This study summarizes estimates and lessons learned from application of the scaling up nutrition (SUN) methodology to assess public financing for nutrition in Bhutan. Using Bhutan's classification of nutrition interventions, per capita public financing for addressing malnutrition is estimated to be Nu 2,003 (approximately United States (U.S.) 29 dollars, 1 percent of gross domestic product (GDP), and 3 percent of total government expenditures), 30 percent of which was for nutrition-specific activities, and about one-third the level of public spending on health. The level of public spending for nutrition is similar in magnitude - and in the shares across nutrition-specific and nutrition-sensitive interventions - when compared with other developing countries; recent estimates from Asia indicated an average of 2 percent of aggregate government expenditures went toward addressing nutrition, with a 20 percent share for nutrition-specific interventions. Despite the level of spending increasing from Nu 1,744 in financial year (FY) 2013-14, there does not appear to be any increase in priority to nutrition over the course of the 11th five-year plan (FYP): increases in the levels of expenditure for nutrition have resulted from growth of the economy and not because of higher budget allocation to addressing nutrition. The largest nutrition-specific expenditures were those related to the national school feeding program and the largest nutrition-sensitive expenditures were those related to water, sanitation, and hygiene (WASH) programs. Notably, the financing locus for nutrition-related expenditures lies within the Ministry of Education (MoE) and the Ministry of Works and Human Settlement (MoWHS). Although Bhutan defines nutrition-specific and nutrition-sensitive interventions somewhat differently from how they are defined globally, the magnitude of resources allocated toward improving nutrition appears similar to those in other developing countries even when adjusted to enhance global comparability.
Background: Access to medicine for the poor is recognized to be difficult task and one of the major challenges in achieving universal health coverage, particularly in low-and- middle income countries. In order to ensure the availability of essential medicines free of cost in public health facilities, Nepal has also commenced Free Health Care Services (FHCS). So, this study aims to evaluate availability, expiry, and stock-out duration of essential medicines at front line service providers in Nepal.Methods: Cross-sectional survey was conducted 28 public health facilities, 7 district warehouses, and 14 private pharmacies in 7 districts of Nepal. The survey was conducted during the March and April 2014. Survey tools recommended by the WHO operational package for assessing, monitoring and evaluating country pharmaceutical situations was used with slight modification as per Nepal's situation.Results: The availability of medicine was found to be 92.44% in this study. The percentage of expired medicines in district warehouse was found to be 8.40. The average stock-out duration in district warehouse was 0.324 days.Conclusions: Although the availability of essential medicines at peripheral health facilities was found to be satisfactory with lesser proportion of expired medicines, a strong monitoring and evaluation of expired and stock medicines are desirable to maintain and improve the access to essential medicines.
The objective of this study was to assess public financing for nutrition in Bhutan, Nepal and Sri Lanka to identify limitations of available data and to discuss policy implications. A variant of the Scaling Up Nutrition Movement methodology was used. Budget allocations and expenditures for relevant government ministries during 2012–2018 were identified. Nutrition‐related line items were tagged using definitions of nutrition‐specific and nutrition‐sensitive interventions. Data were aggregated by year and calculated in constant United States dollars (USD). Expenditures by year were presented as a proportion of gross domestic product and general government expenditures. The percent utilization of budget allocations and proportion of funding from central government sources were determined. Per capita expenditures on nutrition‐specific interventions varied from USD 1.08–8.76 and for nutrition‐sensitive interventions varied from USD 20.22–51.20. Nutrition‐specific expenditures as a percent of gross domestic product ranged from 0.08% in Sri Lanka in 2017% to 0.34% in Nepal in 2016. The median utilization rate was 64% for nutrition‐specific and 84% for nutrition‐sensitive interventions. Nutrition‐specific funding financed by the central government was 90.7% in Bhutan and 99.4% in Sri Lanka. This study revealed the need to prioritize and invest in evidence‐based interventions, including balancing investments in nutrition‐specific versus ‐sensitive interventions. Challenges in estimation of nutrition expenditures and cross‐country comparison were also observed, highlighting the need for appropriate nutrition line item tagging and standardized systems for data collection.
The main purpose of this Guiding Framework document is to present the key elements of a Nutrition Public Expenditure Review (NPER) and offer guidance, practical steps, and examples on carrying out an NPER. It targets a wide-ranging audience, including country nutrition policy makers, development partners (DPs), government technical staff, and advocates and practitioners who are tasked with carrying out NPERs (who are also the main target audience). The Guiding Framework draws upon good practices from the growing body of NPERs as well as common practices and expertise from Public Expenditure Reviews (PERs). However, given the limited number of existing NPERs, this document should be considered as a starting point, or a 'living document,' and is not meant to provide a comprehensive coverage of a standard methodology for NPERs, as this would require further work and analysis. Specifically, this Guiding Framework aims to be a useful tool for practitioners involved in developing an NPER. It does this by: (i) situating NPERs within the context of other similar efforts such as a nutrition budget analysis or sector-specific PERs; (ii) presenting the literature of existing NPERs and related literature to serve as reference; (iii) providing guidance on preparatory work before beginning an NPER (i.e., defining the scope, setting up an NPER team, and identifying data sources); (iv) providing guidance on conducting the core analysis (i.e.,framing the analysis, analyzing the institutional framework, and linking the analysis to the policy dialogue); and (v) clearly identifying knowledge gaps and necessary additional work to enhance the robustness of future NPER analysis.
