Karen Grepin

Karen Grepin

Associate Professor, School of Public Health, The University of Hong Kong

Dissertation Title:  "Influencing Health Systems: Priorities, Policies, and Providers"

In my first paper, I explore the effects of donor financing for HIV/AIDS on health service delivery in sub-Saharan Africa (SSA). Using disaggregated data on health development assistance and multiple measures of heath service coverage, I analyze the effect of HIV/AIDS funding on the delivery of non-targeted health services from 1990-2006. I find evidence that in the short-run funding for HIV/AIDS is associated with lower coverage of immunizations and other health services and that these effects are strongest in countries with the lowest density of doctors per capita. These findings support the view that HIV/AIDS programs have not strengthened health systems and may have had unintended effects on non-targeted health services in SSA.

In my second paper, I evaluate the effect of user fees on the utilization of maternity services in Ghana. User fees reduce demand for health services but are an important source of revenue and provide incentives to health care providers in developing countries. In 2003, Ghana introduced a delivery fee exemption policy, initially rolling the policy out to 4 regions, creating a natural experiment to evaluate the effect of user fees on health service coverage. I find that this policy was effective at increasing the proportion of births supervised by trained medical professionals and delivered in facilities but that the policy may have had an adverse effect on the quality of services delivered. The delivery fee exemption policy was successful at targeting services to pregnant women and may represent an effective strategy where other forms of targeting are more difficult to implement.

In my third paper, I explore the determinants of recent Canadian Physician (CP) migration, by conducting a longitudinal analysis of recent migrants. I find that Canadian trained physicians were less likely to outward migrate and more likely to return home and that many of the departures seen during the 1990s were actually temporary. These findings suggest that, among other factors, additional education and training opportunities abroad may have accounted for a large share of outward migrations seen during the 1990s.


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