the improvement of the health sector’. This target has since been used as a benchmark to hold governments accountable. However, it was never followed by a set of guidelines as to how it should be measured in practice. This article sets out some of the areas of ambiguity and argues for an interpretation which focuses on actual expenditure,…
Knowledgeable antenatal care as a pathway to skilled delivery
The link between antenatal care (ANC) and facility delivery is a specific example of the effect of early medical contacts on later use of essential services. The role of ANC in improving maternal health remains unclear. High levels of ANC are reported in a number of countries where skilled delivery remains uncommon. ANC may influence the use of services by increasing willingness to use services and educating about maternal health. The objective o…
Can community level interventions have an impact on equity and utilization of maternal health care” – Evidence from rural Bangladesh
To sustain equity in health care utilization, the IMNCS programme needs to continue providing free home based services. In addition to this, the programme should also continue to provide funding to bear the cost to those mothers who are not able to have the comprehensive ANC from medically trained providers
Thank You to Reviewers 2012
The impact of economic recession on maternal and infant mortality
The data presented suggest that recessions do have a negative association with maternal and infant outcomes particularly in earlier stages of a country's development although the effects vary widely across different systems. Almost all of the 20 least wealthy countries have suffered a reduction of 10% or more in GDP per capita in at least one of the last five decades. The challenge for today's policy makers is the design and implementation of mec…
Expenditure on obstetric care and the protective effect of insurance on the poor
OBJECTIVE: The Indonesian Government recently introduced a health insurance scheme to improve access to care for the poor. We investigated the payments made by households for different types of obstetric care, the economic consequences of payments and the effects of the new insurance on that expenditure. METHODS: Expenditures on obstetric care for women were collected from three main hospitals in the Serang and Pandeglang districts of Banten Prov…
Level and determinants of incentives for village midwives in Indonesia
Since the early 1990s Indonesia has attempted to increase the level of skilled attendance at birth by placing rural midwives in every village in an effort to reduce persistently high levels of maternal mortality. Yet evidence suggests that there remains insufficient incentive to ensure an equal distribution across areas while the poor in all areas continue to access skilled attendance much less than those in richer groups. We report on a survey t…
Regulating health care in low- and middle-income countries
Overcoming barriers to health service access
Evidence suggests that demand-side barriers may be as important as supply factors in deterring patients from obtaining treatment. Yet relatively little attention is given, either by policy makers or researchers, to ways of minimizing their effect. These barriers are likely to be more important for the poor and other vulnerable groups, where the costs of access, lack of information and cultural barriers impede them from benefiting from public spen…
Informal payments for health care in transition economies
Impact of health financing policies in Cambodia
Improving financial access to services is an essential part of extending universal health coverage in low resource settings. In Cambodia, high out of pocket spending and low levels of utilisation have impeded the expansion of coverage and improvement in health outcomes. For twenty years a series of health financing policies have focused on mitigating costs to increase access particularly by vulnerable groups. Demand side financing policies includ…
Developing health insurance in transitional Asia
Role of trust in sustaining provision and uptake of maternal and child healthcare
Despite increasing attention to implementation research in global health, evidence from low- and middle-income countries (LMICs) using realist evaluations, in understanding how complex health programmes work remains limited. This paper contributes to bridging this knowledge gap by reporting how, why and in what circumstances, the implementation and subsequent termination of a maternal and child health programme affected the trust of service users…
Addressing Unintentional Exclusion of Vulnerable and Mobile Households in Traditional Surveys in Kathmandu, Dhaka, and Hanoi
The methods used in low- and middle-income countries' (LMICs) household surveys have not changed in four decades; however, LMIC societies have changed substantially and now face unprecedented rates of urbanization and urbanization of poverty. This mismatch may result in unintentional exclusion of vulnerable and mobile urban populations. We compare three survey method innovations with standard survey methods in Kathmandu, Dhaka, and Hanoi and summ…
Knowledgeable antenatal care as a pathway to skilled delivery
The link between antenatal care (ANC) and facility delivery is a specific example of the effect of early medical contacts on later use of essential services. The role of ANC in improving maternal health remains unclear. High levels of ANC are reported in a number of countries where skilled delivery remains uncommon. ANC may influence the use of services by increasing willingness to use services and educating about maternal health. The objective o…
Tracing theories in realist evaluations of large-scale health programmes in low- and middle-income countries
