Evidence & Gap Maps: A tool for promoting evidence informed policy and strategic research agendas.

A range of organizations are engaged in the production of evidence on the effects of health, social, and economic development programs on human welfare outcomes. However, evidence is often scattered around different databases, web sites, and the gray literature and is often presented in inaccessible formats. Lack of overview of the evidence in a specific field can be a barrier to the use of existing research and prevent efficient use of limited resources for new research. Evidence & Gap Maps (EGMs) aim to address these issues and complement existing synthesis and mapping approaches. EGMs are a new addition to the tools available to support evidence-informed policymaking. To provide an accessible resource for researchers, commissioners, and decision makers, EGMs provide thematic collections of evidence structured around a framework which schematically represents the types of interventions and outcomes of relevance to a particular sector. By mapping the existing evidence using this framework, EGMs provide a visual overview of what we know and do not know about the effects of different programs. They make existing evidence available, and by providing links to user-friendly summaries of relevant studies, EGMs can facilitate the use of existing evidence for decision making. They identify key "gaps" where little or no evidence from impact evaluations and systematic reviews is available and can be a valuable resource to inform a strategic approach to building the evidence base in a particular sector. The article will introduce readers to the concept and methods of EGMs and present a demonstration of the EGM tool using existing examples.

A private hospital-based study assessing knowledge, attitudes, practices and costs associated with dengue illness in Surat, India.

We conducted a descriptive cross-sectional study at a private children’s and general hospital in Surat,India, during the 2006 dengue season (June to December 2006). We examined knowledge, attitudes and practices of patients associated with dengue and estimated the cost of a dengue episode for the study sample. Of 62 patients with suspected dengue, 40 consented to participate in this study. We interviewed 27 retrospectively in their homes and 13 prospectively during their hospitalization. Among the respondents, 75% were male, 85% were under the age of 14, 63% reported familiarity with dengue, but only 25% correctly knew that clean stagnant water is a breeding place for the dengue vector, and 23% did not know the mode of transmission for dengue infection. While 78% said that they take preventive steps against dengue, only 48% believed dengue to be a preventable illness. There was no significant relationship between their knowledge and prevention practices. Economic costs were measured in 2007 US dollars. For an average dengue episode, the mean costs were US$ 439.44 for direct medical care and US$ 146.13 for indirect costs, with a total cost of US$ 585.57. The indirect costs reflect an average burden of 50 days on a household due to days lost from school,work, and other activities by the patient and their caretakers. While other studies have examined public institutions, this is one of the first studies using data from a private hospital. This study shows that the cost of a dengue episode imposes substantial challenges, even on middle-class households.

Making health insurance work for the poor: learning from the Self-Employed Women's Association's (SEWA) community-based health insurance scheme in India.

How best to provide effective protection for the poorest against the financial risks of ill health remains an unanswered policy question. Community-based health insurance (CBHI) schemes, by pooling risks and resources, can in principal offer protection against the risk of medical expenses, and make accessible health care services that would otherwise be unaffordable. The purpose of this paper is to measure the distributional impact of a large CBHI scheme in Gujarat, India, which reimburses hospitalization costs, and to identify barriers to optimal distributional impact. The study found that the Vimo Self-employed Women's Association (SEWA) scheme is inclusive of the poorest, with 32% of rural members, and 40% of urban members, drawn from households below the 30th percentile of socio-economic status. Submission of claims for inpatient care is equitable in Ahmedabad City, but inequitable in rural areas. The financially better off in rural areas are significantly more likely to submit claims than are the poorest, and men are significantly more likely to submit claims than women. Members living in areas that have better access to health care submit more claims than those living in remote areas. A variety of factors prevent the poorest in rural and remote areas from accessing inpatient care or from submitting a claim. The study concludes that even a well-intentioned scheme may have an undesirable distributional impact, particularly if: (1) the scheme does not address the major barriers to accessing (inpatient) health care; and (2) the process of seeking reimbursement under the scheme is burdensome for the poor. Design and implementation of an equitable scheme must involve: a careful assessment of barriers to health care seeking; interventions to address the main barriers; and reimbursement requiring minimum paperwork and at the time/place of service utilization.