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Understanding drivers of domestic public expenditure on reproductive, maternal, neonatal and child health in Peru at district level: an ecological study

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dc.contributor.author Huicho Oriundo, Luis
dc.contributor.author Hernandez, Patricia
dc.contributor.author Huayanay Espinoza, Carlos Andrés
dc.contributor.author Segura, Eddy R.
dc.contributor.author Niño de Guzman, Jessica
dc.contributor.author Flores-Cordova, Gianfranco
dc.contributor.author Rivera Chira, Maria Concepcion
dc.contributor.author Friedman, Howard S.
dc.contributor.author Berman, Peter
dc.date.accessioned 2018-11-30T23:41:30Z
dc.date.available 2018-11-30T23:41:30Z
dc.date.issued 2018
dc.identifier.uri https://hdl.handle.net/20.500.12866/4206
dc.description.abstract BACKGROUND: Peru has increased substantially its domestic public expenditure in maternal and child health. Peruvian departments are heterogeneous in contextual and geographic factors, underlining the importance of disaggregated expenditure analysis up to the district level. We aimed to assess possible district level factors influencing public expenditure on reproductive, maternal, neonatal and child health (RMNCH) in Peru. METHODS: We performed an ecological study in 24 departments, with specific RMNCH expenditure indicators as outcomes, and covariates of different hierarchical dimensions as predictors. To account for the influence of variables included in the different dimensions over time and across departments, we chose a stepwise multilevel mixed-effects regression model, with department-year as the unit of analysis. RESULTS: Public expenditure increased in all departments, particularly for maternal-neonatal and child health activities, with a different pace across departments. The multilevel analysis did not reveal consistently influential factors, except for previous year expenditure on reproductive and maternal-neonatal health. Our findings may be explained by a combination of inertial expenditure, a results-based budgeting approach to increase expenditure efficiency and effectiveness, and by a mixed-effects decentralization process. Sample size, interactions and collinearity cannot be ruled out completely. CONCLUSIONS: Public district-level RMNCH expenditure has increased remarkably in Peru. Evidence on underlying factors influencing such trends warrants further research, most likely through a combination of quantitative and qualitative approaches. en_US
dc.language.iso eng
dc.publisher BioMed Central
dc.relation.ispartofseries BMC Health Services Research
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Child health en_US
dc.subject Health expenditure en_US
dc.subject Maternal health en_US
dc.subject Neonatal health en_US
dc.subject Reproductive health en_US
dc.title Understanding drivers of domestic public expenditure on reproductive, maternal, neonatal and child health in Peru at district level: an ecological study en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1186/s12913-018-3649-x
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.03.02
dc.relation.issn 1472-6963


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