Achieving universal health coverage (UHC) requires health financing systems that provide prepaid pooled resources for key health services without placing undue financial stress on households. Understanding current and future trajectories of health financing is vital for progress towards UHC. We used historical health financing data for 188 countries from 1995 to 2015 to estimate future scenarios of health spending and pooled health spending through to 2040.We extracted historical data on gross domestic product (GDP) and health spending for 188 countries from 1995 to 2015, and projected annual GDP, development assistance for health, and government, out-of-pocket, and prepaid private health spending from 2015 through to 2040 as a reference scenario. These estimates were generated using an ensemble of models that varied key demographic and socioeconomic determinants. We generated better and worse alternative future scenarios based on the global distribution of historic health spending growth rates. Last, we used stochastic frontier analysis to investigate the association between pooled health resources and UHC index, a measure of a country's UHC service coverage. Finally, we estimated future UHC performance and the number of people covered under the three future scenarios.
The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders. Data for this research was provided by MEASURE Evaluation, funded by the United States Agency for International Development (USAID). Views expressed do not necessarily reflect those of USAID, the US Government, or MEASURE Evaluation. The Palestinian Central Bureau of Statistics granted the researchers access to relevant data in accordance with licence no. SLN2014-3-170, after subjecting data to processing aiming to preserve the confidentiality of individual data in accordance with the General Statistics Law-2000. The researchers are solely responsible for the conclusions and inferences drawn upon available data. ; Background Assessments of age-specific mortality and life expectancy have been done by the UN Population Division, Department of Economics and Social Affairs (UNPOP), the United States Census Bureau, WHO, and as part of previous iterations of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). Previous iterations of the GBD used population estimates from UNPOP, which were not derived in a way that was internally consistent with the estimates of the numbers of deaths in the GBD. The present iteration of the GBD, GBD 2017, improves on previous assessments and provides timely estimates of the mortality experience of populations globally. Methods The GBD uses all available data to produce estimates of mortality rates between 1950 and 2017 for 23 age groups, both sexes, and 918 locations, including 195 countries and territories and subnational locations for 16 countries. Data used include vital registration systems, sample registration systems, household surveys (complete birth histories, summary birth histories, sibling histories), censuses (summary birth histories, household deaths), and Demographic Surveillance Sites. In total, this analysis used 8259 data sources. Estimates of the probability of death between birth and the age of 5 years and between ages 15 and 60 years are generated and then input into a model life table system to produce complete life tables for all locations and years. Fatal discontinuities and mortality due to HIV/AIDS are analysed separately and then incorporated into the estimation. We analyse the relationship between age-specific mortality and development status using the Socio-demographic Index, a composite measure based on fertility under the age of 25 years, education, and income. There are four main methodological improvements in GBD 2017 compared with GBD 2016: 622 additional data sources have been incorporated; new estimates of population, generated by the GBD study, are used; statistical methods used in different components of the analysis have been further standardised and improved; and the analysis has been extended backwards in time by two decades to start in 1950. Findings Globally, 18·7% (95% uncertainty interval 18·4–19·0) of deaths were registered in 1950 and that proportion has been steadily increasing since, with 58·8% (58·2–59·3) of all deaths being registered in 2015. At the global level, between 1950 and 2017, life expectancy increased from 48·1 years (46·5–49·6) to 70·5 years (70·1–70·8) for men and from 52·9 years (51·7–54·0) to 75·6 years (75·3–75·9) for women. Despite this overall progress, there remains substantial variation in life expectancy at birth in 2017, which ranges from 49·1 years (46·5–51·7) for men in the Central African Republic to 87·6 years (86·9–88·1) among women in Singapore. The greatest progress across age groups was for children younger than 5 years; under-5 mortality dropped from 216·0 deaths (196·3–238·1) per 1000 livebirths in 1950 to 38·9 deaths (35·6–42·83) per 1000 livebirths in 2017, with huge reductions across countries. Nevertheless, there were still 5·4 million (5·2–5·6) deaths among children younger than 5 years in the world in 2017. Progress has been less pronounced and more variable for adults, especially for adult males, who had stagnant or increasing mortality rates in several countries. The gap between male and female life expectancy between 1950 and 2017, while relatively stable at the global level, shows distinctive patterns across super-regions and has consistently been the largest in central Europe, eastern Europe, and central Asia, and smallest in south Asia. Performance was also variable across countries and time in observed mortality rates compared with those expected on the basis of development. Interpretation This analysis of age-sex-specific mortality shows that there are remarkably complex patterns in population mortality across countries. The findings of this study highlight global successes, such as the large decline in under-5 mortality, which reflects significant local, national, and global commitment and investment over several decades. However, they also bring attention to mortality patterns that are a cause for concern, particularly among adult men and, to a lesser extent, women, whose mortality rates have stagnated in many countries over the time period of this study, and in some cases are increasing. ; Research reported in this publication was supported by the Bill & Melinda Gates Foundation, the University of Melbourne, Public Health England, the Norwegian Institute of Public Health, St. Jude Children's Research Hospital, the National Institute on Aging of the National Institutes of Health (award P30AG047845), and the National Institute of Mental Health of the National Institutes of Health (award R01MH110163). ; Peer reviewed