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Indonesia - Giving More Weight to Health : Assessing Fiscal Space for Health in Indonesia

World Bank
Fonte: World Bank Publicador: World Bank
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This report analyzes fiscal space issues related to government health spending in Indonesia. Fiscal space refers to the ability of a government to increase expenditures for a desired purpose. In all likelihood, and for a variety of reasons, Indonesia will need to boost health spending in the near future as it expands access to care through the expansion of Jamkesmas, the health insurance scheme for the poor and near poor. In addition, projections based on demographic and epidemiological changes in the country indicate there is likely to be a significant increase in the demand and need for health services and more sophisticated care. Despite a tripling of the public budget for health over the past five years, this increased need, combined with the fact that Indonesia remains a comparatively low spender on health, indicates that there will continue to be upward pressure on resources for the health sector in the near future. A number of different drivers of fiscal space for health in Indonesia are discussed in this paper. These include: (i) conducive macroeconomic conditions; (ii) reprioritization of health within the overall government budget; (iii) increasing health-specific foreign aid and grants; (iv) an increase in other health-specific resources; for example...

How to Improve Public Health Systems : Lessons from Tamil Nadu

Das Gupta, Monica; Desikachari, B.R.; Somanathan, T.V.; Padmanaban, P.
Fonte: Banco Mundial Publicador: Banco Mundial
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Public health systems in India have weakened since the 1950s, after central decisions to amalgamate the medical and public health services, and to focus public health work largely on single-issue programs - instead of on strengthening public health systems broad capacity to reduce exposure to disease. Over time, most state health departments de-prioritized their public health systems. This paper describes how the public health system works in Tamil Nadu, a rare example of a state that chose not to amalgamate its medical and public health services. It describes the key ingredients of the system, which are a separate Directorate of Public Health - staffed by a cadre of professional public health managers with deep firsthand experience of working in both rural and urban areas, and complemented with non-medical specialists with its own budget, and with legislative underpinning. The authors illustrate how this helps Tamil Nadu to conduct long-term planning to avert outbreaks, manage endemic diseases, prevent disease resurgence...

How Might India’s Public Health Systems Be Strengthened?

Das Gupta, Monica; Shukla, Rajendra; Somanathan, T.V.; Datta, K.K.
Fonte: Banco Mundial Publicador: Banco Mundial
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The central government s policies, though well-intentioned, have inadvertently de-emphasized environmental health and other preventive public health services in India since the 1950s, when it was decided to amalgamate the medical and public health services and to focus public health services largely on single-issue programs. This paper discusses how successive policy decisions have diminished the Health Ministry s capacity for stewardship of the nation s public health. These decisions have introduced policies and fiscal incentives that have inadvertently enabled states to prioritize medical services and single-issue programs over broader public health services, and diminished the capacity of the public health workforce to deliver public health services. Diseases resulting from poor environmental health conditions continue to impose high costs even among the more affluent, and hinder development. There are many approaches to strengthening the public health system, and the authors suggest one that may require relatively little modification of existing structures and systems. They suggest establishing a focal point in the Health Ministry for public health stewardship...

The Human Resources for Health Crisis in Zambia : An Outcome of Health Worker Entry, Exit, and Performance within the National Health Labor Market

Herbst, Christopher H.; Vledder, Monique; Campbell, Karen; Sjöblom, Mirja; Soucat, Agnes
Fonte: World Bank Publicador: World Bank
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This report compiles recent evidence on the Zambian health labor market and provides some baseline information on human resources for health (HRH) to help the government address its HRH challenges. Rather than focusing on making policy recommendations, the report is designed to be a source book to benefit and fuel discussions related to HRH in Zambia. Most of the data presented in the report covers the period 2005-08. The report analyzes the national health labor market to better understand the available evidence related to the stock, distribution, and performance of HRH in Zambia (that is, the HRH outcomes). It aims to explain those HRH outcomes by mapping, assessing, and analyzing pre-service education and labor market dynamics, that is, the flow of health workers into, within, and out of the health labor market, as well as the core factors influencing these dynamics. Finally, this report examines the issue of access and equity of HRH. It finds that even if health workers are available, in either urban or rural areas...