Realist evaluations (RE) are increasingly popular in assessing health programmes in low- and middle-income countries (LMICs). This article reflects on processes of gleaning, developing, testing, consolidating and refining two programme theories (PTs) from a longitudinal mixed-methods RE of a national maternal and child health programme in Nigeria. The two PTs, facility security and patient–provider trust, represent complex and diverse issues: tru…
Socio-economic inequalities in access to maternal and child healthcare in Nigeria
This article examines socioeconomic inequalities in maternal and child health care in Nigeria over an 18-year period. Studies demonstrate that maternal and child mortality is much higher amongst the poor in low-income countries, with access to health care concentrated among the wealthiest. Evidence suggests that in Nigeria inequalities in access to quality services continue to persist. We use data from two rounds of the Nigerian Demographic and H…
Expenditure on obstetric care and the protective effect of insurance on the poor
OBJECTIVE: The Indonesian Government recently introduced a health insurance scheme to improve access to care for the poor. We investigated the payments made by households for different types of obstetric care, the economic consequences of payments and the effects of the new insurance on that expenditure. METHODS: Expenditures on obstetric care for women were collected from three main hospitals in the Serang and Pandeglang districts of Banten Prov…
The evaluation of nutritional problems and policy
The plethora of conflicting nutritional advice and opinion makes it especially important that the consequences of any nutrition policy be carefully evaluated, Simply restricting an individual's ability to choose a harmful food will not necessarily increase welfare if the choice is made in full knowledge of the harm it might cause. Economics can contribute to this evaluation by analysing nutritional problems within a framework that considers the p…
Regulating tobacco consumption in developing countries
The tobacco industry is becoming more concerned to expand its markets as traditional consumers in industrialized countries become aware of the health hazards of smoking. As incomes increase in developing countries, these areas become the focus of attempts by the industry to stimulate consumption. It is therefore imperative to target policy so that it achieves maximum effectiveness before the cigarette habit becomes too entrenched. This paper exam…
Informal payments for health care in the former Soviet Union
An important feature of the health care system of the Former Soviet Union (FSU) and Central and Eastern Europe is the presence of informal or under-the-table payments. It is generally accepted that these represent a significant contribution to the income of medical staff. Discussions with medical practitioners suggest that for certain specialities in certain hospitals a doctor might obtain many times his official income. Yet little empirical work…
Developing health insurance in transitional Asia
Do essential service packages benefit the poor? Preliminary evidence from Bangladesh
In 1998 Bangladesh began a sector wide approach (SWAp) to the extension of health care to vulnerable groups in the country. The central feature of this approach is the funding of an essential service package (ESP) emphasizing maternal care, certain communicable diseases and child health. This study examines the way in which public sector expenditures are distributed by comparing the actual beneficiaries of spending with the target groups identifi…
Overcoming barriers to health service access
Evidence suggests that demand-side barriers may be as important as supply factors in deterring patients from obtaining treatment. Yet relatively little attention is given, either by policy makers or researchers, to ways of minimizing their effect. These barriers are likely to be more important for the poor and other vulnerable groups, where the costs of access, lack of information and cultural barriers impede them from benefiting from public spen…
Informal payments for health care in transition economies
Mobilising financial resources for maternal health
Regulating health care in low- and middle-income countries
Roundtable
MOTHERS are still dying during childbirth in your country. We write to you for this reason and because this is a crucial year for accelerating progress towards the Millennium Development Goal for maternal mortality - a three-quarters reduction by 2015. Over 99% of the worlds maternal deaths occur in developing countries. The women dying are in their prime of life: they are crucial to society and the economy; they sustain the next generation; they…
Level and determinants of incentives for village midwives in Indonesia
Since the early 1990s Indonesia has attempted to increase the level of skilled attendance at birth by placing rural midwives in every village in an effort to reduce persistently high levels of maternal mortality. Yet evidence suggests that there remains insufficient incentive to ensure an equal distribution across areas while the poor in all areas continue to access skilled attendance much less than those in richer groups. We report on a survey t…
The impact of economic recession on maternal and infant mortality
The data presented suggest that recessions do have a negative association with maternal and infant outcomes particularly in earlier stages of a country's development although the effects vary widely across different systems. Almost all of the 20 least wealthy countries have suffered a reduction of 10% or more in GDP per capita in at least one of the last five decades. The challenge for today's policy makers is the design and implementation of mec…
Expenditure on obstetric care and the protective effect of insurance on the poor
OBJECTIVE: The Indonesian Government recently introduced a health insurance scheme to improve access to care for the poor. We investigated the payments made by households for different types of obstetric care, the economic consequences of payments and the effects of the new insurance on that expenditure. METHODS: Expenditures on obstetric care for women were collected from three main hospitals in the Serang and Pandeglang districts of Banten Prov…
