Suchergebnisse

The legacy of the Semashko system left Armenia with an oversized and overstaffed health system. Beginning in the 1990s the country focused on re-designing its health system in an attempt to rationalize resources. In order to improve the efficiency, access and quality of health care service provision, the Government undertook supply-side reforms. These reforms included: (a) strengthening Primary Health Care (PHC) provision; (b) downsizing excess hospital capacity; and, (c) changing provider payment mechanisms and introducing a purchaser-provider split.Armenia introduced the Basic Benefit Package (BBP) in 1999 for the socially vulnerable population to target the so-called socially important diseases. The package utilizes public resources to finance, through provider contracts, PHC and emergency services for all Armenian citizens, with co-payment exemptions for the poor and vulnerable. In addition, selected inpatient services are provided for free for the poor, vulnerable and other specific categories.Unfortunately, low public health spending levels and incomplete demand-side health financing reform have resulted in serious shortcomings in financial risk protection outcomes. Armenia's public health financing is among the lowest in the region. High co-payments for BBP covered services, lack of in-patient care coverage for the non-vulnerable population and outpatient pharmaceuticals for all, have resulted in household out-of-pocket (OOP) spending being the predominant source of financing for health in the country. As Armenia is grappling with an aging society and a health care system struggling to adjust to morbidity and mortality epidemiological changes, its path to Universal Health Coverage (UHC) requires increased funding from prepaid pooled sources in order to sustain and make further progress on improving population health outcomes and financial risk protection.This paper examines the Armenian health system, with a focus on the BBP program. It takes stock of implemented reforms and analyzes the pending agenda. The paper is organized as follows. Section two provides a general overview of Armenia's health system, focusing on financing and health service delivery. Section three describes the BBP program including its institutional architecture, beneficiary targeting, BBP services and fund management, and related information dissemination. Section four discusses the sustainability of the BBP program amidst economic, epidemiologic, and demographic challenges. The last section focuses on the pending agenda related to targeting, integrated care, and coverage of the non-vulnerable population.

The paper attempts to provide an overview of the hospital sector in the Philippines with particular emphasis on hospitals being managed by the DOH. The paper begins with an overview of the hospital sector in the Philippines, describing the size, location, and utilization of hospital services. To assess the efficiency and effectiveness of service delivery in DOH-retained hospitals, an analysis of resource management is undertaken by examining the sources of funds, planning and budgeting cycle, uses of funds, and monitoring set-up. The paper provides a critique of recent policies concerning hospitals as outlined in the Health Sector Reform Strategy. The last section concludes and provides some policy recommendations.

This paper, which is borne out of the need to address scarcity of evidence-based studies on barangay financing, analyzes and evaluates key issues on financing of devolved functions at the barangay level, with particular focus on fund utilization and program allocation, and proposes some policy options addressing the issues. Its key findings include: (i) there is a mismatch between financial capabilities and devolved functions owing to limited funds being spent mostly on personal services, with little money left to finance these functions; (ii) different priorities of barangays mean different utilization of their Barangay Development Fund (BDF), with some of them failing to spend on important basic services such as education and health, as well as on economic development sector; (iii) like other barangays, those in the study areas in Agusan del Sur and Dumaguete City are found to be highly IRA-dependent, with IRA comprising 85 to 97 percent of total income; (iv) barangays are not addressing the misalignment of revenue and expenditure assignment, as well as the counter-equalizing and disincentive effects of IRA, by not raising enough own-source revenues in their localities and optimizing their use of corporate powers (as evidenced by zero percentage on borrowings, for example). As a policy intervention strategy to help barangays financially and eventually matter in local service delivery, this paper proposes three major options, namely: (i) giving the barangays the option of allowing the higher LGUs to deliver the development-enhancing services such as education and health that they themselves cannot deliver effectively and sustainably; (ii) making a paradigm shift in understanding and practicing barangay economic development by spending their BDF mostly on economic-enhancing activities aimed at increasing their coffers which would eventually enable them to fund other sectoral responsibilities; and (iii) giving incentives to barangays that excel in their own-source revenue performance and creative use of corporate powers.

One of the major challenges in the Philippine health sector is to secure adequacy of appropriate health facilities. To address this problem, the Health Facilities Enhancement Program (HFEP) was implemented by the Department of Health (DOH) in 2007. Specifically, HFEP aims to improve facilities such as health centers and barangay health stations to sufficiently provide for emergency and primary care services. It also aims to upgrade government hospitals. This study examines the implementation of the program and probes at the rationale for the selection of facilities for upgrading. It lays out policy options to improve equity and efficiency in allocation of funds.

RésuméLes Philippines ont souffert plus que la plupart des autres pays en développement de la pandémie de COVID‐19 et des restrictions concomitantes, à savoir, notamment, un confinement très strict et une fermeture prolongée des écoles. Les auteurs proposent un modèle original pour estimer l'effet de ces mesures sur le travail, le revenu et la pauvreté selon le sexe et la région. Une étude de cas leur permet d'établir par ailleurs que les fermetures d'école ont nui à l'emploi dans l'enseignement privé et au revenu des parents de jeunes enfants. Ils concluent que la pandémie a eu des retombées économiques sans précédent et pénalisé les femmes.

ResumenLa pandemia de COVID‐19 y las políticas de contención asociadas han afectado más a Filipinas que a la mayoría de los países en desarrollo por aplicar confinamientos de los más estrictos del mundo, y cierres generales de escuelas de los más prolongados. Con un modelo de simulación novedoso, se estiman los efectos de estos factores por sector, región administrativa y género en los niveles de empleo, ingresos y pobreza, con particular atención al empleo de los docentes y a los ingresos de las personas con hijos pequeños en relación con el cierre de escuelas. Se constata que la pandemia tiene repercusiones sin precedentes en la actividad económica y afecta desproporcionadamente a las mujeres.

AbstractThe COVID‐19 pandemic and the resulting containment policies have hit the Philippines harder than most developing countries. The government lockdown is among the strictest in the world, and blanket school closures are the lengthiest. This article uses a novel simulation model to estimate the gendered and regional impacts of these factors on labour, income and poverty, and a case study of school closures points to the losses in employment among private school teachers and in the income of parents with young children. The authors find that the pandemic has had unprecedented implications for economic activity and has disproportionately affected women.

As a recognition of the valuable role of private sector in the healthcare delivery system, this paper attempts to collate vital information on private hospitals in the Philippines. This paper looks at the different characteristics and structures of private hospitals sector with regard to geographical distribution, services, financing, human resource, and other information needed by policymakers, investors, and other interested stakeholders. To better understand the current health care delivery system in the country, other sections compare private hospitals vis-a-vis government-owned facilities.