Private Health Sector Assessment in Mali : The Post-Bamako Initiative Reality

Lamiaux, Mathieu; Rouzaud, François; Woods, Wendy
Fonte: World Bank Publicador: World Bank
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This country assessment of the private health sector in Mali is part of a series of studies designed to deepen understanding of ways to enhance the health policy framework, business environment, and investment climate in which the private health sector operates in African countries. The Malian health system has evolved dramatically since the middle of the 1980s. A large part of the analysis in this report relies on the reprocessing and the mining of existing databases, the financial and macroeconomic models based on those data, and elements reconstructed through triangulation. Those calculations proved indispensable for assessing the main demographic trends in the private sector, for estimating the growth of community centers (CSCOMs) and private mutual insurance, and identifying how to reinforce them. The growth of the private sector is further held back by insufficient educational preparation for practice in the private sector and in rural areas. For-profit and not-for-profit health care providers, pharmacies...

Clearing the Global Health Fog : A Systematic Review of the Evidence on Integration of Health Systems and Targeted Interventions

Atun, Rifat; de Jongh, Thyra; Secci, Federica V.; Ohiri, Kelechi; Adeyi, Olusoji
Fonte: World Bank Publicador: World Bank
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A longstanding debate on health systems organization relates to benefits of integrating health programs that emphasize specific interventions into mainstream health systems to increase access and improve health outcomes This paper is organized in five chapters. This introduction is followed by the methodology chapter, which includes a brief section on the conceptual framework used to analyze the studies retrieved and the programs presented within these to map the nature and extent of integration into critical health system functions. The results chapter includes: a summary of the outcomes for each study grouped by the disease area or the clinical problem the intervention seeks to address, including the reported success; for each program, analysis and mapping of the nature and extent of integration into critical health system functions; and an analysis of how contextual factors either created opportunities for introducing or integrating a program or influenced the desirability or feasibility of program integration. The discussion chapter provides an overview of the implication of findings for policy makers...

Improving Primary Health Care Delivery in Nigeria : Evidence from Four States

World Bank
Fonte: World Bank Publicador: World Bank
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This study aims mainly at understanding the performance of primary health care (PHC) providers in four Nigerian states and the variables driving this performance. The study is primarily based on quantitative surveys at the level of primary health care facilities, health care personnel, and households in their vicinity. These surveys were implemented in four states: Bauchi, Cross River, Kaduna, and Lagos. This study represents the second phase of the Nigeria Health, Nutrition, and Population Country Status Report (CSR). The first phase aimed at analyzing the health situation of the poor and how the health system was performing in terms of meeting their needs. This first phase identified PHC as the weakest chain in the entire health sector and the level of care the poor use the most. This second phase of the CSR is therefore focused on the analysis of the delivery of PHC services. In contrast to the first phase, this study is mainly based on primary data, data collected through facility, health personnel...

Public Spending in Russia for Health Care : Issues and Options

World Bank
Fonte: Washington, DC Publicador: Washington, DC
EN_US
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This report examines three critically important areas to inform discussions on the appropriate level of health care spending in the Russian Federation: (i) the efficiency of spending on health care services; (ii) distributional impacts of spending on health care services; and (iii) the key factors that will influence the growth in health care spending over the next 20 years. There are few data showing how spending in health care in the Russian Federation translates into better health outcomes such as improved mortality, improved morbidity, increased economic output and productivity, improvements in the number of life years gained, or more sophisticated composite measures such as Quality Adjusted Life Years (QALYs). There is also limited data on outputs of hospitals and other healthcare providers which allow controlling for case mix, socioeconomic status, supply-side variables, and quality of care. Therefore, it is difficult to assess the efficiency or distributional impacts of health interventions. While the analysis draws on primary data specifically collected for the study...

