| Course | NR 561 Addressing Global Health Disparities |
|---|---|
| Week | 1 |
| Paper type | Discussion post with two replies |
| Length | About 660 words |
| Format | Discussion post with APA 7 citations |
| School | Chamberlain University |
| Program | MSN, Population Health |
| Updated | October 2026 |
Free sample paper for NR 561 Week 1
Week 1 Discussion: Initial Post
Sierra Leone and Liberia, Two Neighbors With Shared Wars and Shared Ebola, and Why Their Maternal Death Ratios Parted After 2010
Initial Post
Sierra Leone and Liberia share a border, a civil war era that ended within a year of each other, and the 2014 to 2016 Ebola epidemic. Yet in the most recent interagency estimates, the maternal mortality ratio for 2020 was 443 deaths per 100,000 live births in Sierra Leone and 652 in Liberia (World Health Organization [WHO], 2023). Both figures are far too high. My question for this week is narrower: why is one lower than the other, given how much the two countries have in common?
The comparison has limits I should state at the outset. Modeled estimates for countries with weak vital registration carry wide uncertainty ranges, and a gap of this size could narrow in a later revision. I am treating the difference as a signal worth explaining, not a settled ranking.
The easy answer would be that Sierra Leone is better off. It is not, in any way that holds up: both countries sit near the bottom of global income tables and both lost health workers to Ebola. Poverty explains why both ratios are high. It cannot explain why they differ.
The explanation I want to argue is a single decision. In April 2010 the Government of Sierra Leone launched the Free Health Care Initiative, which removed fees at public facilities for pregnant women, lactating mothers and children under five. The decision did not stop at fees. It came packaged with a large pay rise for health workers, a cleanup of the health payroll and new attention to absenteeism, so that clinics expected to see more mothers would also have staff present to see them (Witter et al., 2016). The route from that choice to the outcome runs through two links: more women able to come to a facility without paying, and more skilled staff on duty when they arrived. Evaluations found substantial increases in the use of maternal care in public facilities after the launch, though some of the gain may have faded over time (Edoka et al., 2016).
What I can conclude from this alone is modest. Sierra Leone made a choice in 2010 that plausibly contributed to the gap, and the choice was not forced by anything in the country's circumstances. Someone could have decided otherwise, and for decades someone did. I am not ready to say what Liberia should do, or whether the Sierra Leone package would travel.
Question for the group: if a policy produces a gain that partly fades, should we credit the policy for what remains, or the conditions that made it fade for what was lost?
Reply to Monique
Monique, your pair of Rwanda and Burundi is a strong choice because the two share so much, including language, size and colonial history. I wonder whether your outcome, under-five mortality, is precise enough yet. You mention community health workers as the choice, but the post also points to health insurance and to performance-based payments. Those are three different decisions made in different years. If you pick the one with the clearest date and the clearest decision maker, the argument will be easier to defend next week, when the brief asks for the instrument and the signature.
Reply to Andrew
Andrew, I found your post on Haiti and the Dominican Republic persuasive on the size of the gap. One question on attribution: you trace the difference to trade agreements, but the outcome you chose, maternal mortality, depends on what happens in the hours around a birth. Can you show a step between the trade terms and the delivery room, such as a budget line or a staffing decision? Without one, a reader can accept everything you say about trade and still doubt the link. You may find that the choice that matters sits closer to the health ministry than the trade ministry.
References
Edoka, I., Ensor, T., McPake, B., Amara, R., Tseng, F.-M., & Edem-Hotah, J. (2016). Free health care for under-fives, expectant and recent mothers? Evaluating the impact of Sierra Leone's free health care initiative. Health Economics Review, 6(1), Article 19. https://doi.org/10.1186/s13561-016-0096-4
Witter, S., Wurie, H., & Bertone, M. P. (2016). The free health care initiative: How has it affected health workers in Sierra Leone? Health Policy and Planning, 31(1), 1-9. https://doi.org/10.1093/heapol/czv006
World Health Organization. (2023). Trends in maternal mortality 2000 to 2020: Estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA/Population Division. https://www.who.int/publications/i/item/9789240068759
NR 561 Week 1 instructions, in plain terms
The first discussion in this course usually asks you to choose two countries, name one health outcome on which they differ and explain why the difference was not bound to happen. Expect the prompt to want a source for the figure, some reasoning about what produced the gap and two replies to peers. Pick a pair with enough in common that the obvious explanations cancel out. Give the outcome as a number with a year and a publisher. Name one decision, made by a body that can be identified, and show the route from it to the outcome in a step or two. Stop before recommending anything, because the right to propose a fix comes later in the term. End the post with a question a classmate can take further.
