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The purpose of this discussion paper is to help stakeholders understand and consider the issues when developing a new generation medicines policy, so that it is fit for the future.

The Asian Development Bank seeks to assist the Government of Armenia in undertaking major health financing reforms to achieve universal health coverage (UHC) within the context of the Sustainable Development Goals and improving health system performance. Critical to the development, evaluation and implementation of such UHC policies is the need for accurate information of the expenditure implications and revenue needs of alternative policy choices. This report provides guidance in the design, construction, calibration, evaluation, implementation, use, and refinement of a UHC model to assess the expenditure impacts and the revenue requirements to finance alternative universal health insurance (UHI) policies. It develops an actuarial UHC costing model that relies on the most recent and complete health insurance claims data to estimate expenditures and revenue needs for achieving UHC. The report focuses on the development and operationalization of this actuarial model as a tool for assessing the health financing and fiscal implications of Armenia's key UHI policy decisions.

The coronavirus disease (COVID-19) is causing an unprecedented global impact on cities across the world. This guidance note aims to support cities in developing member countries of the Asian Development Bank (ADB) to effectively and immediately respond to the crisis, and to "build back better" in the short and medium terms. It is anchored to the principles outlined in ADB's Strategy 2030 Operational Plan for Priority 4: Making Cities More Livable and also considers the public health and economic impacts of the pandemic. The guidance note is one of a series produced by ADB for key sectors and thematic areas.

This Perspective first examines undernutrition and its consequences in Malaysia, outlining some factors behind the phenomenon's recent national resurgence. The essay then goes on to discuss key issues regarding obesity in Malaysia, before outlining the weaknesses and strengths of Malaysia's public health policies in dealing with the malnutrition paradox. Particular attention is paid to school feeding programmes and why they have not been as effective as they could have been in tackling the double burden. The Perspective concludes with several policy recommendations.

This report provides an assessment of Viet Nam's secondary education sector, including technical and vocational education training programs. The report reviews sector achievements and challenges as well as the Government of Viet Nam's strategy and policies. The report provides recommendations on measures to boost access to secondary education and to improve its overall quality and management.

Caseload midwifery is community-based and at the front line of perinatal public health interventions and outcomes. NZIER was commissioned to investigate the contribution of midwifery to improving health outcomes. Pay and conditions were not the main focus of the project, but this emerged as an underlying factor in the sustainability of improving perinatal health outcomes. The workforce faces challenges from increasing medical and social complexities, which are demanding more time per pregnancy than is allowed under section 88 of the New Zealand Public Health and Disability Act 2000. Pay and conditions is a factor in retention issues. Studies have shown that, for low-risk pregnancies, midwifery can reduce the risk of interventions such as caesarean section, contributing to better health outcomes and health system savings. Adequate training, resources and integration are critical in achieving those outcomes. In this report, the challenges faced by midwifery are investigated and recommendations are made to improve the sustainability of resources for midwifery in New Zealand.

More than 25 years into the implementation of the Local Government Code of 1991, it is inconclusive whether fiscal decentralization indeed improves health service delivery in the Philippines. There is lack of studies that employ rigorous quantitative approach to address the research issue at hand. In this regard, the study attempts to contribute to the small body of literature and motivate further research and generation of reliable data that are crucial for evidence-based/informed policymaking. In particular, the study proposes an analytical framework that examines the effects of fiscal decentralization on health service delivery using difference-in-differences (DID) method. It draws up the standard measure of the extent/degree of fiscal decentralization affecting the health sector. Such endeavor is the first ever attempt to measure the extent/degree of health devolution in the Philippines, i.e., in terms of the health expenditure decentralization ratio. The output variables of interest include access to safe water and sanitation, health facility-based delivery, and access to hospital inpatient services. The control variables include two measures of fiscal decentralization to account for financial/fiscal autonomy of the local government units (LGUs) on the income side (i.e., the ratio of LGU own-source revenue to LGU expenditures and ratio of LGU own-source revenue to LGU income); LGU health spending as a proportion of total LGU expenditures; and per capita LGU income. The choice of variables was constrained by unavailability of disaggregated data at the LGU level. The findings of the DID analysis suggest that greater health decentralization has negative impact on access to hospital inpatient services and access to sanitation (toilet). It contradicts the hypothesis of the study that expects greater health decentralization to result in better health services. Nevertheless, it is consistent with the narrative in the literature that points out the lower province-level spending on hospitals due to mismatch between the cost of devolved hospitals and the internal revenue allotment (IRA), i.e., block grant transferred to the LGUs. Such negative effect has remained over the years because most LGUs do not have adequate health budget to maintain and upgrade devolved health facilities.

NZIER was asked to determine the economic contribution of clinical trials to the New Zealand economy in terms of: 1. Direct economic contribution; 2. Indirect economic contribution 3. Total economic contribution. We were also asked to provide a qualitative assessment of the benefits to New Zealand's health sector from conducting clinical trials in New Zealand. To ensure reliability of our analysis, we have narrowed our scope to pharmaceutical-type clinical trials recommended for approval by the Health Resource Council's (HRC) Standing Committee on Therapeutic Trials (SCOTT) (henceforth, 'SCOTT trials'). These trials are exclusively of interventions that meet the definition of "new medicines" under New Zealand legislation. This means our estimates are conservative as they do not capture the entire clinical trials sector in New Zealand.

This report considers the opportunity of greater use of physiotherapy to contribute to better health and economic outcomes for those with low pain back pain, stroke, and osteoarthritis. These three conditions were selected as leading examples of the potential that physiotherapy could address if the funding and health sector support was put in place. Each of these conditions ranks in the top 10 non-communicable causes of health quality loss in New Zealand.