Egypt Health Policy Note : Egypt Public Expenditure Review

World Bank
Fonte: Washington, DC Publicador: Washington, DC
EN_US
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The public expenditures review (PER) of the health sector was prepared in response to a request from the government of Egypt as part of a broader PER work that covers other sectors. This policy note is intended to inform government policymakers of the key findings from the PER and recommend strategies for improving the efficiency, equity, and sustainability of public financing in the health sector, with a special emphasis on expanding the coverage of social health insurance - a major plank in the health reform strategy announced by President Mubarak in July 2005. There are four sections in the report. The first section provides background information. The second section presents a summary of health outcomes, trends, and financing in Egypt; an analysis of inequities in the allocation and utilization of health resources; and an assessment of the efficiency of the delivery of health services. The third section summarizes existing government policies toward the health sector. The fourth section proposes strategies and recommendations for expanding social insurance coverage and enhancing incentives to deliver health services more efficiently and effectively.

Towards Interventions in Human Resources for Health in Ghana : Evidence for Health Workforce Planning and Results

Appiah-Denkyira, Ebenezer; Herbst, Christopher H.; Soucat, Agnes; Lemiere, Christophe; Saleh, Karima
Fonte: Washington, DC: World Bank Publicador: Washington, DC: World Bank
EN_US
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This book towards interventions in human resources for health in Ghana is a collaborative effort between the government of Ghana and the World Bank, was developed to assist the ministry of health to obtain an overview of the unique human resources for health (HRH) challenges that Ghana faces. Evidence on the stock, distribution, and performance of health workers in Ghana, as well as on some of the underlying determinants of these HRH outcomes, will help support the government resolve to develop strategies and interventions to address HRH concerns and ultimately strengthen its health system. The content of this book was developed, discussed, and validated by means of extensive consultations with the technical working group on (HRH) in Ghana. This book contents totally eight chapters: chapter one covers toward evidence-based interventions for HRH; chapter two covers the stock of health workers; chapter three covers the distribution of health workers; chapter four covers the performance of health workers; chapter five covers Ghana Agencies and their roles and responsibilities in HRH; chapter six covers interventions to increase stock and improve distribution and performance of HRH; chapter seven covers financing available for policy and interventions; and chapter eights covers the political economy of crafting policy.

The Contribution of Traditional Herbal Medicine Practitioners to Kenyan Health Care Delivery : Results from Community Health-seeking Behavior Vignettes and a Traditional Herbal Medicine Practitioner Survey

Lambert, John; Leonard, Kenneth; Mungai, Geoffrey; Omindi-Ogaja, Elizabeth; Gatheru, Gladys; Mirangi, Mirangi; Owara, Jennifer; Herbst, Christopher H.; Ramana, GNV; Lemiere, Christophe
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
EN_US
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This study examines the role that Traditional Herbal Medicine Practitioners (THMPs) play in Kenya in the context of its human resources for health crisis. Two surveys were carried out to obtain evidence. The first documented the choices and perceptions of households in 36 communities on seeking medical assistance for eight common illnesses. The second survey asked 258 THMPs in five provinces to identify their knowledge sources, training, common illnesses treated, forms of payment, challenges, and concerns. Community-derived data show that households make reasonable decisions when faced with difficult circumstances: they prefer hospitals when these are affordable and seek care at clinics and health centers when hospitals are too far away. There is significant self-care and use of pharmacies, although THMPs are preferred for worms and lower respiratory problems. In general, THMPs provide an important though diminishing role in the provision of health care; they are not sought out in situations when inadequate care is dangerous...

Enhancing Efficiency and Equity : Challenges and Reform Opportunities Facing Health and Pension Systems in the Western Balkans

Bredenkamp, Caryn; Gragnolati, Michele; Ramljak, Vedad
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
EN_US
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This collection of papers explores the major challenges to the sustainability of health and pension system financing in the countries of the Western Balkans - Albania, Bosnia and Herzegovina, the Former Yugoslav Republic of Macedonia, Montenegro, Serbia, and the province of Kosovo. It focuses on how the incentives created by the different elements of the financing arrangements affect the behavior of providers and individuals, and the resulting inefficiencies in revenue collection and expenditure containment. The volume commences with an analysis of healthcare financing, exploring patterns of healthcare expenditure, and examining the key drivers of current healthcare expenditure and the most significant barriers to revenue generation. Subsequent chapters give special attention to provider payment mechanisms and the pharmaceutical sector. Equity considerations are highlighted in a chapter that explores the protection that is offered against the financial impact of health expenditures. With respect to the pension sector...

