Suchergebnisse

Confrontées à des critiques pressantes et à une remise en cause de l'efficacité de l'aide au développement, les agences de coopération, en particulier la Banque Mondiale, ont entrepris depuis une quinzaine d'années de vastes évaluations de leurs actions et modes de fonctionnement. Ces études ont mis en avant les limites des modalités d'interventions traditionnelles et suscité l'amorce d'un changement dans le système d'aide internationale. Le "nouveau paradigme partenarial de l'aide" qui a alors émergé est basé sur des principes tels qu'appropriation, responsabilité conjointe, partenariat, vision globale, réduction de la pauvreté, gouvernance et orientation vers les résultats. Ce paradigme a été renforcé par la signature en mars 2005 de la Déclaration de Paris sur l'Efficacité de l'Aide au Développement. Le besoin d'intégrer les programmes de coopération dans les structures des pays bénéficiaires, d'appuyer les politiques conçues par ces pays en utilisant des systèmes de gestion harmonisés, est à présent bien reconnu. L'émergence de l'approche sectorielle – soit une méthode de travail entre un gouvernement et des bailleurs de fonds, qui travaillent ensemble à la mise en place progressive d'une politique et d'une stratégie sectorielles cohérentes pour l'ensemble d'un secteur–, avec ses avantages et ses défis, se situe et va être présentée dans ce contexte. ; info:eu-repo/semantics/published

Confrontées à des critiques pressantes et à une remise en cause de l'efficacité de l'aide au développement, les agences de coopération, en particulier la Banque Mondiale, ont entrepris depuis une quinzaine d'années de vastes évaluations de leurs actions et modes de fonctionnement. Ces études ont mis en avant les limites des modalités d'interventions traditionnelles et suscité l'amorce d'un changement dans le système d'aide internationale. Le "nouveau paradigme partenarial de l'aide" qui a alors émergé est basé sur des principes tels qu'appropriation, responsabilité conjointe, partenariat, vision globale, réduction de la pauvreté, gouvernance et orientation vers les résultats. Ce paradigme a été renforcé par la signature en mars 2005 de la Déclaration de Paris sur l'Efficacité de l'Aide au Développement. Le besoin d'intégrer les programmes de coopération dans les structures des pays bénéficiaires, d'appuyer les politiques conçues par ces pays en utilisant des systèmes de gestion harmonisés, est à présent bien reconnu. L'émergence de l'approche sectorielle – soit une méthode de travail entre un gouvernement et des bailleurs de fonds, qui travaillent ensemble à la mise en place progressive d'une politique et d'une stratégie sectorielles cohérentes pour l'ensemble d'un secteur–, avec ses avantages et ses défis, se situe et va être présentée dans ce contexte. ; Peer reviewed

The goal of universal health coverage is challenging for chronically under-resourced health systems. Although household out-of-pocket payments are the most important source of health financing in low-income countries, relatively little is known about the drivers of primary health care expenditure and the predictability of the burden associated with high fee-for-service payments. This study describes out-of-pocket health expenditure and investigates demand- and supply-side drivers of excessive costs in the Democratic Republic of Congo (DRC), a central African country in the midst of a process of reforming its health financing system towards universal health coverage. ; Background: The goal of universal health coverage is challenging for chronically under-resourced health systems. Although household out-of-pocket payments are the most important source of health financing in low-income countries, relatively little is known about the drivers of primary health care expenditure and the predictability of the burden associated with high fee-for-service payments. This study describes out-of-pocket health expenditure and investigates demand- and supply-side drivers of excessive costs in the Democratic Republic of Congo (DRC), a central African country in the midst of a process of reforming its health financing system towards universal health coverage. Methods: A population-based household survey was conducted in four provinces of the DRC in 2014. Data included type, level and utilization of health care services, accessibility to care, patient satisfaction and disaggregated health care expenditure. Multivariate logistic regressions of excessive expenditure for outpatient care using alternative thresholds were performed to explore the incidence and predictors of atypically high expenditure incurred by individuals. Results: Over 17% (17.5%) of individuals living in sample households reported an illness or injury without being hospitalized. Of 3341 individuals reporting an event in the four-week period prior to the survey, ...