Inside the NR 561 Week 1 example
The sample opens with Sierra Leone and Liberia, gives the 2020 interagency ratios of 443 and 652 deaths per 100,000 live births, and immediately flags that modeled figures for countries with weak registration carry wide ranges. A short paragraph sets poverty aside because it describes both countries equally. The argument then names the April 2010 Free Health Care Initiative and explains that it removed fees for mothers and young children while raising pay, cleaning the payroll and watching attendance. Two links carry the route: women able to attend without paying, and staff present when they arrived. A sentence notes that the gain in facility use may have faded. The reply to Monique asks whether her Rwanda and Burundi cause is one decision or three, and the reply to Andrew asks for a step between trade terms and the delivery room.
NR 561 Week 1 rubric: what full points look like
Points in this opening week tend to follow four things: a measured difference with a credible source, an argument that names a choice rather than a condition, honest limits, plus replies which move a classmate's thinking forward. A post that sets aside poverty with a reason shows the writer understands why a shared condition cannot explain a gap. Naming the government, the month and the instruments makes the choice checkable, and that checkability is what instructors look for. Two documented links between the choice and the outcome earn more than a confident leap. Admitting that the gain may have faded protects the claim rather than weakening it. Replies that test whether a peer's cause is a single decision show careful reading. Accurate APA 7 citations and a courteous tone complete the week.
Common NR 561 Week 1 mistakes, and how to avoid them
The most frequent slip in this post is naming poverty, culture or corruption as the cause, which describes a condition nobody signed and leaves the argument with nothing to attach to. A second is a figure carried from memory with no year or source. Some students choose a pair so unequal, such as the richest and poorest country on a list, that the gap explains itself and the post has nothing left to argue. Others arrive with a remedy in the first week, which reads as skipping the analysis. Replies that only agree add warmth but no evidence. Keep the post within the word limit by cutting any restatement of the prompt. If you want an opening post built on your own country pair and outcome, send the pair and the outcome you have in mind.
Get a NR 561 Week 1 example written to your instructions
Send us the prompt for your week, the rubric if your classroom posts one, and the country pair you have in mind if you have already picked one. We write a fresh example to your instructions and return it inside 24-48h. The first one is free, it is written for you alone, and it is never resold to anybody else.
More NR 561 papers and MSN samples
- NR 561 Week 2: Disparity Argument Brief
- NR 561 Week 3: Historical Determinants Analysis
- NR 561 Week 4: Case Study Analysis
- NR 561 Week 5: Agenda Setting Review
- NR 561 Week 6: Intervention Proposal
- NR 561 Week 7: Ethics Analysis
- NR 561 Week 8: Advocacy Brief
- NR 553 Week 1: Global Health Discussion
- NR 550 Week 1: Disparity Statement Discussion
- NR 530 Week 1: Discussion on Choosing a Population
- NR 540 Week 1: Discussion on a Program That Faded
NR 561 Week 1 questions, answered
How specific does the country pair have to be?
Specific enough that both are named and the outcome is one measured thing rather than health in general. A pair sharing a region, a language of administration or a similar population size gives you more to argue with, because the obvious explanations are already ruled out. Most sections will accept any pair as long as your sources are current and cited in the post itself.
Is it acceptable to write about the United States as one of the two?
In many sections yes, and it can work well, since you can describe one side from experience and the other from published sources. The risk is that the post turns into an account of American practice with a second country attached for contrast. Keep the outcome at the center, not the system you happen to know best, and give both sides the same number of sentences.
What if I cannot find the choice behind the difference?
Then say so and narrow the claim. A post that traces an outcome to a documented rule, marks the point where the record runs out and stops there is stronger than one that invents a culprit. Instructors read the honest stop as analysis. They read the confident guess as something the next paragraph will turn out to be unable to support.
Where can I find a free NR 561 Week 1 sample paper?
The Sierra Leone and Liberia discussion post above, with two replies, is the full NR 561 Week 1 sample. A different pair or outcome can be written up on request.
Can the NR 561 Week 1 post name a policy as the cause?
Yes, and it usually should. A dated policy with a named decision maker gives the argument something checkable, which a broad condition such as poverty never does.