Loading...
Dolan, Carrie
Collections
Biography
As a spatial epidemiologist at William & Mary, Assistant Professor Carrie Dolan’s research and teaching expertise in global health are tightly integrated through her work as the Director of Ignite, a multidisciplinary research lab based in William & Mary’s Global Research Institute and in partnership with the Department Health Sciences. Her research is grounded in a well-established framework for evidence-based global health, focusing on the effective, efficient, and equitable distribution of global health resources, especially among women and children.
Institutional profile
https://www.wm.edu/as/health-sciences/faculty/dolan-c.php
20 results
Publication Search Results
Now showing 1 - 10 of 20
Publication Open Access Pulling the purse strings: Are there sectoral differences in political preferencing of Chinese aid to Africa?(2020-04-22) Dolan, Carrie; Kennedy McDade, KaciChina is emerging as an increasingly important player in the global development space, but may be less bound to compacts that aim to curb political preferencing and therefore may produce less yield in terms of impact toward Sustainable Development Goals. This research tests the hypothesis that the disproportionate aid allocation to the birth regions of the current African political leaders that applies to some sectors more than others.Publication Open Access The impact of an insecticide treated bednet campaign on all-cause child mortality: A geospatial impact evaluation from the Democratic Republic of Congo(PLoS, 2019-02-22) Dolan, Carrie; BenYishay, Ariel; Grepin, Karen A; Tanner, Jeffery C.Objective To test the impact of a nationwide Long-Lasting Insecticidal Nets [LLINs] distribution program in the Democratic Republic of Congo [DRC] on all-cause under-five child mortality exploiting subnational variation in malaria endemicity and the timing in the scale-up of the program across provinces. Design Geospatial Impact Evaluation using a difference-in-differences approach. Setting Democratic Republic of the Congo. Participants 52,656 children sampled in the 2007 and 2013/2014 DRC Demographic and Health Surveys. Interventions The analysis provides plausibly causal estimates of both average treatment effects of the LLIN distribution campaign and geospatial heterogeneity in these effects based on malaria endemicity. It compares the under-five, all-cause mortality for children pre- and post-LLIN campaign relative to children in those areas that had not yet been exposed to the campaign using a difference-in-differences model and controlling for year- and province-fixed effects, and province-level trends in mortality. Results We find that the campaign led to a 41% decline [3.7 percentage points, 95% CI 1.3 to 6.0] in under-5 mortality risk among children living in rural areas with malaria ecology above the sample median. Results were robust to controlling for household assets and the presence of other health aid programs. No effect was detected in children living in areas with malaria ecology below the median. Conclusion The findings of this paper make important contributions to the evidence base for the effectiveness of large scale-national LLIN campaigns against malaria. We found that the program was effective in areas of the DRC with the highest underlying risk of malaria. Targeting bednets to areas with greatest underlying risk for malaria may help to increase the efficiency of increasingly limited malaria resources but should be balanced against other malaria control concerns.Publication Open Access Health aid projects have both expanded and constrained the capacity of health facilities to deliver malaria services to under-five children in Malawi(BMJ, 2018-12-01) Dolan, CarrieAbstract Objective This article examines the potential pathways health aid may use to influence the availability of malaria services at a facility level and the utilisation of malaria services for children under five in Malawi. Methods This work is grounded in a health services research theoretical model and combines a subnational census of health services available at Malawi health facilities with individual-level data on health service utilisation and the Government of Malawi’s official source of data about health aid allocation at a child-level (n=2171). Logistic and multinomial logistic models were used to assess the relationship between health aid, malaria service readiness and malaria service utilisation. Models were adjusted for predisposing, enabling and need factors and accounted for the complex relationship using a mediation approach. Results The evidence presented suggests that health aid translates into increased diagnostic capacity, but not overall or training readiness. Results indicate that increasing aid projects in a region boost its facilities’ diagnostic readiness, increasing each facility’s relative likelihood of having a medium level of diagnostic readiness by 12% (relative risk (RR)=1.118; 95% CI 1.060 to 1.179) and its likelihood of having a high level of readiness by 23% (RR=1.230; 95% CI 1.161 to 1.303), but decreasing its readiness to provide training by 8% (RR=0.925; 95% CI 0.879 to 0.974). Conclusion The results of this research highlight the fact that health aid is working to increase malaria diagnostic capacity at a facility level, but that increasing facility readiness to implement the diagnostic tests has been neglected.Publication Open Access Childhood health and the changing distribution of foreign aid: Evidence from Nigeria’s transition to lower-middle-income status(PLOS, 2020-11-01) Dolan, Carrie; Saunders, McKinley; BenYishay, ArielWith sustained economic growth in many parts of the developing world, an increasing number of countries are transitioning away from the most subsidized development finance as they exceed income and other qualification requirements. Cross-country evidence suggests that Development Assistance Committee (DAC) donors view the crossing over of the World Bank’s International Development Association (IDA) eligibility threshold to signal that a country needs less aid, with subsequent reductions in both IDA and other donors’ concessional funding. Within the health sector, it is particularly