Tuberculosis (TB) is a major global public health problem which affects poorest individuals the worst. A high proportion of patients incur 'catastrophic costs' which have been shown to result in severe financial hardship and adverse health outcomes. Data on catastrophic cost incidence is not routinely collected, and current definitions of this indicator involve several practical and conceptual barriers to doing so. We analysed data from TB programmes in India (Bangalore), Bangladesh and Tanzania to determine whether dissaving (the sale of assets or uptake of loans) is a useful indicator of financial hardship. ; info:eu-repo/semantics/published

Background In their mission to achieve better access to quality healthcare services, mutual health organisations (MHOs) are not limited to providing health insurance. As democratically controlled member organisations, MHOs aim to make people's voices heard. At national level, they seek involvement in the design of social protection policies; at local level, they seek to improve responsiveness of healthcare services to members' needs and expectations. Methods In this qualitative study, we investigated whether MHOs in the Democratic Republic of Congo (DRC) succeed in defending members' rights by improving healthcare quality while minimising expenses. The data originate from an earlier in-depth investigation conducted in the DRC in 2016 of the performance of 13 MHOs. We re-analysed this existing dataset and more specifically investigated actions that the MHOs undertook to improve quality and affordability of healthcare provision for their members, using a framework for analysis based on Hirschman's exit-voice theory. This framework distinguishes four mechanisms for MHO members to use in influencing providers: (1) 'exit' or 'voting with the feet'; (2) 'co-producing a long voice route' or imposing rules through strategic purchasing; (3) 'guarding over the long voice route of accountability' or pressuring authorities to regulate and enforce regulations; and (4) 'strengthening the short voice route' by transforming the power imbalance at the provider-patient interface. Results All studied MHOs used these four mechanisms to improve healthcare provision. Most healthcare providers, however, did not recognise their authority to do so. In the DRC, controlling quality and affordability of healthcare is firmly seen as a role for the health authorities, but the authorities only marginally take up this role. Under current circumstances, the power of MHOs in the DRC to enhance quality and affordability of healthcare is weak. Conclusion On their own, mutual health organisations in the DRC do not have sufficient power to influence ...

Objective: To determine the factors associated with paediatric inappropriate use (IU) of the accident and emergency department (A&E). Method: An observational prospective survey was performed. All the patients (< 16 years) attending A&E in 12 Belgian hospitals during 2 weeks in 2010 were included. The use of A&E was considered appropriate if, at least, one of the following criteria was met: child referred by a doctor or the police, brought by ambulance, need for a short stay, need for technical examination or orthopaedic treatment, in patient admission, death. A short stay is A&E attendance which the duration is between 4 and 24 hours. Results: The median age of the 3220 children included was 3.3 years old (0-15.9); 39.3% of the visits were not appropriate according to the definition above. Five determinants were included in a multivariate analyze: age, having a family doctor, night or week-end use of A&E, parents' perception of severity for child's illness and insurance status. The multivariate model (table 2), showed that the disadvantage families had not more risk for IU after controlling for other variables. Four factors were associated with an increase of IU: children's age less than 2 year old, night or week-end attendance, short home-ED distance and, surprisingly, having a family doctor. The parent's perception of high severity for child's illness and the localization in Flanders region were associated with a decrease of IU. Conclusions: In a country like Belgium, where it is not compulsory to be registered with a family doctor, the risk of an IU is mainly due to the failure of outpatient care for children <2 years and the use of A&E during night or weekend. Parents' perception of high severity for child's health status and having a family doctor were associated with the appropriateness of A&E use. ; info:eu-repo/semantics/nonPublished