Ischemia-reperfusion (I/R) injury is an unresolved problem in liver resection and transplantation. The preexisting nutritional status related to the gut microbial profile might contribute to primary non-function after surgery. Clinical studies evaluating artificial nutrition in liver resection are limited. The optimal nutritional regimen to support regeneration has not yet been exactly defined. However, overnutrition and specific diet factors are crucial for the nonalcoholic or nonalcoholic steatohepatitis liver diseases. Gut-derived microbial products and the activation of innate immunity system and inflammatory response, leading to exacerbation of I/R injury or impaired regeneration after resection. This review summarizes the role of starvation, supplemented nutrition diet, nutritional status, and alterations in microbiota on hepatic I/R and regeneration. We discuss the most updated effects of nutritional interventions, their ability to alter microbiota, some of the controversies, and the suitability of these interventions as potential therapeutic strategies in hepatic resection and transplantation, overall highlighting the relevance of considering the extended criteria liver grafts in the translational liver surgery. ; This research was supported by the Ministerio de Ciencia, Innovacion y Universidades (RTI2018-095114-B-I00) Madrid, Spain; European Union (Fondos Feder, "una manera de hacer Europa"); CERCA Program/Generalitat de Catalunya and Secretaria d'Universitats I Recerca del Departament d'Economia I Coneixement (2017 SGR-551) Barcelona, Spain. ; Yes

Coronavirus disease (COVID-19) has unleashed unparalleled challenges. At the same time, it offers a window to rethink Asia's most fundamental development policies and strategies to address inequality, socioeconomic vulnerability, and environmental challenges. This publication gathers blogs and short policy pieces contributed by ADB staff and experts in an attempt to tackle immediate challenges and prepare for what may lie beyond the horizon. It covers a broad range of development challenges and highlights the crucial role of rapid adoption of digital technologies, adequate supply of quality infrastructure, disaster risk management, and strengthening regional cooperation for a resilient and sustainable future by shaping post-pandemic conditions.

Singapore, a multiethnic country with one of the highest median incomes in the world, is undergoing a demographic shift. Twenty-five percent of the population is predicted to be aged 65 and older by 2030, versus 14.4% in 2019. This demographic shift has profound implications on the country's health and care needs. In response, Singapore has been moving toward a more holistic view of aging, health, and care, along with policies and systems related to these.

Tobacco Industry (TI) is constantly evolving strategies to outwit all the efforts to make this world tobacco-free4, 12. Under the garb of 'harm reduction', the tobacco companies have been attempting to rehabilitate their reputation to influence the government to soften their policies or create exemptions for products such as HTPs. Such efforts are intended at renormalization of the tobacco products and increase social acceptability. The industry is more actively yet discretely exploiting the policy gaps, regulatory loopholes, and enactment of stricter laws especially in those countries where the implementation of such laws is weak, or non-existent. Pakistan continues to be an example where multiple laws exist, however, its sluggish implementation as well as excessive TI influence in taxation adds to the defiance space. Pursuant to these developments in the tobacco market, WHO in a report on the Global Tobacco Epidemic in 2019,13 claimed that there is 'insufficient independent evidence to support the use of [E-Cigarettes] as a population-level tobacco cessation intervention to help people quit conventional tobacco use'; these products are 'undoubtedly harmful'. This report further concluded that there is a similarity between the toxic chemicals emitted through regular smoking and HTPs, and there is no evidence that these products will reduce tobacco-related diseases.13 Sustainable Development Policy Institute (SDPI) shares the commonality of the views with the authentic opinion and positions taken by the leading international health experts, including WHO and The Union, and aspires to highlight the localized context concerning Pakistan. This is our first study in this regard and we intend to contextualize the issue of ENDS/ENNDS with specific problems and the tobacco control environment in Pakistan. We also intend to highlight that the current studies and policy proposals are focused on the evidence generated/collected and analyzed concerning the High-Income Countries (HICs) whereas there are evidence and policy void related to the LMICs. The urgency to address this gap is further hastened by the fact that the TI is aggressively and consciously introducing these products in the market. Many policymakers and legislators and those proposing the policies lack the comprehensive understanding, capacity, and requisite knowledge about the health, social and cultural effects of these products on the youth, existing smokers and beginners. In the presence of such a murky environment with conflicting interests of multiple segments of the society and government, SDPI recommends an urgent need for discussion and policy development in handling the E-Cigarettes and HTPs.

This study assesses the implementation of selected agribusiness venture arrangements (AVAs) and identifies the prerequisites needed to ensure that the adoption of AVAs will improve farm income and productivity, thereby enhancing sustainability of the agrarian sector. As such, a framework for AVAs was devised considering the supply chain, the policy environment, and the global market influence. Using a case study approach, the study focused on two export crops—banana and pineapple—that were selected based on their significant contribution to the Philippines' export earnings and gross value added of agriculture. In particular, the AVAs considered in the study were lease/leaseback and growership arrangements for banana and pineapple. The study notes several issues on production and capital investments, marketing and pricing, institutional support, and contract terms that affect the implementation of AVAs. It recommends that AVAs should be encouraged but government has to provide a policy environment for Philippine export crops to be competitive. Agrarian reform beneficiaries and their associations should also be supported through capacity-building activities and access to legal advice.

Palm oil, a major commodity crop in the region, is likely to be phased out in the EU by 2030. Given the potential regional and transboundary implications, a Singaporecentric perspective can be helpful.