Can community level interventions have an impact on equity and utilization of maternal health care” – Evidence from rural Bangladesh
To sustain equity in health care utilization, the IMNCS programme needs to continue providing free home based services. In addition to this, the programme should also continue to provide funding to bear the cost to those mothers who are not able to have the comprehensive ANC from medically trained providers
Thank You to Reviewers 2012
How to (or not to) … measure performance against the Abuja target for public health expenditure
In 2001, African heads of state committed ‘to set a target of allocating at least 15% of our annual budget to the improvement of the health sector’. This target has since been used as a benchmark to hold governments accountable. However, it was never followed by a set of guidelines as to how it should be measured in practice. This article sets out some of the areas of ambiguity and argues for an interpretation which focuses on actual expenditure,…
Knowledgeable antenatal care as a pathway to skilled delivery
The link between antenatal care (ANC) and facility delivery is a specific example of the effect of early medical contacts on later use of essential services. The role of ANC in improving maternal health remains unclear. High levels of ANC are reported in a number of countries where skilled delivery remains uncommon. ANC may influence the use of services by increasing willingness to use services and educating about maternal health. The objective o…
Changes in catastrophic health expenditure in post-conflict Sierra Leone
The findings support the need to continue expanding current demand-side policies in Sierra Leone to reduce the financial risk of exposure to ill health
Socio-economic inequalities in access to maternal and child healthcare in Nigeria
This article examines socioeconomic inequalities in maternal and child health care in Nigeria over an 18-year period. Studies demonstrate that maternal and child mortality is much higher amongst the poor in low-income countries, with access to health care concentrated among the wealthiest. Evidence suggests that in Nigeria inequalities in access to quality services continue to persist. We use data from two rounds of the Nigerian Demographic and H…
Impact of health financing policies in Cambodia
Improving financial access to services is an essential part of extending universal health coverage in low resource settings. In Cambodia, high out of pocket spending and low levels of utilisation have impeded the expansion of coverage and improvement in health outcomes. For twenty years a series of health financing policies have focused on mitigating costs to increase access particularly by vulnerable groups. Demand side financing policies includ…
Nutrition transition, overweight and obesity among rural-to-urban migrant women in Kenya
Objective: To assess the effect of rural-to-urban migration on nutrition transition and overweight/obesity risk among women in Kenya. Design: Secondary analysis of data from nationally representative cross-sectional samples. Outcome variables were women’s BMI and nutrition transition. Nutrition transition was based on fifteen different household food groups and was adjusted for socio-economic and demographic characteristics. Stepwise backward mul…
Was the Maternal Health Cash Transfer Programme in Nigeria Sustainable and Cost-Effective
Background: The Subsidy Reinvestment and Empowerment Programme (SURE-P), Maternal and Child Health (MCH) was introduced by the Nigerian government to increase the use of skilled maternal health services and reduce maternal mortality. The programme, funded out of a reduction in the fuel subsidy, was implemented between October 2012 and April 2015 and incorporated a conditional cash transfer to women to encourage use of facility based maternal serv…
Which mechanisms explain the motivation of primary health workers? Insights from the realist evaluation of a maternal and child health programme in Nigeria
INTRODUCTION: Well-trained, adequately skilled and motivated primary healthcare (PHC) workers are essential for attaining universal health coverage (UHC). While there is abundant literature on the drivers of workforce motivation, published knowledge on the mechanisms of motivation within different contexts is limited, particularly in resource-limited countries. This paper contributes to health workforce literature by reporting on how motivation w…
We shouldn’t count chickens before they hatch
Results-based financing (RBF) is subject to fierce debate and the evidence-base on its cost effectiveness is scarce. To our knowledge, only one cost-effectiveness study of RBF in a lower-middle income country has been published in a peer reviewed journal. That study – in Zambia – concludes that RBF is cost-effective, which was then uncritically repeated in an editorial accompanying its release. Here we would like to warn against readily accepting…
Addressing Unintentional Exclusion of Vulnerable and Mobile Households in Traditional Surveys in Kathmandu, Dhaka, and Hanoi
The methods used in low- and middle-income countries' (LMICs) household surveys have not changed in four decades; however, LMIC societies have changed substantially and now face unprecedented rates of urbanization and urbanization of poverty. This mismatch may result in unintentional exclusion of vulnerable and mobile urban populations. We compare three survey method innovations with standard survey methods in Kathmandu, Dhaka, and Hanoi and summ…
Economics (26 works) · Economic growth (24 works) · Business (22 works) · Global Maternal and Child Health (22 works) · Health care (16 works) · Healthcare Systems and Reforms (16 works) · Medicine (16 works) · Global Health Care Issues (12 works) · Political science (12 works) · Environmental health (10 works)