important to understand the implications of these status changes for children under five years of age since improving early childhood health is critical to fostering health and social and economic development. Therefore, we examine the implications of the IDA transition by measuring the extent t which World Bank commitments—including both IDA and IBRD—are directed to infant and child health needs in Nigeria. Ordinary Least Squares (OLS) models were used in a difference-indifferences (DID) strategy to compare World Bank IBRD/IDA lending before and after the crossover to regions with varying initial levels of under-five and infant need. We find that the infant need orientation of World Bank aid has increased post-crossover. Conversely, alignment of World Bank commitments to regional child needs appears to have diminished after Nigeria crosses the IDA threshold. However, these effects are statistically insignificant and therefore provides inconclusive evidence. This research addresses an important policy question because the transition away from concessional funding mechanisms will result in difficult tradeoffs in allocating limited health resources; without providing conclusive evidence that crossover results in changes in need-based allocation, it does offer an essential path for future research. These results are directly relevant to policy debates about what we know and do not know about aid in transition and health. This research’s value is especially important in the Sustainable Development Goal (SDG) era in understanding how donor exits could derail progress in health improvement.Publication Open Access Cost-effectiveness of Paediatric Surgery: An Economic Evaluation of World Paediatric Project Surgical Interventions in St. Vincent and the Grenadines (2002–2019)(BJM, 2021-12-01) Dolan, Carrie; Agyemang, Samuel A.; Clare, Brian; Coleman, CharlesObjectives The purpose of this study is to examine the cost-effectiveness of six types of surgical interventions as part of a sustained paediatric surgical programme in St.Vincent and the Grenadines from 2002 to 2019. Design In this economic model, six paediatric surgical interventions (ophthalmic, orthopaedic, plastic, general, urology, neurosurgery) were compared with no surgery in a deterministic cost-effectiveness model. We assessed health benefits as averted disability-adjusted life-years (DALYs). Costs were included from the programme perspective and measured using standard micro-costing methods. Incremental cost-effectiveness ratios (ICERs) were calculated for each type of surgical intervention. Interventions with ICERs of <50% of gross domestic product (GDP) per capita were considered cost-effective. Costs are reported in 2019 US$. Univariate sensitivity analyses were conducted to assess the effect of uncertainty. Results The average cost per procedure was US$16 685 (range: US$9791.78–US$72 845.76). The cumulative discounted 18-year health impact was 5815 DALYs averted with a cost per DALY averted of US$2622. Most paediatric surgical interventions were cost-effective, yielding cost per DALY estimates less than 50% of GDP per capita of St. Vincent and the Grenadines. When undiscounted, only orthopaedic surgeries had cost per DALY more than 50% GDP per capita. When considering discounting, orthopaedic and urology surgeries exceeded the adopted threshold for cost-effectiveness. Conclusions We found that short-term, recurrent surgical interventions could yield substantial economic benefits in this limited resource setting. This research indicates that investment in paediatric surgical interventions is cost-effective for the majority of specialties. These findings are of clinical significance given the large burden of disease attributable to surgically treatable diseases. This work demonstrates that scaling up dedicated surgical programmes for children is a cost-effective and essential component to improve paediatric health.Publication Open Access Chinese Health Funding in Africa: The Untold Story(PLOS, 2023-06-01) Dolan, Carrie; Malik, Ammar A.; Zhang, Sheng; Svoboda, Eli; Odhiambo, Julius NyerereThe motivations behind China’s allocation of health aid to Africa remain complex due to limited information on the details of health aid project activities. Insufficient knowledge about the purpose of China’s health aid hinders our understanding of China’s comprehensive role in supporting Africa’s healthcare system. To address this gap, our study aimed to gain better insights into China’s health aid priorities and the factors driving these priorities across Africa. To achieve this, we utilized AidData’s Chinese Official Finance Dataset and adhered to the Organisation for Economic Co-operation and Development (OECD) guidelines. We reclassified all 1,026 health projects in Africa, originally categorized under broad 3-digit OECDDAC sector codes, into more specific 5-digit CRS codes. By analyzing the project count and financial value, we assessed the shifting priorities over time. Our analysis revealed that China’s priorities in health aid have evolved between 2000 and 2017. In the early 2000s, China primarily allocated aid to basic health personnel and lacked diversity in sub-sectors. However, after 2004, China shifted its focus more toward basic infrastructure and reduced emphasis on clinical-level staff. Furthermore, China’s interest in addressing malaria expanded both in scale and depth between 2006 and 2009. This trend continued in 2012 and 2014 when China responded to the Ebola outbreak by shifting its focus from basic infrastructure to infectious diseases. In summary, our findings demonstrate the changes in China’s health aid strategy, starting with addressing diseases already eliminated in China and gradually transitioning towards global health security, health system strengthening, and shaping the governance mechanisms.Publication Open Access The Economic Efficiency of Aid Targeting(2022-07-31) BenYishay, Ariel; DiLorenzo, Matthew; Dolan, CarrieHow efficient is the targeting of foreign aid to populations in need? A long literature has focused on the impacts of foreign aid, but much rarer are studies that examine how such aid is allocated within countries. We examine the