Integration of Health Systems and Priority Health, Nutrition, and Population Interventions : A Framework for Analysis and Policy Choices

Atun, Rifat; Ohiri, Kelechi; Adeyi, Olusoji
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
EN_US
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A longstanding debate on health system organization relates to the benefits of integrating programs that emphasize specific interventions into mainstream health systems to increase access and improve health outcomes. This debate has long been characterized by polarization of views and ideologies, with protagonists for and against integration arguing relative merits of each approach. Recently, the debate has been rekindled due to substantial rises in externally funded programs for priority health, nutrition, and population (HNP) interventions and an increase in international efforts aimed at health system strengthening. In this paper the author present a conceptual framework and an analytical approach to define and assess the nature and extent of integration in relation to critical health system functions. The framework can also be used to systematically compare and contrast programs in different settings to generate meaningful evidence to inform policy. In this framework, the author defines integration as the extent...

Better Outcomes through Health Reforms in the Russian Federation : The Challenge in 2008 and Beyond

Marquez, Patricio V.
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
EN_US
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The purpose of this discussion paper is to discuss selected health challenges in the Russian Federation, focusing on outcomes, expenditures and options for policy and institutional reforms in the health care system. The areas covered in the paper draw on recent studies and reports, and take into account lessons derived from the implementation of the World Bank-funded Health Reform Implementation Project (HRIP) at the federal level and in the Chuvash Republic and the Voronezh Oblast-the pilot regions of the project, over the 2005-2007 period.

Universal Health Coverage for Inclusive and Sustainable Development : A Synthesis of 11 Country Case Studies

Maeda, Akiko; Araujo, Edson; Cashin, Cheryl; Harris, Joseph; Ikegami, Naoki; Reich, Michael R.
Fonte: Washington, DC: World Bank Publicador: Washington, DC: World Bank
EN_US
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The goals of Universal Health Coverage (UHC) are to ensure that all people can access quality health services, to safeguard all people from public health risks, and to protect all people from impoverishment due to illness, whether from out-of-pocket payments for health care or loss of income when a household member falls sick. Countries as diverse as Brazil, France, Japan, Thailand, and Turkey that have achieved UHC are showing how these programs can serve as vital mechanisms for improving the health and welfare of their citizens, and lay the foundation for economic growth and competitiveness grounded in the principles of equity and sustainability. Ensuring universal access to affordable, quality health services will be an important contribution to ending extreme poverty by 2030 and boosting shared prosperity in low income and middle-income countries (LMICs), where most of the world s poor live.

Kyrgyz Republic Public Expenditure Review Policy Notes : Health

World Bank
Fonte: Washington, DC Publicador: Washington, DC
EN_US
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Over the past two decades the Kyrgyz Republic implemented important health financing and organization reforms. Compared to other former Soviet republics and other low-income countries, the Kyrgyz Republic shows good results in term of health outcomes, access to health services, and financial protection. Life expectancy exceeds that of several of the most prosperous former Soviet republics, including Russia. Infant and under-5 mortality rates were halved between 1990 and 2010. More than 98 percent of births are attended by skilled health staff and children immunization rates exceed 90 percent. Utilization of both hospital and outpatient health services are quite equal across income groups. Overall distribution of public health spending is slightly pro-poor. The Kyrgyz health system shows low incidence of catastrophic and impoverishing out-of pocket spending for health care.

Timor Leste : Health Equity and Financial Protection Project

World Bank
Fonte: Washington, DC Publicador: Washington, DC
EN_US
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This report analyses equity and financial protection in the health sector of Timor-Leste. In particular, it examines inequalities in health outcomes, health behavior and health care utilization; benefit incidence analysis; financial protection; and the progressivity of health care financing. Data are drawn from the 2009/2010 Demographic and Health Survey, the 2001-2002 and 2007-2008 Living Standards and Measurement Surveys as well as 2011-2012 Household Income Expenditure Survey, and the Ministry of Finance. All analyses are conducted using original data and performed using the health modules of the ADePT software.

Universal Health Coverage for Inclusive and Sustainable Development : Country Summary Report for Vietnam

Barroy, Helene; Jarawan, Eva; Bales, Sarah
Fonte: World Bank Group, Washington, DC Publicador: World Bank Group, Washington, DC
EN_US
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Vietnam is regarded as a development success story. Political and economic reforms ( Doi Moi ) launched at the end of the 1980s have transformed the country from one of the poorest in the world to a lower middle-income country in a quarter century, with per capita income of $1,130 (World Bank, 2013). Over the past 10 years, Vietnam has seen average annual economic growth of nearly 8 percent. Poverty tumbled from 58 percent in 1993 to 12 percent in 2009. Economic development and innovative policy interventions led to steep gains in health outcomes and access to health care, although large disparities persist between the rich and poor, and between poorer and better-off regions (Vietnam General Statistics Office 2011b). Infant mortality declined from 30 to 16 per 100,000 live births, and under-five mortality rates from 42 to 25 per 100,000 live births, between 2001 and 2009 (Vietnam General Statistics Office 2011a, 2011c). Vietnam has shown strong political commitment toward universal health coverage (UHC), making it a national goal for 2014. A major challenge lies now in expanding coverage to the non-covered population (64 percent had coverage in 2012) while addressing the model s financial sustainability.

Transport for Health : The Global Burden of Disease from Motorized Road Transport

Global Road Safety Facility, The World Bank; Institute for Health Metrics and Evaluation
Fonte: Seattle: Institute for Health Metrics and Evaluation Publicador: Seattle: Institute for Health Metrics and Evaluation
Tipo: Publications & Research :: Publication
ENGLISH; EN_US
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This report summarizes the findings of a long and meticulous journey of data gathering and analysis to quantify the health losses from road deaths and injuries worldwide, as part of the path-finding Global Burden of Disease (GBD) study. It is important, first, to acknowledge the profound contribution made by the lead authors and global team of injury prevention professionals to estimate the disease burden of road trauma, before absorbing their findings and recommendations. Without their dedication and tenacity, the way forward would be less certain. The first GBD study, published nearly two decades ago, signaled an emerging road safety crisis in developing regions of the world. It triggered a remarkable program of global advocacy that culminated in the United Nations decade of action for road safety and global plan to bring road safety outcomes under control in these regions by 2020. However, limited investment has been mobilized so far to implement the UN initiative. The second GBD studies, and related analyses presented in this report...

A model for incorporating specialist nurse education into a university context. Part 1: Methodological perspectives

Bruce,Judith C.; Klopper,Hester C.
Fonte: Health SA Gesondheid (Online) Publicador: Health SA Gesondheid (Online)
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2010 EN
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The education of nurses for specialist practice takes place mainly in nursing colleges. In view of ongoing debates about the future positioning of nursing education, an investigation regarding the incorporation of college-based specialist nurse education into universities was needed. The purpose of the study was to develop and describe a model for specialist nurse education in a university. The objectives were set in two phases: Phase 1 objectives were designed to enable the identification of concepts in relation to university education and Phase 2 objectives, to enable the development of a model for specialist nurse education in a university context. This paper gives an account of only the methodology used to meet the research purpose and objectives. It outlines the objectives of Phases 1 and 2, including a detailed description of the research design. In discussing the research design, particular attention was given to theory development. The research methods were described with reference to data collection methods and procedures, study samples and sampling methods, data analysis methods and processes, to ensure the trustworthiness of the study. The model is described in Part 2 of the article.