extent to which donors efficiently respond to exogenous budget shocks by shifting resources toward needier districts within a given country, as predicted by theory. We use recently geocoded data on the World Bank’s aid in 23 countries that crossed the lower-middle income threshold between 1995 and 2010 and thus experienced sharp aid reductions. We measure locations’ need along a number of dimensions, including nighttime lights emissions, population density, conflict exposure, and child mortality. We find little evidence that aid project siting is increasingly concentrated in worse-off areas as budgets shrink; the only exception appears to be a growing share of funding in more conflict-affected areas. We further analyze the relationship of health aid to child mortality measures in six key countries, again finding little evidence of efficient responses to budget shocks. Taken together, these results suggest that large efficiency gains may be possible in the distribution of aid from the World Bank and other donors.Publication Open Access Assessing the Causal Impact of Chinese Aid on Vegetative Land Cover in Burundi and Rwanda Under Conditions of Spatial Imprecision(Elsevier, 2019-01-01) Marty, Robert; Goodman, Seth; LeFew, Michael; Dolan, Carrie; BenYishay, Ariel; Runfola, Daniel; AidDataThere has been considerable debate regarding the efficacy of international aid in meeting the dual goals of human development and environmental sustainability. Many donors have sought to engage with this challenge by introducing environmental safeguard and monitoring initiatives; however, evidence on the success of these interventions is limited. Evaluating aid is a particular challenge in the case of donors that do not disclose information on the nature, geographic location, or extents of their interventions. In such cases, new methods that extract and geoparse data on the activities of opaque donors through the manual interpretation of thousands of news and other articles allow us to investigate the impacts of these activities. However, residual spatial uncertainty in these data remains a potential source of bias. In this article, we apply and discuss a Geographic Simulation and Extrapolation (GeoSIMEX) approach to mitigate the spatial imprecision inherent in geoparsed data. In conjunction with GeoSIMEX, we test and contrast multiple approaches to reducing the imprecision of aid, including high-assumption cases in which other covariates (i.e., nighttime lights) are leveraged to allocate aid. In our application, we find that methods which do not account for spatial imprecision find statistically significant relationships between Chinese aid and vegetation change; after accounting for spatial uncertainty, findings are similar for Rwanda and inconclusive for Burundi.Publication Open Access Taking the Health Aid Debate to the Sub-National Level: The Impact and Allocation of Foreign Health Aid in Malawi(BMJ, 2017-01-11) Marty, Robert; Dolan, Carrie; Leu, Matthias; Runfola, DanielObjective: Cross-national studies provide inconclusive results as to the effectiveness of foreign health aid. We highlight a novel application of using subnational data to evaluate aid impacts, using Malawi as a case study. Design: We employ two rounds of nationally representative household surveys (2004/2005 and 2010/2011) and geo-referenced foreign aid data. We examine the determinants of Malawi's traditional authorities receiving aid according to health, environmental risk, socioeconomic and political factors. We use two approaches to estimate the impact of aid on reducing malaria prevalence and increasing healthcare quality: difference-in-difference models, which include traditional authority and month-of-int erview fixed effects and control for individual and household level time-varying factors, and entropy balancing, where models balance on health-related and socioeconomic baseline characteristics. General: health aid and four specific health aid sectors are examined. Results Traditional authorities with greater proportions of individuals living in urban areas, more health facilities and greater proportions of those in major ethnic groups were more likely to receive aid. Difference-in-difference models show health infrastructure and parasitic disease control aid reduced malaria prevalence by 1.20 (95% CI −0.36 to 2.76) and 2. 20 (95% CI 0.43 to 3.96) percentage points, respectively, and increased the likelihood of individuals reporting healthcare as more than adequate by 12.1 (95% CI 1.51 to 22.68) and 14.0 (95% CI 0.11 to 28.11) percentage points. Entropy balancing shows similar results. Conclusions: Aid was targeted to areas with greater existing health infrastructure rather than areas most in need, but still effectively reduced malaria prevalence and enhanced self-reported healthcare quality.Publication Open Access The effectiveness of national-level containment and closure policies across income levels during the COVID-19 pandemic: an analysis of 113 countries(2021-05-04) Pincombe, Morgan; Reese, Victoria; Dolan, CarrieDespite heterogeneity in income levels, countries implemented similarly strict containment and closure policies to mitigate the COVID-19 pandemic. This research assesses the effectiveness of these containment and closure policies, which we defined as larger decreases in mobility and smaller COVID-19 case and death growth rates. Using daily data for 113 countries on mobility and cumulative COVID-19 case and death counts over the 130 days between February 15, 2020 and June 23, 2020, we examined changes in mobility, morbidity, and mortality growth rates across the World Bank’s income group classifications. Containment policies correlated with the largest declines in mobility in higher income countries. High-income countries also achieved lower COVID-19 case and death growth rates than low-income countries. This study finds better epidemiological outcomes of containment and closure policies for higher income countries than lower income countries. These findings urge policymakers to consider contextual differences, including levels of economic activity and the structure of the economy, when crafting policies in response to public health emergencies.